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Gal DB, Cleveland JD, Vergales JE, Kipps AK. Immunisation deferral practices surrounding congenital heart surgery. Cardiol Young 2024:1-4. [PMID: 38557603 DOI: 10.1017/s1047951124000507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
BACKGROUND Perioperative immunisation administration surrounding congenital heart surgery is controversial. Delayed immunisation administration results in children being at risk of vaccine-preventable illnesses and is associated with failure to complete immunisation schedules. Among children with CHD, many of whom are medically fragile, vaccine-preventable illnesses can be devastating. Limited research shows perioperative immunisation may be safe and effective. METHODS We surveyed Pediatric Acute Care Cardiology Collaborative member centres and explored perioperative immunisation practices. We analysed responses using descriptive statistics. RESULTS Complete responses were submitted by 35/46 (76%) centres. Immunisations were deferred for any period prior to surgery by 23 (66%) centres and after surgery by 31 (89%) centres. Among those who deferred post-operative immunisation, 20 (65%) required deferral only for patients whose operations required cardiopulmonary bypass. Duration of deferral in the pre- and post-operative periods was variable. Many centres included exceptions to their policy for specific vaccine-preventable illnesses. Almost all (34, 97%) centres administer routine childhood immunisation to patients who remain admitted for prolonged periods. CONCLUSIONS Most centres defer routine childhood immunisation for some period before and after congenital heart surgery. Centre specific practices vary. Immunisation deferral confers risk to patients and may not be warranted in this population. Further research would be necessary to understand the immunologic impact of these practices.
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Affiliation(s)
- Dana B Gal
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Division of Pediatric Cardiology, Children's Hospital of Los Angeles, Los Angeles, CA, USA
| | - John D Cleveland
- Division of Pediatric Cardiology, Children's Hospital of Los Angeles, Los Angeles, CA, USA
- Department of Cardiothoracic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jeffrey E Vergales
- Division of Pediatric Cardiology, University of Virginia, Charlottesville, VA, USA
| | - Alaina K Kipps
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA
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Eliason EL, Agostino J, Vivier P. Infant Health Care Disruptions by Race and Ethnicity, Income, and Insurance During the COVID-19 Pandemic. Acad Pediatr 2024; 24:105-110. [PMID: 37487800 DOI: 10.1016/j.acap.2023.07.005] [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: 05/19/2023] [Revised: 07/12/2023] [Accepted: 07/14/2023] [Indexed: 07/26/2023]
Abstract
OBJECTIVE Research has found disruptions in pediatric care during the COVID-19 pandemic, likely exacerbating existing disparities, which has not been explored among infants. This study evaluated how infant health care was disrupted during the COVID-19 pandemic overall and by race and ethnicity, income, and insurance type. METHODS This cross-sectional study used the Pregnancy Risk Assessment Monitoring System COVID-19 supplement with data from 29 jurisdictions to examine infant health care disruptions due to the pandemic: 1) well visits/checkups canceled or delayed, 2) well visits/checkups changed to virtual appointments, and 3) postponed immunizations. Unadjusted, weighted proportions of outcomes were calculated overall and by race and ethnicity, income, and insurance. We estimated multivariable odds ratios for the association between infant care disruptions and race and ethnicity, income, and insurance. RESULTS Overall, among 12,053 parental respondents with infants born from April to December 2020, 7.25% reported cancelations or delays in infant well visits/checkups, 5.49% reported changes to virtual infant care appointments, and 5.33% reported postponing immunizations, with significant differences by race and ethnicity, income, and insurance type. In adjusted analyses, we found higher odds of canceling/delaying visits and postponing immunizations among non-Hispanic Black infants and infants whose parents were uninsured or had Medicaid-paid deliveries. The odds of switching to virtual appointments were significantly higher among Hispanic infants and infants whose parents had Medicaid-paid deliveries. CONCLUSIONS Study findings suggest that the COVID-19 pandemic particularly affected infant health care for non-Hispanic Black infants and infants whose parents were uninsured or had Medicaid, with important implications for addressing infant health inequities and improving health outcomes in the United States.
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Affiliation(s)
- Erica L Eliason
- Department of Health Services, Policy & Practice (EL Eliason and J Agostino), Brown University School of Public Health, Providence, RI.
| | - Jasmine Agostino
- Department of Health Services, Policy & Practice (EL Eliason and J Agostino), Brown University School of Public Health, Providence, RI
| | - Patrick Vivier
- Department of Public Health and Community Medicine (P Vivier), Tufts University School of Medicine, Boston, Mass
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Zürcher SJ, Signorell A, Léchot-Huser A, Aebi C, Huber CA. Childhood vaccination coverage and regional differences in Swiss birth cohorts 2012-2021: Are we on track? Vaccine 2023; 41:7226-7233. [PMID: 38593195 DOI: 10.1016/j.vaccine.2023.10.043] [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: 07/25/2023] [Revised: 10/13/2023] [Accepted: 10/15/2023] [Indexed: 04/11/2024]
Abstract
AIMS Many western countries are challenged by delayed and insufficient vaccination coverage rates in children, and thus missing WHO coverage targets. This study aimed to estimate vaccination coverage and timeliness in Swiss children over a decade. Furthermore, we evaluated the impact of COVID-19, regional variations, and the adherence to the amended vaccination schedule in 2019. METHODS Retrospective observational study with Swiss health insurance claims data including birth cohorts 2012-2021 of children continuously observed until ages 13, 25, and 48 months respectively. We used population-weighted proportions and time-to-event analyses to describe coverage and timeliness of diphtheria/tetanus/pertussis/poliomyelitis/haemophilus influenzae type b (DTaP-IPV-Hib), measles/mumps/rubella (MMR), hepatitis B (HBV), pneumococcal (PCV), and meningococcal (MCV) vaccinations according to the national schedule. The potential impact of COVID-19 and vaccination schedule adherence were evaluated descriptively. Logistic regression was used to investigate regional factors potentially associated with non-vaccination. RESULTS 120,073 children, representing between 12 and 17 % of all Swiss children born in corresponding years, were included. Coverage remained stable or improved over the years. The 2019 amendment of the national immunization schedule was associated with an increase of ~10 % points in full coverage in Swiss children for DTaP-IPV-Hib, MMR and HBV despite the concurrent COVID-19 pandemic. Nonetheless, full vaccination coverage remained below 90 % with many vaccination series being delayed or not completed. The comparison across the different vaccines revealed large differences in coverage. Moreover, we observed large regional differences in non-vaccination with children living in rural and German-speaking areas more likely to be entirely unvaccinated. CONCLUSION Full vaccination coverage in Swiss children is still below 90 % with many vaccinations administered delayed. Given regional differences, missed or delayed booster vaccinations, and differences in vaccine-specific acceptability, more effort may be needed to achieve national vaccination targets.
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Affiliation(s)
- Simeon J Zürcher
- Department of Health Sciences, Helsana Group, Zürich, Switzerland.
| | - Andri Signorell
- Department of Health Sciences, Helsana Group, Zürich, Switzerland
| | | | - Christoph Aebi
- Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Carola A Huber
- Department of Health Sciences, Helsana Group, Zürich, Switzerland; Institute of Primary Care, University of Zurich, University Hospital Zurich, Switzerland
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Wariri O, Utazi CE, Okomo U, Metcalf CJE, Sogur M, Fofana S, Murray KA, Grundy C, Kampmann B. Mapping the timeliness of routine childhood vaccination in The Gambia: A spatial modelling study. Vaccine 2023; 41:5696-5705. [PMID: 37563051 DOI: 10.1016/j.vaccine.2023.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/29/2023] [Accepted: 08/01/2023] [Indexed: 08/12/2023]
Abstract
INTRODUCTION Timeliness of routine vaccination shapes childhood infection risk and thus is an important public health metric. Estimates of indicators of the timeliness of vaccination are usually produced at the national or regional level, which may conceal epidemiologically relevant local heterogeneities and makeitdifficultto identify pockets of vulnerabilities that could benefit from targeted interventions. Here, we demonstrate the utility of geospatial modelling techniques in generating high-resolution maps of the prevalence of delayed childhood vaccination in The Gambia. To guide local immunisation policy and prioritize key interventions, we also identified the districts with a combination of high estimated prevalence and a significant population of affected infants. METHODS We used the birth dose of the hepatitis-B vaccine (HepB0), third-dose of the pentavalent vaccine (PENTA3), and the first dose of measles-containing vaccine (MCV1) as examples to map delayed vaccination nationally at a resolution of 1 × 1-km2 pixel. We utilized cluster-level childhood vaccination data from The Gambia 2019-20 Demographic and Health Survey. We adopted a fully Bayesian geostatistical model incorporating publicly available geospatial covariates to aid predictive accuracy. The model was implemented using the integrated nested Laplace approximation-stochastic partial differential equation (INLA-SPDE) approach. RESULTS We found significant subnational heterogeneity in delayed HepB0, PENTA3 and MCV1 vaccinations. Specificdistricts in the central and eastern regions of The Gambia consistentlyexhibited the highest prevalence of delayed vaccination, while the coastal districts showed alower prevalence forallthree vaccines. We also found that districts in the eastern, central, as well as in coastal parts of The Gambia had a combination of high estimated prevalence of delayed HepB0, PENTA3 and MCV1 and a significant population of affected infants. CONCLUSIONS Our approach provides decision-makers with a valuable tool to better understand local patterns of untimely childhood vaccination and identify districts where strengthening vaccine delivery systems could have the greatest impact.
