COVID-19 outbreak: a potential threat to routine vaccination programme activities in Nigeria

Addressing the re-emergence and resurgence of vaccine-preventable diseases in Africa: A health equity perspective

Vaccination is one of the greatest public health achievements of the 20th century, with a tremendous impact in the prevention and control of diseases. However, the recent reemergence of vaccine-preventable diseases calls for a need to evaluate current vaccination practices and disparities in vaccination between high-income countries and low-and-middle-income countries. There are massive deficits in vaccine availability and coverage in resource-constrained settings. Therefore, this perspective seeks to highlight the reemergence of vaccine-preventable diseases in Africa within the lens of health equity and offer recommendations on how the continent should be prepared to deal with the myriad of its health systems challenges. Among the notable factors contributing to the reemergence, stand health inequities affecting vaccine availability and the dynamic vaccine hesitancy. Strengthening health systems and addressing health inequities could prove useful in halting the reemergence of vaccine-preventable diseases.

How the COVID-19 pandemic affected infant vaccination trends in rural and urban communities in Ibadan, Nigeria: a cross-sectional study

OBJECTIVES

This study compared the infant vaccination trends a year before and a year after the onset of the COVID-19 pandemic in selected urban and rural communities in Ibadan, Nigeria.

DESIGN

This was a cross-sectional study in which data were extracted from infant vaccination records.

SETTING

Two rural and three urban vaccination centres in primary health clinics at Ibadan Southeast and Olúyòlé local government areas, respectively.

PARTICIPANTS

Infant vaccination records 1 year before and 1 year after the onset of the COVID-19 pandemic (March 2019-February 2020 and March 2020-February 2021, respectively).

OUTCOME MEASURES

Timeliness of vaccination (vaccination taken within 2 weeks of appointment) and vaccination completion according to the Nigerian routine infant vaccination schedule.

RESULTS

2000 vaccination records were included in the study (1013 (50.6%) for male infants). 840 (42.0%) of the records were from the rural immunisation clinics. There were 1194 (59.7%) and 806 (40.3%) records from before and after the onset of the COVID-19 pandemic, respectively. Before the pandemic, birth dose vaccines were timelier among infants from urban communities, while vaccines given at 6 weeks were timelier in the rural areas. Following the onset of the pandemic, the rural communities had a higher proportion of infants with timelier and complete vaccination except for the birth dose vaccines. Overall, there was higher vaccination completion before the pandemic, and this was higher in the rural compared with the urban communities both before (54.8% vs 11.7%) and after (23.6% vs 1.0%) the onset of the pandemic.

CONCLUSIONS

A decline in infant vaccination uptake, timeliness and completion persisted 1 year after the COVID-19 pandemic onset, and urban communities were more affected. More efforts are required to ensure optimal infant vaccination, especially in urban communities, to forestall outbreaks of vaccine-preventable diseases.

Structural and social factors affecting COVID-19 vaccine uptake among healthcare workers and older people in Uganda: A qualitative analysis

The COVID-19 vaccine rollout programme in Uganda was launched in March 2021 for priority groups: Healthcare Workers (HCWs), older persons (≥50 years), and persons with chronic conditions. Misinformation, distrust in healthcare systems, and cultural beliefs, pose significant challenges to vaccine uptake. We describe the social and structural factors affecting the uptake of COVID-19 vaccines among HCWs and older people in Uganda. Between September and October 2021, we conducted 33 in-depth interviews with 25 HCWs aged 21-63 years from three hospitals in central Uganda and eight older people from Wakiso district. Participant selection was purposive, based on sex, occupation, education, cadre of HCWs and vaccination status. We explored participants' knowledge, beliefs, personal experiences, barriers, and facilitators to vaccine uptake as well as suggestions for future COVID-19 vaccine rollout. Interviews were audio-recorded, transcribed and translated into English, coded, and analysed by theme. Twenty-two of the 25 (88%) HCWs and 3 of the 8 (38%) older people had received at least one dose of the COVID-19 vaccine at the time of interview. The structural facilitating factors to vaccine uptake included access to correct information, fear of a risky work environment, and mandatory vaccination requirements especially for frontline HCWs. Age, chronic health conditions, and the fear of death were facilitating factors for older people. Misconceptions about COVID-19 vaccines and fear of side effects were common social barriers for both groups. Long distances to vaccination centres, vaccine stock-outs, and long queues at the vaccination centres were specific barriers for older people. The prerequisite of signing a consent form was a specific structural barrier for HCWs. Future roll out of new vaccines should have a comprehensive information dissemination strategy about the vaccines. Improved access to vaccines through community outreach, reliable vaccine supplies and addressing vaccine misinformation, may enhance COVID-19 vaccine uptake.

