Pentavalent vaccination in Kenya: coverage and geographical accessibility to health facilities using data from a community demographic and health surveillance system in Kilifi County

Number of medical facilities within driving distance of residence and influenza vaccination status in Japan: A cross-sectional study

Vaccine hesitancy primarily consists of confidence, complacency, and convenience, including geographical accessibility. However, few studies in developed countries have focused on the association between geographical accessibility to vaccination services and vaccination status and previous studies have shown conflicting results. This cross-sectional study aimed to clarify the association between the number of medical facilities within a 15-minute driving distance from the place of residence and influenza vaccination status, using a large nationwide internet survey in Japan (n = 27,440). Postal codes were used to determine participants' place of residence and the number of medical facilities within a 15-minute drive was calculated using geographic information system data. Participants were classified into quartiles based on the number of medical facilities nearby. They reported their influenza vaccination status over the past year. Modified Poisson regression analysis was conducted with influenza vaccination status as the dependent variable and the number of medical facilities nearby as the independent variable, adjusted for covariates stratified by age (under 65 years: or 65 years and older). Among participants aged 65 years and older, those with fewer medical facilities within a 15-minute drive of their place of residence were significantly less likely to have received an influenza vaccination than those with more medical facilities nearby (prevalence ratio in Q1 relative to Q4: 0.93, 95% confidence interval 0.87-0.99). In contrast, no association was observed among participants aged under 65 years. Geographical accessibility to vaccination services may influence vaccine hesitancy among older adults in Japan, a developed country.

Further analysis of determinants of Pentavalent and Measles immunizations dropouts among children under five years of age in Ethiopia from Mini-EDHS 2019

BACKGROUND

Globally, immunization prevents an estimated 2-3 million deaths from illnesses that can be prevented by vaccination. The predictors of Pentavalent and Measles immunization dropout were not investigated sufficiently. Therefore, this analysis was meant to determine the coverage, burden, and predictors of Pentavalent and Measles immunizations in Ethiopia.

MATERIALS AND METHODS

This study was a further analysis of the Mini Ethiopian Demographic Health Survey (EDHS) 2019, conducted with a nationally representative sample. In this study, immunization data was collected from a total sample of 3208 children of which 2004 (34.8%) children who received pentavalent 1 were considered for this study. Univariable, bi-variable, and multilevel mixed effect analysis was done using STATA version 17 Software. The mixed-effect model with the lowest AIC and BIC (information criteria) was chosen. A factor was designated as a significant predictor of immunization dropout if its p-value was less than 0.05 at 95% CI. The best-fitting model among the fitted models was ultimately chosen using the Akaike and Bayesian Information Criteria (AIC and BIC).

RESULT

The mean age of the head of the household was 37.6. The majority (68.9%) of the residents were from rural areas and of the total population, 64.9% have no formal education. Being residents of Afar increased the odds of dropping out by 3.28 (AOR = 3.28; 95% CI: 1.12, 9.56), whereas being residents of Addis Ababa reduced their odds of dropping out from prentavalent 3 by 68.1% (AOR = 0.319; 95% CI: 0.122, 0.833) compared to their Tigray counterparts. The dropout rate of Pentavalent 1 to measles 1 vaccination was 4.33 times higher among residents of Afar (AOR = 4.33; 95% CI: 1.38, 13.56). As the level of wealth increases, the quintile increases from poorer to richer compared to those in the poorest wealth quantile category, and marital status also affects the immunization dropout rate of their children.

CONCLUSIONS

Immunization coverage of Ethiopian children was low and the dropout from pentavalent 1 and measles vaccination was high compared to the national and international targets to improve immunization coverage and reduce dropout. So different cost-effective interventions like Education provision for the community, decision-making facilitation, behavioral change support, and multi-system participation were required to increase vaccination coverage and reduce the vaccine dropout among children in Ethiopia.

Prevalence of hepatitis B virus infection in Kenya: A study nested in the Kenya Population-based HIV Impact Assessment 2018

BACKGROUND

Sub-Saharan Africa region bears the highest chronic hepatitis B virus (HBV) infection burden worldwide. National estimates of HBV burden are necessary for a viral hepatitis program planning. This study estimated the national prevalence of HBV infection in Kenya among people aged 15-64 years.

METHODS

Of 27,745 participants age 15-64 years in the Kenya Population-based HIV Impact Assessment (KENPHIA) 2018 household survey, we analyzed data for all persons living with HIV (PLHIV; n = 1,521) and a random sample of HIV-negative persons (n = 1,551), totaling to 3,072 participants. We tested whole blood samples for hepatitis B surface antigen (HBsAg) using Determine™ HBsAg rapid test and used population projections to estimate national disease burden. Pearson chi square was performed and the weighted prevalence proportions presented.

FINDINGS

Of the 3,072 participants,124 tested HBsAg positive, resulting in a weighted national HBV prevalence of 3.0% (95% CI: 2.2-3.9%). This translated to an HBV infection burden of 810,600 (95% CI: 582,700-1,038,600) persons age 15-64 years in Kenya. Distribution of HBV prevalence varied widely (p<0.001) by geography, ranging from 0.1% in Eastern Kenya regions to over 5% in northern and western Kenya. Prevalence of HBV infection was higher in PLHIV (4.7%; 95% CI: 3.3-6.0%) compared to HIV-negative persons (3.0%; 95% CI: 2.1-3.9%), and was highest among persons: age 45-54 years (6.4%; 95% CI: 3.3-9.5%), those who reported no formal education (10.7%; 95% CI: 5.1-16.4%), in polygamous marriages (6.8%; 95% CI: 1.7-11.8%), and in the lowest wealth quintile (5.3%; 95% CI: 2.8-7.7). When adjusted for covariates, lack of formal education (aOR = 4.2; 95% CI: 1.5-12.6) was significantly associated with HBV infection. In stratified analysis by HIV status, residing in rural areas and history of blood transfusion were independently associated with HBV infection among PLHIV, while lack of formal education and no history of blood transfusion were associated with HBV infection among HIV-negative participants (p<0.05).