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Affiliation(s)
- Oghenebrume Wariri
- Vaccines and Immunity Theme, MRC Unit The Gambia a London School of Hygiene and Tropical Medicine, Fajara, Gambia; Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom; Vaccine Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom.
| | - Chigozie Edson Utazi
- WorldPop, School of Geography and Environmental Science, University of Southampton, Southampton, United Kingdom; Southampton Statistical Sciences Research Institute, University of Southampton, Southampton, United Kingdom
| | - Uduak Okomo
- Vaccines and Immunity Theme, MRC Unit The Gambia a London School of Hygiene and Tropical Medicine, Fajara, Gambia; MARCH Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - C Jessica E Metcalf
- Department of Ecology & Evolutionary Biology, Princeton University, Princeton, NJ, USA
| | - Malick Sogur
- Expanded Programme on Immunization, Ministry of Health and Social Welfare, The Gambia, Banjul, Gambia
| | - Sidat Fofana
- Expanded Programme on Immunization, Ministry of Health and Social Welfare, The Gambia, Banjul, Gambia
| | - Kris A Murray
- Centre on Climate Change and Planetary Health, MRC Unit The Gambia at The London School of Hygiene and Tropical Medicine, Fajara, Gambia
| | - Chris Grundy
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Beate Kampmann
- Vaccines and Immunity Theme, MRC Unit The Gambia a London School of Hygiene and Tropical Medicine, Fajara, Gambia; Vaccine Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom; Centre for Global Health, Charité Universitatsmedizin, Berlin, Germany
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Das SK, Khan J. Timeliness in the uptake of hepatitis B birth dose among Indian children under age five: A population-based study. Vaccine 2023; 41:5368-5375. [PMID: 37468388 DOI: 10.1016/j.vaccine.2023.07.015] [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: 05/16/2023] [Revised: 07/05/2023] [Accepted: 07/07/2023] [Indexed: 07/21/2023]
Abstract
OBJECTIVE To assess the timeliness and risk factors for the delay in the uptake of the hepatitis B birth dose among Indian children aged 0-59 months. Information regarding whether the children received the birth dose and the time of receiving it was recorded based on the vaccination card available at the time of the National Family Health Survey (NFHS). METHODS Using data from the fourth and fifth round of India's National Family Health Survey (NFHS), the percentage of uptake and timely receipt of the hepatitis B birth dose were obtained by background characteristics and at the sub-national level (state). Multinomial logistic regression analysis was used to examine the risk factors. This study further performed a negative binomial regression estimation to predict the probability of receiving the birth dose at each day within a multivariable framework. RESULTS It was found that approximately 34 % of the children who received the birth dose and the timing of receiving the birth dose was made available through the vaccination card were administered the dose within 24-hours during 2015-16. However, the percentage increased to 51.91 % during 2019-21. During 2019-21, Ladakh had the highest proportion (85.03 %) of children receiving the dose within 24-hours, followed by Jammu & Kashmir with 78 %, and Arunachal Pradesh with 68 %. Mother's education, economic status of the child's family and region (children belong from) were found to be significant predictors in delay of receiving the birth dose within 24 hours. CONCLUSION Results indicated a need for targeted interventions to improve the coverage and timeliness in the uptake of this critical vaccine dose in the country. These interventions could include strategies such as strengthening the healthcare system, improving awareness among parents and healthcare providers, addressing logistical challenges in vaccine delivery, and promoting community engagement and education on importance of timely vaccination.
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Affiliation(s)
| | - Junaid Khan
- International Institute for Population Sciences, Mumbai, India.
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Wariri O, Utazi CE, Okomo U, Sogur M, Murray KA, Grundy C, Fofanna S, Kampmann B. Timeliness of routine childhood vaccination among 12-35 months old children in The Gambia: Analysis of national immunisation survey data, 2019-2020. PLoS One 2023; 18:e0288741. [PMID: 37478124 PMCID: PMC10361478 DOI: 10.1371/journal.pone.0288741] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 07/03/2023] [Indexed: 07/23/2023] Open
Abstract
The Gambia's routine childhood vaccination programme is highly successful, however, many vaccinations are delayed, with potential implications for disease outbreaks. We adopted a multi-dimensional approach to determine the timeliness of vaccination (i.e., timely, early, delayed, and untimely interval vaccination). We utilised data for 3,248 children from The Gambia 2019-2020 Demographic and Health Survey. Nine tracer vaccines administered at birth and at two, three, four, and nine months of life were included. Timeliness was defined according to the recommended national vaccination windows and reported as both categorical and continuous variables. Routine coverage was high (above 90%), but also a high rate of untimely vaccination. First-dose pentavalent vaccine (PENTA1) and oral polio vaccine (OPV1) had the highest timely coverage that ranged from 71.8% (95% CI = 68.7-74.8%) to 74.4% (95% CI = 71.7-77.1%). Delayed vaccination was the commonest dimension of untimely vaccination and ranged from 17.5% (95% CI = 14.5-20.4%) to 91.1% (95% CI = 88.9-93.4%), with median delays ranging from 11 days (IQR = 5, 19.5 days) to 28 days (IQR = 11, 57 days) across all vaccines. The birth-dose of Hepatitis B vaccine had the highest delay and this was more common in the 24-35 months age group (91.1% [95% CI = 88.9-93.4%], median delays = 17 days [IQR = 10, 28 days]) compared to the 12-23 months age-group (84.9% [95% CI = 81.9-87.9%], median delays = 16 days [IQR = 9, 26 days]). Early vaccination was the least common and ranged from 4.9% (95% CI = 3.2-6.7%) to 10.7% (95% CI = 8.3-13.1%) for all vaccines. The Gambia's childhood immunization system requires urgent implementation of effective strategies to reduce untimely vaccination in order to optimize its quality, even though it already has impressive coverage rates.
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Affiliation(s)
- Oghenebrume Wariri
- Vaccines and Immunity Theme, MRC Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Vaccine Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Chigozie Edson Utazi
- WorldPop, School of Geography and Environmental Science, University of Southampton, Southampton, United Kingdom
- Southampton Statistical Sciences Research Institute, University of Southampton, Southampton, United Kingdom
| | - Uduak Okomo
- Vaccines and Immunity Theme, MRC Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
- MARCH Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Malick Sogur
- Expanded Programme on Immunization, Ministry of Health and Social Welfare, Banjul, The Gambia
| | - Kris A. Murray
- Centre on Climate Change and Planetary Health, MRC Unit The Gambia at The London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Chris Grundy
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sidat Fofanna
- Expanded Programme on Immunization, Ministry of Health and Social Welfare, Banjul, The Gambia
| | - Beate Kampmann
- Vaccines and Immunity Theme, MRC Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
- Centre for Global Health, Charite Universitatsmedizin Berlin, Berlin, Germany
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7
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Terrell R, Alami A, Krewski D. Interventions for COVID-19 Vaccine Hesitancy: A Systematic Review and Narrative Synthesis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6082. [PMID: 37372669 DOI: 10.3390/ijerph20126082] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/25/2023] [Accepted: 06/02/2023] [Indexed: 06/29/2023]
Abstract
Vaccines effectively protect against COVID-19, but vaccine hesitancy and refusal hinder vaccination rates. This systematic review aimed to (1) review and describe current interventions for addressing COVID-19 vaccine hesitancy/refusal and (2) assess whether these interventions are effective for increasing vaccine uptake. The protocol was registered prospectively on PROSPERO and comprehensive search included Medline, Embase, CINAHL, PsycInfo, and Web of Science databases. Only studies that evaluated the effectiveness of non-financial interventions to address COVID-19 vaccine hesitancy were included, while those focusing intentions or financial incentive were excluded. Risk of bias for all included studies was evaluated using Cochrane risk of bias tools. In total, six articles were included in the review (total participants n = 200,720). A narrative synthesis was performed due to the absence of common quantitative metrics. Except for one randomized controlled trial, all studies reported that interventions were effective, increasing COVID-19 vaccination rates. However, non-randomized studies were subject to confounding biases. Evidence on the effectiveness of COVID-19 vaccine hesitancy interventions remains limited and further evidence is needed for the development of clear guidance on effective interventions to increase vaccine uptake.