The evolution of household forgone essential care and its determinants during the COVID-19 pandemic in Nigeria: A longitudinal analysis

Apart from the morbidity and mortality, the Coronavirus disease 2019 (COVID-19) pandemic has increased the predisposition of households in Nigeria to forgone care, thereby increasing their vulnerability to adverse health consequences. Since there is no previous study in Nigeria on the evolution of pandemic-related forgone care and its drivers, our study assess the evolution of the problem using descriptive and nationally representative panel data analyses. We found about a 30% prevalence of forgone care during the lockdown, which declined progressively afterwards, dropping by 69.50 percentage points between April 2020 and April 2022. This decline produced a surge in households needing care from about 35.00% in the early pandemic to greater than 50%, beginning in early 2021. The forgone care was primarily due to financial hindrances, movement restrictions, and supply-side disruptions. Household socioeconomic factors such as income loss had 2.74 [95%CI: 1.45-5.17] times higher odds of forgone care, job loss, food insecurity, and poverty were 87% (OR: 1.87 [95%CI: 1.25-2.79]), 60% (OR: 1.60 [95%CI: 1.12-2.31]) and 76% (OR: 1.76 [95%CI: 1.12-2.75]) more likely to predispose households to forgone care, respectively. Also, geographical location, such as the South-South zone, induced 1.98 [95%CI: 1.09-3.58] times higher odds of forgone care than North-Central. A married female household head increased the odds by 6.07 [95%CI: 1.72-21.47] times compared with an unmarried female head. However, having a married household head, social assistance, and North-East or North-West zone compared with North-Central increased the chance of accessing care by 69% (OR 0.31 [95%CI: 0.16-0.59]), 59%,(OR 0.41 [95%CI: 0.21-0.77]), 72% (OR 0.28 [95%CI: 0.15-0.53]) and 64% (OR 0.36 [95%CI: 0.20-0.65]), respectively. Non-communicable diseases, disability, old age, large household size and rural-urban location did not affect the forgone care. Our study highlights the need to strengthen Nigeria's health system, create policies to promote healthcare accessibility and prepare the country for future pandemic challenges.

Key Learnings from the Development and Early Use of Global Guidance on the Integration of COVID-19 Vaccination into Broader Health Systems

More than 13.5 billion COVID-19 vaccine doses were delivered between 2021 and 2023 through a mix of delivery platforms, with mass vaccination campaigns being the main approach. In 2022, with the continued circulation of SARS-CoV2 and the need for periodic boosters being most likely, countries were required to plan for more sustainable approaches to provide COVID-19 vaccinations. In this context of uncertainty, a global tool for integrating COVID-19 vaccines into immunization programs and as part of broader health systems was published jointly by the WHO and UNICEF to respond to country needs. This paper summarizes the approach to, and lessons learned during, the development of a global guidance document and describes some examples of its early use in low- and middle-income countries (LMICs). The guidance leveraged existing health system frameworks, proposed four steps for planning and implementing the COVID-19 vaccination integration journey, and identified investment areas. The development process maximized robust global stakeholder and country engagement, and the timeframe was aligned with donor funding windows to support countries with the integration of COVID-19 vaccination. The rapid dissemination of the guidance document allowed countries to ascertain their readiness for integrating COVID-19 vaccination and inform the development of national plans and funding applications. While progress has been made in specific areas (e.g., optimizing cold chain and logistics leveraging COVID-19 vaccination), in the context of decreasing demand for COVID-19 vaccines, reaching adult COVID-19 vaccine high-priority-use groups and engaging and coordinating with other health programs (beyond immunization) remain challenges, particularly in LMICs. We share the learning that despite the uncertainties of a pandemic, guidance documents can be developed and used within a short timeframe. Working in partnership with stakeholders within and beyond immunization towards a common objective is powerful and can allow progress to be made in terms of integrating health services and better preparing for future pandemics.

Vaccination Utilization and Subnational Inequities during the COVID-19 Pandemic: An Interrupted Time-Series Analysis of Administrative Data across 12 Low- and Middle-Income Countries

BACKGROUND

During and after the SARS-CoV-2 (COVID-19) pandemic, many countries experienced declines in immunization that have not fully recovered to pre-pandemic levels. This study uses routine health facility immunization data to estimate variability between and within countries in post-pandemic immunization service recovery for BCG, DPT1, and DPT3.

METHODS

After adjusting for data reporting completeness and outliers, interrupted time series regression was used to estimate the expected immunization service volume for each subnational unit, using an interruption point of March 2020. We assessed and compared the percent deviation of observed immunizations from the expected service volume for March 2020 between and within countries.

