1
|
Hartner AM, Li X, Gaythorpe K. COVID-19 related disruption and resilience in immunisation activities in LMICs: a rapid review. BMJ Open 2024; 14:e076607. [PMID: 39107008 PMCID: PMC11331918 DOI: 10.1136/bmjopen-2023-076607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 07/19/2024] [Indexed: 08/09/2024] Open
Abstract
OBJECTIVES We conducted a rapid review to determine the extent that immunisation services in low-income and middle-income countries (LMICs) were disrupted by the COVID-19 pandemic and synthesised the factors that can be used to build resilience in future. DESIGN Rapid review reported in accordance with the Preferred reporting for Systematic reviews and Meta-Analyses (PRISMA) guidelines. DATA SOURCES PubMed and Web of Science were searched through 6 October 2023. ELIGIBILITY CRITERIA FOR SELECTING STUDIES We included studies that focused on disruption to immunisation activities due to the COVID-19 pandemic in LMICs. Outcomes included routine vaccine coverage, supplementary immunisation activities, vaccine doses, timing of vaccination, supply chain changes, and factors contributing to disruption or resilience. DATA EXTRACTION AND SYNTHESIS Two independent reviewers used standardised methods to search, screen and code studies. Quality assessment was performed using a modified version of the Critical Appraisal Skills Programme for qualitative research. Findings were summarised qualitatively. RESULTS Of 4978 identified studies, 85 met the eligibility criteria. Included studies showed declines in immunisation activities across LMICs related to the COVID-19 pandemic. These included reductions in achieved routine coverage, cancellation or postponement of campaigns and underimmunised cohorts. Immunisation was most disrupted in the early months of the pandemic; however, recovery varied by country, age-group and vaccine. Though many countries observed partial recovery in 2020, disruption in many countries continued into 2021. It has also been noted that clinician staff shortages and vaccine stock-outs caused by supply chain disruptions contributed to immunisation delays, but that concern over COVID-19 transmission was a leading factor. Key resiliency factors included community outreach and healthcare worker support. CONCLUSIONS There is limited information on whether reductions in vaccination coverage or delays have persisted beyond 2021. Further research is needed to assess ongoing disruptions and identify missed vaccine cohorts.
Collapse
Affiliation(s)
- Anna-Maria Hartner
- MRC Centre for Global Infectious Disease Analysis, Jameel Institute, School of Public Health, Imperial College London, London, UK
- Centre for Artificial Intelligence in Public Health Research, Robert Koch Institute, Wildau, Germany
| | - Xiang Li
- MRC Centre for Global Infectious Disease Analysis, Jameel Institute, School of Public Health, Imperial College London, London, UK
| | - Katy Gaythorpe
- MRC Centre for Global Infectious Disease Analysis, Jameel Institute, School of Public Health, Imperial College London, London, UK
| |
Collapse
|
2
|
Shaikh BT, Abdullah MA, Sattar NY, Shaikh WQ. COVID-19 Pandemic and Its Global Impact on the Accessibility and Provision of Maternal and Child Health Care Services. Asia Pac J Public Health 2024; 36:511-512. [PMID: 38695363 DOI: 10.1177/10105395241250120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2024]
|
3
|
Packham A, Taylor AE, Karangwa MP, Sherry E, Muvunyi C, Green CA. Measles Vaccine Coverage and Disease Outbreaks: A Systematic Review of the Early Impact of COVID-19 in Low and Lower-Middle Income Countries. Int J Public Health 2024; 69:1606997. [PMID: 38725903 PMCID: PMC11079172 DOI: 10.3389/ijph.2024.1606997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 03/27/2024] [Indexed: 05/12/2024] Open
Abstract
Objectives: We aimed to evaluate changes to measles-containing vaccine (MCV) provision and subsequent measles disease cases in low- and lower-middle income countries (LICs, LMICs) in relation to the COVID-19 pandemic. Methods: A systematic search was conducted of MEDLINE, OVID EMBASE and PubMed records. Primary quantitative and qualitative research studies published from January 2020 were included if they reported on COVID-19 impact on MCV provision and/or measles outbreak rates within LICs and LMICs. Results: 45 studies were included. The change in MCV1 vaccination coverage in national and international regions ranged -13% to +44.4% from pre-COVID time periods. In local regions, the median MCV1 and overall EPI rate changed by -23.3% and -28.5% respectively. Median MCV2 rate was disproportionally impacted in local areas during COVID-interruption time-periods (-48.2%) with ongoing disruption in early-recovery time-periods (-17.7%). 8.9% of studies reported on vaccination status of confirmed measles cases; from these, 71%-91% had received no MCV dose. Conclusion: MCV vaccination coverage experienced ongoing disruption during the recovery periods after initial COVID-19 disruption. Vaccination in local area datasets notably experienced longer-term disruption compared to nationally reported figures.