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Affiliation(s)
- Rowan Terrell
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1S 5B6, Canada
| | - Abdallah Alami
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1S 5B6, Canada
| | - Daniel Krewski
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1S 5B6, Canada
- Risk Sciences International, Ottawa, ON K1P 5J6, Canada
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Nayar R, Pattath B, Mantha N, Debnath S, Deo S. Routine childhood vaccination in India from 2005-2006 to 2015-2016: Temporal trends and geographic variation. Vaccine 2022; 40:6924-6930. [PMID: 36280561 DOI: 10.1016/j.vaccine.2022.10.024] [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: 02/09/2022] [Revised: 09/22/2022] [Accepted: 10/07/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE India has experienced a substantial increase in the coverage of routine childhood vaccines in recent years. However, a large fraction of these vaccines is not delivered in a timely manner, i.e., at the recommended age. Further, substantial disparities exist in both coverage and timeliness across states. We aim to quantify the changes in coverage and timeliness of routine childhood vaccination in India over time, their variation across states, and changes in these variations over time. METHODS We used data from two rounds of India's National Family Health Surveys, NFHS-3 (2005-06) and NFHS-4 (2015-16) on bacille Calmette-Guerin vaccine (BCG), three doses of diphtheria, pertussis, and tetanus vaccine (DPT1, DPT2, DPT3), and measles-containing vaccine (MCV). We used the Turnbull estimator to estimate the cumulative distribution function (CDF) of administering each vaccine by a certain age while accounting for two-sided censoring in the survey data. We then used these estimated CDFs to calculate coverage and timeliness at the national and state levels. FINDINGS At the national level, both vaccination coverage and timeliness estimates increased from NFHS-3 to NFHS-4 for all vaccines. The increase in timeliness ranging from 27.3% for DPT3 to 74.0% for MCV continued to be lower than coverage, ranging from 75.3% (95% CI 57.7-87.2) for DPT3 to 74.0% (95% CI 42.2-33.0) for MCV, for all vaccines. Cross-state variation in timeliness was greater than the variation in coverage. Variation in both timeliness and coverage reduced from NFHS-3 to NFHS-4. However, this reduction was greater for timeliness than for coverage. CONCLUSIONS A large fraction of the children in India receive vaccines later than the recommended age thereby keeping them exposed to vaccine-preventable diseases. Interventions that specifically focus on improving the timely delivery of vaccines are needed to improve the overall effectiveness of the routine immunization program.
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Affiliation(s)
| | | | - Nivedita Mantha
- Department of International Economics, The Graduate Institute, Geneva, Switzerland
| | - Sisir Debnath
- Department of Humanities and Social Sciences, Indian Institute of Technology Delhi, New Delhi, India
| | - Sarang Deo
- Indian School of Business, Hyderabad, India
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Poshattiwar RS, Anjankar A. Assessment of Disruption of Routine Childhood Immunization in Developing Countries Due to Pandemic. Cureus 2022; 14:e30845. [DOI: 10.7759/cureus.30845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 10/29/2022] [Indexed: 11/06/2022] Open
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10
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Wariri O, Okomo U, Kwarshak YK, Utazi CE, Murray K, Grundy C, Kampmann B. Timeliness of routine childhood vaccination in 103 low-and middle-income countries, 1978-2021: A scoping review to map measurement and methodological gaps. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000325. [PMID: 36962319 PMCID: PMC10021799 DOI: 10.1371/journal.pgph.0000325] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 06/14/2022] [Indexed: 11/19/2022]
Abstract
Empiric studies exploring the timeliness of routine vaccination in low-and middle-income countries (LMICs) have gained momentum in the last decade. Nevertheless, there is emerging evidence suggesting that these studies have key measurement and methodological gaps that limit their comparability and utility. Hence, there is a need to identify, and document these gaps which could inform the design, conduct, and reporting of future research on the timeliness of vaccination. We synthesised the literature to determine the methodological and measurement gaps in the assessment of vaccination timeliness in LMICs. We searched five electronic databases for peer-reviewed articles in English and French that evaluated vaccination timeliness in LMICs, and were published between 01 January 1978, and 01 July 2021. Two reviewers independently screened titles and abstracts and reviewed full texts of relevant articles, following the guidance framework for scoping reviews by the Joanna Briggs Institute. From the 4263 titles identified, we included 224 articles from 103 countries. China (40), India (27), and Kenya (23) had the highest number of publications respectively. Of the three domains of timeliness, the most studied domain was 'delayed vaccination' [99.5% (223/224)], followed by 'early vaccination' [21.9% (49/224)], and 'untimely interval vaccination' [9% (20/224)]. Definitions for early (seven different definitions), untimely interval (four different definitions), and delayed vaccination (19 different definitions) varied across the studies. Most studies [72.3% (166/224)] operationalised vaccination timeliness as a categorical variable, compared to only 9.8% (22/224) of studies that operationalised timeliness as continuous variables. A large proportion of studies [47.8% (107/224)] excluded the data of children with no written vaccination records irrespective of caregivers' recall of their vaccination status. Our findings show that studies on vaccination timeliness in LMICs has measurement and methodological gaps. We recommend the development and implement of guidelines for measuring and reporting vaccination timeliness to bridge these gaps.
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Affiliation(s)
- Oghenebrume Wariri
- Vaccines and Immunity Theme, MRC Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Vaccine Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Uduak Okomo
- Vaccines and Immunity Theme, MRC Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | | | - Chigozie Edson Utazi
- WorldPop, School of geography and Environmental Science, University of Southampton, Southampton, United Kingdom
- Southampton Statistical Sciences Research Institute, University of Southampton, Southampton, United Kingdom
| | - Kris Murray
- MRC Unit The Gambia at The London School of Hygiene and Tropical Medicine, Fajara, The Gambia
- MRC Centre for Global Infectious Disease Analysis, Imperial College School of Public Health, Imperial College London, London, United Kingdom
| | - Chris Grundy
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Beate Kampmann
- Vaccines and Immunity Theme, MRC Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
- Vaccine Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
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11
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Vaccines on time: Exploring determinants of delaying child vaccination in states of India. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2022. [DOI: 10.1016/j.cegh.2022.100996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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12
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Dejene H, Girma D, Geleta LA, Legesse E. Vaccination timeliness and associated factors among children aged 12-23 months in Debre Libanos district of North Shewa Zone, Oromia Regional State, Ethiopia. Front Pediatr 2022; 10:867846. [PMID: 35967570 PMCID: PMC9363667 DOI: 10.3389/fped.2022.867846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 07/04/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Globally, vaccination is one of the most cost-effective interventions in promoting child survival, preventing 2-3 million child deaths annually from vaccine-preventable diseases (VPDs). In Ethiopia, timely vaccination is stated as key to the prevention of unnecessary childhood mortality from measles, pneumonia, diarrheal diseases, and other VPDs. However, Ethiopia ranked fifth among the ten countries with the most unprotected children. Furthermore, previous vaccine timeliness studies produced widely disparate results. As a result, it was suggested that more research be conducted to investigate the potential factors behind the high proportion of untimely vaccination. Therefore, this study was intended to explore the association between different factors and the proportion of vaccination timeliness administered under the Expanded Program on Immunization in Debre Libanos district, Ethiopia. METHODS A community-based cross-sectional study design was employed from 1 May to 30 May 2021 among children aged 12 to 23 months with their mother/caregiver, who had started vaccination and had vaccination cards in the Debre Libanos. Simple random sampling techniques and pretested semi-structured questionnaires were used for data collection. At last, a multivariable logistic regression was used to identify factors associated with the vaccination timeliness. RESULT In this study, 413 children aged 12 to 23 months were interviewed with their mother/caregiver. Overall, 33.7% [95% CI (29.1-38.3)] of children received their vaccines timely. Having a female child [AOR: 2.9, 95% CI: 1.58-5.35], mother/caregiver attending primary [AOR: 6.33, 95% CI: 2.66-15.06] and secondary/above education [AOR: 5.61, 95% CI: 2.41-13.04], sufficient vaccination knowledge [AOR: 3.46, 95% CI: 1.87-6.38], mother/caregiver with least hesitant [AOR: 3.35, 95% CI: 1.51-7.41] and middle hesitant [AOR: 1.89, 95% CI: 1.05-3.58], utilization of ANC [AOR: 2.89, 95% CI: 1.32-6.33], and giving birth at health facility [AOR: 4.32, 95% CI: 1.95-9.59] were the factors independently associated with vaccination timeliness. CONCLUSION In comparison to Ethiopia's existing vaccination coverage, the proportion of children immunized at the recommended time interval is low in the study district. Policymakers should prioritize vaccine timeliness and integrate it into childhood vaccination strategies.