RESULTS

Six countries experienced significant service volume declines for at least one vaccine as of October 2022. The shortfall in BCG service volume was ~6% (95% CI -1.2%, -9.8%) in Guinea and ~19% (95% CI -16%, 22%) in Liberia. Significant cumulative shortfalls in DPT1 service volume are observed in Afghanistan (-4%, 95% CI -1%, -7%), Ghana (-3%, 95% CI -1%, -5%), Haiti (-7%, 95% CI -1%, -12%), and Kenya (-3%, 95% CI -1%, -4%). Afghanistan has the highest percentage of subnational units reporting a shortfall of 5% or higher in DPT1 service volume (85% in 2021 Q1 and 79% in 2020 Q4), followed by Bangladesh (2020 Q1, 83%), Haiti (80% in 2020 Q2), and Ghana (2022 Q2, 75%). All subnational units in Bangladesh experienced a 5% or higher shortfall in DPT3 service volume in the second quarter of 2020. In Haiti, 80% of the subnational units experienced a 5% or higher reduction in DPT3 service volume in the second quarter of 2020 and the third quarter of 2022.

CONCLUSIONS

At least one region in every country has a significantly lower-than-expected post-pandemic cumulative volume for at least one of the three vaccines. Subnational monitoring of immunization service volumes using disaggregated routine health facility information data should be conducted routinely to target the limited vaccination resources to subnational units with the highest inequities.

Impact of COVID-19 Pandemic on Respiratory Syncytial Virus (RSV) Prophylaxis Program: A Tertiary-Care Center Experience

OBJECTIVES

The purpose of this investigation was to evaluate the effects of the COVID-19 pandemic on the respiratory syncytial virus (RSV) prevention program at our institution across three time frames: 2019-2020, 2020-2021, and 2021-2022.

METHODS

We carried out a descriptive, single-site observational study spanning four years, from June 2019 to June 2022. Our study included patients in our institution's RSV program who met our enrollment criteria. We collected information about the number of children receiving immunoprophylaxis, immunoprophylaxis doses, and RSV risk factors.

RESULTS

The number of patients receiving immunoprophylaxis dropped across the three periods, from 315 patients in the first period (2019-2020) to 176 in the second period (2020-2021), and further decreased to 128 in the third period (2021-2022). Following the COVID-19 pandemic, there was a 50% reduction in the number of patients receiving immunoprophylaxis. The proportion of RSV-infected patients remained relatively similar in the first and second periods (2.86% and 2.27%, respectively) but increased in the third period (5.47%). In the first period, most patients (60.32%) received seven doses, 11.75% got four to six doses, and 27.95% received three doses or fewer. The second period saw 59.66% of patients receiving four to six doses and 40.34% receiving three doses or fewer. In the third period, a mere 9.38% received four to five doses, while 90.63% got three doses or fewer.

CONCLUSIONS

While preventative measures associated with COVID-19 may have helped reduce the number of RSV cases, the pandemic seems to have caused a significant decrease in the number of children receiving immunoprophylaxis and the doses of immunoprophylaxis. More extensive, multicenter research is needed to understand the impact of the COVID-19 pandemic on RSV immunoprophylaxis, its activity, and seasonal patterns fully.

Evidence for "Whole Family Approach" in accelerating uptake of COVID-19 and routine immunizations among integrated primary health services in Nigeria

The family is the simplest unit but possesses the strongest bond in society. These qualities - bond and proximity - that exist both within and across neighboring families, according to our research, can be instrumental in shaping a new kind of health promotion strategy that can transform health behaviors in communities. The Whole Family Approach (WFA) is a government-sanctioned approach to increase uptake of COVID-19 vaccines in Nigeria. The approach entails leveraging the high family-based demand for some primary health services, such as malaria, diabetes, hypertension, and reproductive services, to generate demand for COVID-19 and routine immunizations. However, since the announcement in 2021, there has been no available evidence to show the impact of the approach on COVID-19 vaccine uptake, though global literature generally favors family-centered health approaches. This study tests the effectiveness of the approach in increasing the utilization of target services in a Nigerian community and further provides a theoretical framework for the strategy. Two primary healthcare facilities were selected in two communities located in Abuja in a quasi-experimental design. After a small-sample landscape assessment of the communities and the facilities, family-targeting health promotion activities were facilitated in the intervention community (integrated health education by trained community health influencers) and facility (opportunistic health promotion through in-facility referrals) for one month. Anonymized service utilization data were acquired from both facilities over a period of four months to analyze their respective month-by-month service utilization trends. Time trend analysis was conducted and revealed that WFA significantly increased service utilization (N = 5870; p < 0.001, α = 0.01, 99% CI) across all the package services provided at the intervention facility. A supplementary Pearson's correlation analysis further presented a positive relationship (r = 0.432-0.996) among the services which favored the result. It can therefore be concluded that the "Whole Family Approach" of health promotion is efficacious in accelerating uptake of priority health services such as COVID-19 and routine immunizations. While there is more to be understood about this interesting approach, we recommend the improvement of communication and capacity gaps in Nigeria's primary healthcare system to ensure that promising strategies such as the WFA are adequately implemented at the community and facility levels.