Collapse
Affiliation(s)
- Alice Packham
- School of Chemical Engineering, College of Engineering and Physical Sciences, University of Birmingham, Birmingham, England, United Kingdom
- Department of Infectious Diseases and Tropical Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Alice E. Taylor
- School of Chemical Engineering, College of Engineering and Physical Sciences, University of Birmingham, Birmingham, England, United Kingdom
- Department of Infectious Diseases and Tropical Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | | | - Emma Sherry
- School of Chemical Engineering, College of Engineering and Physical Sciences, University of Birmingham, Birmingham, England, United Kingdom
- Department of Infectious Diseases and Tropical Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | | | - Christopher A. Green
- School of Chemical Engineering, College of Engineering and Physical Sciences, University of Birmingham, Birmingham, England, United Kingdom
- Department of Infectious Diseases and Tropical Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| |
Collapse
|
4
|
Khan AM, Ahmed I, Jawwad M, Islam M, Tahir R, Anwar S, Nauman AA, Bhutta ZA. A Low-Cost, Integrated Immunization, Health, and Nutrition Intervention in Conflict Settings in Pakistan-The Impact on Zero-Dose Children and Polio Coverage. Pathogens 2024; 13:185. [PMID: 38535529 PMCID: PMC10975858 DOI: 10.3390/pathogens13030185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 02/14/2024] [Accepted: 02/17/2024] [Indexed: 04/01/2024] Open
Abstract
Pakistan is one of two countries globally still endemic for poliovirus. While increasing immunization coverage is a concern, providing equitable access to care is also a priority, especially for conflict-affected populations. Recognizing these challenges, Naunehal, an integrated model of maternal, newborn, and child health (MNCH), immunization, and nutrition services delivered through community mobilization, mobile outreach, and private-sector engagement was implemented in conflict-affected union councils (UCs) with high poliovirus transmission, including Kharotabad 1(Quetta, Balochistan) and Bakhmal Ahmedzai (Lakki Marwat, Khyber Pakhtunkhwa). A quasi-experimental pre-post-design was used to assess the impact of the interventions implemented between April 2021 and April 2022, with a baseline and an endline survey. For each of the intervention UCs, a separate, matched-control UC was identified. At endline, the proportion of fully immunized children increased significantly from 27.5% to 51.0% in intervention UCs with a difference-in-difference (DiD) estimate of 13.6%. The proportion of zero-dose children and non-recipients of routine immunization (NR-RI) children decreased from 31.6% to 0.9% and from 31.9% to 3.4%, respectively, with a significant decrease in the latter group. Scaling up and assessing the adoption and feasibility of integrated interventions to improve immunization coverage can inform policymakers of the viability of such services in such contexts.