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Affiliation(s)
- Hiwot Dejene
- Department of Public Health, Salale University, Fiche, Ethiopia
| | - Derara Girma
- Department of Public Health, Salale University, Fiche, Ethiopia
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Wagner AL, Tefera YA, Gillespie BW, Carlson BF, Boulton ML. Vaccine coverage, timeliness and delay estimated from regional and national cross-sectional surveys in Ethiopia, 2016. Pan Afr Med J 2021; 39:205. [PMID: 34603586 PMCID: PMC8464200 DOI: 10.11604/pamj.2021.39.205.22777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 07/07/2021] [Indexed: 12/04/2022] Open
Abstract
Introduction measures of vaccine timing require data on vaccination dates, which may be unavailable. This study compares estimates of vaccine coverage and timing; and compares regression techniques that model these measures in the presence of incomplete data. Methods this cross-sectional study used the 2016 Ethiopian Demographic and Health Survey (DHS), and a 2016 survey from Worabe, Ethiopia. Three measures of vaccine uptake were calculated: coverage (regardless of timing), timeliness (within 1 week of recommended administration), and delay (the number of days between the recommended and actual date of vaccination). Vaccine coverage and timeliness were modeled with logistic regressions. After excluding those without dates, vaccine delay was estimated using linear regression or survival analysis. Vaccine delay was also estimated using accelerated failure time (AFT) models. Results the DHS survey included 3819 children aged 12-60 months and the Worabe survey included 484 children aged 12-23 months. In the Worabe survey, vaccine coverage for pentavalent vaccine dose 3 was 87.4%, with 8.6% receiving it within 1 week, and 71.7% within 4 weeks; the median delay was 19 days. Predictors of outcomes were similar in both the Worabe survey and Ethiopian DHS, with the largest numbers of significant associations seen in models with vaccine coverage or delays (with AFT models) as the outcomes. Conclusion estimates of coverage may miss a substantial proportion of infants who have delayed vaccination. Accelerated failure time (AFT) models are useful to estimate vaccine delay because they include information from all respondents (those with full and partial data on vaccination dates) and are agnostic about an age limit for timely vaccination.
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Affiliation(s)
- Abram Luther Wagner
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Yemesrach Abeje Tefera
- Department of Public Health, St. Paul´s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Brenda Wilson Gillespie
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Bradley Frederick Carlson
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Matthew Lester Boulton
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA.,Department of Internal Medicine, Division of Infectious Disease, University of Michigan Medical School, Ann Arbor, Michigan, USA
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Ekanem AM, Oloyede IP, Ekrikpo UE, Idung AU, Edward E. Rate of BCG Immunization in HIV-Exposed Infants in a Selected Primary Health Centre in Southern Nigeria: Implications of No Vaccine Policy for HIV-Positive Infants. J Trop Pediatr 2021; 67:5863686. [PMID: 32591805 DOI: 10.1093/tropej/fmaa030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Maternal and infant HIV status influences the decision of BCG immunization of infants at birth. The objective of this study was to determine the HIV status of HIV-exposed infants (HEIs) by the first HIV DNA PCR test and the rate of BCG uptake among the HEIs who were confirmed HIV negative. METHODS This was a retrospective descriptive cross-sectional study involving the review of results of 99 dried blood samples (DBS) for the first HIV DNA PCR test of HEIs whose mothers were diagnosed HIV positive on presentation of the infants at first immunization visit at a Primary Health Centre from January 2018 to January 2019. RESULTS Of the 99 DBS examined, 86; 86.9% (95% CI 80.1-93.6) were HIV negative, 9; 9.1% (95% CI 3.3-14.8) were positive while the results of 4 (4.0%) infants were not in the register. Only 7; 7.1% (95% CI 1.9-12.2) of the 99 HEIs returned for BCG immunization at the centre. BCG immunization status of the HEIs after first PCR results was not significantly associated with sex of the infants or availability of phone number of the guardians (p = 0.70 and 0.12, respectively). CONCLUSION The majority of HEIs were HIV negative at first HIV DNA PCR test. Few of these HIV negative infants returned for BCG immunization. Hence, all HEIs should be given BCG immunization according to WHO GAVCS committee recommendation on BCG immunization for settings with poor HIV diagnostic and treatment facilities for mothers and infants.
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Affiliation(s)
- A M Ekanem
- Department of Community Health, Faculty of Clinical Sciences, University of Uyo/University of Uyo Teaching Hospital, Uyo, Akwa Ibom State, Nigeria 520271
| | - I P Oloyede
- Department of Paediatrics, University of Uyo/University of Uyo Teaching Hospital, Uyo, Akwa Ibom State, Nigeria 520271
| | - U E Ekrikpo
- Department of Internal Medicine, University of Uyo/University of Uyo Teaching Hospital, Uyo, Akwa Ibom State, Nigeria 520271
| | - A U Idung
- Department of Family Medicine, University of Uyo/University of Uyo Teaching Hospital, Uyo, Akwa Ibom State, Nigeria 520271
| | - E Edward
- Department of Community Health, University of Uyo Teaching Hospital, Uyo, Akwa Ibom state, Nigeria 520261
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Wariri O, Okomo U, Kwarshak YK, Murray KA, Grundy C, Kampmann B. Timeliness of routine childhood vaccination in low- and middle-income countries, 1978-2021: Protocol for a scoping review to map methodologic gaps and determinants. PLoS One 2021; 16:e0253423. [PMID: 34138965 PMCID: PMC8211249 DOI: 10.1371/journal.pone.0253423] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 06/04/2021] [Indexed: 11/18/2022] Open
Abstract
The literature on the timeliness of childhood vaccination (i.e. vaccination at the earliest appropriate age) in low-and middle-income countries has important measurement and methodological issues that may limit their usefulness and cross comparison. We aim to conduct a comprehensive scoping review to map the existing literature with a key focus on how the literature on vaccination timeliness has evolved, how it has been defined or measured, and what determinants have been explored in the period spanning the last four decades. This scoping review protocol was developed based on the guidance for scoping reviews from the Joanna Briggs Institute. We will include English and French language peer-reviewed publications and grey literature on the timeliness of routine childhood vaccination in low-and middle-income countries published between January 1978 through to 2021. A three-step search strategy that involves an initial search of two databases to refine the keywords, a full search of all included electronic databases, and screening of references of previous studies for relevant articles missing from our full search will be employed. The search will be conducted in five electronic databases: MEDLINE, EMBASE, Global Health, CINAHL and Web of Science. Google search will also be conducted to identify relevant grey literature on vaccination timeliness. All retrieved titles from the search will be imported into Endnote X9.3.3 (Clarivate Analytics) and deduplicated. Two reviewers will screen the titles, abstracts and full texts of publications for eligibility using Rayyan-the web based application for screening articles for systematic reviews. Using a tailored data extraction template, we will extract relevant information from eligible studies. The study team will analyse the extracted data using descriptive statistical methods and thematic analysis. The results will be presented using tables, while charts and maps will be used to aid the visualisation of the key findings and themes. The proposed review will generate evidence on key methodological gaps in the literature on timeliness of childhood vaccination. Such evidence would shape the direction of future research, and assist immunisation programme managers and country-level stakeholders to address the needs of their national immunisation system.
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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
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Uduak Okomo
- Vaccines and Immunity Theme, MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | | | - Kris A. Murray
- MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
- MRC Centre for Global Infectious Disease Analysis, Imperial College School of Public Health, Imperial College London, London, United Kingdom
| | - Chris Grundy
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - 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, United Kingdom
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Jain R, Chopra A, Falézan C, Patel M, Dupas P. COVID-19 related immunization disruptions in Rajasthan, India: A retrospective observational study. Vaccine 2021; 39:4343-4350. [PMID: 34154863 PMCID: PMC8196298 DOI: 10.1016/j.vaccine.2021.06.022] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 06/07/2021] [Accepted: 06/09/2021] [Indexed: 02/07/2023]
Abstract
Disruptions during the COVID-19 lockdown caused children to miss immunizations. Government catch-up efforts substantially reversed these effects. Yet, children that were due vaccinations during the lockdown remained 10–15% less likely to be immunized 4–5 months later. Catch-up was more likely to be incomplete among children of low socioeconomic status. Ensuring all children are fully immunized requires careful tracking and disaggregated data.