The Impact of COVID-19 on Supplies of Routine Childhood Immunization in Oromia Regional State, Ethiopia: A Mixed Method Study

BACKGROUND

Globally, national immunization programs are at risk of disruption due to severe health system constraints caused by the ongoing Corona Virus Disease 2019 (COVID-19) pandemic.

OBJECTIVE

To assess the impact of COVID-19 on the availability of supplies of routine childhood immunization in the Oromia Regional State in Ethiopia.

METHODS

A health facility-based mixed-methods of study design was conducted. Both quantitative and qualitative data were collected using pre-tested questionnaires and key informant interview question guides, respectively. Descriptive statistics such as frequencies, means, and standard deviations were performed. Binary logistic regression analysis was employed to assess the associations between the COVID-19 pandemic and the availability of vaccine-related supplies at health facilities in study area. The qualitative data were analyzed using a thematic content analysis approach.

RESULTS

Of the total 448 study participants, 214 (47.8%) reported that COVID-19 has disrupted childhood vaccines availability. A significant proportion of participants agreed with the disruption of BCG (62.1%), OPV (48%), IPV (40.4%), and PENTA (36.9%) vaccine availabilities. These findings were also supported with key informant interviews. Fear of not maintaining physical distance (71.4%) followed by government lockdown (68.1%) and inadequate supply by local providers/suppliers (62.4%) were the most frequently reported likely causes for the observed disruptions. A large proportion of participants (87.7% and 81.7%) reported disruptions in the supply of face masks and hand gloves, respectively. As to the binary logistic regression analysis, the study participants from hospitals were 1.72 (1.01, 2.68; 95% CI) times more likely to report the impacts of COVID-19.

CONCLUSION

Corona Virus Disease -19 significantly disrupted the availability of supplies of childhood immunization in the Oromia region. The most disrupted vaccines and related supplies were BCG, OPV, IPV, PENTA, facemasks, and hand gloves. An effective vaccine supply management is crucial to prevent disruptions during pandemics such as COVID-19.

Long-term effect of mobile phone-based education and influencing factors of willingness to receive HPV vaccination among female freshmen in Shanxi Province, China

BACKGROUND

This study was conducted to characterize the long-term effect of mobile-based education on Chinese female freshmen and disclose the possible predictors of their willingness to get vaccinated based on the information-motivation-behavioral skills (IMB) model.

METHODS

We randomly assigned 509 participants to a 7-day mobile-based educational intervention or control group and collected information about general information, health, and sexual behavior, HPV vaccination intention and action, HPV-related knowledge, cognition, and behavioral skill by an online self-administrated questionnaire at baseline, post-intervention, and at the 1-month and 3-month follow-ups.

RESULTS

The intervention arm showed an improvement in IMB scores after education. Despite the persistent improvement in knowledge, the improvement in their motivation and behavioral skills decreased at the 1-month and 3-month follow-ups. Participants' vaccination willingness was elevated after the baseline survey in both the intervention and control groups, while the overall appointment/vaccination rate was only 3.73% 3 months later. The intention to get vaccinated was associated with knowing HPV (adjusted OR: 2.37, 95% CI: 1.44 - 3.89), perceiving more barriers (adjusted OR: 2.16, 95% CI: 1.44 - 3.25), higher subjective norms (adjusted OR: 2.05, 95% CI: 1.26 - 3.32), and having more behavioral skills (adjusted OR: 2.95, 95% CI: 1.79 - 4.87).

CONCLUSION

Seven-day mobile-based education was effective to increase IMB model scores among female freshmen. However, the improvement in motivation and behavioral skills was not persistent. Information, perceived barriers, subjective norms, and behavioral skills were discovered to be influencing factors of vaccination intention. Future research with longer, more convenient, and more tailored education to the main influencing factors is warranted.

An Internet-Based Education Program for Human Papillomavirus Vaccination Among Female College Students in Mainland China: Application of the Information-Motivation-Behavioral Skills Model in a Cluster Randomized Trial

Background

Patients diagnosed with cervical cancer in the last 2 decades were mainly young females. Human papillomavirus (HPV) vaccination is the most radical way to prevent HPV infection and cervical cancer. However, most female college students in mainland China have not yet been vaccinated, and their relevant knowledge is limited. Theory-based education delivered via the internet is a potentially accessible and useful way to promote HPV vaccination among this population.

