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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.
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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
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Sangwe CN, Budzi MN, Shifu IN, Ghangha JG, Njedock SN. The use of community-oriented primary care (COPC) model to generate vaccine demand: The case of a remote fishing community in Cameroon. Vaccine 2024:126173. [PMID: 39089959 DOI: 10.1016/j.vaccine.2024.126173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 07/20/2024] [Accepted: 07/22/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND Cameroon, a country in sub-Saharan Africa, ranks among the top 15 countries worldwide with the highest number of zero-dose (unvaccinated) children. Among other reasons, pockets of hard-to-reach communities that traditionally miss essential healthcare services, including childhood immunization, largely contribute to this sub-optimal vaccination coverage. This is the case of Manoka Health District (MHD), an archipelago district with a zero-dose proportion of 91.7%. High disease burdens such as malaria and water-borne diseases have forced the population to depend on herbalists and roadside drug vendors, eroding trust in the primary healthcare system and worsening vaccine hesitancy. This study, therefore, aims to describe how a project optimized vaccine demand generation in these hard-to-reach settlements using an integrated community health worker service delivery package developed using the Community-oriented primary healthcare (COPC) model. METHODOLOGY This cross-sectional descriptive study was based on data collected from November 2021 to August 2022 in three project-implementing health areas (Kombo Moukoko, Kooh, and Toube) in the Manoka health district. Data was collected on the integrated health packages offered by Community Health Workers (CHWs). It comprised health education on malaria and water-borne diseases, screening for malaria using Rapid Diagnostic Test (RDT), treatment of under-5 for uncomplicated malaria and diarrhea, conduct of essential Antenatal Care (ANC) services, and vaccination counseling and referral in the three health areas. Microsoft Excel 2013 was used to analyze descriptive data and expressed results as percentages, with tables and column charts used for data visualization. All missing data were considered in the final analysis. RESULTS Over 550 under-5 children and 187 pregnant women were identified to be in need of curative and preventive care services during the project period. About 81% of pregnant women received a minimum ANC package by CHWs, and 47% adhered to referrals to health facilities for continuous ANC and delivery. Half of the children under 5 with health issues were diagnosed and managed for uncomplicated malaria. Also, during home visits, 617 under-immunized and zero-dose children less than two years of age were identified, referred, and vaccinated either during an outreach program or at the nearest health post in a neighboring health area, representing about 64% (617/964) of under-2 children identified in these communities. There was a gradual increase from 0% vaccine acceptance post-referral in the first month to 47% after six months and 64% at one year of intervention. CONCLUSION The use of the COPC model to co-develop integrated essential health service packages that meet the needs of communities showed value in building trust and increasing childhood immunization uptake in hard-to-reach communities.
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Affiliation(s)
- Clovis Nchinjoh Sangwe
- Community Health Research Hub, Rural Doctors, Buea, Cameroon; Faculty of Medicine, The Hebrew University-Hadassah Braun School of Public Health and Community Medicine, Jerusalem 91120, Israel.
| | - Michael Ngenge Budzi
- Community Health Research Hub, Rural Doctors, Buea, Cameroon; Faculty of Medicine, The Hebrew University-Hadassah Braun School of Public Health and Community Medicine, Jerusalem 91120, Israel
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Lababidi G, Lababidi H, Bitar F, Arabi M. COVID-19 Vaccines in the Pediatric Population: A Focus on Cardiac Patients. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2024; 2024:2667033. [PMID: 38779616 PMCID: PMC11111306 DOI: 10.1155/2024/2667033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 04/04/2024] [Accepted: 04/27/2024] [Indexed: 05/25/2024]
Abstract
Due to the deleterious global impact of the COVID-19 pandemic, tremendous effort has been invested in the development of vaccines against the virus. Vaccine candidates are first tested in adult populations, a number of which have been approved for EUL by the WHO, and are in use across the USA and MENA region. The question remains whether these (or other) vaccines should be recommended to a neonatal, pediatric, and/or adolescent cohort. Incidence and severity of COVID-19 infection are low in pediatric, neonatal, and adolescent patients. Since both overall incidence and severity are lower in children than in adults, safety is an important consideration in vaccine approval for these age groups, in addition to efficacy and a decreased risk of transmission. The following review discusses vaccine immunology in children aged 0-18 years, with emphasis on the negative impact of the COVID-19 pandemic on the lives of children, considerations for pediatric vaccine approval, and available vaccines for pediatric cohorts along with a breakdown of the efficacy, advantages, and disadvantages for each. This review also contains current and future perspectives, as well as a section on the cardiovascular implications and related dynamics of pediatric COVID-19 vaccination.
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Affiliation(s)
- Ghena Lababidi
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hossam Lababidi
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Fadi Bitar
- Children's Heart Center, Division of Pediatric Cardiology, Pediatric Department, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mariam Arabi
- Children's Heart Center, Division of Pediatric Cardiology, Pediatric Department, American University of Beirut Medical Center, Beirut, Lebanon
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Habchy P, Tahan L, Moussi C, Barakat MA, Ghanem L, Kattan O, Njeim A, Abou Habib L, El Bitar W, El Asmar B, Chahine MN. Referrals and Determinant Factors of a National School Health Campaign in Lebanon on Children Aged between 3 and 12 Years Old. CHILDREN (BASEL, SWITZERLAND) 2024; 11:175. [PMID: 38397287 PMCID: PMC10886849 DOI: 10.3390/children11020175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 01/20/2024] [Accepted: 01/24/2024] [Indexed: 02/25/2024]
Abstract
In this extensive study examining the health of 7184 school children aged 3 to 12 in 27 Lebanese schools, screenings involved medical evaluation and interviews, complemented by phone interviews with 3880 parents. Notably, one in two students received a medical referral, revealing prevalent issues such as dental cavities (33%), under-vaccination (25%), undetected vision problems (13%), abnormal growth (6%), underweight (27%), and overweight (33%). Additional concerns encompassed abnormal vital signs (3%), abuse signs (0.6%), infectious skin lesions (1.6%), scoliosis (1.7%), abnormal auscultation (heart 1.1%, lungs 1.2%), ear problems (3.3%), precocious puberty (0.7%), and neurologic signs (0.6%). Mental health challenges affected 20-25% of students. Public schools and Beirut exhibited higher referral rates, with girls, older children, overweight students, those lacking regular pediatrician visits, and children of self-employed or less educated parents facing elevated referral rates. In contrast, children of healthcare workers experienced fewer referrals. Against this backdrop, the study emphasizes the imperative for targeted health initiatives, particularly in marginalized areas and for socioeconomically disadvantaged students. Priority areas include dental care, weight issues, mental health, vaccination compliance, and addressing vision problems to enhance learning outcomes.
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Affiliation(s)
- Peter Habchy
- Faculty of Medical Sciences, Lebanese University, Hadath 1519, Lebanon; (P.H.); (L.T.); (C.M.); (M.A.B.); (L.G.); (O.K.); (A.N.)
| | - Léa Tahan
- Faculty of Medical Sciences, Lebanese University, Hadath 1519, Lebanon; (P.H.); (L.T.); (C.M.); (M.A.B.); (L.G.); (O.K.); (A.N.)
| | - Charbel Moussi
- Faculty of Medical Sciences, Lebanese University, Hadath 1519, Lebanon; (P.H.); (L.T.); (C.M.); (M.A.B.); (L.G.); (O.K.); (A.N.)
| | - Muhammad A. Barakat
- Faculty of Medical Sciences, Lebanese University, Hadath 1519, Lebanon; (P.H.); (L.T.); (C.M.); (M.A.B.); (L.G.); (O.K.); (A.N.)
| | - Laura Ghanem
- Faculty of Medical Sciences, Lebanese University, Hadath 1519, Lebanon; (P.H.); (L.T.); (C.M.); (M.A.B.); (L.G.); (O.K.); (A.N.)
| | - Ogarite Kattan
- Faculty of Medical Sciences, Lebanese University, Hadath 1519, Lebanon; (P.H.); (L.T.); (C.M.); (M.A.B.); (L.G.); (O.K.); (A.N.)
| | - Alain Njeim
- Faculty of Medical Sciences, Lebanese University, Hadath 1519, Lebanon; (P.H.); (L.T.); (C.M.); (M.A.B.); (L.G.); (O.K.); (A.N.)
| | - Leila Abou Habib
- Lebanese Association of the Knights of Malta (Order of Malta Lebanon), Vanlian Bldg, 6th Fl. City Rama Str. Dekwaneh, Beirut P.O. Box 11-4286, Lebanon; (L.A.H.); (W.E.B.); (B.E.A.)
| | - Wassim El Bitar
- Lebanese Association of the Knights of Malta (Order of Malta Lebanon), Vanlian Bldg, 6th Fl. City Rama Str. Dekwaneh, Beirut P.O. Box 11-4286, Lebanon; (L.A.H.); (W.E.B.); (B.E.A.)
- Department of Pediatrics, Bellevue Medical Center University Hospital, Mansourieh P.O. Box 295, Lebanon
| | - Béchara El Asmar
- Lebanese Association of the Knights of Malta (Order of Malta Lebanon), Vanlian Bldg, 6th Fl. City Rama Str. Dekwaneh, Beirut P.O. Box 11-4286, Lebanon; (L.A.H.); (W.E.B.); (B.E.A.)
- Faculty of Medicine, Saint Joseph University, Beirut P.O. Box 17-5208, Lebanon
- Department of Cardiology, Hotel-Dieu de France Hospital, Achrafieh, Beirut 1100, Lebanon
| | - Mirna N. Chahine
- Faculty of Medical Sciences, Lebanese University, Hadath 1519, Lebanon; (P.H.); (L.T.); (C.M.); (M.A.B.); (L.G.); (O.K.); (A.N.)
- Lebanese Association of the Knights of Malta (Order of Malta Lebanon), Vanlian Bldg, 6th Fl. City Rama Str. Dekwaneh, Beirut P.O. Box 11-4286, Lebanon; (L.A.H.); (W.E.B.); (B.E.A.)
- Basic Sciences Department, Faculty of Medical Sciences, Lebanese University, Hadath 1519, Lebanon
- Foundation-Medical Research Institutes (F-MRI), Achrafieh, Beirut 1100, Lebanon
- Foundation-Medical Research Institutes (F-MRI), 1211 Geneva, Switzerland
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She B, Mangal TD, Adjabeng AY, Colbourn T, Collins JH, Janoušková E, Li Lin I, Mnjowe E, Mohan S, Molaro M, Phillips AN, Revill P, Smith RM, Twea PD, Nkhoma D, Manthalu G, Hallett TB. The changes in health service utilisation in Malawi during the COVID-19 pandemic. PLoS One 2024; 19:e0290823. [PMID: 38232073 PMCID: PMC10793884 DOI: 10.1371/journal.pone.0290823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 08/17/2023] [Indexed: 01/19/2024] Open
Abstract
INTRODUCTION The COVID-19 pandemic and the restriction policies implemented by the Government of Malawi may have disrupted routine health service utilisation. We aimed to find evidence for such disruptions and quantify any changes by service type and level of health care. METHODS We extracted nationwide routine health service usage data for 2015-2021 from the electronic health information management systems in Malawi. Two datasets were prepared: unadjusted and adjusted; for the latter, unreported monthly data entries for a facility were filled in through systematic rules based on reported mean values of that facility or facility type and considering both reporting rates and comparability with published data. Using statistical descriptive methods, we first described the patterns of service utilisation in pre-pandemic years (2015-2019). We then tested for evidence of departures from this routine pattern, i.e., service volume delivered being below recent average by more than two standard deviations was viewed as a substantial reduction, and calculated the cumulative net differences of service volume during the pandemic period (2020-2021), in aggregate and within each specific facility. RESULTS Evidence of disruptions were found: from April 2020 to December 2021, services delivered of several types were reduced across primary and secondary levels of care-including inpatient care (-20.03% less total interactions in that period compared to the recent average), immunisation (-17.61%), malnutrition treatment (-34.5%), accidents and emergency services (-16.03%), HIV (human immunodeficiency viruses) tests (-27.34%), antiretroviral therapy (ART) initiations for adults (-33.52%), and ART treatment for paediatrics (-41.32%). Reductions of service volume were greatest in the first wave of the pandemic during April-August 2020, and whereas some service types rebounded quickly (e.g., outpatient visits from -17.7% to +3.23%), many others persisted at lower level through 2021 (e.g., under-five malnutrition treatment from -15.24% to -42.23%). The total reduced service volume between April 2020 and December 2021 was 8 066 956 (-10.23%), equating to 444 units per 1000 persons. CONCLUSION We have found substantial evidence for reductions in health service delivered in Malawi during the COVID-19 pandemic which may have potential health consequences, the effect of which should inform how decisions are taken in the future to maximise the resilience of healthcare system during similar events.
