1
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Yaro S, Njanpop Lafourcade BM, Ouangraoua S, Ouoba A, Kpoda H, Findlow H, Tall H, Seanehia J, Martin C, Ouedraogo JB, Gessner B, Meda N, Borrow R, Trotter C, Mueller JE. Antibody Persistence at the Population Level 5 Years After Mass Vaccination With Meningococcal Serogroup A Conjugate Vaccine (PsA-TT) in Burkina Faso: Need for a Booster Campaign? Clin Infect Dis 2020; 68:435-443. [PMID: 30481265 DOI: 10.1093/cid/ciy488] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 06/06/2018] [Indexed: 01/10/2023] Open
Abstract
Background In Burkina Faso, serogroup A meningococcal (NmA) conjugate vaccine (PsA-TT, MenAfriVac) was introduced through a mass campaign in children and adults in December 2010. Similar to a serological survey in 2011, we followed population-level antibody persistence for 5 years after the campaign and estimated time of return to previously-published pre-vaccination levels. Methods We conducted 2 cross-sectional surveys in 2013 and early 2016, including representative samples (N = 600) of the general population of Bobo-Dioulasso, Burkina Faso. Serum bactericidal antibody titers (rabbit complement) were measured against NmA reference strain F8236 (SBA-ref), NmA strain 3125 (SBA-3125), and NmA-specific immunoglobulin G (IgG) concentrations. Results During the 2016 survey, in different age groups between 6 and 29 years, the relative changes in geometric means compared to 2011 values were greater among younger age groups. They were between -87% and -43% for SBA-ref; -99% and -78% for SBA-3125; and -89% and -63% for IgG. In linear extrapolation of age-specific geometric means from 2013 to 2016, among children aged 1-4 years at the time of the PsA-TT campaign, a return to pre-vaccination levels should be expected after 12, 8, and 6 years, respectively, according to SBA-ref, SBA-3125, and IgG. Among older individuals, complete return to baseline is expected at the earliest after 11 years (SBA-ref and SBA-3125) or 9 years (IgG). Conclusions Based on SBA-3125, a booster campaign after 8 years would be required to sustain direct immune protection for children aged 1-4 years during the PsA-TT campaign. Antibodies persisted longer in older age groups.
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Affiliation(s)
| | | | | | | | | | - Helen Findlow
- Vaccine Evaluation Unit, Public Health England, Manchester, United Kingdom
| | - Haoua Tall
- Agence de Medecine Preventive, Paris, France
| | - Joy Seanehia
- EHESP French School of Public Health, Sorbonne Paris Cité, France et Institut Pasteur, Paris
| | | | | | | | | | - Ray Borrow
- Vaccine Evaluation Unit, Public Health England, Manchester, United Kingdom
| | | | - Judith E Mueller
- EHESP French School of Public Health, Sorbonne Paris Cité, France et Institut Pasteur, Paris
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2
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Nkwenkeu SF, Jalloh MF, Walldorf JA, Zoma RL, Tarbangdo F, Fall S, Hien S, Combassere R, Ky C, Kambou L, Diallo AO, Krishnaswamy A, Aké FH, Hatcher C, Patel JC, Medah I, Novak RT, Hyde TB, Soeters HM, Mirza I. Health workers' perceptions and challenges in implementing meningococcal serogroup a conjugate vaccine in the routine childhood immunization schedule in Burkina Faso. BMC Public Health 2020; 20:254. [PMID: 32075630 PMCID: PMC7031928 DOI: 10.1186/s12889-020-8347-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 02/12/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Meningococcal serogroup A conjugate vaccine (MACV) was introduced in 2017 into the routine childhood immunization schedule (at 15-18 months of age) in Burkina Faso to help reduce meningococcal meningitis burden. MACV was scheduled to be co-administered with the second dose of measles-containing vaccine (MCV2), a vaccine already in the national schedule. One year following the introduction of MACV, an assessment was conducted to qualitatively examine health workers' perceptions of MACV introduction, identify barriers to uptake, and explore opportunities to improve coverage. METHODS Twelve in-depth interviews were conducted with different cadres of health workers in four purposively selected districts in Burkina Faso. Districts were selected to include urban and rural areas as well as high and low MCV2 coverage areas. Respondents included health workers at the following levels: regional health managers (n = 4), district health managers (n = 4), and frontline healthcare providers (n = 4). All interviews were recorded, transcribed, and thematically analyzed using qualitative content analysis. RESULTS Four themes emerged around supply and health systems barriers, demand-related barriers, specific challenges related to MACV and MCV2 co-administration, and motivations and efforts to improve vaccination coverage. Supply and health systems barriers included aging cold chain equipment, staff shortages, overworked and poorly trained staff, insufficient supplies and financial resources, and challenges with implementing community outreach activities. Health workers largely viewed MACV introduction as a source of motivation for caregivers to bring their children for the 15- to 18-month visit. However, they also pointed to demand barriers, including cultural practices that sometimes discourage vaccination, misconceptions about vaccines, and religious beliefs. Challenges in co-administering MACV and MCV2 were mainly related to reluctance among health workers to open multi-dose vials unless enough children were present to avoid wastage. CONCLUSIONS To improve effective administration of vaccines in the second-year of life, adequate operational and programmatic planning, training, communication, and monitoring are necessary. Moreover, clear policy communication is needed to help ensure that health workers do not refrain from opening multi-dose vials for small numbers of children.
