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Connolly E, Boley EJ, Fejfar DL, Varney PF, Aron MB, Fulcher IR, Lambert W, Ndayizigiye M, Law MR, Mugunga JC, Hedt-Gauthier B. Childhood immunization during the COVID-19 pandemic: experiences in Haiti, Lesotho, Liberia and Malawi. Bull World Health Organ 2022; 100:115-126C. [PMID: 35125536 PMCID: PMC8795848 DOI: 10.2471/blt.21.286774] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 10/28/2021] [Accepted: 10/29/2021] [Indexed: 01/15/2023] Open
Abstract
Objective To examine changes in vaccination of children younger than 1 year during the coronavirus disease 2019 (COVID-19) pandemic (March 2020–August 2021) in Haiti, Lesotho, Liberia and Malawi. Methods We used data from health management information systems on vaccination of children aged 12 months or younger in districts supported by Partners In Health. We used data from January 2016 to February 2020 and a linear model with negative binomial distribution to estimate the expected immunization counts for March 2020–August 2021 with 95% prediction intervals, assuming no pandemic. We compared these expected levels with observed values and estimated the immunization deficits or excesses during the pandemic months. Findings Baseline vaccination counts varied substantially by country, with Lesotho having the lowest count and Haiti the highest. We observed declines in vaccination administration early in the COVID-19 pandemic in Haiti, Lesotho and Liberia. Continued declines largely corresponded to high rates of COVID-19 infection and discrete stock-outs. By August 2021, vaccination levels had returned to close to or above expected levels in Haiti, Liberia and Lesotho; in Malawi levels remained below expected. Conclusion Patterns of childhood immunization coverage varied by country over the course of the pandemic, with significantly lower than expected vaccination levels seen in one country during subsequent COVID-19 waves. Governments and health-care stakeholders should monitor vaccine coverage closely and consider interventions, such as community outreach, to avoid or combat the disruptions in childhood vaccination.
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Affiliation(s)
| | | | | | | | | | - Isabel R Fulcher
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA
| | | | | | - Michael R Law
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | | | - Bethany Hedt-Gauthier
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA
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Wariri O, Nkereuwem E, Erondu NA, Edem B, Nkereuwem OO, Idoko OT, Agogo E, Enegela JE, Sesay T, Conde IS, Kaucley L, Awuah AAA, Abdullahi S, Luce RR, Banda R, Nomhwange T, Kampmann B. A scorecard of progress towards measles elimination in 15 west African countries, 2001-19: a retrospective, multicountry analysis of national immunisation coverage and surveillance data. LANCET GLOBAL HEALTH 2021; 9:e280-e290. [PMID: 33607028 PMCID: PMC7900524 DOI: 10.1016/s2214-109x(20)30481-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 10/16/2020] [Accepted: 10/28/2020] [Indexed: 01/08/2023]
Abstract
Background The WHO Regional Office for the Africa Regional Immunization Technical Advisory Group, in 2011, adopted the measles control and elimination goals for all countries of the African region to achieve in 2015 and 2020 respectively. Our aim was to track the current status of progress towards measles control and elimination milestones across 15 west African countries between 2001 and 2019. Methods We did a retrospective multicountry series analysis of national immunisation coverage and case surveillance data from Jan 1, 2001, to Dec 31, 2019. Our analysis focused on the 15 west African countries that constitute the Economic Community of West African States. We tracked progress in the coverage of measles-containing vaccines (MCVs), measles supplementary immunisation activities, and measles incidence rates. We developed a country-level measles summary scorecard using eight indicators to track progress towards measles elimination as of the end of 2019. The summary indicators were tracked against measles control and elimination milestones. Findings The weighted average regional first-dose MCV coverage in 2019 was 66% compared with 45% in 2001. 73% (11 of 15) of the west African countries had introduced second-dose MCV as of December, 2019. An estimated 4 588 040 children (aged 12–23 months) did not receive first-dose MCV in 2019, the majority (71%) of whom lived in Nigeria. Based on the scorecard, 12 (80%) countries are off-track to achieving measles elimination milestones; however, Cape Verde, The Gambia, and Ghana have made substantial progress. Interpretation Measles will continue to be endemic in west Africa after 2020. The regional measles incidence rate in 2019 was 33 times the 2020 elimination target of less than 1 case per million population. However, some hope exists as countries can look at the efforts made by Cape Verde, The Gambia, and Ghana and learn from them. Funding None.