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Affiliation(s)
- Bingling She
- Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
| | - Tara D. Mangal
- Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
| | - Anna Y. Adjabeng
- Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
| | - Tim Colbourn
- Institute for Global Health, University College London, London, United Kingdom
| | - Joseph H. Collins
- Institute for Global Health, University College London, London, United Kingdom
| | - Eva Janoušková
- Institute for Global Health, University College London, London, United Kingdom
| | - Ines Li Lin
- Institute for Global Health, University College London, London, United Kingdom
| | | | - Sakshi Mohan
- Centre for Health Economics, University of York, York, United Kingdom
| | - Margherita Molaro
- Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
| | - Andrew N. Phillips
- Institute for Global Health, University College London, London, United Kingdom
| | - Paul Revill
- Centre for Health Economics, University of York, York, United Kingdom
| | - Robert Manning Smith
- Centre for Advanced Spatial Analysis (CASA), University College London, London, United Kingdom
| | - Pakwanja D. Twea
- Department of Planning and Policy Development, Ministry of Health and Population, Lilongwe, Malawi
| | - Dominic Nkhoma
- College of Medicine, University of Malawi, Lilongwe, Malawi
| | - Gerald Manthalu
- Department of Planning and Policy Development, Ministry of Health and Population, Lilongwe, Malawi
| | - Timothy B. Hallett
- Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
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Gadeka DD, Aheto JMK. Healthcare utilization and associated factors during the first wave of COVID-19 pandemic in Ghana: A cross-sectional survey. Health Sci Rep 2024; 7:e1805. [PMID: 38213781 PMCID: PMC10781887 DOI: 10.1002/hsr2.1805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 10/12/2023] [Accepted: 12/21/2023] [Indexed: 01/13/2024] Open
Abstract
Background and Aims Understanding healthcare utilization during the coronavirus disease 2019 (COVID-19) pandemic is crucial to inform policy and to prepare health systems for future pandemics. We examined self-reported healthcare utilization and associated factors, including public health preventive practices, perceptions, and coping strategies among the general public in Ghana during the first wave of the COVID-19 pandemic. Methods We adopted a cross-sectional study design using a public survey to recruit 643 respondents between May 23, and July 11, 2020 during the first wave of confirmed COVID-19 cases and after the fifth week of a partial lockdown in Ghana. Descriptive, bivariate, and binary logistic regression analyses were carried out in Stata version 15. Results Overall, there was a high level of compliance with COVID-19 public health preventive measures. In terms of perception, 357 (55.5%) of respondents stated unnecessary worry was created about the disease. In relation to coping strategies, 376 (58.5%) of respondents stayed home for more than 6 h, while 35 (5%) reported drinking alcohol to overcome the fear created by the disease. The results showed that 176 (27.4%) of the respondents utilized healthcare while 44 (9.4%) did not utilized healthcare for fear of contracting the disease at the health facility. Marital status (adjusted odds ratio [aOR] = 0.63; 95% confidence interval [CI] = 0.409, 0.963), religion (aOR = 2.34; 95% CI = 1.10, 4.98), and possession of valid health insurance (aOR = 1.51; 95% CI = 1.020, 2.235) were associated with healthcare utilization. Conclusion There was low healthcare utilization coupled with fear of contracting the COVID-19 disease at the health facilities among the respondents. The findings suggest the need for effective public education that ensures that future pandemics' prevention information and recommendations are easily understandable by the general public. Additionally, investment in health insurance coverage may contribute to healthcare utilization during future pandemics.
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Affiliation(s)
- Dominic D. Gadeka
- Department of Health Policy, Planning and ManagementUniversity of Ghana School of Public HealthLegon‐AccraGhana
| | - Justice M. K. Aheto
- Department of BiostatisticsUniversity of Ghana School of Public HealthLegon‐AccraGhana
- WorldPop, School of Geography and Environmental ScienceUniversity of SouthamptonSouthamptonUK
- College of Public HealthUniversity of South FloridaTampaFloridaUSA
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Ismail SA, Tomoaia-Cotisel A, Noubani A, Fouad FM, Bell S, Borghi J, Blanchet K. Resilience in childhood vaccination: analysing delivery system responses to shocks in Lebanon. BMJ Glob Health 2023; 8:e012399. [PMID: 37931939 PMCID: PMC10632819 DOI: 10.1136/bmjgh-2023-012399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 09/09/2023] [Indexed: 11/08/2023] Open
Abstract
INTRODUCTION Despite rapidly growing academic and policy interest in health system resilience, the empirical literature on this topic remains small and focused on macrolevel effects arising from single shocks. To better understand health system responses to multiple shocks, we conducted an in-depth case study using qualitative system dynamics. We focused on routine childhood vaccination delivery in Lebanon in the context of at least three shocks overlapping to varying degrees in space and time: large-scale refugee arrivals from neighbouring Syria; COVID-19; and an economic crisis. METHODS Semistructured interviews were performed with 38 stakeholders working at different levels in the system. Interview transcripts were analysed using purposive text analysis to generate individual stakeholder causal loop diagrams (CLDs) mapping out relationships between system variables contributing to changes in coverage for routine antigens over time. These were then combined using a stepwise process to produce an aggregated CLD. The aggregated CLD was validated using a reserve set of interview transcripts. RESULTS Various system responses to shocks were identified, including demand promotion measures such as scaling-up community engagement activities and policy changes to reduce the cost of vaccination to service users, and supply side responses including donor funding mobilisation, diversification of service delivery models and cold chain strengthening. Some systemic changes were introduced-particularly in response to refugee arrivals-including task-shifting to nurse-led vaccine administration. Potentially transformative change was seen in the integration of private sector clinics to support vaccination delivery and depended on both demand side and supply side changes. Some resilience-promoting measures introduced following earlier shocks paradoxically increased vulnerability to later ones. CONCLUSION Flexibility in financing and human resource allocation appear key for system resilience regardless of the shock. System dynamics offers a promising method for ex ante modelling of ostensibly resilience-strengthening interventions under different shock scenarios, to identify-and safeguard against-unintended consequences.
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Affiliation(s)
- Sharif A Ismail
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Aya Noubani
- Institute for Global Health and Development, Queen Margaret University, Musselburgh, UK
| | - Fouad M Fouad
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Sadie Bell
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Josephine Borghi
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Karl Blanchet
- Geneva Center of Humanitarian Studies, University of Geneva, Geneva, Switzerland
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Gusmão JD, da Silva TPR, Velasquez-Melendez G, Mendes LL, Pessoa MC, Lachtim SAF, Felisbino-Mendes MS, Santos LC, Rodrigues GJC, Vimieiro AM, Vieira EWR, Matozinhos FP. Association between contextual factors and coverage of the Acwy meningococcal vaccine, after three years of its overdue, in the vaccination calendar of adolescents in the state of Minas Gerais, Brazil: global space regressions. BMC Infect Dis 2023; 23:615. [PMID: 37726684 PMCID: PMC10507822 DOI: 10.1186/s12879-023-08549-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 08/18/2023] [Indexed: 09/21/2023] Open
Abstract
The objective of the study was to analyze the spatial distribution of vaccination coverage of bacterial meningitis vaccine: A, C, W and Y (menacwy) and identify the association between socioeconomic and social environment factors with menacwy vaccine coverage among adolescents in the state of Minas Gerais (MG), Brazil. This is an ecological, mixed study, conducted with secondary data from the 853 municipalities of the State of MG, Brazil, from 2020 to 2022, provided by the information system of the National Immunization Program. For spatial statistical analysis, spatial dependence and the presence of spatial clusters formed by municipalities with high and low vaccination coverage of Menacwy were evaluated. In the year 2021, MG presented the largest vaccination coverage (60.58%) since the introduction of the Menacwy vaccine by the PNI. Regarding the analysis of global regressions, it is observed that for the year 2020, as the MG Index of Social Responsibility-Health increased and MG Index of Social Responsibility-Public Security increased, increased the vaccination coverage of the municipalities of the Menacwy vaccine. Finally, compared to 2021, similar association was observed in relation to the proportion of the population served by the Family Health Strategy of the municipalities of the state of MG and per capita spending on education activities: as this indicator increased, with increased coverage of the Vaccine of the Menacwy vaccine of the state municipalities. They reinforce the importance of assessing the quality-of-care management and health surveillance system, professional training, and damage reduction to populations, especially adolescents.
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Affiliation(s)
| | - Thales Philipe Rodrigues da Silva
- Post Doctoral Resident. Graduate Nursing Program, School of Nursing, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Gustavo Velasquez-Melendez
- Department of Maternal and Child Nursing and Public Health, School of Nursing, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Larissa Loures Mendes
- Nutrition Department, School of Nursing, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Milene Cristine Pessoa
- Nutrition Department, School of Nursing, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Sheila Aparecida Ferreira Lachtim
- Department of Maternal and Child Nursing and Public Health, School of Nursing, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Mariana Santos Felisbino-Mendes
- Department of Maternal and Child Nursing and Public Health, School of Nursing, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Luana Carolina Santos
- Nutrition Department, School of Nursing, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | | | - Ed Wilson Rodrigues Vieira
- Department of Maternal and Child Nursing and Public Health, School of Nursing, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Fernanda Penido Matozinhos
- Department of Maternal and Child Nursing and Public Health, School of Nursing, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
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Mwinnyaa G, Peters MA, Shapira G, Neill R, Sadat H, Yuma S, Akilimali P, Hossain S, Wendrad N, Atiwoto WK, Ofosu AA, Alfred JP, Kiarie H, Wesseh CS, Isokpunwu C, Kangbai DM, Mohamed AA, Sidibe K, Drouard S, Fernandez PA, Azais V, Hashemi T, Hansen PM, Ahmed T. 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. Vaccines (Basel) 2023; 11:1415. [PMID: 37766092 PMCID: PMC10536121 DOI: 10.3390/vaccines11091415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/31/2023] [Accepted: 08/17/2023] [Indexed: 09/29/2023] Open
Abstract
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.
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Affiliation(s)
- George Mwinnyaa
- The Global Financing Facility for Women, Children, and Adolescents, Washington, DC 1818, USA
| | | | - Gil Shapira
- The World Bank, Washington, DC 20433, USA (G.S.)
| | - Rachel Neill
- The Global Financing Facility for Women, Children, and Adolescents, Washington, DC 1818, USA
| | - Husnia Sadat
- The Global Financing Facility for Women, Children, and Adolescents, Washington, DC 1818, USA
| | - Sylvain Yuma
- Ministe’re de la Sante, Kinshasa 4310, Democratic Republic of the Congo
| | - Pierre Akilimali
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa P.O. Box 11850, Democratic Republic of the Congo
| | | | | | | | | | - Jean Patrick Alfred
- Ministère de la Sante Publique et de la Population, Port-au-Prince HT6123, Haiti
| | - Helen Kiarie
- Ministry of Health, Nairobi P.O. Box 30016-00100, Kenya
| | | | | | | | | | - Kadidja Sidibe
- The Global Financing Facility for Women, Children, and Adolescents, Washington, DC 1818, USA
| | | | | | - Viviane Azais
- The Global Financing Facility for Women, Children, and Adolescents, Washington, DC 1818, USA
| | - Tawab Hashemi
- The Global Financing Facility for Women, Children, and Adolescents, Washington, DC 1818, USA
| | - Peter M. Hansen
- The Global Financing Facility for Women, Children, and Adolescents, Washington, DC 1818, USA
| | - Tashrik Ahmed
- The Global Financing Facility for Women, Children, and Adolescents, Washington, DC 1818, USA
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10
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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.