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Affiliation(s)
| | - Mohamed F. Jalloh
- U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329 USA
| | - Jenny A. Walldorf
- U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329 USA
| | - Robert L. Zoma
- Institut National de Statistique et Démographie, Ouagadougou, Burkina Faso
| | | | - Soukeynatou Fall
- UNICEF Ouagadougou, 01 PO Box 3420, Ouagadougou 01, Burkina Faso
| | - Sansan Hien
- UNICEF Ouagadougou, 01 PO Box 3420, Ouagadougou 01, Burkina Faso
| | | | - Cesaire Ky
- Ministère de la Santé, Ouagadougou, Burkina Faso
| | | | | | | | | | - Cynthia Hatcher
- U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329 USA
| | - Jaymin C. Patel
- U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329 USA
| | - Isaïe Medah
- Ministère de la Santé, Ouagadougou, Burkina Faso
| | - Ryan T. Novak
- U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329 USA
| | - Terri B. Hyde
- U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329 USA
| | - Heidi M. Soeters
- U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329 USA
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3
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Greenwood B. Sustaining Protection Against Epidemic Meningitis in Africa After Vaccination. Clin Infect Dis 2019; 68:444-445. [DOI: 10.1093/cid/ciy489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 06/11/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Brian Greenwood
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, United Kingdom
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4
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Jackson ML, Diallo AO, Médah I, Bicaba BW, Yaméogo I, Koussoubé D, Ouédraogo R, Sangaré L, Mbaeyi SA. Initial validation of a simulation model for estimating the impact of serogroup A Neisseria meningitidis vaccination in the African meningitis belt. PLoS One 2018; 13:e0206117. [PMID: 30359419 PMCID: PMC6201925 DOI: 10.1371/journal.pone.0206117] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 10/08/2018] [Indexed: 12/23/2022] Open
Abstract
We previously developed a mathematical simulation of serogroup A Neisseria meningitidis (NmA) transmission in Burkina Faso, with the goal of forecasting the relative benefit of different vaccination programs. Here, we revisit key structural assumptions of the model by comparing how accurately the different assumptions reproduce observed NmA trends following vaccine introduction. A priori, we updated several of the model's parameters based on recently published studies. We simulated NmA disease under different assumptions about duration of vaccine-induced protection (including the possibility that vaccine-induced protection may last longer than natural immunity). We compared simulated and observed case counts from 2011-2017. We then used the best-fit model to forecast the impact of different vaccination strategies. Our updated model, with the assumption that vaccine-induced immunity lasts longer than immunity following NmA colonization, was able to reproduce observed trends in NmA disease. The updated model predicts that, following a mass campaign among persons 1-29 years of age, either routine immunization of 9 month-old children or periodic mini-campaigns among children 1-4 years of age will lead to sustained control of epidemic NmA in Burkina Faso. This validated model can help public health officials set policies for meningococcal vaccination in Africa.