Objective

This 3-month follow-up study intended to identify the feasibility and efficacy of an information-motivation-behavioral skills (IMB) model–based online intervention for promoting awareness and willingness regarding HPV vaccination among female college students.

Methods

A 7-day online HPV education program for female college students in mainland China was developed using a cluster randomized trial design. Recruitment and questionnaire surveys were performed online without face-to-face contact. SPSS 23.0 was used for statistical analysis. The chi-square test and t test were used to compare differences in qualitative and continuous variables between intervention and control groups. The generalized estimating equation was used to test the effectiveness of the intervention with a consideration of the time factor.

Results

Among 3867 participants, 102 had been vaccinated against HPV before the study (vaccination rate of 2.6%). A total of 3484 participants were followed up after the baseline survey, with no statistical difference in the loss rate between the intervention and control groups during the intervention and follow-up periods. At different follow-up time points, HPV-related knowledge, and the motivation, behavioral skills, and willingness regarding HPV vaccination were higher in the intervention group than in the control group. HPV-related knowledge was statistically different between the 2 groups, while the motivation, behavioral skills, and willingness regarding HPV vaccination only showed statistical differences right after the intervention, reaching a peak right after the intervention and then gradually reducing over time. Furthermore, there was no statistical difference in the HPV vaccination rate between the 2 groups.

Conclusions

IMB model–based online education could be a promising way to increase the HPV vaccination rate and reduce the burden of HPV infection and cervical cancer among high-risk female college students in China.

Trial Registration

Chinese Clinical Trial Registry ChiCTR1900025476; http://www.chictr.org.cn/showprojen.aspx? proj=42672

International Registered Report Identifier (IRRID)

RR2-DOI:10.1186/s12889-019-7903-x

Drivers of Routine and Outbreak Vaccination Uptake in the Western Democratic Republic of Congo: An Exploratory Study in Ten Health Zones

We performed a cross-sectional survey on vaccination-related knowledge, attitudes, and practices (KAP) among randomly selected parents of <5 years-old children, elderly populations (aged ≥ 55 years), and health care workers (HCWs) in 10 health zones from 4 provinces of the Democratic Republic of Congo (DRC). Questionnaires targeted both routine (BCG, measles, polio) and outbreak-related (cholera, Ebola, COVID-19) vaccinations. In total, 2751 participants were included, 1165 parents, 1040 elderly, and 546 HCWs. In general, KAP expressed were supportive of vaccination uptake, although concerns regarding side effects and feelings of being insufficiently informed were more prevalent among parents and the elderly. Vaccine acceptance was lower for outbreak vaccinations (57%) than for routine vaccinations (90%). HCWs expressed the highest vaccine acceptance. Problems with the vaccine supply chain were reported by 20% of respondents. Despite a high level of positive KAP towards vaccination, parents and the elderly expressed a need to be better informed and had concerns regarding vaccine side-effects. A high acceptance for routine vaccinations was reported by participants, but somewhat less for outbreak vaccinations. In conclusion, HCWs in the communities could play a key role in the increased uptake of routine vaccinations and in optimizing uptake during outbreaks, provided that the supply chain is functioning well.

A mixed methods study to assess the impact of COVID-19 on maternal, newborn, child health and nutrition in fragile and conflict-affected settings

BACKGROUND

The impacts of COVID-19 are unprecedented globally. The pandemic is reversing decades of progress in maternal, newborn, child health and nutrition (MNCHN), especially fragile and conflict-affected settings (FCAS) whose populations were already facing challenges in accessing basic health and nutrition services. This study aimed to investigate the collateral impact of COVID-19 on funding, services and MNCHN outcomes in FCAS, as well as adaptations used in the field to continue activities.

METHODS

A scoping review of peer-reviewed and grey literature published between 1st March 2020-31st January 2021 was conducted. We analysed 103 publications using a narrative synthesis approach. 39 remote semi-structured key informant interviews with humanitarian actors and donor staff within 12 FCAS were conducted between October 2020 and February 2021. Thematic analysis was undertaken independently by two researchers on interview transcripts and supporting documents provided by key informants, and triangulated with literature review findings.

RESULTS

Funding for MNCHN has been reduced or suspended with increase in cost of continuing the same activities, and diversion of MNCHN funding to COVID-19 activities. Disruption in supply and demand of interventions was reported across different settings which, despite data evidence still being missing, points towards likely increased maternal and child morbidity and mortality. Some positive adaptations including use of technology and decentralisation of services have been reported, however overall adaptation strategies have been insufficient to equitably meet additional challenges posed by the pandemic, and have not been evaluated for their effectiveness.