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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
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11
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H OREYFA, Hassan SHEIKMOHAMUDK, Nor ABDULLEIA, Hassan MOHAMOUDJ, Bashiru GARBA, Hussein ADAMM, Abdullahi DAHIEH, Abdullahi SHNURM, Isse DIRIEN. BACKSLIDING ON CHILDHOOD IMMUNIZATIONS DUE TO ONGOING COVID-19 PANDEMIC: A RETROSPECTIVE STUDY IN BANADIR REGION, SOMALIA. Afr J Infect Dis 2023; 17:6-12. [PMID: 37822555 PMCID: PMC10564103 DOI: 10.21010/ajidv17i2s.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 04/05/2023] [Accepted: 04/25/2023] [Indexed: 10/13/2023] Open
Abstract
Background SARS-CoV-2 has resulted in a global public health crisis. During the pandemic, considerable delay was observed making it impossible for some children to receive their due vaccines on time. Like most resource-poor countries, COVID-19 pandemic is thought to have a negative impact on Somalia's immunization coverage. Materials and methods This study aimed to assess the impact of the COVID-19 pandemic on routine childhood immunization coverage in Somalia. A retrospective comparative cross-sectional approach was employed to investigate the number of under-5-year children who got their immunization from the two major mother and child hospital, (Banadir and SOS hospitals) in Mogadishu, Somalia from October 2019 to December 2020. To do this, a total of 112, 060 data relating to the routine childhood immunization (measles, polio, whooping cough, hepatitis B, pneumonia, and tuberculosis) were collected from the monthly immunization report-data from the two hospitals. Results The results showed that all the vaccines except birth vaccines have remarkably dropped with Penta-3 (27%), Penta-2 (11%), measles (10%) and Penta-1 (8%) respectively. However, the birth vaccines (BCG and Polio 0) were not affected as observed in this study. The reduction in children immunization rate in Somalia may be a combination of many other factors, we however recognize that the COVID-19 pandemic may have contributed significantly to this outcome . Conclusion The government needed to take proactive measures to encourage parents to present their children for immunizations, including increasing community awareness concerning the importance of these routine childhood immunizations despite the ongoing COVID-19 pandemics.
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Affiliation(s)
- OREY, Fartun Abdullahi H
- Department of Pediatrics and Child Health, Dr Sumait Hospital, Faculty of Medicine and Health Sciences, SIMAD University, Mogadishu, Somalia
| | | | | | - MOHAMOUD, Jamal Hassan
- Department of Public Health, Faculty of Medicine and Health Sciences, SIMAD University, Mogadishu, Somalia
| | - GARBA, Bashiru
- Department of Public Health, Faculty of Medicine and Health Sciences, SIMAD University, Mogadishu, Somalia
- Department of Veterinary Public Health and Preventive Medicine, Faculty of Veterinary Medicine, Usmanu Danfodiyo University, Sokoto. 840212, Sultan Abubakar Road, City Campus Complex, Sokoto State, Nigeria
| | - ADAM, Mohamed Hussein
- Department of Public Health, Faculty of Medicine and Health Sciences, SIMAD University, Mogadishu, Somalia
| | - DAHIE, Hassan Abdullahi
- Nursing and Midwifery Department, Faculty of Medicine and Health Sciences, SIMAD University, Mogadishu 2526, Somalia
| | - SH. NUR, Maryan Abdullahi
- Department of Obstetrics and Gynecology, Dr Sumait Hospital, Faculty of Medicine and Health Sciences, SIMAD University, Mogadishu, Somalia
| | - DIRIE, Najib Isse
- Department of Urology, Dr. Sumait Hospital, Faculty of Medicine, and Health Sciences, SIMAD University, Mogadishu, Somalia
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12
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Hora R, Ray A, Mehra R, Priya T, Koshal SS, Agrawal P, Kaur A, Quadri SF, Deb Roy A. Enablers and Barriers to the Scaling Up of Pneumococcal Conjugate Vaccine in India During the COVID-19 Pandemic: A Qualitative Study. Health Serv Insights 2023; 16:11786329231189407. [PMID: 37533503 PMCID: PMC10392212 DOI: 10.1177/11786329231189407] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 07/05/2023] [Indexed: 08/04/2023] Open
Abstract
Background Pneumonia is one of the leading causes of death in under-5 children in India. This led the Ministry of Health & Family Welfare (MoHFW) in India to decide for the nationwide roll-out of the Pneumococcal Conjugate Vaccine (PCV). However, the introduction of PCV became more complex in the face of unprecedented challenges set forth by the COVID-19 pandemic. The study aims to assess enablers and barriers to the introduction of PCV in India during the pandemic. Methodology Qualitative research approach involving key-informant interviews from John Snow India (JSI), the lead technical agency that supported MoHFW in the PCV expansion was employed to delineate the enablers and barriers. Principle of saturation was employed to derive the sample size. Thematic analysis using inductive approach was based on the modified World Health Organization (WHO) framework for new vaccine introduction impact on the Immunization and Health Systems, using NVIVO 12 qualitative data analysis software. Results A total of 11 key informants (4 national-level program managers and 7 state technical officers) were telephonically interviewed. The study found social acceptance, lower cost of the vaccine, and intensive communication activities as potential enablers. Other enablers for PCV introduction included a robust vaccine supply-chain system, ample cold-chain space availability, and strong political commitment, despite the ongoing second wave. Further, the identified barriers included poor physical access, insufficient social mobilization, and limited advocacy along with a stretched workforce. Conclusion The study delineated several enablers and barriers to introducing PCV in the country during the pandemic. The existing barriers in the PCV roll-out prompted the need to address these gaps, making key program-based recommendations to improve future new vaccine introductions during the pandemic.
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Affiliation(s)
| | - Arindam Ray
- Bill and Melinda Gates Foundation, New Delhi, India
| | | | - Tanwi Priya
- Gurugram University, Gurugram, Haryana, India
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13
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Yaacoub S, Zmeter C, Abou Abbas L, Leresche E, Kdouh O, Hammoud R, Leaning J, Hamadeh R, Truppa C. Has the COVID-19 pandemic changed the utilization and provision of essential health care services from 2019 to 2020 in the primary health care network in Lebanon? Results from a nationwide representative cross-sectional survey. PLoS One 2023; 18:e0288387. [PMID: 37440540 DOI: 10.1371/journal.pone.0288387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
There is limited research soliciting the patient and staff perspectives on the overall effects of COVID-19 on the utilization and provision of primary care in Lebanon. The present study was part of a larger study on the overall effect of COVID-19 on both utilization and provision of essential health care services within the Lebanese primary health care network (PHCN). Here, we present the patient and staff perspectives on continuity of service provision, adherence to infection prevention and control measures, and the role of the PHCN in epidemic preparedness and response. We conducted a cross-sectional survey between June and July 2021 among patients who had received a health care service in 2019 or 2020 from registered primary healthcare centers (PHCs) in the network and among the respective PHC staff working during the same period. A total of 763 patients and 198 staff completed the surveys. Services were reported as interrupted by 15% of the total patients who used services either in 2020 only or in both 2019 and 2020. Access to chronic (67%) and acute medications (40%) were reported as the main interrupted services. Immunization also emerged as a foregone service in 2020. Among the staff, one third (33%) reported interruptions in the provision of services. Financial barriers rather than fear of COVID-19 were reported as main reasons for interruption. Both groups considered that the facilities implemented adequate infection prevention and control measures. They perceived that the PHCN maintained some essential healthcare services and that it should have played a bigger role in the response to the pandemic. There was a continuity in utilization and provision of services in the PHCN that was higher than expected, with non-communicable diseases and immunizations suffering more than other services.
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Affiliation(s)
- Sally Yaacoub
- International Committee of the Red Cross, Lebanon Delegation, Beirut, Lebanon
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Center for Research in Epidemiology and Statistics (CRESS), Paris, France
| | - Carla Zmeter
- International Committee of the Red Cross, Lebanon Delegation, Beirut, Lebanon
| | - Linda Abou Abbas
- International Committee of the Red Cross, Lebanon Delegation, Beirut, Lebanon
| | - Enrica Leresche
- London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom
| | - Ola Kdouh
- Global Health Team of Experts, Ministry of Public Health Lebanon, Baabda, Lebanon
| | - Rawan Hammoud
- Global Health Team of Experts, Ministry of Public Health Lebanon, Baabda, Lebanon
| | - Jennifer Leaning
- Harvard FXB Center for Health and Human Rights, Boston, MA, United States of America
| | - Randa Hamadeh
- Global Health Team of Experts, Ministry of Public Health Lebanon, Baabda, Lebanon
| | - Claudia Truppa
- International Committee of the Red Cross, Lebanon Delegation, Beirut, Lebanon
- CRIMEDIM-Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Università del Piemonte Orientale, Novara, Italy
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14
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Saidu Y, Di Mattei P, Nchinjoh SC, Edwige NN, Nsah B, Muteh NJ, Ndoula ST, Abdullahi R, Zamir CS, Njoh AA, Adidja A, Ndiaye S, Wiwa O, Montomoli E, Clemens SAC. The Hidden Impact of the COVID-19 Pandemic on Routine Childhood Immunization Coverage in Cameroon. Vaccines (Basel) 2023; 11:645. [PMID: 36992229 PMCID: PMC10058217 DOI: 10.3390/vaccines11030645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 02/16/2023] [Accepted: 02/27/2023] [Indexed: 03/15/2023] Open
Abstract
Background: The third round of the global pulse survey demonstrated that the abrupt and rapid progression of the COVID-19 pandemic significantly disrupted childhood immunization in many countries. Although Cameroon has reported over 120,000 COVID-19 cases, the reported national childhood vaccination coverage during the pandemic seems to have increased compared to that during the pre-COVID-19 period. Indeed, the first dose of the diphtheria, tetanus, and pertussis-containing vaccine (DTP-1) coverage increased from 85.4% in 2019 to 87.7% in 2020, and DTP-3 coverage increased from 79.5% in 2019 to 81.2% in 2020. The paucity of literature on the impact of COVID-19 on childhood vaccination in COVID-19 hotspot regions poses a challenge in developing a context-specific immunization recovery plan, hence the need to conduct this study. Methodology: We conducted a cross-sectional study using 2019 (pre-pandemic period) and 2020 (pandemic period) district childhood immunization data from the DHIS-2 database, weighted using completeness for each data entry against regional data completeness in 2020. Based on COVID-19 incidence, two hotspot regions were selected, with all districts (56/56) included in the final analysis. The Chi-square test was used to compare DTP-1 and DTP-3 coverage during the pre-pandemic and pandemic periods. Results: In the two hotspot regions, 8247 children missed DTP-1, and 12,896 children did not receive DTP-3 vaccines in the pandemic period compared to the results from the pre-pandemic period. Indeed, there was a significant drop in DTP-1 and DTP-3 coverage of 0.8% (p = 0.0002) and 3.1% (p = 0.0003), respectively, in the Littoral Region. Moreover, the Centre Region reported a 5.7% (p < 0.0001) and 7.6% (p < 0.0001) drop in DTP-1 and DTP-3 coverage, respectively. Most districts in the hotspot regions reported a decline in childhood immunization access (62.5%) and utilization (71.4%). Indeed, in the Littoral Region, 46% (11/24) and 58% (14/24) of districts experienced decreased vaccination access and utilization, respectively. Meanwhile, 75% (24/32) and 81% (26/32) of districts in the Centre Region experienced a drop in vaccination access and utilization, respectively. Conclusion: This study reported a situation where the national immunization indicators mask the impact of COVID-19 on childhood immunization in heavily hit regions. Therefore, this study presents valuable information for ensuring continuous vaccination service delivery during public health emergencies. The findings could also contribute to developing an immunization recovery plan and informing policy on future pandemic preparedness and response.