Collapse
Affiliation(s)
- Amira M. Khan
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON M5G OA4, Canada; (A.M.K.); (M.I.)
| | - Imran Ahmed
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi 74800, Pakistan; (I.A.); (M.J.)
| | - Muhammad Jawwad
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi 74800, Pakistan; (I.A.); (M.J.)
| | - Muhammad Islam
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON M5G OA4, Canada; (A.M.K.); (M.I.)
| | - Rehman Tahir
- Trust for Vaccines and Immunization, Al Sehat Centre, Rafiqui Shaheed Road, Karachi 74350, Pakistan;
| | - Saeed Anwar
- Prime Foundation, Peshawar Medical College, Warsak Road, Peshawar 25160, Pakistan; (S.A.); (A.A.N.)
| | - Ahmed Ali Nauman
- Prime Foundation, Peshawar Medical College, Warsak Road, Peshawar 25160, Pakistan; (S.A.); (A.A.N.)
| | - Zulfiqar A. Bhutta
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON M5G OA4, Canada; (A.M.K.); (M.I.)
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi 74800, Pakistan; (I.A.); (M.J.)
| |
Collapse
|
5
|
Dalton M, Sanderson B, Robinson LJ, Homer CSE, Pomat W, Danchin M, Vaccher S. Impact of COVID-19 on routine childhood immunisations in low- and middle-income countries: A scoping review. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002268. [PMID: 37611014 PMCID: PMC10446229 DOI: 10.1371/journal.pgph.0002268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 07/17/2023] [Indexed: 08/25/2023]
Abstract
Routine vaccines are critical to child health. The COVID-19 pandemic significantly impacted essential health services, particularly in low-and middle-income countries (LMICs). We reviewed literature to determine the impact of COVID-19 on service delivery and uptake of routine childhood immunisation in LMICs. We reviewed papers published between March 2020 and June 2022 using a scoping review framework, and assessed each paper across the World Health Organisation health system strengthening framework. Our search identified 3,471 publications; 58 studies were included. One-quarter of studies showed routine childhood immunisation coverage declined (10% to 38%) between 2019 to 2021. Declines in the number of vaccine doses administered (25% to 51%), timeliness (6.2% to 34%), and the availability of fixed and outreach services were also reported. Strategies proposed to improve coverage included catch-up activities, strengthening supply chain and outreach services. Re-focusing efforts on increasing coverage is critical to improve child health and reduce the likelihood of disease outbreaks.
Collapse
Affiliation(s)
| | | | - Leanne J. Robinson
- Burnet Institute, Melbourne, Victoria, Australia
- Population Health & Immunity Division, Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
- Department of Medical Biology, University of Melbourne, Melbourne, Australia
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | | | - William Pomat
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Margie Danchin
- Department of General Medicine, The Royal Children’s Hospital, Parkville, Victoria, Australia
- Vaccine Uptake Group, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | | |
Collapse
|
6
|
Mohamed WI, Umar M. The rising cases of diphtheria in Pakistan: A new epidemic boiling? J Glob Health 2023; 13:03027. [PMID: 37224521 DOI: 10.7189/jogh.13.03027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
|
7
|
Haq FU, Rahman SU, Imran M, Romman M, Shah A, Aslam Z, Ullah F, Madadi S, Dino Steinmetz CH, Cuschieri S. COVID‐19 among health care workers and their impact on the health care system in a teaching hospital in Pakistan: A cross sectional observational study. Health Sci Rep 2023; 6:e975. [DOI: 10.1002/hsr2.975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 11/05/2022] [Accepted: 11/21/2022] [Indexed: 12/04/2022] Open
Affiliation(s)
- Faiz Ul Haq
- Department of Microbiology University of Health Sciences Lahore Pakistan
| | - Saeed Ur Rahman
- Department of Nursing University of Health Sciences Lahore Pakistan
| | - Muhammad Imran
- Department of Microbiology University of Health Sciences Lahore Pakistan
| | - Muhammad Romman
- Pharmacognosy laboratory University of Chitral Pakistan Chitral Pakistan
| | - Asaf Shah
- Institute of Nursing Khyber Medical University Peshawar Peshawar Pakistan
| | - Zeenaf Aslam