CONCLUSIONS

COVID-19 is further exacerbating negative women's and children's health outcomes in FCAS. Increased funding is urgently required to re-establish MNCHN activities which have been deprioritised or halted. Improved planning to sustain routine health services and enable surge planning for emergencies with focus on the community/service users throughout adaptations is vital for improved MNCHN outcomes in FCAS.

Impact of COVID-19 on routine immunization in Oyo State, Nigeria: trend analysis of immunization data in the pre- and post-index case period; 2019-2020

Introduction

the response to COVID-19 pandemic has posed new obstacles to the fragile health system, most especially in the area of vaccination across much of Africa. As the response to the pandemic intensifies through the application of non-pharmacologic interventions as well as enforcement of the lockdowns across African cities, there is a significant risk that more children will miss out on life-saving vaccines that can prevent childhood killer diseases. This study was therefore conducted to look at the impact of the COVID-19 pandemic on routine immunization in Oyo State, Nigeria.

Methods

we conducted a descriptive secondary analysis of immunization data between July 2019 and August 2020. These data were retrieved from the monitoring and evaluation unit of Oyo State Primary Health Care Board. The data were extracted from the original paper format and entered into Excel sheets. Line graphs were plotted to compare the trends of the coverage rates before and after the index case of the COVID-19 pandemic.

Results

the average coverage rates for Bacillus Calmette-Guérin (BCG) before and after index case were 85.8% and 82.1% respectively, while it was 63.5% and 60.0% for HBV0. For the co-administered vaccines at 14 weeks, Penta 3, OPV 3, PCV 3 and IPV coverage rates dropped from 76.1%, 75.4%, 75.1% and 73.5% to 72.0%, 71.4%, 72.0% and 71.9% respectively. The average coverage rates for yellow fever and measles dropped sharply from 77.0% and 74.5% and 64.6% and 58.6% respectively. The average drop-out rates for the pre-and post-index case periods were 5.0% and 4.7% respectively. For the planned fixed and outreach sessions, none of the monthly sessions met the target of 100.0% in the post-index case period.

Conclusion

decreased vaccination coverage for vaccine-preventable diseases could cause parallel outbreaks with COVID-19 and further exacerbate the strain on health systems attempting to end the acute phase of this pandemic. Therefore, as the dramatic second wave unfolds, the Government of Nigeria must take deliberate steps to strike a balance between a fresh lockdown and the imperative of uninterrupted social service. In this wise, it must remain committed to a timely vaccination program.

Impact of COVID-19 pandemic on routine vaccination coverage of children and adolescents: A systematic review

BACKGROUND AND AIMS

Scientists and healthcare workers have expressed their concerns on the impacts of the COVID-19 pandemic on vaccination coverage in children and adolescents. Therefore, we aimed to systematically review the studies addressing this issue worldwide.

METHODS

We conducted a systematic search of relevant studies using the keywords on databases of PubMed, Web of Science, and Cochrane on May 22, 2021. The identified records were imported into EndNote software and underwent a two-phase screening process consisting of title/abstract and full-text screenings against inclusion criteria. The data of the included studies were summarized into a table and the findings were analyzed in a systematic approach.

RESULTS

From 26 eligible studies, 21 studies demonstrated decreased vaccination rates in the children during the COVID-19 pandemic, while three studies found increased or no significant changes only in influenza vaccination. The two remaining studies from Brazil and Sweden also showed no significant changes in vaccination rates in the children during the pandemic.

CONCLUSION

Most of the reports worldwide reported a decline or delay in vaccination at the time of the COVID-19 pandemic. A sustained catch-up program seems to be necessary, especially in low-income countries, to avoid any vaccine dose missing. Facilitating the vaccination process is recommended, such as decreasing the waiting time for vaccination at the health center, addressing the fear and concerns related to COVID infection for parents, and enhancing vaccine availability, and promoting access in remote areas. Countries should ensure proper vaccination to prevent future pandemics related to vaccine-preventable diseases.

COVID-19 and missed or delayed vaccination in 26 middle- and high-income countries: An observational survey

BACKGROUND

The COVID-19 pandemic has disrupted vaccination services and raised the risk of a global resurgence of preventable diseases. We assessed the extent of and reasons for missed or delayed vaccinations (hereafter 'missed') in middle- and high-income countries in the early months of the pandemic.

METHODS

From May to June 2020, participants completed an online survey on missed vaccination. Analyses separated missed childhood and adult vaccination in middle-and high-income countries.