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Affiliation(s)
- Yauba Saidu
- Clinton Health Access Initiative Inc., Yaounde P.O. Box 2664, Cameroon
- Institute for Global Health, University of Siena, 53100 Siena, Italy
| | | | - Sangwe Clovis Nchinjoh
- Clinton Health Access Initiative Inc., Yaounde P.O. Box 2664, Cameroon
- Faculty of Medicine, The Hebrew University-Hadassah Braun School of Public Health and Community Medicine, Jerusalem 91120, Israel
| | | | - Bernard Nsah
- Clinton Health Access Initiative Inc., Yaounde P.O. Box 2664, Cameroon
| | | | - Shalom Tchokfe Ndoula
- Expanded Program on Immunization, Cameroon Ministry of Public Health, Yaounde P.O. Box 2084, Cameroon
| | - Rakiya Abdullahi
- Global Vaccine Team, Clinton Health Access Initiative Inc., Boston, MA 02127, USA
| | - Chen Stein Zamir
- Faculty of Medicine, The Hebrew University-Hadassah Braun School of Public Health and Community Medicine, Jerusalem 91120, Israel
| | - Andreas Ateke Njoh
- Expanded Program on Immunization, Cameroon Ministry of Public Health, Yaounde P.O. Box 2084, Cameroon
- School of Global Health and Bioethics, Euclid University, Bangui BP 157, Central African Republic
| | - Amani Adidja
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaounde B.P. 337, Cameroon
| | - Sidy Ndiaye
- Regional Office for Africa, World Health Organization, Brazzaville P.O. Box 06, Congo
| | - Owens Wiwa
- Clinton Health Access Initiative Inc., Yaounde P.O. Box 2664, Cameroon
| | - Emanuele Montomoli
- Institute for Global Health, University of Siena, 53100 Siena, Italy
- Department Molecular Medicine, University of Siena, Via Aldo Moro 3, 53100 Siena, Italy
- VisMederi srl, Via Ferrini 53, 53035 Siena, Italy
| | - Sue Ann Costa Clemens
- Institute for Global Health, University of Siena, 53100 Siena, Italy
- Department of Pediatrics, University of Oxford, Oxford OX1 2JD, UK
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15
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AlMahasis SO, Fox B, Ha D, Qian J, Wang CH, Westrick SC. Pharmacy-based immunization in rural USA during the COVID-19 pandemic: A survey of community pharmacists from five southeastern states. Vaccine 2023; 41:2503-2513. [PMID: 36898932 PMCID: PMC9988709 DOI: 10.1016/j.vaccine.2023.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 02/23/2023] [Accepted: 03/01/2023] [Indexed: 03/09/2023]
Abstract
INTRODUCTION Immunization rates for seasonal and non-seasonal vaccines dropped during the COVID-19 pandemic. Little is known about the extent to which community pharmacies in the USA continued to serve as immunization sites during the pandemic. This study compared 1) the types and perceived changes in non-COVID-19 vaccine doses administered at rural community pharmacies in 2020 (during the pandemic) to 2019 (pre-pandemic) and 2) the delivery of non-COVID-19 immunization services in 2020 to 2019. METHODS A mixed-mode (paper/electronic) survey of a convenience sample of 385 community pharmacies operating in rural settings and have administered ≥1 vaccine in 2019 and 2020 was distributed in May-August 2021. Survey development was informed by relevant literature, pre-tested with three individuals, and pilot-tested with 20 pharmacists. Non-response bias was assessed, and survey responses were analyzed using descriptive and bivariate statistics. RESULTS Of the 385 community pharmacies, 86 qualified pharmacies completed the survey (Response Rate = 23.8%). The percentage of pharmacies offering a given vaccine in 2019 and 2020 were similar; with one exception, a higher percentage of pharmacies reported having MMR administered for adults in the pharmacy in 2020 (McNemar's test; p-value = 0.0253). For each given vaccine, the majority of respondents did not perceive a change in the number of doses administered in 2020 compared to 2019. Further, the majority reported no difference in how they delivered immunization services during and pre-pandemic. However, a small percentage of respondents (6.0-22.0%) adapted their services by adopting several measures to ensure the safety and continuity of immunizations during the pandemic. CONCLUSION Findings highlight the importance of community pharmacies as immunization sites during the pandemic. Community pharmacies continued immunization delivery at community pharmacies during the pandemic with almost no noticeable change to types and doses of vaccines compared to pre-pandemic nor the process of vaccine delivery.
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Affiliation(s)
- Sura O AlMahasis
- Department of Health Outcomes Research and Policy, Harrison College of Pharmacy, Auburn University, Auburn, AL, USA; Social & Administrative Sciences Division, School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA
| | - Brent Fox
- Department of Health Outcomes Research and Policy, Harrison College of Pharmacy, Auburn University, Auburn, AL, USA
| | - David Ha
- Stanford Health Care, Stanford, CA, USA; Stanford University, Stanford, CA, USA
| | - Jingjing Qian
- Department of Health Outcomes Research and Policy, Harrison College of Pharmacy, Auburn University, Auburn, AL, USA
| | - Chih-Hsuan Wang
- Department of Educational Research, Measurement, and Assessment, Auburn University, Auburn, AL, USA
| | - Salisa C Westrick
- Department of Health Outcomes Research and Policy, Harrison College of Pharmacy, Auburn University, Auburn, AL, USA.
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Silva TPRD, Vimieiro AM, Gusmão JD, Souza JFA, Lachtim SAF, Vieira EWR, Silva TMRD, Matozinhos FP. [Transmission risk classification for vaccine-preventable diseases in Minas Gerais, Brazil: two years since the onset of the COVID-19 pandemic]. CIENCIA & SAUDE COLETIVA 2023; 28:699-710. [PMID: 36888855 DOI: 10.1590/1413-81232023283.11192022] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 09/28/2022] [Indexed: 03/08/2023] Open
Abstract
The scope of this study is to analyze the risk classification of transmission of vaccine-preventable diseases (VPDs) in the 853 municipalities in the state of Minas Gerais (MG) two years after the onset of the COVID-19 pandemic. It is an epidemiological study with secondary data on vaccination coverage and dropout rate of ten immuno-biologicals recommended for under 2-year-old children in 2021 in MG. With respect to the dropout rate, this indicator was only evaluated for the multidose vaccines. After calculating all the indicators, the municipalities of the state were classified according to the transmission risk of VPDs into five categories: very low, low, medium, high, and very high risk. Minas Gerais had 80.9% of municipalities classified as high transmission risk for VPDs. Regarding the homogeneity of vaccination coverage (HCV), large municipalities had the highest percentage of HCV classified as very low, and 100% of these municipalities were classified as high or very high risk for transmission of VPDs, with statistical significance. The use of immunization indicators by municipality is effective for the classification of the scenario of each territory and the proposal of public policies seeking to increase vaccination coverage.
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Affiliation(s)
| | | | | | | | - Sheila Aparecida Ferreira Lachtim
- Departamento de Enfermagem Materno-Infantil e Saúde Pública, Escola de Enfermagem, Universidade Federal de Minas Gerais. Av. Alfredo Balena 190, Santa Efigênia. 30130-100 Belo Horizonte MG Brasil.
| | - Ed Wilson Rodrigues Vieira
- Departamento de Enfermagem Materno-Infantil e Saúde Pública, Escola de Enfermagem, Universidade Federal de Minas Gerais. Av. Alfredo Balena 190, Santa Efigênia. 30130-100 Belo Horizonte MG Brasil.
| | - Tércia Moreira Ribeiro da Silva
- Departamento de Enfermagem Materno-Infantil e Saúde Pública, Escola de Enfermagem, Universidade Federal de Minas Gerais. Av. Alfredo Balena 190, Santa Efigênia. 30130-100 Belo Horizonte MG Brasil.
| | - Fernanda Penido Matozinhos
- Departamento de Enfermagem Materno-Infantil e Saúde Pública, Escola de Enfermagem, Universidade Federal de Minas Gerais. Av. Alfredo Balena 190, Santa Efigênia. 30130-100 Belo Horizonte MG Brasil.
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Atkinson KM, Ntacyabukura B, Hawken S, Laflamme L, Wilson K. Effects of the COVID-19 pandemic on self-reported 12-month pneumococcal vaccination series completion rates in Canada. Hum Vaccin Immunother 2022; 18:2158005. [PMID: 36581328 PMCID: PMC9891678 DOI: 10.1080/21645515.2022.2158005] [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] [Indexed: 12/31/2022] Open
Abstract
Routine childhood vaccination improves health and prevents morbidity and mortality from vaccine-preventable diseases. There are indications that the COVID-19 pandemic has negatively impacted immunization rates globally, but systematic studies on this are still lacking in Canada. This study aims to add knowledge on the pandemic's effect on children's immunization rates with pneumococcal vaccine using self-reported immunization data from CANImmunize. An interrupted time series analysis was conducted on aggregated monthly enrollment of children on the platform (2016-2021) and their pneumococcal immunization series completion rates (2016-2020). Predicted trends before and after the onset of the COVID19-related restriction (March 1, 2020) were compared by means of an Autoregressive Integrated Moving Average (ARIMA). The highest monthly enrollment was 3,474 new infant records observed in January 2020, and the lowest was 100 records in December 2021. The highest Self-reported pneumococcal immunization series completion rate was 78.89%, observed in February 2017, and the lowest was 6.94% in December 2021. Enrollment decreased by 1177.52 records (95% CI: -1865.47, -489.57), with a continued decrease of 80.84 records each month. Completion rates had an immediate increase of 14.57% (95% CI 4.64, 24.51), followed by a decrease of 3.54% each month. The onset of the COVID-19 related restrictions impacted the enrollment of children in the CANImmunize digital immunization platform and an overall decrease in self-reported pneumococcal immunization series completion rates. Our findings support efforts to increase catch-up immunization campaigns so that children who could not get scheduled immunization during the pandemic are not missed.
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Affiliation(s)
| | - Blaise Ntacyabukura
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Steven Hawken
- Clinical Epidemiology Program, Ottawa Hospital Research Institute (OHRI), Ottawa, Canada
| | - Lucie Laflamme
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Kumanan Wilson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute (OHRI), Ottawa, Canada,Bruyere Research Institute, Ottawa, Canada,Department of Medicine, University of Ottawa, Ottawa, Canada,CONTACT Kumanan Wilson Clinical Epidemiology Program, Ottawa Hospital Research Institute (OHRI), Ottawa, Canada
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18
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Omale UI, Iyare O, Ewah RL, Amuzie CI, Oka OU, Uduma VU, Adeke AS, Ikegwuonu CO, Nnachi OO, Ukpabi OO, Okeke IM, Nkwo GE, Nwali UI. COVID-19 vaccination acceptance among community members and health workers in Ebonyi state, Nigeria: study protocol for a concurrent-independent mixed method analyses of intention to receive, timeliness of the intention to receive, uptake and hesitancy to COVID-19 vaccination and the determinants. BMJ Open 2022; 12:e061732. [PMID: 36521883 PMCID: PMC9755909 DOI: 10.1136/bmjopen-2022-061732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION The COVID-19 pandemic has gravely affected the lives and economies of the global population including Nigeria. The attainment of herd immunity through mass COVID-19 vaccination is the foremost control strategy, however, the deployments of COVID-19 vaccinations are facing challenges of non-acceptance. Despite the efforts of the Nigerian government and COVAX facility in making COVID-19 vaccination more available/accessible, the vaccination rate remains unexpectedly very low in Nigeria/Ebonyi state. Therefore, it is important to investigate the acceptability of COVID-19 vaccination to elucidate the explanations for the very low coverage rate. This study aims to evaluate/explore COVID-19 vaccination acceptance and the determinants among community members and health workers in Ebonyi state, Nigeria. METHODS AND ANALYSES The study is an analytical cross-sectional survey with a concurrent-independent mixed method design. Quantitative data will be collected from all consenting/assenting community members aged 15 years and above, in 28 randomly selected geographical clusters, through structured interviewer-administered questionnaire household survey using KoBoCollect installed in android devices. Quantitative data will be collected from all consenting health workers, selected via convenience and snowball techniques, through structured self-administered questionnaire survey distributed via WhatsApp and interviewer-administered survey using KoBoCollect installed in android devices. Qualitative data will be collected from purposively selected community members and health workers through focus group discussions. Quantitative analyses will involve descriptive statistics, generalised estimating equations (for community members data) and generalised linear model (for health workers data). Qualitative analyses will employ the thematic approach. ETHICS AND DISSEMINATION Ethical approval for this study was obtained from the Ebonyi State Health Research and Ethics Committee (EBSHREC/15/01/2022-02/01/2023) and Research and Ethics Committee of Alex Ekwueme Federal University Teaching Hospital Abakaliki (14/12/2021-17/02/2022), and verbal consent will be obtained from participants. Study findings will be reported at local, national and international levels as appropriate. TRIAL REGISTRATION NUMBER ISRCTN16735844.