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Affiliation(s)
- Michael L. Jackson
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Washington, United States of America
| | - Alpha Oumar Diallo
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Isaie Médah
- Direction de la Lutte Contre la Maladie, Ministère de la Santé, Ouagadougou, Burkina Faso
| | - Brice Wilfried Bicaba
- Direction de la Lutte Contre la Maladie, Ministère de la Santé, Ouagadougou, Burkina Faso
| | - Issaka Yaméogo
- Direction de la Lutte Contre la Maladie, Ministère de la Santé, Ouagadougou, Burkina Faso
| | - Daouda Koussoubé
- Direction de la Lutte Contre la Maladie, Ministère de la Santé, Ouagadougou, Burkina Faso
| | - Rasmata Ouédraogo
- Direction de la Lutte Contre la Maladie, Ministère de la Santé, Ouagadougou, Burkina Faso
| | - Lassané Sangaré
- Direction de la Lutte Contre la Maladie, Ministère de la Santé, Ouagadougou, Burkina Faso
| | - Sarah A. Mbaeyi
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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5
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Haddison EC, Abdullahi LH, Muloiwa R, Hussey GD, Kagina BM. Comparison of school based and supplemental vaccination strategies in the delivery of vaccines to 5-19 year olds in Africa - a systematic review. F1000Res 2017; 6:1833. [PMID: 29375814 PMCID: PMC5765397 DOI: 10.12688/f1000research.12804.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/09/2017] [Indexed: 02/03/2023] Open
Abstract
Background: Some vaccine preventable diseases (VPDs) still remain a public health burden in many African countries. The occurrence of VPDs in all age groups has led to the realization of the need to extend routine immunisation services to school age children, adolescents and adults. Supplemental immunisation activities (SIAs) and school based vaccinations (SBVs) are common strategies used to complement the expanded programme on immunisation (EPI). This review aimed to assess the effectiveness of SIAs compared to SBVs in the administration of vaccines to 5-19 year olds in Africa. Methods: Systematic review methods were used to address our study aim. Several electronic databases were searched up to March 30, 2017 for primary studies investigating the delivery of vaccines via SIAs or SBVs to 5-19 year olds. This search was complemented by browsing reference lists of potential studies obtained from search outputs. Outcomes considered for inclusion were: vaccination coverage, costs of the strategy or its effect on routine immunisation services. Results: Out of the 4938 studies identified, 31 studies met the review inclusion criteria. Both SIAs and SBVs showed high vaccination coverage. However, the SIAs reported higher coverage than SBVs: 91% (95% CI: 84%, 98%) versus 75% (95% CI: 67%, 83%). In most settings, SBVs were reported to be more expensive than SIAs. The SIAs were found to negatively affect routine immunisation services. Conclusions: Both SIAs and SBVs are routinely used to complement the EPI in the delivery of vaccines in Africa. In settings where school enrolment is suboptimal, as is the case in many African countries, our results show SIAs may be more effective in reaching school age children and adolescents than SBVs. Our results re-iterate the importance of evaluating systematic evidence to best inform African authorities on the optimal vaccine delivery strategies targeting school age children and adolescents.
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Affiliation(s)
- Eposi C Haddison
- Vaccines for Africa Initiative (VACFA), University of Cape Town, Cape Town, South Africa.,School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Leila H Abdullahi
- Vaccines for Africa Initiative (VACFA), University of Cape Town, Cape Town, South Africa.,Division of Medical Microbiology & Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Rudzani Muloiwa
- Vaccines for Africa Initiative (VACFA), University of Cape Town, Cape Town, South Africa.,Department of Paediatrics & Child Health, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Gregory D Hussey
- Vaccines for Africa Initiative (VACFA), University of Cape Town, Cape Town, South Africa.,Division of Medical Microbiology & Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Benjamin M Kagina
- Vaccines for Africa Initiative (VACFA), University of Cape Town, Cape Town, South Africa.,School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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6
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Cutts FT, Hanson M. Seroepidemiology: an underused tool for designing and monitoring vaccination programmes in low- and middle-income countries. Trop Med Int Health 2016; 21:1086-98. [PMID: 27300255 DOI: 10.1111/tmi.12737] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Seroepidemiology, the use of data on the prevalence of bio-markers of infection or vaccination, is a potentially powerful tool to understand the epidemiology of infection before vaccination and to monitor the effectiveness of vaccination programmes. Global and national burden of disease estimates for hepatitis B and rubella are based almost exclusively on serological data. Seroepidemiology has helped in the design of measles, poliomyelitis and rubella elimination programmes, by informing estimates of the required population immunity thresholds for elimination. It contributes to monitoring of these programmes by identifying population immunity gaps and evaluating the effectiveness of vaccination campaigns. Seroepidemiological data have also helped to identify contributing factors to resurgences of diphtheria, Haemophilus Influenzae type B and pertussis. When there is no confounding by antibodies induced by natural infection (as is the case for tetanus and hepatitis B vaccines), seroprevalence data provide a composite picture of vaccination coverage and effectiveness, although they cannot reliably indicate the number of doses of vaccine received. Despite these potential uses, technological, time and cost constraints have limited the widespread application of this tool in low-income countries. The use of venous blood samples makes it difficult to obtain high participation rates in surveys, but the performance of assays based on less invasive samples such as dried blood spots or oral fluid has varied greatly. Waning antibody levels after vaccination may mean that seroprevalence underestimates immunity. This, together with variation in assay sensitivity and specificity and the common need to take account of antibody induced by natural infection, means that relatively sophisticated statistical analysis of data is required. Nonetheless, advances in assays on minimally invasive samples may enhance the feasibility of including serology in large survey programmes in low-income countries. In this paper, we review the potential uses of seroepidemiology to improve vaccination policymaking and programme monitoring and discuss what is needed to broaden the use of this tool in low- and middle-income countries.
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Affiliation(s)
- Felicity T Cutts
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Matt Hanson
- Vaccine Delivery, Global Development, The Bill & Melinda Gates Foundation, Seattle, WA, USA
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