RESULTS

Respondents were 28,429 adults from 26 middle- and high-income countries. Overall, 9% of households had missed a vaccine, and 13% were unsure. More households in middle- than high-income countries reported missed childhood vaccination (7.6% vs. 3.0%) and missed adult vaccination (9.6% vs. 3.4%, both p < .05). Correlates of missed childhood vaccination in middle-income countries included COVID-19 risk factors (respiratory and cardiovascular diseases), younger age, male sex, employment, psychological distress, larger household size, and more children. In high-income countries, correlates of missed childhood vaccination also included immunosuppressive conditions, but did not include sex or household size. Fewer correlates were associated with missed adult vaccination other than COVID-19 risk factors and psychological distress. Common reasons for missed vaccinations were worry about getting COVID-19 at the vaccination clinic (15%) or when leaving the house (11%). Other reasons included no healthcare provider recommendation, clinic closure, and wanting to save services for others.

INTERPRETATION

Missed vaccination was common and more prevalent in middle- than high-income countries. Missed vaccination could be mitigated by emphasizing COVID-19 safety measures in vaccination clinics, ensuring free and accessible immunization, and clear healthcare provider recommendations.

Effect of an IMB Model-Based Education on the Acceptability of HPV Vaccination Among College Girls in Mainland China: A Cluster RCT

Objective

Despite the fact that the human papillomavirus vaccine (HPVV) has been approved in mainland China since 2016, there is a lack of inoculation among Chinese college women. This multi-center, online interventional RCT based on the information-motivation-behavioral skills (IMB) model intended to investigate if the intervention may improve human papillomavirus vaccine acceptance and awareness among target women.

Methods

Participants were selected from comprehensive universities and allocated to 1 of 2 groups: intervention or control. After the baseline survey, participants in the intervention group were given 10-minute online IMB model-based education every day for 7 days. Self-administered questionnaire surveys on Human papillomavirus knowledge, HPVV acceptability, and IMB construct toward HPV vaccination were performed at pre- and post-intervention.

Results

The baseline survey was completed by 3739 female university students from the intervention (n = 1936) and control groups (n = 1803) between February and April 2020. The average score of students on 11 HPV-related questions was 5.225 ± 2.739, and only 32.07% (1199/3739) of them showed a willingness to be vaccinated against HPV. After the intervention, the intervention group had a higher willingness to vaccinate themselves and encourage their friends to get the HPVV compared to the control group (40.39% vs 31.56%, 82.67 vs 73.18%, P < .001), and the difference in knowledge scores between the 2 groups was significant (7.917 ± 1.840 vs 5.590 ± 2.859, P < .001). In addition, 8 students in the intervention group self-reported receiving HPVV during the research period.

Conclusions

This IMB model-based intervention showed positive effects on the participants’ knowledge, motivation, and perceived objective skills toward HPV vaccination and has the potential to improve the vaccination among Chinese college women.

The impact of publicly funded immunization programs on human papillomavirus vaccination in boys and girls: An observational study

Background

Reaching and maintaining high global human papillomavirus (HPV) vaccine uptake has been challenging. The impact of publicly funded HPV immunization programs and the interplay of sociodemographic, psychosocial and policy factors in maximizing vaccination is poorly understood. This observational study examined the impact of introducing publicly funded school-based HPV vaccination programs for boys directly on uptake in boys and indirectly on uptake in girls, while concurrently examining other important sociodemographic and psychosocial factors.

Methods

Data were collected from a national, longitudinal sample of Canadian parents of children aged 9-16 years during August-September 2016 (T1) and June-July 2017 (T2). Participants completed an online questionnaire measuring sociodemographic characteristics, vaccine knowledge and attitudes, health care provider recommendation, and HPV vaccine uptake. Analyses were conducted separately for parents of boys and girls using logistic regression analyses at T1 and T2. Jurisdictions with HPV vaccine funding for boys at both time-points were compared to those with funding at neither time-points and those that introduced funding between time-points.

Findings

The sample included parents of boys (n = 716) and girls (n = 843). In multivariable analyses, jurisdictions with funding for boys at both time-points had higher odds of vaccination (adjusted odds ratio, T1 = 10.18, T2 = 11.42; 95% confidence interval, T1 = 3.08-33.58, T2 = 5.61-23.23) than jurisdictions without funding at both time-points; however, funded jurisdictions did not have higher odds of vaccination compared to jurisdictions that newly introduced funding for boys. Vaccination was associated with consistent determinants in boys and girls including child's age, health care provider recommendation, perceived vaccine harms, and perceived vaccine affordability.

Interpretation

This gender-sensitive analysis highlights the interplay of sociodemographic, psychosocial, and policy factors that can improve HPV vaccination. Publicly funded school-based programs are an impactful strategy to increase vaccine uptake.