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Affiliation(s)
- Ugwu I Omale
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki (AEFUTHA), Abakaliki, Nigeria
| | - Osarhiemen Iyare
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki (AEFUTHA), Abakaliki, Nigeria
| | - Richard L Ewah
- Department of Anaesthesia, Alex Ekwueme Federal University Teaching Hospital Abakaliki (AEFUTHA), Abakaliki, Nigeria
- Anaesthesia Unit, Department of Surgery, Ebonyi State University, Abakaliki, Nigeria
| | - Chidinma I Amuzie
- Department of Community Medicine, Federal Medical Centre, Umuahia, Nigeria
| | - Onyinyechukwu U Oka
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki (AEFUTHA), Abakaliki, Nigeria
| | - Victor U Uduma
- Department of Internal Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki (AEFUTHA), Abakaliki, Nigeria
| | - Azuka S Adeke
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki (AEFUTHA), Abakaliki, Nigeria
| | - Cordis O Ikegwuonu
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki (AEFUTHA), Abakaliki, Nigeria
| | - Olaedo O Nnachi
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki (AEFUTHA), Abakaliki, Nigeria
| | - Okechukwu O Ukpabi
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki (AEFUTHA), Abakaliki, Nigeria
| | - Ifeyinwa M Okeke
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki (AEFUTHA), Abakaliki, Nigeria
| | - Glory E Nkwo
- Department of Community Medicine, Federal Medical Centre, Umuahia, Nigeria
| | - Ugochi Ia Nwali
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki (AEFUTHA), Abakaliki, Nigeria
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19
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Adilo TM, Endale SZ, Demie TG, Dinka TG. The Impact of COVID-19 on Supplies of Routine Childhood Immunization in Oromia Regional State, Ethiopia: A Mixed Method Study. Risk Manag Healthc Policy 2022; 15:2343-2355. [PMID: 36536936 PMCID: PMC9759002 DOI: 10.2147/rmhp.s386717] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 11/19/2022] [Indexed: 10/29/2023] Open
Abstract
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.
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Affiliation(s)
- Takele Menna Adilo
- School of Public Health, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Samson Zegeye Endale
- School of Public Health, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Takele Gezahegn Demie
- School of Public Health, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Temesgen Geleta Dinka
- School of Public Health, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
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20
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Nchinjoh SC, Saidu Y, Agbor VN, Mbanga CM, Jude Muteh N, Njoh AA, Ndoula ST, Nsah B, Edwige NN, Roberman S, Zamir CS. Factors Associated with Zero-Dose Childhood Vaccination Status in a Remote Fishing Community in Cameroon: A Cross-Sectional Analytical Study. Vaccines (Basel) 2022; 10:vaccines10122052. [PMID: 36560465 PMCID: PMC9784537 DOI: 10.3390/vaccines10122052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/24/2022] [Accepted: 11/25/2022] [Indexed: 12/05/2022] Open
Abstract
Background: Cameroon's suboptimal access to childhood vaccinations poses a significant challenge to achieving the Immunization Agenda 2030 goal-ranking among the top 15 countries with a high proportion of zero-dose (unvaccinated) children worldwide. There are clusters of zero-dose children in pockets of communities that traditionally miss essential healthcare services, including vaccination. The Manoka Health District (MHD) is home to such settlements with consistently low vaccination coverages (DPT-HepB-Hib-1: 19.8% in 2021) and frequent outbreaks of vaccine-preventable diseases (VPD). Therefore, the absence of literature on zero-dose children in this context was a clarion call to characterize zero-dose children in fragile settings to inform policy and intervention design. Methodology: This cross-sectional analytical study involved 278 children, 0-24 months of age, selected from a 2020 door-to-door survey conducted in the two most populous health areas in an archipelago rural district, MHD (Cap-Cameroon and Toube). We used R Statistical Software (v4.1.2; R Core Team 2021) to run a multivariable logistic regression to determine zero-dose associated factors. Results: The survey revealed a zero-dose proportion of 91.7% (255) in MHD. Children who were delivered in health facilities were less likely to be zero-dose than those born at home (AOR: 0.07, 95% CI: 0.02-0.30, p = 0.0003). Compared to children born of Christian mothers, children born to minority non-Christian mothers had higher odds of being zero-dose (AOR: 6.55, 95% CI: 1.04-41.25, p = 0.0453). Children born to fathers who are immigrants were more likely to be zero-dose children than Cameroonians (AOR: 2.60, 95% CI = 0.65-10.35, p = 0.0016). Younger children were likely to be unvaccinated compared to older peers (AOR: 0.90, 95% CI: 0.82-1.00, p = 0.0401). Conclusions: In the spirit of "leaving no child behind," the study highlights the need to develop context-specific approaches that consider minority religious groups, immigrants, and younger children, including newborns, often missed during vaccination campaigns and outreaches.
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Affiliation(s)
- Sangwe Clovis Nchinjoh
- Clinton Health Access Initiative Inc., Yaounde P.O. Box 2664, Cameroon
- Faculty of Medicine, The Hebrew University-Hadassah Braun School of Public Health and Community Medicine, Jerusalem 91120, Israel
- Correspondence: ; Tel.: +237-678-687-939
| | - Yauba Saidu
- Clinton Health Access Initiative Inc., Yaounde P.O. Box 2664, Cameroon
- Institute for Global Health, University of Siena, 53100 Siena, Italy
| | - Valirie Ndip Agbor
- Clinton Health Access Initiative Inc., Yaounde P.O. Box 2664, Cameroon
- Nuffield Department of Population Health, University of Oxford, Oxford OX1 2JD, UK
| | | | | | - Andreas Ateke Njoh
- Expanded Program on Immunization, Cameroon Ministry of Public Health, Yaoundé P.O. Box 2084, Cameroon
- School of Global Health and Bioethics, Euclid University, Bangui BP 157, Central African Republic
| | - Shalom Tchofke Ndoula
- Expanded Program on Immunization, Cameroon Ministry of Public Health, Yaoundé P.O. Box 2084, Cameroon
| | - Bernard Nsah
- Clinton Health Access Initiative Inc., Yaounde P.O. Box 2664, Cameroon
| | | | - Sveta Roberman
- Faculty of Medicine, The Hebrew University-Hadassah Braun School of Public Health and Community Medicine, Jerusalem 91120, Israel
- The Gordon Academic College of Education, Haifa 3570503, Israel
| | - Chen Stein Zamir
- Faculty of Medicine, The Hebrew University-Hadassah Braun School of Public Health and Community Medicine, Jerusalem 91120, Israel
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21
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Kissi J, Owusu-Marfo J, Osei E, Dzamvivie K, Akorfa Anku V, Naa Lamiokor Lamptey J. Effects of coronavirus pandemic on expanded program on immunization in weija gbawe municipality (Accra-Ghana). Hum Vaccin Immunother 2022; 18:2129830. [PMID: 36194867 DOI: 10.1080/21645515.2022.2129830] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The introduction of Expanded Program on Immunization (EPI) and the availability of vaccines have contributed to significant reduction in morbidity and mortality rate, particularly among infants and children under five years. The coronavirus pandemic has however interrupted vaccination systems, limiting access and coverage for children. This study assesses the effect of the coronavirus disease outbreak on the EPI activities. The study employed a cross-sectional study design. Purposive and convenience sampling methods were used to sample 510 health workers directly engaged in immunization activities from 15 health care facilities. Coverages for five selected antigens (Diphtheria, Tetanus, Pertussis, Poliomyelitis, Tuberculosis) and Measles in the year 2020 experienced an overall decline ranging from 38.8% for measles rubella vaccine to 53.1% for Penta vaccine. The year 2019 recorded coverages ranging from 69.1% for BCG vaccine to 78.4% for penta vaccine, relatively higher than 2020. EPI services patronization rose up after COVID-19 peaks periods for BCG vaccine 67.7% to 89.2% for penta vaccine. The COVID-19 pandemic disrupted the delivery of EPI services significantly. Healthcare stakeholders can envisage telehealth services in care delivery against pandemic outbreaks. This study contributes to empirical knowledge by recommending vital predictive factors during a pandemic outbreak.
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Affiliation(s)
- Jonathan Kissi
- School of Allied Health Sciences, Department of Health Information Management, University of Cape Coast, University Post Office, Cape Coast, Ghana
| | - Joseph Owusu-Marfo
- Department of Epidemiology, Biostatistics and Disease Control, University for Development Studies, Tamale, Ghana
| | - Ernest Osei
- Faculty of Health and Allied Sciences, Catholic University of Ghana, Sunyani, Ghana
| | - Kennedy Dzamvivie
- School of Allied Health Sciences, Department of Health Information Management, University of Cape Coast, University Post Office, Cape Coast, Ghana
| | - Vivian Akorfa Anku
- Department of Epidemiology and Disease Control, University of Ghana, Accra, Ghana
| | - Jessica Naa Lamiokor Lamptey
- School of Allied Health Sciences, Department of Health Information Management, University of Cape Coast, University Post Office, Cape Coast, Ghana
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22
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Osei I, Sarwar G, Hossain I, Sonko K, Ceesay L, Baldeh B, Secka E, Mackenzie GA. Attendance and vaccination at immunization clinics in rural Gambia before and during the COVID-19 pandemic. Vaccine 2022; 40:6367-6373. [PMID: 36180374 PMCID: PMC9468317 DOI: 10.1016/j.vaccine.2022.09.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 09/01/2022] [Accepted: 09/07/2022] [Indexed: 01/27/2023]
Abstract
INTRODUCTION The COVID-19 pandemic has affected the delivery of essential health services, such as routine immunization. We assessed the impact of the pandemic on the uptake of routine immunization in rural Gambia. METHODS We collected real-time vaccine administration data in the Basse and Fuladu West Health & Demographic Surveillance Systems from September 01, 2019, to December 31, 2020. We assessed the monthly number of Expanded Program on Immunization (EPI) clinic attendances and vaccines administered, comparing data during the baseline period (September 01, 2019-March 31, 2020), COVID-19 interruption period (April 01-June 30, 2020), initial recovery period (Jul 01-September 30, 2020) and the late recovery period (October 01-December 31, 2020). RESULTS Compared to the baseline period, there was an overall average monthly decline of 13.4% in EPI attendance and 38.3% reduction in average monthly immunizations during the interruption period. This decrease was particularly noticeable for Bacille Calmette-Guérin (BCG) (47.2%), birth dose hepatitis B (Hep B) (46.9%), 1st dose pentavalent (Penta1) (43.1%), 1st dose pneumococcal conjugate vaccine (PCV1) (42.4%), and measles vaccines (15.5%). Comparing the late recovery to baseline period, average monthly EPI attendance was 5.3% higher, with 1.9% increase in average monthly immunizations. Monthly immunizations for BCG were 3.0% greater, 2.5% greater for Hep B, 22.7% greater for oral polio vaccine (OPV1), 2.0% less for Penta1, 19.2% less for Penta2, and 2.6% less for PCV1. CONCLUSION The reduced EPI attendance during the pandemic interruption period lasted only 3 months. Significant recovery in EPI attendance occurred during the late recovery period, while rates of monthly immunization returned to pre-pandemic levels for most antigens. EPI programmes should implement strategies to deliver missed antigens when infants do present to EPI clinics, aware that missed doses may be age dependent.