Introduction Governments around the world suspended immunization outreach to control COVID-19 spread. Many have since resumed services with an emphasis on catch-up vaccinations. This paper evaluated immunization disruptions during India’s March-May 2020 lockdown and the extent to which subsequent catch-up efforts reversed them in Rajasthan, India. Methods In this retrospective observational study, we conducted phone surveys to collect immunization details for 2,144 children that turned one year old between January and October 2020. We used logistic regressions to compare differences in immunization timeliness and completed first-year immunization status among children that were due immunizations just before (unexposed), during (heavily exposed), and after (post-exposure) the lockdown. Results Relative to unexposed children, heavily exposed children were significantly less likely to be immunized at or before 9 months (OR 0.550; 95% CI 0.367–0.824; p = 0.004), but more likely to be immunized at 10–12 months (OR 1.761; 95% CI 1.196–2.591; p = 0.004). They were also less likely to have completed their key first-year immunizations (OR 0.624; 95% CI 0.478–0.816; p = 0.001) by the time of survey. In contrast, post-exposure children showed no difference in timeliness or completed first-year immunizations relative to unexposed children, despite their younger age. First-year immunization coverage among heavily exposed children decreased by 6.9 pp to 10.4 pp (9.7% to 14.0%). Declines in immunization coverage were larger among children in households that were poorer, less educated, lower caste, and residing in COVID red zones, although subgroup comparisons were not statistically significant. Conclusion Disruptions to immunization services resulted in children missing immunization during the lockdown, but catch-up efforts after it was eased ensured many children were reached at later ages. Nevertheless, catch-up was incomplete and children due their immunizations during the lockdown remained less likely to be fully immunized 4–5 months after it lifted, even as younger cohorts due immunizations in June or later returned to pre-lockdown schedules.
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Affiliation(s)
- Radhika Jain
- Stanford University, Stanford, CA 94305-6055, United States.
| | - Ambika Chopra
- The Abdul Latif Jameel Poverty Action Lab (J-PAL) South Asia, Institute for Financial Management and Research, New Delhi, Delhi, India
| | | | - Mustufa Patel
- The Abdul Latif Jameel Poverty Action Lab (J-PAL) South Asia, Institute for Financial Management and Research, New Delhi, Delhi, India
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Janusz CB, Mutua MK, Wagner AL, Boulton ML. New Vaccine Introduction and Childhood Vaccination Timeliness in Two Urban, Informal Settlements in Nairobi, Kenya. Am J Trop Med Hyg 2021; 105:245-253. [PMID: 33999852 DOI: 10.4269/ajtmh.21-0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 03/22/2021] [Indexed: 11/07/2022] Open
Abstract
New vaccine introduction accompanied by social mobilization activities could contribute to improved routine immunization timeliness. This study assesses the impact of Kenya's introduction of pneumococcal conjugate vaccine (PCV) on the timeliness of routine childhood vaccination in two informal, urban settlements in Nairobi. Data collected from 2007 to 2015 as part of a demographic surveillance system were used to estimate annual vaccination delays of ≥ 4 weeks among children aged 12-23 months in the period before and after the introduction of PCV in Kenya. Binomial segmented regression models using generalized estimating equations examined the association between vaccine introduction and timeliness of routine immunization. Over half of all children vaccinated in the two urban areas received one or more doses ≥ 4 weeks after the recommended age. The timeliness of routine immunization showed slight improvements or nonsignificant changes during the years following PCV introduction compared with the preceding years (adjusted prevalence ratio [aPR]: 0.67, 95% CI: 0.45-0.99 for Bacille Calmette-Guerin receipt; aPR: 0.59, 95% CI: 0.41-0.83 for third dose Pentavalent receipt; aPR: 1.19, 95% CI: 0.99-1.42 for measles). However, as of 2015, delayed vaccination remained prevalent in children, particularly among the poorest residing in the settlements. Many sub-Saharan African countries have introduced new life-saving vaccines into their routine childhood immunization schedule. Additional evidence regarding the positive or neutral influence of new vaccine introduction on the performance of delivery systems provides further justification to sustain the inclusion of these more costly vaccines in the immunization schedule.
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Affiliation(s)
- Cara Bess Janusz
- 1Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan.,2The Institute of Global Health Equity, University of Michigan, Ann Arbor, Michigan
| | - Martin K Mutua
- 3Data Measurements and Evaluation, African Population and Health Research Center, Nairobi, Kenya
| | - Abram L Wagner
- 1Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan.,2The Institute of Global Health Equity, University of Michigan, Ann Arbor, Michigan
| | - Matthew L Boulton
- 1Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan.,2The Institute of Global Health Equity, University of Michigan, Ann Arbor, Michigan.,4Department of Internal Medicine, Infectious Disease Division, Michigan Medicine, Ann Arbor, Michigan
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Hepatitis B Vaccination in Senegalese Children: Coverage, Timeliness, and Sociodemographic Determinants of Non-Adherence to Immunisation Schedules (ANRS 12356 AmBASS Survey). Vaccines (Basel) 2021; 9:vaccines9050510. [PMID: 34063390 PMCID: PMC8155976 DOI: 10.3390/vaccines9050510] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 05/07/2021] [Accepted: 05/12/2021] [Indexed: 12/15/2022] Open
Abstract
Detailed knowledge about hepatitis B virus (HBV) vaccination coverage and timeliness for sub-Saharan Africa is scarce. We used data from a community-based cross-sectional survey conducted in 2018–2019 in the area of Niakhar, Senegal, to estimate coverage, timeliness, and factors associated with non-adherence to the World Health Organisation-recommended vaccination schedules in children born in 2016 (year of the birth dose (BD) introduction in Senegal) and 2017–2018. Vaccination status was assessed from vaccination cards, surveillance data, and healthcare post vaccination records. Among 241 children with available data, for 2016 and 2017–2018, respectively, 31.0% and 66.8% received the BD within 24 h of birth (BD schedule), and 24.3% and 53.7% received the BD plus at least two pentavalent vaccine doses within the recommended timeframes (three-dose schedule). In logistic regression models, home birth, dry season birth, and birth in 2016 were all associated with non-adherence to the recommended BD and three-dose schedules. Living over three kilometres from the nearest healthcare post, being the firstborn, and living in an agriculturally poorer household were only associated with non-adherence to the three-dose schedule. The substantial proportion of children not vaccinated according to recommended schedules highlights the importance of considering vaccination timeliness when evaluating vaccination programme effectiveness. Outreach vaccination activities and incentives to bring children born at home to healthcare facilities within 24 h of birth, must be strengthened to improve timely HBV vaccination.
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Raguindin PF, Morales-Dizon M, Aldaba J, Mangulabnan LP, Reyes RP, Batmunkh N, Ducusin MJ, Lopez AL. Timeliness of childhood vaccinations in the Philippines. J Public Health Policy 2021; 42:53-70. [PMID: 33398056 PMCID: PMC7979588 DOI: 10.1057/s41271-020-00255-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2020] [Indexed: 12/02/2022]
Abstract
Timeliness of vaccinations is rarely part of monitoring in a routine immunization program. We reviewed infant immunization and conducted caregiver interviews in three regions in the Philippines from January to October 2016. We randomly selected thirty public health centers, one for each region. We defined timeliness of the receipt of antigen as within 4 weeks after the recommended age at vaccination. We assessed a total of 986 infants for timeliness of vaccination. The median age of receipt of vaccine was at 2.7 weeks (BCG), 10.1 weeks (Penta 1), and 21.7 weeks (Penta 3) compared to the recommended 0, 6, and 14 weeks of age, respectively. We found timely receipt only in 74.4% for BCG, 70.3% for Penta 1, and 39.1% for Penta 3 recipients. Thus, alongside declining immunization coverage, the infants in the Philippines had substantial delays in vaccine receipt.