Funding

This work was supported by the Canadian Cancer Society Research Institute (#704,036). GKS was supported by the Vanier Canada Graduate Scholarship and Queen Elizabeth II Diamond Jubilee Scholarship programs. The funders of this work had no role in the data collection, analysis, or interpretation, or any aspect pertinent to the study.

Willingness to Accept Human Papillomavirus Vaccination and its Influencing Factors Using Information-Motivation-Behavior Skills Model: A Cross-Sectional Study of Female College Freshmen in Mainland China

BACKGROUND

This study aimed to assess the awareness and attitudes toward human papillomavirus (HPV) vaccination among female college freshmen and explore their willingness and associated factors to receive the HPV vaccine based on the information-motivation-behavior skills (IMB) model.

METHODS

From February 21 to April 30, 2020, a cross-sectional survey was conducted among female freshmen in seven colleges in mainland China. Socio-demographic characteristics, health-related awareness, knowledge of HPV, motivation, and behavioral skills toward HPV vaccination were assessed using questionnaires. Univariate and multivariate logistic regression analyses were performed to identify the influencing factors of willingness to receive the HPV vaccine in the next 6 months.

RESULTS

Among the 3867 students invited to participate in this study, 102 (2.64%) reported having taken the HPV vaccine. Among the unvaccinated participants, 59.89% had previously heard of HPV, and 32.08% were willing to take the HPV vaccine in the next 6 months. Willingness to get the HPV vaccine was associated with sexual experience(s) (AOR = 1.96, 95% CI: 1.25-3.08), family or friends with cancer (AOR = 1.24, 95% CI: 1.04-1.48), having heard of HPV (AOR = 1.23, 95% CI: 1.03-1.47), and having actively searched for or having consulted on issues concerning HPV vaccine (AOR = 1.22, 95% CI: 1.02-1.45). In the dimensions of the IMB model, "perceived susceptibility" (AOR = 1.20, 95% CI: 1.09-1.31), "perceived severity" (AOR = 1.24, 95% CI: 1.11-1.39), "subjective norms" (AOR = 2.09, 95% CI: 1.75-2.49), and "self-efficacy" (AOR: 2.95, 95% CI: 2.44-3.58) were positively associated with HPV vaccination acceptance, while "perceived barriers" (AOR = .60, 95% CI: .52-.69) negatively affected intention to get HPV vaccination.

CONCLUSION

HPV vaccination rates and willingness to receive the HPV vaccine in the next 6 months were found to be poor among female college freshmen in mainland China. Having a positive attitude toward HPV vaccination, creating vaccine-friendly social norms, and removing related barriers are important measures to promote HPV immunization.

Intense and Mild First Epidemic Wave of Coronavirus Disease, The Gambia

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic is evolving differently in Africa than in other regions. Africa has lower SARS-CoV-2 transmission rates and milder clinical manifestations. Detailed SARS-CoV-2 epidemiologic data are needed in Africa. We used publicly available data to calculate SARS-CoV-2 infections per 1,000 persons in The Gambia. We evaluated transmission rates among 1,366 employees of the Medical Research Council Unit The Gambia (MRCG), where systematic surveillance of symptomatic cases and contact tracing were implemented. By September 30, 2020, The Gambia had identified 3,579 SARS-CoV-2 cases, including 115 deaths; 67% of cases were identified in August. Among infections, MRCG staff accounted for 191 cases; all were asymptomatic or mild. The cumulative incidence rate among nonclinical MRCG staff was 124 infections/1,000 persons, which is >80-fold higher than estimates of diagnosed cases among the population. Systematic surveillance and seroepidemiologic surveys are needed to clarify the extent of SARS-CoV-2 transmission in Africa.

Analysis of Facilitators and Barriers to the Delivery of Routine Care during the COVID-19 Global Pandemic: A Systematic Review

The delivery of routine health care during the COVID-19 global pandemic continues to be challenged as public health guidelines and other local/regional/state and other policies are enforced to help prevent the spread of the virus. The objective of this systematic review is to identify the facilitators and barriers affecting the delivery of routine health care services during the pandemic to provide a framework for future research. In total, 32 articles were identified for common themes surrounding facilitators of routine care during COVID-19. Identified constructed in the literature include enhanced education initiatives for parents/patients regarding routine vaccinations, an importance of routine vaccinations as compared to the risk of COVID-19 infection, an enhanced use of telehealth resources (including diagnostic imagery) and identified patient throughput/PPE initiatives. Reviewers identified the following barriers to the delivery of routine care: conservation of medical providers and PPE for non-routine (acute) care delivery needs, specific routine care services incongruent the telehealth care delivery methods, and job-loss/food insecurity. Review results can assist healthcare organizations with process-related challenges related to current and/or future delivery of routine care and support future research initiatives as the global pandemic continues.