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Affiliation(s)
- Oghenebrume Wariri
- Vaccines and Immunity Theme, MRC Unit the Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia.
| | - Esin Nkereuwem
- Vaccines and Immunity Theme, MRC Unit the Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | | | - Bassey Edem
- Vaccines and Immunity Theme, MRC Unit the Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Oluwatosin O Nkereuwem
- Vaccines and Immunity Theme, MRC Unit the Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Olubukola T Idoko
- Sanofi Pasteur, Lyon, France; The Vaccine Centre, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Joseph E Enegela
- Africa Diseases Prevention and Research Development Initiative, Abuja, Nigeria
| | - Tom Sesay
- Expanded Programme on Immunization, Freetown, Sierra Leone
| | | | | | | | | | - Richard Ray Luce
- WHO, West African Regional Support Team, Ouagadougou, Burkina Faso
| | | | | | - Beate Kampmann
- Vaccines and Immunity Theme, MRC Unit the Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia; The Vaccine Centre, London School of Hygiene and Tropical Medicine, London, UK
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Chandir S, Siddiqi DA, Mehmood M, Setayesh H, Siddique M, Mirza A, Soundardjee R, Dharma VK, Shah MT, Abdullah S, Akhter MA, Ali Khan A, Khan AJ. Impact of COVID-19 pandemic response on uptake of routine immunizations in Sindh, Pakistan: An analysis of provincial electronic immunization registry data. Vaccine 2020; 38:7146-7155. [PMID: 32943265 PMCID: PMC7428732 DOI: 10.1016/j.vaccine.2020.08.019] [Citation(s) in RCA: 127] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 08/07/2020] [Accepted: 08/09/2020] [Indexed: 11/02/2022]
Abstract
BACKGROUND COVID-19 pandemic has affected routine immunization globally. Impact will likely be higher in low and middle-income countries with limited healthcare resources and fragile health systems. We quantified the impact, spatial heterogeneity, and determinants for childhood immunizations of 48 million population affected in the Sindh province of Pakistan. METHODS We extracted individual immunization records from real-time provincial Electronic Immunization Registry from September 23, 2019, to July 11, 2020. Comparing baseline (6 months preceding the lockdown) and the COVID-19 lockdown period, we analyzed the impact on daily immunization coverage rate for each antigen by geographical area. We used multivariable logistic regression to explore the predictors associated with immunizations during the lockdown. RESULTS There was a 52.5% decline in the daily average total number of vaccinations administered during lockdown compared to baseline. The highest decline was seen for Bacille Cal-mette Guérin (BCG) (40.6% (958/2360) immunization at fixed sites. Around 8438 children/day were missing immunization during the lockdown. Enrollments declined furthest in rural districts, urban sub-districts with large slums, and polio-endemic super high-risk sub-districts. Pentavalent-3 (penta-3) immunization rates were higher in infants born in hospitals (RR: 1.09; 95% CI: 1.04-1.15) and those with mothers having higher education (RR: 1.19-1.50; 95% CI: 1.13-1.65). Likelihood of penta-3 immunization was reduced by 5% for each week of delayed enrollment into the immunization program. CONCLUSION One out of every two children in Sindh province has missed their routine vaccinations during the provincial COVID-19 lockdown. The pool of un-immunized children is expanding during lockdown, leaving them susceptible to vaccine-preventable diseases. There is a need for tailored interventions to promote immunization visits and safe service delivery. Higher maternal education, facility-based births, and early enrollment into the immunization program continue to show a positive association with immunization uptake, even during a challenging lockdown.