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Affiliation(s)
- Peter Francis Raguindin
- Institute of Child Health and Human Development, National Institutes of Health – University of the Philippines Manila, Manila, Philippines
- Present Address: Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland
| | - Merrylle Morales-Dizon
- Institute of Child Health and Human Development, National Institutes of Health – University of the Philippines Manila, Manila, Philippines
| | - Josephine Aldaba
- Institute of Child Health and Human Development, National Institutes of Health – University of the Philippines Manila, Manila, Philippines
| | - Lailani P. Mangulabnan
- Department of Health, Center for Health Development Region 3, San Fernando City, Pampanga Philippines
| | - Renelyn P. Reyes
- Department of Health, Center for Health Development Region 6, Iloilo City, Iloilo Philippines
| | - Nyambat Batmunkh
- Vaccine Preventable Diseases and Immunization, World Health Organization Regional Office for the Western Pacific, Manila, Philippines
| | - Maria Joyce Ducusin
- Department of Health, Disease Prevention and Control Bureau, Manila, Philippines
| | - Anna Lena Lopez
- Institute of Child Health and Human Development, National Institutes of Health – University of the Philippines Manila, Manila, Philippines
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Janusz CB, Frye M, Mutua MK, Wagner AL, Banerjee M, Boulton ML. Vaccine Delay and Its Association With Undervaccination in Children in Sub-Saharan Africa. Am J Prev Med 2021; 60:S53-S64. [PMID: 33189500 PMCID: PMC10601532 DOI: 10.1016/j.amepre.2020.10.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 10/02/2020] [Accepted: 10/02/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Improving the timeliness and completion of vaccination is the key to reducing under-5 childhood mortality. This study examines the prevalence of delayed vaccination for doses administered at birth and age 6 weeks, 10 weeks, 14 weeks, and 9 months and its association with undervaccination among infants in Sub-Saharan Africa. METHODS Pooling data across 33 Sub-Saharan Africa countries, vaccination timing and series completion were assessed for children aged 12-35 months who were included in the immunization module of the Demographic and Health Surveys conducted between 2010 and 2019. Survey design-adjusted logistic regression modeled the likelihood of not fully completing the basic immunization schedule associated with dose-specific delays in vaccination. Data were obtained and analyzed in May 2020. RESULTS Among children with complete date records (n=70,006), the proportion of children vaccinated with delays by ≥1 month was high: 25.9% for Bacille Calmette-Guerin (at birth); 49.1% for the third dose of pentavalent combination vaccine (at 14 weeks); and 63.9% for the first dose of measles vaccines (at 9 months). Late vaccination was more common for children born to mothers with lower levels of educational attainment (p<0.001) and wealth (p<0.001). Controlling for place, time, and sociodemographics, vaccination delays at any dose were significantly associated with not completing the immunization schedule by 12 months (Bacille Calmette-Guerin: AOR=1.93, [95% CI=1.83, 2.02]; pentavalent 3: AOR=1.50 [95% CI=1.35, 1.64]; measles: AOR=3.76 [95% CI=3.37, 4.15]). CONCLUSIONS Timely initiation of vaccination could contribute to higher rates of immunization schedule completion, improving the reach and impact of vaccination programs on child health outcomes in Sub-Saharan Africa. SUPPLEMENT INFORMATION This article is part of a supplement entitled Global Vaccination Equity, which is sponsored by the Global Institute for Vaccine Equity at the University of Michigan School of Public Health.
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Affiliation(s)
- Cara Bess Janusz
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan; The Global Institute for Vaccine Equity, University of Michigan, Ann Arbor, Michigan.
| | - Margaret Frye
- Department of Sociology, College of Literature, Science, and the Arts, University of Michigan, Ann Arbor, Michigan
| | - Martin K Mutua
- African Population and Health Research Center, Nairobi, Kenya
| | - Abram L Wagner
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan; The Global Institute for Vaccine Equity, University of Michigan, Ann Arbor, Michigan
| | - Mousumi Banerjee
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan; Center for Healthcare Outcomes & Policy, University of Michigan, Ann Arbor, Michigan
| | - Matthew L Boulton
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan; The Global Institute for Vaccine Equity, University of Michigan, Ann Arbor, Michigan; Infectious Disease Division, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan
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Beauregard M, Brousseau N, Ouakki M, Kiely M, Sauvageau C, Clément P, Guay M. Participation in an action research project on vaccine services for children: relationship with vaccine delays. Hum Vaccin Immunother 2020; 16:3170-3176. [PMID: 32429743 PMCID: PMC8641605 DOI: 10.1080/21645515.2020.1748980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 02/28/2020] [Accepted: 03/25/2020] [Indexed: 10/24/2022] Open
Abstract
Multicomponent interventions are effective in improving vaccine coverage. However, few studies have assessed their effect on timely vaccination. The aim of this study was to compare the proportion of children with vaccine delays at 2- and 12-month visits according to whether or not health centers have participated in an action research project on the organization of vaccination services for 0-5-year-olds. The action research project included a multicomponent intervention and was conducted between 2011 and 2015 in Quebec, Canada. An ecological before/after design was used for this analysis. A total of 264,579 DTaP-IPV-Hib (2-month visits) and 240,541 Men-C-C (12-month visits) vaccine doses were administered during 2011-2012 to 2014-2015 fiscal years, including 19% in 14 participating health centers and the remaining in 78 nonparticipating centers. Vaccine delays demonstrated a more pronounced decreasing trend in participating versus nonparticipating health centers (p < .0001 at 2 and 12 months). Between 2011-2012 and 2014-2015, participating centers managed to eliminate 35% of their vaccine delays at 2-month visits and 33% at 12-month visits, whereas nonparticipating centers eliminated 19% of delays at both visits. Our results are consistent with a positive impact of the multicomponent intervention, despite the fact that it had not specifically aimed at decreasing vaccine delays.
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Affiliation(s)
- Mariejka Beauregard
- Département de médecine sociale et préventive, Université Laval, Québec, Canada
| | - Nicholas Brousseau
- Département de médecine sociale et préventive, Université Laval, Québec, Canada
- Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec, Québec, Canada
- Centre de recherche du CHU de Québec-Université Laval, CHU de Québec, Québec, Canada
| | - Manale Ouakki
- Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec, Québec, Canada
| | - Marilou Kiely
- Département de médecine sociale et préventive, Université Laval, Québec, Canada
- Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec, Québec, Canada
- Centre de recherche du CHU de Québec-Université Laval, CHU de Québec, Québec, Canada
| | - Chantal Sauvageau
- Département de médecine sociale et préventive, Université Laval, Québec, Canada
- Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec, Québec, Canada
- Centre de recherche du CHU de Québec-Université Laval, CHU de Québec, Québec, Canada
| | - Paule Clément
- Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec, Québec, Canada
| | - Maryse Guay
- Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec, Québec, Canada
- Centre de recherche Charles-Le Moyne – Saguenay – Lac-St-Jean sur les Innovations en santé, CISSS de la Montérégie-Centre, Longueuil, Canada
- Département des Sciences de la santé communautaire, Université de Sherbrooke, Longueuil, Canada
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Bassoum O, Kimura M, Tal Dia A, Lemoine M, Shimakawa Y. Coverage and Timeliness of Birth Dose Vaccination in Sub-Saharan Africa: A Systematic Review and Meta-Analysis. Vaccines (Basel) 2020; 8:E301. [PMID: 32545322 PMCID: PMC7350240 DOI: 10.3390/vaccines8020301] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 06/06/2020] [Accepted: 06/06/2020] [Indexed: 12/12/2022] Open
Abstract
Background: Depending on the epidemiological context of each country, three vaccines are recommended by the World Health Organization (WHO) to be administered as soon as possible after birth (birth vaccines); namely, BCG, zero dose of oral polio vaccine (OPV0), and birth dose of hepatitis B vaccine (HepB-BD). The timely administration of these vaccines immediately after birth might pose significant challenges in sub-Saharan Africa, where about half of childbirths occur outside health facilities. We therefore conducted a systematic review and meta-analysis to estimate the coverage rate of these vaccines at a specific timing in neonates in sub-Saharan Africa. Methods: We searched PubMed, Embase, CINAHL, and Web of Science for studies conducted in sub-Saharan Africa and published up to March 31, 2017, which provided a coverage rate of the birth vaccines at any specific time points within 28 days after birth. Two investigators independently screened the titles and abstracts and extracted data from the eligible full-text articles. This study was registered in PROSPERO (CRD42017071269). Results: Of 7283 articles identified, we finally included 31 studies with 204,111 infants in the meta-analysis. The pooled coverage rates at day 0-1 after birth were 14.2% (95% CI: 10.1-18.9) for BCG and 1.3% (0.0-4.5) for HepB-BD. No data were available for OPV0 at day 0-1. The coverage at day 28 was 71.7% (63.7-79.2) for BCG, 60.8% (45.8-74.7) for HepB-BD, and 76.1% (67.1-84.0) for OPV0. No significant difference in the vaccine coverage was observed between infants born in healthcare facilities and those born outside facilities. Conclusions: The rates of vaccine coverage immediately after birth were very low for BCG and HepB-BD, and no data for OPV0. We need additional data to better define barriers and facilitators for the timely administration of the birth vaccines in sub-Saharan Africa, since the delay in its provision may increase the burden of these vaccine-preventable diseases.