- Department of Nursing University of Health Sciences Lahore Pakistan
| | - Farman Ullah
- Department of Nursing Riphah international university Islamabad Pakistan
| | - Shekiba Madadi
- Medical Research Center Kateb University Kabul Afghanistan
| | | | - Sarah Cuschieri
- Department of Anatomy, Faculty of Medicine & Surgery University of Malta Msida Malta
| |
Collapse
|
8
|
Ali I, Hamid S. Implications of COVID-19 and "super floods" for routine vaccination in Pakistan: The reemergence of vaccine preventable-diseases such as polio and measles. Hum Vaccin Immunother 2022; 18:2154099. [PMID: 36573023 PMCID: PMC9891673 DOI: 10.1080/21645515.2022.2154099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
With multiple waves and variants, the coronavirus disease 2019 (COVID-19) pandemic has affected routine vaccination programs globally. Its impact is also visible in Pakistan as routine health services continue to be disrupted. Consequently, thousands of children have emerged as vulnerable in the face of vaccine-preventable diseases (VPDs), which have already started causing outbreaks in the country. Infections with polio and measles have been significantly reported, especially during the last few years. This reemergence of both diseases is posing great challenges for the country at local, national, and global levels. These impacts are being multiplied by the 2022 flooding - called "super floods" - in the country. Hence, relevant stakeholders, such as the Pakistani government and the World Health Organization (WHO), need to revisit the entire vaccination program to address and resolve issues occurring at the management or local levels. It is highly important to pay attention to the context that provides a fertile ground to negatively affect vaccine uptake.
Collapse
Affiliation(s)
- Inayat Ali
- Department of Public Health and Allied Sciences, Fatima Jinnah Women University, Rawalpindi, Pakistan,Department of Anthropology, Fatima Jinnah Women University, Rawalpindi, Pakistan,CONTACT Inayat Ali Department of Public Health and Allied Sciences, Fatima Jinnah Women University, Rawalpindi, Pakistan
| | - Saima Hamid
- Fatima Jinnah Women University, Rawalpindi, Pakistan
| |
Collapse
|
9
|
Cardoso Pinto AM, Ranasinghe L, Dodd PJ, Budhathoki SS, Seddon JA, Whittaker E. Disruptions to routine childhood vaccinations in low- and middle-income countries during the COVID-19 pandemic: A systematic review. Front Pediatr 2022; 10:979769. [PMID: 36034563 PMCID: PMC9403570 DOI: 10.3389/fped.2022.979769] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 07/22/2022] [Indexed: 11/16/2022] Open
Abstract
Background The COVID-19 pandemic has disrupted routine childhood vaccinations worldwide with low- and middle-income countries (LMICs) most affected. This study aims to quantify levels of disruption to routine vaccinations in LMICs. Methods A systematic review (PROSPERO CRD42021286386) was conducted of MEDLINE, Embase, Global Health, CINAHL, Scopus and MedRxiv, on the 11th of February 2022. Primary research studies published from January 2020 onwards were included if they reported levels of routine pediatrics vaccinations before and after March 2020. Study appraisal was performed using NHLBI tool for cross-sectional studies. Levels of disruption were summarized using medians and interquartile ranges. Results A total of 39 cross-sectional studies were identified. These showed an overall relative median decline of -10.8% [interquartile range (IQR) -27.6%, -1.4%] across all vaccines. Upper-middle-income countries (upper-MICs) (-14.3%; IQR -24.3%, -2.4%) and lower-MICs (-18.0%; IQR -48.6%, -4.1%) showed greater declines than low-income countries (-3.1%; IQR -12.8%, 2.9%), as did vaccines administered at birth (-11.8%; IQR -27.7%, -3.5%) compared to those given after birth (-8.0%; IQR -28.6%, -0.4%). Declines during the first 3 months of the pandemic (-8.1%; IQR -35.1%, -1.4%) were greater than during the remainder of 2020 (-3.9%; IQR -13.0%, 11.4%) compared to baseline. Conclusion There has been a decline in routine pediatric vaccination, greatest in MICs and for vaccines administered at birth. Nations must prioritize catch-up programs alongside public health messaging to encourage vaccine uptake. Systematic review registration Identifier: CRD42021286386.