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Affiliation(s)
- Isaac Osei
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia; Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK.
| | - Golam Sarwar
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Ilias Hossain
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Kemo Sonko
- Regional Health Directorate, Upper River Region, Ministry of Health, Basse, The Gambia
| | - Lamin Ceesay
- Regional Health Directorate, Upper River Region, Ministry of Health, Basse, The Gambia
| | - Bubacarr Baldeh
- Regional Health Directorate, Central River Region, Ministry of Health, Bansang, The Gambia
| | - Ebba Secka
- Regional Health Directorate, Central River Region, Ministry of Health, Bansang, The Gambia
| | - Grant A Mackenzie
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia; Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK; Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia
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23
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Souza JFA, Silva TPRD, Silva TMRD, Amaral CD, Ribeiro EEN, Vimieiro AM, Oliveira MMMD, Matozinhos FP. [Vaccination coverage in children under one year of age in Minas Gerais state, Brazil]. CIENCIA & SAUDE COLETIVA 2022; 27:3659-3667. [PMID: 36000652 DOI: 10.1590/1413-81232022279.07302022] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/16/2022] [Indexed: 11/22/2022] Open
Abstract
The scope of this article is to analyze vaccination coverage rates in children under one year of age during the period from 2015 to 2020 in the state of Minas Gerais (MG). It involved an ecological, time-series study on vaccination coverage in children under 1 year of age, considering the 28 Regional Health Management/Superintendencies (GRS/SRS) of MG as the unit of analysis. The following immunobiological vaccine coverage was analyzed: Bacillus Calmette and Guérin, human rotavirus, pneumococcal 10, pentavalent, meningococcus C, yellow fever, and polio vaccines. The Prais-Winsten autoregressive model was employed for trend analysis. The year 2020 stands out, as it presented the lowest proportion of GRS and SRS that reached the recommended vaccine coverage goals for the immunobiologicals analyzed. Regarding the analysis of the coverage trend, 8 of the 28 GRS/SRS showed a decreasing trend for at least 5 of the 7 immunobiologicals evaluated. We observed a downward trend in the vaccination coverage of at least five immunobiologicals in eight of the GRS/SRS, with emphasis on the Pentavalent vaccine, which showed a downward trend in vaccination coverage in 60.71% of the GRS and SRS.
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Affiliation(s)
- Janaina Fonseca Almeida Souza
- Secretaria de Estado da Saúde de Minas Gerais. Rodovia Papa João Paulo II 4143, Serra Vede. 31630-900 Belo Horizonte MG Brasil.
| | - Thales Philipe Rodrigues da Silva
- Programa de Pós-Graduação em Enfermagem, Departamento de Enfermagem Materno-Infantil e Saúde Pública, Escola de Enfermagem, Universidade Federal de Minas Gerais (UFMG). Belo Horizonte MG Brasil
| | | | - Carolina Dourado Amaral
- Secretaria de Estado da Saúde de Minas Gerais. Rodovia Papa João Paulo II 4143, Serra Vede. 31630-900 Belo Horizonte MG Brasil.
| | - Elice Eliane Nobre Ribeiro
- Secretaria de Estado da Saúde de Minas Gerais. Rodovia Papa João Paulo II 4143, Serra Vede. 31630-900 Belo Horizonte MG Brasil.
| | - Aline Mendes Vimieiro
- Secretaria de Estado da Saúde de Minas Gerais. Rodovia Papa João Paulo II 4143, Serra Vede. 31630-900 Belo Horizonte MG Brasil.
| | | | - Fernanda Penido Matozinhos
- Departamento de Enfermagem Materno-Infantil e Saúde Pública, Escola de Enfermagem, UFMG. Belo Horizonte MG Brasil
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24
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Chiu NC, Lo KH, Chen CC, Huang SY, Weng SL, Wang CJ, Kuo HH, Chi H, Lien CH, Tai YL, Lin CY. The impact of COVID-19 on routine vaccinations in Taiwan and an unexpected surge of pneumococcal vaccination. Hum Vaccin Immunother 2022; 18:2071079. [PMID: 35561305 PMCID: PMC9359358 DOI: 10.1080/21645515.2022.2071079] [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] [Indexed: 11/05/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has had substantial impacts, including disruptions in routine vaccinations. In Taiwan, COVID-19 was relatively controllable, and the reduction in routine vaccinations was not profound. The impact of the pandemic on vaccination remained unclear. We collected vaccination uptake data at our hospital and analyzed the weekly trends of different vaccines. We calculated the monthly number of vaccinations and compared consumption before and during the COVID-19 pandemic (year 2019 vs years 2020 and 2021). Except for self-paid pneumococcal conjugate vaccines (PCV13), a mild (14.6%, p < .001) monthly decrease in government-funded routine vaccination and a moderate (28.2%, p = .018) monthly decrease in self-paid vaccination were observed during the COVID-19 pandemic. Interestingly, an unexpected surge of PCV13 vaccination occurred with a 355.8% increase. The shortage of COVID-19 vaccines and the potential benefits of PCV13 against COVID-19 may have contributed to this surge. In conclusion, our study found an obvious disruption of vaccination rates in Taiwan during the COVID-19 epidemic. However, an increase in PCV13 vaccination was also observed, and the important role of the infodemic was emphasized.
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Affiliation(s)
- Nan-Chang Chiu
- Department of Pediatrics, MacKay Children's Hospital, Taipei city, Taiwan.,Department of Medicine, MacKay Medical College, New Taipei city, Taiwan
| | - Kai-Hsun Lo
- Department of Pharmacy, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan
| | - Chung-Chu Chen
- Department of Internal Medicine, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan.,Teaching Center of Natural Science, Minghsin University of Science and Technology, Hsinchu, Taiwan
| | - Shih-Yu Huang
- Department of Internal Medicine, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan.,Teaching Center of Natural Science, Minghsin University of Science and Technology, Hsinchu, Taiwan
| | - Shun-Long Weng
- Department of Medicine, MacKay Medical College, New Taipei city, Taiwan.,Department of Obstetrics and Gynecology, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan
| | - Chung-Jen Wang
- Department of Pharmacy, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan
| | - Hsiao-Huai Kuo
- Department of Pharmacy, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan
| | - Hsin Chi
- Department of Pediatrics, MacKay Children's Hospital, Taipei city, Taiwan.,Department of Medicine, MacKay Medical College, New Taipei city, Taiwan
| | - Chi-Hone Lien
- Department of Pediatrics, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan
| | - Yu-Lin Tai
- Department of Pediatrics, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan
| | - Chien-Yu Lin
- Department of Medicine, MacKay Medical College, New Taipei city, Taiwan.,Department of Pediatrics, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan
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25
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da Silva TPR, Brandão LGVA, Vieira EWR, Maciel TBS, da Silva TMR, Luvisaro BMO, de Menezes FR, Matozinhos FP. Impact of COVID-19 pandemic on vaccination against meningococcal C infection in Brazil. Vaccine X 2022; 10:100156. [PMID: 35340279 PMCID: PMC8933283 DOI: 10.1016/j.jvacx.2022.100156] [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: 07/12/2021] [Revised: 01/31/2022] [Accepted: 03/15/2022] [Indexed: 11/19/2022] Open
Abstract
Objective Analyzing the impact of COVID-19 pandemic on meningococcal C conjugate vaccination in Brazil. Methods Ecological study, based on interrupted time series, carried out with data collected through the Information System of the National Immunization Program (IS-NIP). Collected data refer to the number of meningococcal C conjugate vaccine doses administered from March 2019 to December 2020. Results In total, 14,832,054 meningococcal C conjugate vaccine doses were administered throughout the investigated period; 66.30% of them, from March 2019 to February 2020 and 33.70%, from March to December 2020. Statistically significant steps were observed, i.e., the COVID-19 pandemic had negative impact on the number of MenC vaccine doses administered in the North and South regions (26,98% and 41.47%, respectively) and in the eleven Brazilian States. Conclusion The current study has shown that the COVID-19 pandemic had negative impact on the number of MenC vaccine doses administered in the Northern and Southern Brazil, and in eleven Brazilian states. Among all challenges experienced during the COVID-19 pandemic, one finds reduced MenC vaccine coverage, which, consequently, may lead to increased meningococcal infection rates in Brazil.
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Affiliation(s)
- Thales Philipe Rodrigues da Silva
- Postdoctoral Fellow, Ph.D, Post-graduate Program in Nursing, School of Nursing, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | - Ed Wilson Rodrigues Vieira
- Department of Maternal and Child Nursing and Public Health, School of Nursing, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | - Tércia Moreira Ribeiro da Silva
- Department of Maternal and Child Nursing and Public Health, School of Nursing, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Bianca Maria Oliveira Luvisaro
- Post-graduate Program in Nursing, School of Nursing, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Fabiana Ramos de Menezes
- Post-graduate Program in Nursing, School of Nursing, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Fernanda Penido Matozinhos
- Department of Maternal and Child Nursing and Public Health, School of Nursing, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Corresponding author at: Department of Maternal and Child Nursing and Public Health, Universidade Federal de Minas Gerais, 190, Professor Alfredo Balena Avenue, Santa Efigênia, Room 400, Belo Horizonte, Minas Gerais 30130-100, Brazil.
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26
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Bayram Z, Musharrafieh U, Bizri AR. Revisiting the potential role of BCG and MMR vaccines in COVID-19. Sci Prog 2022; 105:368504221105172. [PMID: 35848578 PMCID: PMC10450304 DOI: 10.1177/00368504221105172] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2023]
Abstract
Despite the development and deployment of effective COVID-19 vaccines, many regions remain poorly covered. Seeking alternative tools for achieving immunity against COVID-19 remains to be of high importance. "Trained immunity" is the nonspecific immune response usually established through administering live attenuated vaccines and is a potential preventive tool against unrelated infections. Evidence regarding a possible protective role for certain live attenuated vaccines against COVID-19 has emerged mainly for those administered as part of childhood vaccination protocols. This review summarizes the relevant literature about the potential impact of Bacille Calmette-Guérin (BCG) and measles, mumps and rubella (MMR) vaccines on COVID-19. Existing available data suggest a potential role for BCG and MMR in reducing COVID-19 casualties and burden. However, more investigation and comparative studies are required for a better understanding of their impact on COVID-19 outcomes.
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Affiliation(s)
| | - Umayya Musharrafieh
- Department of Internal Medicine, Division of Infectious Diseases, American University of Beirut Medical Center, Beirut, Lebanon
- Department of Family Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Abdul Rahman Bizri
- Department of Internal Medicine, Division of Infectious Diseases, American University of Beirut Medical Center, Beirut, Lebanon
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Silva TMRD, Nogueira de Sá ACMG, Beinner MA, Abreu MNS, Matozinhos FP, Sato APS, Vieira EWR. Impact of the COVID-19 Pandemic on Human Papillomavirus Vaccination in Brazil. Int J Public Health 2022; 67:1604224. [PMID: 35431762 PMCID: PMC9008128 DOI: 10.3389/ijph.2022.1604224] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 03/03/2022] [Indexed: 11/25/2022] Open
Abstract
Objective: To analyze the number of applied HPV vaccine doses before (from April 2019 to March 2020) and after (from April 2020 to September 2020) social distancing measures in response to the COVID-19 pandemic in states and regions of Brazil. Methods: Ecological time-series study, using data from the Brazilian National Immunization Program (PNI). Using the Mann-Whitney test, we evaluated the difference between the median number of applied doses during the periods April 2019 to March 2020 and from April 2020 to September 2020. Spatial analysis identified clusters with a high or low percentage reduction in the median applied doses. Prais-Winsten regression models identified temporal trends in the applieddoses from both periods. Results: There was a significant reduction in the median HPV vaccine doses applied, formation of spatial clusters and, after a sharp drop in the number of applieddoses during the months following social distancing. There was a tendency to increase the applied vaccines doses. Conclusion: The COVID-19 pandemic resulted in reduction of the number of HPV vaccine doses applied as a possible effect of restrictive measures caused by the pandemic.