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Affiliation(s)
- Oumar Bassoum
- Faculté de Médecine, de Pharmacie et d’Odontologie, Université Cheikh Anta Diop de Dakar, Dakar-Fann 5005, Senegal; (O.B.); (A.T.D.)
- Institut de Santé et Développement, Université Cheikh Anta Diop de Dakar, Dakar-Fann 16390, Senegal
| | - Moe Kimura
- Department of Metabolism, Digestion and Reproduction, Section of Hepatology and Gastroenterology, Imperial College, London W2 1NY, UK; (M.K.); (M.L.)
- Faculty of Medicine, Tokyo Medical and Dental University, Tokyo 113-8510, Japan
| | - Anta Tal Dia
- Faculté de Médecine, de Pharmacie et d’Odontologie, Université Cheikh Anta Diop de Dakar, Dakar-Fann 5005, Senegal; (O.B.); (A.T.D.)
- Institut de Santé et Développement, Université Cheikh Anta Diop de Dakar, Dakar-Fann 16390, Senegal
| | - Maud Lemoine
- Department of Metabolism, Digestion and Reproduction, Section of Hepatology and Gastroenterology, Imperial College, London W2 1NY, UK; (M.K.); (M.L.)
| | - Yusuke Shimakawa
- Unité d’Épidémiologie des Maladies Émergentes, Institut Pasteur, 25-28 rue du Dr Roux, 75015 Paris, France
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23
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Vader DT, Lee BK, Evans AA. Hepatitis B Birth Dose Effects on Childhood Immunization in the U.S. Am J Prev Med 2020; 58:208-215. [PMID: 31959321 DOI: 10.1016/j.amepre.2019.10.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 10/02/2019] [Accepted: 10/03/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION The Advisory Committee on Immunization Practices recommends administering the first dose of hepatitis B vaccine at birth, making it the first vaccine that many children receive. However, few studies examine whether children who miss the birth dose are at increased risk of vaccination delay. This study investigates birth dose as a determinant of up-to-date immunization status at age 18 months, considering 7 core childhood vaccine series: diphtheria, tetanus, and acellular pertussis; polio; measles, mumps, and rubella; Haemophilus influenzae type B; varicella; hepatitis B; and pneumococcal conjugate vaccine. METHODS Cross-sectional data were collected in 2017 by National Immunization Survey-Child, a nationally representative survey of children aged 19-35 months living in the U.S., and were analyzed in 2019. The primary outcome was combined 7-vaccine series (4:3:1:3:3:1:4) up-to-date status at 18 months. Doubly robust estimates of association were calculated using survey logistic regression and propensity scores estimated with boosted classification and regression trees. RESULTS Children who received the birth dose had 2.01 (95% CI=1.74, 2.33) times the odds of being up-to-date on the combined 7-vaccine series as children who did not. ORs for all the 7 individual vaccine series were positive, ranging from 1.59 (95% CI=1.28, 1.97) for measles, mumps, and rubella to 4.97 (95% CI=3.97, 6.24) for hepatitis B. CONCLUSIONS Receiving the birth dose is positively associated with up-to-date status later in childhood, highlighting the importance of starting vaccination early. The association is insensitive to confounding by factors observed in National Immunization Survey-Child, but investigation of unobserved factors such as vaccine hesitancy could provide critical information to guide intervention strategy.
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Affiliation(s)
- Daniel T Vader
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health at Drexel University, Philadelphia, Pennsylvania.
| | - Brian K Lee
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health at Drexel University, Philadelphia, Pennsylvania
| | - Alison A Evans
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health at Drexel University, Philadelphia, Pennsylvania
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Bossio JC, Sanchis I, Armando GA, Arias SJ, Jure H. [Result of a strategy using reminders before and after date of vaccination to improve timeliness of vaccination at six month]. CAD SAUDE PUBLICA 2019; 35:e00214518. [PMID: 31800789 DOI: 10.1590/0102-311x00214518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 06/17/2019] [Indexed: 11/21/2022] Open
Abstract
The impact of immunization depends on timely application of the vaccines, especially relevant in children. Successful strategies for improving timeliness include the use of nominalized records and follow-up mechanisms. This study assessed the result of reminders before and after the scheduled date of vaccination to improve timely vaccination at six months. A before-and-after intervention study was performed with a time series and comparator group with 1,856 children from Villa María, Córdoba, Argentina. The strategy was implemented in the city's public services and consisted of preparing weekly vaccination schedules, performing follow-up, and contacting and/or making active searches for no-show cases. Assessment of the result used the percentage of timely vaccination with the third dose of the pentavalent vaccine. Time series were built for each group, before and after, and were analyzed with a simple linear model. Means of the percentages were calculated with their confidence intervals, using bootstrap, and compared with the permutation method. In the intervention group, the mean percentage of timely vaccination increased significantly by 2.6 times, reaching 61.7% (56.2; 78.1). No significant increase occurred in the comparator group: p = 0.1101. The mean rates were similar before the implementation. Timely vaccination improved in children receiving the intervention. The results indicate that the proposed strategy to use nominalized records can reduce the delay in application of vaccines.
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Affiliation(s)
- Juan Carlos Bossio
- Instituto Nacional de Enfermedades Respiratorias "Emilio Coni", Administración Nacional de Laboratorios e Institutos de Salud "Dr. Carlos G. Malbrán", Santra Fe, Argentina.,Facultad de Bioquímica y Ciencias Biológicas, Universidad Nacional del Litoral, Santa Fe, Argentina
| | - Ivan Sanchis
- Facultad de Bioquímica y Ciencias Biológicas, Universidad Nacional del Litoral, Santa Fe, Argentina
| | - Gustavo Ariel Armando
- Instituto Nacional de Enfermedades Respiratorias "Emilio Coni", Administración Nacional de Laboratorios e Institutos de Salud "Dr. Carlos G. Malbrán", Santra Fe, Argentina.,Facultad de Ingeniería Química, Universidad Nacional del Litoral, Santa Fe, Argentina
| | - Sergio Javier Arias
- Instituto Nacional de Enfermedades Respiratorias "Emilio Coni", Administración Nacional de Laboratorios e Institutos de Salud "Dr. Carlos G. Malbrán", Santra Fe, Argentina.,Facultad de Bioquímica y Ciencias Biológicas, Universidad Nacional del Litoral, Santa Fe, Argentina
| | - Humberto Jure
- Secretaría de Salud - Municipalidad de Villa María, Villa María, Argentina.,Facultad de Medicina, Universidad Nacional del Nordeste, Corrientes, Argentina
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25
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Masters NB, Wagner AL, Boulton ML. Vaccination timeliness and delay in low- and middle-income countries: a systematic review of the literature, 2007-2017. Hum Vaccin Immunother 2019; 15:2790-2805. [PMID: 31070992 PMCID: PMC6930087 DOI: 10.1080/21645515.2019.1616503] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background: Traditional measurements of vaccine coverage at specific ages can mask poor vaccine timeliness. However, optimal measurement of timing is unclear due to variations in countries’ recommended vaccination schedules and lack of a commonly accepted standard for “timeliness”. We conducted a systematic review of literature on vaccine timeliness and delay in low- and middle-income countries from 2007 to 2017. Methods: A search of articles published between January 1 2007 and December 31 2017, was performed in PubMed, EBSCOhost, and Embase. Results: 67 papers were included, of which 83% used a categorical measure of delay and 41% evaluated continuous delay. The most common age at assessment was 1 month, with earlier age benchmarks typically used with birth doses. Conclusions: Categorical definitions of vaccination timing vary widely, with benchmarks of delay varying from days to weeks to months. Use of a continuous measure of vaccine delay may be more informative and comparable.