INTERPRETATION

HBV prevalence among persons aged 15-64 years in Kenya was 3.0%. Higher prevalence was documented among persons without formal education, in the lowest wealth quintile, and those living in Kenya's North-Eastern, Rift Valley-North and Nyanza regions. Targeted programmatic measures to strengthen interventions against HBV infections including newborn vaccination and treatment of infected adults to limit mother-to-child transmission, would be helpful in reducing burden of HBV-associated viral hepatitis.

Zero-Dose Childhood Vaccination Status in Rural Democratic Republic of Congo: Quantifying the Relative Impact of Geographic Accessibility and Attitudes toward Vaccination

Despite efforts to increase childhood vaccination coverage in the Democratic Republic of the Congo (DRC), approximately 20% of infants have not started their routine immunization schedule (zero-dose). The present study aims to evaluate the relative influence of geospatial access to health facilities and caregiver perceptions of vaccines on the vaccination status of children in rural DRC. Pooled data from two consecutive nationwide immunization surveys conducted in 2022 and 2023 were used. Geographic accessibility was assessed based on travel time from households to their nearest health facility using the AccessMod 5 model. Caregiver attitudes to vaccination were assessed using the survey question "How good do you think vaccines are for your child?" We used logistic regression to assess the relationship between geographic accessibility, caregiver attitudes toward vaccination, and their child's vaccination status. Geographic accessibility to health facilities was high in rural DRC, with 88% of the population living within an hour's walk to a health facility. Responding that vaccines are "Bad, Very Bad, or Don't Know" relative to "Very Good" for children was associated with a many-fold increased odds of a zero-dose status (ORs 69.3 [95%CI: 63.4-75.8]) compared to the odds for those living 60+ min from a health facility, relative to <5 min (1.3 [95%CI: 1.1-1.4]). Similar proportions of the population fell into these two at-risk categories. We did not find evidence of an interaction between caregiver attitude toward vaccination and travel time to care. While geographic access to health facilities is crucial, caregiver demand appears to be a more important driver in improving vaccination rates in rural DRC.

Coverage of the Combined DTaP-IPV/Hib Vaccine Among Children Aged 2-18 Months - 9 PLADs, China, 2019-2021

What is already known on this topic?

In China, there is limited data available on the use and coverage of the non-program, combined diphtheria, tetanus toxoid, acellular pertussis adsorbed, inactivated poliovirus and haemophilus influenzae type b (DTaP-IPV/Hib) pentavalent vaccine, and its role as a substitute for the separately administered standalone program vaccines.

What is added by this report?

We evaluated the use and coverage of the pentavalent vaccine in nine provincial-level administrative divisions (PLADs) spanning eastern, central, and western China from 2019 to 2021. Initial use and coverage were low, but demonstrated annual growth albeit with regional and urban-rural discrepancies. The pentavalent vaccine was increasingly substituted for standalone vaccines over the course of this period.

What are the implications for public health practice?

Parents in China are increasingly opting to replace the standard program vaccines with voluntarily purchased combination vaccines, particularly the pentavalent vaccine. The development of combination vaccines should thus be promoted in China, as it could enhance utilization and coverage rates, and decrease the economic burden.

Exploring the factors contributing to low vaccination uptake for nationally recommended routine childhood and adolescent vaccines in Kenya

BACKGROUND

Vaccination remains the most effective means of reducing the burden of infectious disease among children. It is estimated to prevent between two to three million child deaths annually. However, despite being a successful intervention, basic vaccination coverage remains below the target. About 20 million infants are either under or not fully vaccinated, most of whom are in Sub-Saharan Africa region. In Kenya, the coverage is even lower at 83% than the global average of 86%. The objective of this study is to explore the factors that contribute to low demand or vaccine hesitancy for childhood and adolescent vaccines in Kenya.

METHODS

The study used qualitative research design. Key Informant Interviews (KII) was used to obtain information from national and county-level key stakeholders. In-depth Interviews (IDI) was done to collect opinions of caregivers of children 0-23 months and adolescent girls eligible for immunization, and Human papillomavirus (HPV) vaccine respectively. The data was collected at the national level and counties such as Kilifi, Turkana, Nairobi and Kitui. The data was analyzed using thematic content approach. A total of 41 national and county-level immunization officials and caregivers formed the sample.

RESULTS

Insufficient knowledge about vaccines, vaccine supply issues, frequent healthcare worker's industrial action, poverty, religious beliefs, inadequate vaccination campaigns, distance to vaccination centers, were identified as factors driving low demand or vaccine hesitancy against routine childhood immunization. While factors driving low uptake of the newly introduced HPV vaccine were reported to include misinformation about the vaccine, rumors that the vaccine is a form of female contraception, the suspicion that the vaccine is free and available only to girls, poor knowledge of cervical cancer and benefits of HPV vaccine.

CONCLUSIONS

Rural community sensitization on both routine childhood immunization and HPV vaccine should be key activities post COVID-19 pandemic. Likewise, the use of mainstream and social media outreaches, and vaccine champions could help reduce vaccine hesitancy. The findings are invaluable for informing design of context-specific interventions by national and county-level immunization stakeholders. Further studies on the relationship between attitude towards new vaccines and connection to vaccine hesitancy is necessary.