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Affiliation(s)
- Tércia Moreira Ribeiro Da Silva
- Department of Maternal and Child Nursing and Public Health, School of Nursing, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Mark Anthony Beinner
- Department of Maternal and Child Nursing and Public Health, School of Nursing, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Fernanda Penido Matozinhos
- Department of Maternal and Child Nursing and Public Health, School of Nursing, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Ed Wilson Rodrigues Vieira
- Department of Maternal and Child Nursing and Public Health, School of Nursing, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Oduwole EO, Laurenzi CA, Mahomed H, Wiysonge CS. Enhancing Routine Childhood Vaccination Uptake in the Cape Metropolitan District, South Africa: Perspectives and Recommendations from Point-of-Care Vaccinators. Vaccines (Basel) 2022; 10:vaccines10030453. [PMID: 35335085 PMCID: PMC8950960 DOI: 10.3390/vaccines10030453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 02/28/2022] [Accepted: 03/01/2022] [Indexed: 02/01/2023] Open
Abstract
Vaccination, and particularly childhood vaccination, is widely acknowledged as one of the greatest public health interventions in history. Nevertheless, challenges exist that threaten the progress of childhood vaccination in many parts of the world. We investigated challenges to vaccination experienced by point-of-care vaccinators in the Cape Town Metropolitan District (Cape Metro), and reported on their current and proposed efforts to combat these challenges. Semi-structured interviews were conducted with 19 vaccinators in 16 purposively selected healthcare facilities in the Cape Metro from September to November 2019. Interviews were transcribed and analysed using thematic and narrative analysis methods. Challenges of both the demand and the supply side of routine vaccination were reported by the study participants, as were contextual challenges such as community safety issues. Defaulting was the most common challenge encountered, reported by 16 of the 19 participants. The use of computerized appointment systems, the enlistment of community health workers to track down defaulters, and the use of certificates to incentivize caregivers are part of the creative ways of mitigating some of the challenges encountered by these vaccinators. Their insightful recommendations can positively influence the landscape of childhood vaccination uptake in the Cape Metro and beyond if adapted and applied.
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Affiliation(s)
- Elizabeth O. Oduwole
- Division of Health Systems and Public Health, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 7505, South Africa;
- Cochrane South Africa, South African Medical Research Council, Cape Town 7505, South Africa;
- Correspondence: ; Tel.: +27-08-2799-0866
| | - Christina A. Laurenzi
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 7505, South Africa;
| | - Hassan Mahomed
- Division of Health Systems and Public Health, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 7505, South Africa;
| | - Charles S. Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town 7505, South Africa;
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 7505, South Africa
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Alhaddad AR, Ahmadnezhad E, Fotouhi A. The vaccination coverage rate in under-five children in Nasiriyah (Iraq) before and during the COVID-19 pandemic. Epidemiol Health 2022; 44:e2022035. [PMID: 35381166 PMCID: PMC9350418 DOI: 10.4178/epih.e2022035] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 03/14/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Ali Rifaat Alhaddad
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Elham Ahmadnezhad
- National Institute of Health Research (NIHR), Tehran University of Medical Sciences, Tehran, Iran
- Correspondence: Elham Ahmadnezhad National Institute of Health Research (NIHR), Tehran University of Medical Sciences, 70 Bozorgmehr Street, Tehran 1416833481, Iran E-mail:
| | - Akbar Fotouhi
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Sabbatucci M, Odone A, Signorelli C, Siddu A, Silenzi A, Maraglino FP, Rezza G. Childhood Immunisation Coverage during the COVID-19 Epidemic in Italy. Vaccines (Basel) 2022; 10:120. [PMID: 35062781 PMCID: PMC8782029 DOI: 10.3390/vaccines10010120] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/08/2022] [Accepted: 01/10/2022] [Indexed: 12/05/2022] Open
Abstract
The COVID-19 pandemic has affected national healthcare systems worldwide, with around 282 million cumulative confirmed cases reported in over 220 countries and territories as of the end of 2021. The Italian National Health System was heavily affected, with detrimental impacts on preventive service delivery. Routine vaccination services were disrupted across the country during the first months of the pandemic, and both access to and demand for vaccines have decreased during the pandemic. In many cases, parents preferred to postpone scheduled appointments for routine paediatric vaccinations because of stay-at-home orders or fear of COVID-19 infection when accessing care. The objective of the current study was to assess the routine childhood vaccine coverage (VC) rates during the COVID-19 epidemic in Italy. We compared 2020 and 2019 VC by age group and vaccine type. The Italian Ministry of Health collected anonymised and aggregated immunisation national data through the local health authorities (LHAs). Results were considered statistically significant at a two-tailed p-value ≤ 0.05. VC rates for mandatory vaccinations decreased in 2020 compared to 2019 (range of VC rate decrease: -1% to -2.7%), while chicken pox increased (+2.2%) in 7-year-old children. Recommended vaccinations were moderately affected (range of VC rate decrease in 2020 vs. 2019: -1.4% to -8.5%), with the exception of anti-HPV in males, Men ACWY, and anti-rotavirus vaccination (VC increase 2020 vs. 2019: +1.8%, +4.7% and +9.4%, respectively). In the COVID-19 era, the implementation of coherent, transparent, and effective communication campaigns and educational programs on safe childhood vaccinations, together with the increase in the number of healthcare staff employed, is essential to support strategies to reinforce vaccination confidence and behaviour, thus avoiding health threats due to VPD during and beyond COVID-19 times.
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Affiliation(s)
- Michela Sabbatucci
- Department Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
- Department Infectious Diseases, National Institute of Health, 00161 Rome, Italy
- Ministry of Health, Directorate General Health Prevention, Communicable Diseases and International Prophylaxis, 00144 Rome, Italy; (A.S.); (A.S.); (F.P.M.); (G.R.)
| | - Anna Odone
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy;
| | - Carlo Signorelli
- School of Medicine, Vita-Salute San Raffaele University, 20132 Milan, Italy;
| | - Andrea Siddu
- Ministry of Health, Directorate General Health Prevention, Communicable Diseases and International Prophylaxis, 00144 Rome, Italy; (A.S.); (A.S.); (F.P.M.); (G.R.)
| | - Andrea Silenzi
- Ministry of Health, Directorate General Health Prevention, Communicable Diseases and International Prophylaxis, 00144 Rome, Italy; (A.S.); (A.S.); (F.P.M.); (G.R.)
| | - Francesco Paolo Maraglino
- Ministry of Health, Directorate General Health Prevention, Communicable Diseases and International Prophylaxis, 00144 Rome, Italy; (A.S.); (A.S.); (F.P.M.); (G.R.)
| | - Giovanni Rezza
- Ministry of Health, Directorate General Health Prevention, Communicable Diseases and International Prophylaxis, 00144 Rome, Italy; (A.S.); (A.S.); (F.P.M.); (G.R.)
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Patel K, Nayak B, Rana S, Krishnan P, Tandale BV, Basak S, Sinha A, Kumar MS, Borah P, Singh H, Gupta N, Dutta S, Mohan A, Das MK, Landge Y, Ganguly B, Devi U, Pati S, Palo SK. OUP accepted manuscript. Trans R Soc Trop Med Hyg 2022; 116:814-821. [PMID: 35235677 PMCID: PMC8903434 DOI: 10.1093/trstmh/trac011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 01/06/2022] [Accepted: 01/29/2022] [Indexed: 11/20/2022] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic has led to disruption in delivering routine healthcare services including routine immunization (RI) worldwide. Understanding the enablers and barriers for RI services during a pandemic is critically important to develop context-appropriate strategies to ensure uninterrupted routine services. Methods A community-based, cross-sectional descriptive study was conducted in five different states of India, nested within an ongoing multicentric study on RI. Telephone in-depth interviews among 56 health workers were carried out and the data were analyzed using a content analysis method. Results During the COVID-19 pandemic, healthcare providers encountered many challenges at the health system, community and individual level when rendering RI services. Challenges like the limited availability of personal protective equipment and vaccines, deployment for COVID-19 duty at system level, the difficulty in mobilizing people in the community, fear among people at community level, mobility restrictions and limited family support, as well as the stress and stigma at individual level, were barriers to providing RI services. By contrast, the issuing of identification cards to health staff, engaging community volunteers, the support given to health workers by their families and training on COVID-19, were factors that enabled health workers to maintain RI services during the pandemic. Conclusions When addressing the COVID-19–related public health emergency, we should not lose sight of the importance of services like RI.
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Affiliation(s)
- Kripalini Patel
- Regional Medical Research Centre, Department of Epidemiology, Odisha 751023, India
| | - Bhagyashree Nayak
- Regional Medical Research Centre, Department of Epidemiology, Odisha 751023, India
| | - Salaj Rana
- Indian Council of Medical Research, Department of Epidemiology and Communicable Disease, Delhi 110029, India
| | - Parthiban Krishnan
- Indian Council of Medical Research, Department of Epidemiology and Communicable Disease, Delhi 110029, India
| | | | - Surajit Basak
- National Institute of Cholera and Enteric Diseases, Department of Bacteriology, West Bengal 700010, India
| | - Abhik Sinha
- National Institute of Cholera and Enteric Diseases, Department of Bacteriology, West Bengal 700010, India
| | | | - Prasant Borah
- Regional Medical Research Centre, Department of Epidemiology, Assam 786001, India
| | - Harpreet Singh
- Indian Council of Medical Research, Department of Epidemiology and Communicable Disease, Delhi 110029, India
| | - Nivedita Gupta
- Indian Council of Medical Research, Department of Epidemiology and Communicable Disease, Delhi 110029, India
| | - Shanta Dutta
- National Institute of Cholera and Enteric Diseases, Department of Bacteriology, West Bengal 700010, India
| | - Aswini Mohan
- National Institute of Epidemiology, Department of Public Health, Chennai 600077, India
| | - Manuj K Das
- Regional Medical Research Centre, Department of Epidemiology, Assam 786001, India
| | - Yovhan Landge
- National Institute of Virology, Department of Epidemiology, Pune 411021, India
| | - Bappaditya Ganguly
- National Institute of Cholera and Enteric Diseases, Department of Bacteriology, West Bengal 700010, India
| | - Utpala Devi
- Regional Medical Research Centre, Department of Epidemiology, Assam 786001, India
| | - Sanghamitra Pati
- Regional Medical Research Centre, Department of Epidemiology, Odisha 751023, India
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Yunusa A, Cabral C, Anderson E. The impact of the Covid-19 pandemic on the uptake of routine maternal and infant vaccines globally: A systematic review. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000628. [PMID: 36962643 PMCID: PMC10022285 DOI: 10.1371/journal.pgph.0000628] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 09/19/2022] [Indexed: 02/11/2023]
Abstract
Maintaining routine vaccination coverage is essential to avoid outbreaks of vaccine-preventable diseases. We aimed to understand the international impact of the COVID-19 pandemic on routine vaccination in pregnant women and children aged 0-5-years-old. A systematic review of quantitative and mixed methods studies exploring changes in vaccination coverage, vaccination services, and vaccine confidence since the start of the Covid-19 pandemic was conducted. MEDLINE, EMBASE, CINHAL, PsychINFO, Web of Science, Google Scholar, World Health Organisation, UK Government Joint Committee on Vaccination and Immunisation (including EU and US equivalents), and SAGE Journals were searched between 15-17th June 2021. Selected studies included pregnant women, health professionals, and/or infants aged 0-5-years-old including their parents (population); reported on the Covid-19 pandemic (exposure); presented comparisons with pre-COVID-19 pandemic period (comparator) and reported changes in routine maternal and infant vaccination coverage, services, and confidence (outcomes). Sources published only in non-English language were excluded. The Newcastle Ottawa Scale was used to assess study quality and risk of bias (ROB), and a narrative synthesis was undertaken. This review has been registered with PROSPERO (CRD42021262449). 30 studies were included in the review; data from 20 high-income countries (HICs), seven low- and middle-income countries (LMICs), and three regional studies (groups of countries). 18 studies had a low ROB, 12 had a higher risk, however both low and high ROB studies showed similar results. Two studies meeting the inclusion criteria discussed changes in routine vaccinations for pregnant women while 29 studies discussed infants. Both groups experienced declines in vaccination coverage (up to -79%) with larger disruptions in the accessibility and delivery of vaccination services reported within LMICs compared to HICs. Changes in vaccine confidence remained unclear. The COVID-19 pandemic resulted in decreased vaccine coverage and reduced routine vaccination services for pregnant women and infants, impacts on vaccine confidence requires more research.