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Affiliation(s)
- Subhash Chandir
- IRD Global, 15 Beach Road #02-01, Singapore 189677, Singapore; Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115, USA.
| | | | - Mariam Mehmood
- IRD Pakistan, 4th Floor Woodcraft Building, Korangi Creek, Karachi 75190, Pakistan
| | - Hamidreza Setayesh
- Gavi, the Vaccine Alliance, Chemin du Pommier 40, 1218 Le Grand-Saconnex, Switzerland
| | - Muhammad Siddique
- IRD Pakistan, 4th Floor Woodcraft Building, Korangi Creek, Karachi 75190, Pakistan
| | - Amna Mirza
- IRD Pakistan, 4th Floor Woodcraft Building, Korangi Creek, Karachi 75190, Pakistan
| | - Riswana Soundardjee
- Gavi, the Vaccine Alliance, Chemin du Pommier 40, 1218 Le Grand-Saconnex, Switzerland
| | - Vijay Kumar Dharma
- IRD Pakistan, 4th Floor Woodcraft Building, Korangi Creek, Karachi 75190, Pakistan; Global Health Directorate, Indus Health Network, 5th Floor Woodcraft Building, Korangi Creek, Karachi 75190, Pakistan
| | | | - Sara Abdullah
- IRD Pakistan, 4th Floor Woodcraft Building, Korangi Creek, Karachi 75190, Pakistan
| | - Mohammed Adil Akhter
- IRD Pakistan, 4th Floor Woodcraft Building, Korangi Creek, Karachi 75190, Pakistan; Global Health Directorate, Indus Health Network, 5th Floor Woodcraft Building, Korangi Creek, Karachi 75190, Pakistan
| | - Anokhi Ali Khan
- IRD Pakistan, 4th Floor Woodcraft Building, Korangi Creek, Karachi 75190, Pakistan
| | - Aamir Javed Khan
- IRD Global, 15 Beach Road #02-01, Singapore 189677, Singapore; Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115, USA
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Masresha BG, Luce R, Weldegebriel G, Katsande R, Gasasira A, Mihigo R. The impact of a prolonged ebola outbreak on measles elimination activities in Guinea, Liberia and Sierra Leone, 2014-2015. Pan Afr Med J 2020; 35:8. [PMID: 32373259 PMCID: PMC7196330 DOI: 10.11604/pamj.supp.2020.35.1.19059] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 01/05/2020] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Guinea, Sierra Leone and Liberia have attained significant reduction in measles incidence between 2004 and 2013. The Ebola outbreak in 2014-2015 in West Africa caused significant disruption of the health service delivery in the three worst affected countries. The magnitude of the impact on the immunization program has not been well documented. METHODS We reviewed national routine immunization administrative coverage data as well as measles surveillance performance and measles epidemiology in the years before, during and after the EVD outbreak in Guinea, Liberia, Sierra Leone. RESULTS Both Liberia and Guinea experienced a sharp decline of more than 25% in the monthly number of children vaccinated against measles in 2014 and 2015 as compared to the previous years, while there was no reported decline in Sierra Leone. Guinea and Liberia experienced a decline in measles surveillance activity and performance indicators in 2014 and 2015. During this period, there was an increase in measles incidence and a decline in the mean age of measles cases reported in Liberia and Sierra Leone. Guinea started reporting high measles incidence in 2016. All three countries organized measles supplemental immunization activities by June 2015. Liberia achieved 99% administrative coverage, while Guinea and Sierra Leone attained 90.6% and 97.2% coverage respectively. There were no severe adverse events reported during these mass vaccination activities. The disruptive effect of the Ebola outbreak on immunization services was especially evident in Guinea and Liberia. Our review of the reported administrative vaccination coverage at national level does not show significant decline in measles first dose vaccination coverage in Sierra Leone as compared to other reports. This may be due to inaccuracies in coverage monitoring and data quality problems. The increases in measles transmission and incidence in these three countries can be explained by the rapid accumulation of susceptible children. Despite the organization of mass vaccination activities, measles incidence through 2017 has remained higher than the pre-Ebola period in all three countries. CONCLUSION The Ebola outbreak in West Africa significantly affected measles vaccination coverage rates in two of the three worst affected countries, and led to persistent gaps in coverage, along with high measles incidence that was documented until two years after the end of the Ebola outbreak. Liberia and Sierra Leone have demonstrated coverage improvements after the end of the Ebola outbreak.