Collapse
Affiliation(s)
| | - Lasith Ranasinghe
- Academic Foundation Doctor, Imperial College London, London, United Kingdom
| | - Peter J Dodd
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Shyam Sundar Budhathoki
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - James A Seddon
- Department of Infectious Disease, Imperial College London, London, United Kingdom
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Elizabeth Whittaker
- Department of Infectious Disease, Imperial College London, London, United Kingdom
| |
Collapse
|
10
|
Oberemok VV, Andreeva OA, Laikova KV, Novikov IA, Kubyshkin AV. Post-genomic platform for development of oligonucleotide vaccines against RNA viruses: diamond cuts diamond. Inflamm Res 2022; 71:729-739. [PMID: 35523969 PMCID: PMC9075145 DOI: 10.1007/s00011-022-01582-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/01/2022] [Indexed: 12/02/2022] Open
Abstract
The coronavirus pandemic has starkly demonstrated the need to create highly effective vaccines against various viral diseases. The emerging new platforms for vaccine creation (adenovirus vectors and mRNA vaccines) have shown their worth in the fight against the prevention of coronavirus infection. However, adenovirus vectors and mRNA vaccines have a serious disadvantage: as a rule, only the S protein of the coronavirus is presented as an antigen. This tactic for preventing infection allows the ever-mutating virus to escape quickly from the immunity protection provided by such vaccines. Today, viral genomic databases are well-developed, which makes it possible to create new vaccines on a fundamentally new post-genomic platform. In addition, the technology for the synthesis of nucleic acids is currently experiencing an upsurge in demand in various fields of molecular biology. The accumulated experience suggests that the unique genomic sequences of viruses can act as antigens that trigger powerful humoral and cellular immunity. To achieve this effect, the following conditions must be created: the structure of the nucleic acid must be single-stranded, have a permanent 3D nanostructure, and have a unique sequence absent in the vaccinated organism. Oligonucleotide vaccines are able to resist the rapidly changing genomic sequences of RNA viruses by using conserved regions of their genomes to generate a long-term immune response, acting according to the adage that a diamond cuts a diamond. In addition, oligonucleotide vaccines will not contribute to antibody-dependent enhanced infection, since the nucleic acid of the coronavirus is inside the viral particle. It is obvious that new epidemics and pandemics caused by RNA viruses will continue to arise periodically in the human population. The creation of new, safe, and effective platforms for the production of vaccines that can flexibly change and adapt to new subtypes of viruses is very urgent and at this moment should be considered as a strategically necessary task.
Collapse
Affiliation(s)
- V V Oberemok
- Department of Molecular Genetics and Biotechnologies, V.I. Vernadsky Crimean Federal University, Simferopol, Crimea. .,Engineering Center 'Genetic and Cell Biotechnologies', V.I. Vernadsky Crimean Federal University, Simferopol, Crimea.
| | - O A Andreeva
- Department of Molecular Genetics and Biotechnologies, V.I. Vernadsky Crimean Federal University, Simferopol, Crimea.,Engineering Center 'Genetic and Cell Biotechnologies', V.I. Vernadsky Crimean Federal University, Simferopol, Crimea
| | - K V Laikova
- Biochemistry Department, V.I. Vernadsky Crimean Federal University, Simferopol, Crimea
| | - I A Novikov
- Department of Molecular Genetics and Biotechnologies, V.I. Vernadsky Crimean Federal University, Simferopol, Crimea
| | - A V Kubyshkin
- Engineering Center 'Genetic and Cell Biotechnologies', V.I. Vernadsky Crimean Federal University, Simferopol, Crimea
| |
Collapse
|