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Affiliation(s)
| | - Christie Cabral
- NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, United Kingdom
| | - Emma Anderson
- NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, United Kingdom
- Centre for Academic Child Health, University of Bristol, Bristol, United Kingdom
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Number of doses of Measles-Mumps-Rubella vaccine applied in Brazil before and during the COVID-19 pandemic. BMC Infect Dis 2021; 21:1237. [PMID: 34886804 PMCID: PMC8655492 DOI: 10.1186/s12879-021-06927-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 11/26/2021] [Indexed: 12/23/2022] Open
Abstract
Background Due to the social isolation measures adopted in an attempt to mitigate the risk of transmission of SARS-CoV-2, there has been a reduction in vaccination coverage of children and adolescents in several countries and regions of the world. Objective Analyze the number of doses of vaccine against Measles-Mumps-Rubella (MMR) applied before and after the beginning of mitigation measures due to COVID-19 pandemic in Brazil.
Methods The data collected refer to the number of doses of the MMR vaccine applied monthly to the target population residing in Brazil: cahildren, aged 12 months (first dose) and children, aged 9 years (second dose), from April 2019 to December 2020. Differences in MMR vaccine doses from April 2019 to March 2020 (before the start of mitigation measures) and April 2020 to September 2020 (after the start of the mitigation measures) were evaluated. Spatial analysis identified clusters with a high percentage of reduction in the median of applied doses no Brazil. Results There was a reduction in the median of doses applied in the Regions North (− 33.03%), Northeast (− 43.49%) and South (− 39.01%) e nos Estados Acre (− 48.46%), Amazonas (− 28.96%), Roraima (− 61.91%), Paraíba (− 41.58%), Sergipe (− 47.52%), Rio de Janeiro (-59.31%) and Santa Catarina (− 49.32) (p < 0.05). High-high type spatial clusters (reduction between 34.00 and 90.00%) were formed in the five regions of Brazil (Moran’s I = 0.055; p = 0.01). Conclusion A reduction in the number of MMR vaccine doses was evidenced as a possible effect by the restrictive actions of COVID-19 in Brazil.
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Ota MOC, Badur S, Romano-Mazzotti L, Friedland LR. Impact of COVID-19 pandemic on routine immunization. Ann Med 2021; 53:2286-2297. [PMID: 34854789 PMCID: PMC8648038 DOI: 10.1080/07853890.2021.2009128] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 11/16/2021] [Indexed: 11/04/2022] Open
Abstract
The current COVID-19 global pandemic continues to impact healthcare services beyond those directly related to the management of SARS-CoV-2 transmission and disease. We reviewed the published literature to assess the pandemic impact on existing global immunization activities and how the impact may be addressed. Widespread global disruption in routine childhood immunization has impacted a majority of regions and countries, especially in the initial pandemic phases. While data indicate subsequent recovery in immunization rates, a substantial number of vulnerable people remain unvaccinated. The downstream impact may be even greater in resource-limited settings and economically poorer populations, and consequently there are growing concerns around the resurgence of vaccine-preventable diseases, particularly measles. Guidance on how to address immunization deficits are available and continue to evolve, emphasizing the importance of maintaining and restoring routine immunization and necessary mass vaccination campaigns during and after pandemics. In this, collaboration between a broad range of stakeholders (governments, industry, healthcare decision-makers and frontline healthcare professionals) and clear communication and engagement with the public can help achieve these goals.Key messagesThe COVID-19 pandemic has a substantial impact on essential immunization activities.Disruption to mass vaccination campaigns increase risk of VPD resurgence.Catch-up campaigns are necessary to limit existing shortfalls in vaccine uptake.Guidance to mitigate these effects continues to evolve.
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Yuliyanti S, Rifqi FM, Prasetyo RL, Nurhasanah E, Priambada AB, Abbas P. Analysis of Basic Immunization Services during the COVID-19 Pandemic at Public Health Centers in Semarang. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.7336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: The Corona Virus Disease 2019 (COVID-19) pandemic has affected public health services, including routine immunization services. If this condition continues, the national immunization coverage will decrease, thereby potentially increasing the risk of immunization preventable diseases.
AIM: This study aims to determine the coverage of complete basic immunization services in Semarang before (December 2019) and during the pandemic (May 2020) and the factors that affect the coverage of complete basic immunization services.
METHODS: This study describes complete basic immunization based on data taken in June-August 2021 at three health centers in Semarang. The data used were the number of visits and the type of immunization obtained from the medical records of the Health Center Management Information System. In addition, in-depth interviews were conducted with the person in charge of the immunization program at the Public Health Center (Puskesmas) to determine the influence factors of the immunization coverage. The data from the interviews were then analyzed thematically.
RESULTS: There were 3594 infants who received immunization services, consisting of 2401 before the pandemic and 1193 during the pandemic. The average decrease in the number of basic immunization services was 50.31%. The decrease in the number of basic immunization services occurred in all network public health centers with an average of Puskesmas Genuk (−36.63%), Halmahera (−40%), and Pandanaran (−26.35%). The mother’s fear of COVID-19 contagious, service time and patients restrictions by the PHC, and IPV vaccine stock out have reduced the basic vaccination coverage in all public health centers.
CONCLUSION: There was a decline in basic immunization coverage during the pandemic, so it is necessary to fulfill basic immunization needs and service inn
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Sharma M, Singh SK, Sharma L, Dwiwedi MK, Agarwal D, Gupta GK, Dhiman R. Magnitude and causes of routine immunization disruptions during COVID-19 pandemic in developing countries. J Family Med Prim Care 2021; 10:3991-3997. [PMID: 35136757 PMCID: PMC8797101 DOI: 10.4103/jfmpc.jfmpc_1102_21] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/23/2021] [Accepted: 07/30/2021] [Indexed: 11/28/2022] Open
Abstract
The ongoing pandemic of COVID-19 is a threat to various routine healthcare services. India's routine immunization (RI) campaign is one of largest ever known. In this review, we discuss the magnitude of disruption of RI activities due to COVID-19 pandemic, various causes of it and recommend ways to reduce the disruptions. Prominent literature databases were searched till April 30, 2021 for articles reporting disruptions of RI due to COVID-19. One study from India and numerous from outside India reported significant declines in the vaccine coverage rates during the lockdown period, which ranged from March 2020 till August 2020 in different regions of the world. Some reported disruptions for all vaccines, while a few reported sparing of birth doses. Shortage of healthcare workers due for them being diverted to patient care services and their reduced movement due to lockdowns and non-availability of public transport were prominent causes. Parents avoided RI sessions as they feared them or their children getting infected. They also faced travel restrictions, just like the healthcare workers. Children of school entry age and those from poorer socio-demographic profile appeared to miss the doses more frequently. Ministry of Health and Family Welfare, India has issued guidelines for conducting fixed and outreach RI sessions while following COVID-appropriate behavior. Promptly identifying missed out children and scheduling catch-up sessions is required to sustain the gains made over the decades by the immunization program of India.
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Affiliation(s)
- Mohit Sharma
- Department of Community Medicine, Punjab Institute of Medical Sciences, Jalandhar City, Punjab, India
| | - Snehil K. Singh
- Santosh World Medical University, Ghaziabad, Uttar Pradesh, India
| | - Lokesh Sharma
- School of Business Management, Jaipur National University, Jaipur, Rajasthan, India
- Address for correspondence: Dr. Lokesh Sharma, Flat No. 318, Sector E, Pocket 2, Vasant Kunj, New Delhi - 110070, India. E-mail: ,
| | - Manish K. Dwiwedi
- School of Business Management, Jaipur National University, Jaipur, Rajasthan, India
| | - Deepika Agarwal
- Community Medicine Department, Santosh Medical College, Ghaziabad, Uttar Pradesh, India
| | - Gajendra K. Gupta
- Community Medicine Department, Santosh Medical College, Ghaziabad, Uttar Pradesh, India
| | - Ranjit Dhiman
- Immunization Specialist, UNICEF Country Office, Afghanistan
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Rahman SU, Haq FU, Imran M, Shah A, Bibi N, Khurshid R, Romman M, Gaffar F, Khan MI. Impact of the COVID-19 lockdown on routine vaccination in Pakistan: a hospital-based study. Hum Vaccin Immunother 2021; 17:4934-4940. [PMID: 34554897 DOI: 10.1080/21645515.2021.1979380] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
The effect of the coronavirus disease (COVID-19) pandemic on routine vaccination in low- and middle-income countries are scarce. The current pandemic has disrupted routine immunization globally. We aimed to analyze the effect of COVID-19 pandemic on routine immunizations practice in Pakistan. A retrospective study was conducted. The data were extracted from the immunization registry in order to assess the disruption in routine immunization coverage during 5 months of the lockdown period. We compared 5 months post lockdown against the baseline period of 5 months preceding lockdown. To broaden the horizon of our research we also collected data of vaccination from rural areas within the country. The results of the current study showed that on average, there was a disruption in routine immunization by 36% during lockdown when compared with the prepandemic period. The largest decline was observed for measles vaccination with a decline of 48%. In rural areas there was a lower decline in vaccination coverage with the highest decline noted for rotavirus vaccination of 15%. This monthly decrease in routine vaccination continued to be at a decline for several months during lockdown; however, it slightly increased post lockdown. In conclusion, on average, there was more than 30% declined in routine vaccination during the lockdown period, while somewhat improved post lockdown, i.e. 12%. Thus, this ongoing pandemic is a reminder for the national immunization programs to consider to tackle the disruption in routine immunization, otherwise, this continued disruption may lead to secondary outbreaks of vaccine preventable diseases amongst the public.
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Affiliation(s)
- Saeed Ur Rahman
- Department of Nursing, University of Health Sciences, Lahore, Pakistan
| | - Faiz Ul Haq
- Department of Microbiology, University of Health Sciences, Lahore, Pakistan.,Center for Biotechnology and Microbiology, University of Swat, Mingora, Pakistan
| | - Muhammad Imran
- Department of Microbiology, University of Health Sciences, Lahore, Pakistan
| | - Asaf Shah
- Institute of Nursing, Khyber Medical University, Peshawar, Pakistan
| | - Naeema Bibi
- Institute of Nursing, Khyber Medical University, Peshawar, Pakistan
| | - Robina Khurshid
- Department of Nursing, University of Health Sciences, Lahore, Pakistan
| | - Muhammad Romman
- Pharmacognosy Laboratory, University of Chitral, Khyber Pakhtunkhwa, Pakistan
| | - Fatema Gaffar
- Institute of Allied Health Sciences, De Montfort University, Leicester, UK
| | - Muhammad Iqbal Khan
- Center for Biotechnology and Microbiology, University of Swat, Mingora, Pakistan
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Abouzeid M, Halwani DA, Mokdad AH, Habib RR. A Generation at Risk: The Impacts of Lebanon's Escalating Humanitarian Crisis on Children. Front Public Health 2021; 9:704678. [PMID: 34485230 PMCID: PMC8415263 DOI: 10.3389/fpubh.2021.704678] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 07/20/2021] [Indexed: 11/29/2022] Open
Abstract
Lebanon is in the midst of a rapidly escalating, unprecedented humanitarian crisis that is plunging the country deep into poverty and threatens population well-being, economic development, social welfare and national and regional stability. The dire situation is due to the compounding effects of the August 2020 Beirut blast, massive economic collapse and the COVID-19 pandemic, in a setting of longstanding entrenched political corruption and a dysfunctional, mismanaged crisis response by the state. This current emergency occurs on the background of a turbulent history and complex regional geopolitical context – including the Syrian refugee crisis, the ongoing influence of foreign actors and their local proxies, the United-States-imposed sanctions, endemic corruption, a culture of nepotism and entitlement among the political dynasties, dysfunctional power-sharing and deep-seated sectarian divides. With over half the population now living in poverty, a generation of children are among those at risk. This Perspective provides a brief overview of Lebanon's current complex humanitarian crisis, discusses the impacts of the evolving situation on youth and proposes a suite of recommendations to mitigate the effects.
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Affiliation(s)
- Marian Abouzeid
- Alfred Deakin Institute for Citizenship and Globalisation, Deakin University, Burwood, VIC, Australia.,Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Dana A Halwani
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Ali H Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, United States
| | - Rima R Habib
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
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