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Affiliation(s)
| | - Richard Luce
- WHO, Inter-country team for Western Africa, Ouagadougou, Burkina Faso
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Sesay T, Denisiuk O, Zachariah R. Paediatric morbidity and mortality in Sierra Leone. Have things changed after the 2014/2015 Ebola outbreak? F1000Res 2019; 8:796. [PMID: 33299543 PMCID: PMC7676393 DOI: 10.12688/f1000research.18552.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/09/2019] [Indexed: 12/02/2022] Open
Abstract
Background: Sierra Leone was severely affected by the 2014/2015 Ebola outbreak which is likely to have had longer term repercussions on the health system including on paediatric morbidity and mortality. We thus assessed under-five morbidity and mortality for malaria, acute respiratory Infections (ARI)/pneumonia, watery diarrhoea and measles during the post-Ebola period in Sierra Leone and compared this with the pre- and intra-Ebola periods. Methods: This was a retrospective cross-sectional study using program data from the District Health Information system (DHIS2) and sourced from 14 districts in Sierra Leone. It included under-five children from 1,250 health facilities country-wide. Study periods included: before (June 1
st, 2013-April 30
th, 2014); during (June 1
st, 2014-April 30
th, 2015); and after Ebola (June 1
st, 2016-April 30
th, 2017). Results: Malaria, ARI/pneumonia and diarrhoea consultations declined during Ebola but recovered to pre-Ebola levels in the post-Ebola period. During the post-Ebola period, there was a highly significant reduction in case-fatality for the first three morbidities compared to the pre-Ebola period (
P<0.0001). Average number of measles cases increased from 48/month in the pre-Ebola period to 568/month (12-fold increase) post-Ebola. Although there was no difference in measles case-fatality between the pre- and post-Ebola periods, case-fatality post-Ebola was significantly lower than during Ebola (Relative Risk: 0.05, 95% confidence interval 0.02-0.15,
P<0.0001). Conclusions: Consultations for under-five children at health facilities in Sierra Leone recovered to pre-Ebola levels and case-fatality for common childhood illnesses declined significantly. This is a change for the better. However, the high level of reported measles cases in the post-Ebola period indicates gaps in immune status and needs focused attention.
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Affiliation(s)
- Tom Sesay
- Child Health and Immunization Programme, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | | | - Rony Zachariah
- Special Programme for Research and Training in Tropical Diseases (WHO/TDR), Geneva, Switzerland
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Colavita F, Biava M, Castilletti C, Quartu S, Vairo F, Caglioti C, Agrati C, Lalle E, Bordi L, Lanini S, Guanti MD, Miccio R, Ippolito G, Capobianchi MR, Di Caro A. Measles Cases during Ebola Outbreak, West Africa, 2013-2106. Emerg Infect Dis 2018; 23:1035-1037. [PMID: 28518027 PMCID: PMC5443435 DOI: 10.3201/eid2306.161682] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The recent Ebola outbreak in West Africa caused breakdowns in public health systems, which might have caused outbreaks of vaccine-preventable diseases. We tested 80 patients admitted to an Ebola treatment center in Freetown, Sierra Leone, for measles. These patients were negative for Ebola virus. Measles virus IgM was detected in 13 (16%) of the patients.
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Ratnayake R, Crowe SJ, Jasperse J, Privette G, Stone E, Miller L, Hertz D, Fu C, Maenner MJ, Jambai A, Morgan O. Assessment of Community Event-Based Surveillance for Ebola Virus Disease, Sierra Leone, 2015. Emerg Infect Dis 2018; 22:1431-7. [PMID: 27434608 PMCID: PMC4982166 DOI: 10.3201/eid2208.160205] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Case detection improved, but many false alerts were generated, suggesting a need for additional staff training. In 2015, community event–based surveillance (CEBS) was implemented in Sierra Leone to assist with the detection of Ebola virus disease (EVD) cases. We assessed the sensitivity of CEBS for finding EVD cases during a 7-month period, and in a 6-week subanalysis, we assessed the timeliness of reporting cases with no known epidemiologic links at time of detection. Of the 12,126 CEBS reports, 287 (2%) met the suspected case definition, and 16 were confirmed positive. CEBS detected 30% (16/53) of the EVD cases identified during the study period. During the subanalysis, CEBS staff identified 4 of 6 cases with no epidemiologic links. These CEBS-detected cases were identified more rapidly than those detected by the national surveillance system; however, too few cases were detected to determine system timeliness. Although CEBS detected EVD cases, it largely generated false alerts. Future versions of community-based surveillance could improve case detection through increased staff training and community engagement.
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