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Affiliation(s)
- Nina B Masters
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Abram L Wagner
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Matthew L Boulton
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA.,Department of Internal Medicine, Division of Infectious Disease, University of Michigan Medical School, Ann Arbor, MI, USA
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26
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Choudhary TS, Reddy NS, Apte A, Sinha B, Roy S, Nair NP, Sindhu KN, Patil R, Upadhyay RP, Chowdhury R. Delayed vaccination and its predictors among children under 2 years in India: Insights from the national family health survey-4. Vaccine 2019; 37:2331-2339. [PMID: 30914221 PMCID: PMC6996155 DOI: 10.1016/j.vaccine.2019.03.039] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 03/15/2019] [Accepted: 03/19/2019] [Indexed: 12/20/2022]
Abstract
Objective Delayed vaccination increases the susceptibility window for vaccine preventable diseases. Our analysis estimates the proportion of children between 10 and 23 months of age with delayed vaccination in India and the associated socio-demographic, maternal and child related factors. Methods We used individual level data from the National Family and Health Survey 4, conducted in 2015–2016. The primary outcome of the study was delayed vaccination for BCG, DPT- 1st dose and Measles. Delayed vaccination for each vaccine was defined as administration of the vaccine dose after 28 days of the minimum recommended age, as per the national immunization schedule in India. We estimated the proportion of children with delayed vaccination for each vaccine and used multivariable logistic regression to explore associated factors. Findings In the current analysis, 23.1%, 29.3% and 34.8% of children aged 10 to 23 months had delayed vaccination for BCG, DPT-1st dose and Measles respectively. Children from Muslim families (aOR 1.36 for BCG; aOR 1.45 for DPT-1; aOR 1.26 for Measles); birth weight < 2000 g (aOR 2.33 for BCG; aOR 1.53 for DPT-1; aOR 1.36 for Measles) had higher odds of delayed vaccination. Lower maternal education and belonging to a family from lower wealth quintile had higher odds of delayed vaccination. Children of mothers who had tetanus toxoid immunization during pregnancy had lower odds of delayed vaccination (aOR 0.69 for BCG; aOR 0.76 for DPT-1; aOR 0.78 for Measles). Conclusion The proportion of children with delayed vaccination is high in India. Vaccine timeliness should be a core indicator of the immunization program with greater focus on groups with higher chances of delayed vaccination i.e. home birth, low birth weight new-borns, poorer households, children of mothers with lower education and children from Muslim families.
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Affiliation(s)
- Tarun Shankar Choudhary
- Research Scientist and PRERNA Young Investigator, Centre for Health Research and Development, Society for Applied Studies, New Delhi, India.
| | | | - Aditi Apte
- PRERNA Young Investigator, KEM Hospital Research Centre, Pune, India
| | - Bireshwar Sinha
- Research Scientist and PRERNA Young Investigator, Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Sudipto Roy
- PRERNA Young Investigator, KEM Hospital Research Centre, Pune, India
| | - Nayana P Nair
- PRERNA Young Investigator, Christian Medical College, Vellore, India
| | | | - Rutuja Patil
- PRERNA Young Investigator, KEM Hospital Research Centre, Pune, India
| | - Ravi Prakash Upadhyay
- Research Scientist and PRERNA Young Investigator, Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Ranadip Chowdhury
- Research Scientist and PRERNA Young Investigator, Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
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Albertsen N, Fencker IM, Noasen HE, Pedersen ML. Immunisation rates among children in Nuuk. Int J Circumpolar Health 2019; 77:1426948. [PMID: 29392992 PMCID: PMC5804675 DOI: 10.1080/22423982.2018.1426948] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
The children immunisation programme in Greenland correlates to the one in Denmark with the addition of the Bacille Calmette-Guerin (BCG)-vaccine and the immunisation against Hepatitis B (HBV). The immunisation rate among children in Greenland has been and is currently unknown and this study aims to estimate the immunisation rates among children in Nuuk from 1 July 2015 until 30 June 2016. We did an observational cross-sectional study based on a statistical extraction identifying all children in Nuuk eligible for an immunization in the children immunisation programme from 1 July 2015 until 30 June 2016 and a review of their medical records. We found acceptable coverage rates among children younger than 12 months, but coverage rates lower than recommended by the World Health Organization (WHO) among older children. Among children between 15 months and 4 years the coverage dropped as low as 33.9 %. Increased awareness of child immunisation rates is suggested including continuously monitoring and adjusting of the organisation of the immunisation programme. ABBREVIATIONS Bacille Calmette-Guerin immunisation (BCG); Chief Medical Officer (CMO); Diphtheria, Tetanus, Pertussis, Polio, Haemophilus influenza B, Pneumococcal (DTP); Electronic medical report (EMR); Hepatitis B (HBV); Human Papilloma Virus (HPV); Measles, Mumps, Rubella (MMR); World Health Organization (WHO).
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Affiliation(s)
- Nadja Albertsen
- a Department of Medicine , Queen Ingrid Hospital , Nuuk , Greenland
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28
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Rybak A, Vié le Sage F, Béchet S, Werner A, Thiebault G, Bakhache P, Virey B, Caulin E, Cohen R, Levy C. Timeliness of routine immunization in non-preterm children less than 2 years old using electronic data capture in an ambulatory setting in France in the context of vaccine hesitancy. Arch Pediatr 2019; 26:56-64. [DOI: 10.1016/j.arcped.2018.11.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 10/19/2018] [Accepted: 11/17/2018] [Indexed: 10/27/2022]
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29
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Kiely M, Boulianne N, Talbot D, Ouakki M, Guay M, Landry M, Sauvageau C, De Serres G. Impact of vaccine delays at the 2, 4, 6 and 12 month visits on incomplete vaccination status by 24 months of age in Quebec, Canada. BMC Public Health 2018; 18:1364. [PMID: 30537969 PMCID: PMC6288945 DOI: 10.1186/s12889-018-6235-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 11/20/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Timeliness in the administration of recommended vaccines is often evaluated using vaccine delays and provides more information regarding the susceptibility of children to vaccine-preventable diseases compared with vaccine coverage at a given age. The importance of on-time administration of vaccines scheduled at the first visit is well documented, but data are scarce about the impact of vaccine delays at other visits on vaccination status by 24 months of age. Using vaccine delays for the first three doses of DTaP-containing vaccines and for the first dose of measles-containing vaccines as markers of timeliness at the 2, 4, 6 and 12 month visits, we estimated the proportion of incomplete vaccination status by 24 months of age attributable to a vaccine delay at each of these visits. METHODS We used the data from six cross-sectional coverage surveys conducted in the Province of Quebec from 2006 to 2016 which included 7183 children randomly selected from the universal health insurance database. A vaccine dose was considered delayed if received 30 days or more after the recommended age. The impact of new vaccine delays at each visit on incomplete vaccination status by 24 months of age was estimated with the attributable risk in the population. RESULTS The proportion of children with vaccine delay was 5.4% at 2 months, 13.3% at 4 months, 23.1% at 6 months and 23.6% at 12 months. Overall, 72.5% of all 2-year-old children with an incomplete status by 24 months were attributable with a vaccine delay, of which 16.1% were attributable with a first vaccine delay at 2 months, 10.6% at 4 months, 14.0% at 6 months and 31.8% at 12 months. CONCLUSIONS While great emphasis has been put on vaccine delays at the first vaccination visit, the prevalence of vaccine delays was greater with later visits and most children with an incomplete vaccination status by 24 months had a vaccine delay occurring during these later visits. Interventions to improve timeliness should address vaccine delays at each visit and not only focus on the first visit.
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Affiliation(s)
- Marilou Kiely
- Institut national de santé publique du Quebec, 2400 d'Estimauville Avenue, Quebec, G1E 7G9, Canada. .,Department of Social and Preventive Medicine, Laval University, Quebec, Canada.
| | - Nicole Boulianne
- Institut national de santé publique du Quebec, 2400 d'Estimauville Avenue, Quebec, G1E 7G9, Canada
| | - Denis Talbot
- Department of Social and Preventive Medicine, Laval University, Quebec, Canada.,CHU de Québec-Université Laval, Quebec, Canada
| | - Manale Ouakki
- Institut national de santé publique du Quebec, 2400 d'Estimauville Avenue, Quebec, G1E 7G9, Canada
| | - Maryse Guay
- Institut national de santé publique du Quebec, 2400 d'Estimauville Avenue, Quebec, G1E 7G9, Canada.,Department of Community Health Sciences, Sherbrooke University, Quebec, Canada.,Centre intégré de Santé et Services Sociaux de la Montérégie-Centre, Quebec, Canada
| | - Monique Landry
- Ministère de la Santé et des Services Sociaux, Quebec, Canada
| | - Chantal Sauvageau
- Institut national de santé publique du Quebec, 2400 d'Estimauville Avenue, Quebec, G1E 7G9, Canada.,Department of Social and Preventive Medicine, Laval University, Quebec, Canada.,CHU de Québec-Université Laval, Quebec, Canada
| | - Gaston De Serres
- Institut national de santé publique du Quebec, 2400 d'Estimauville Avenue, Quebec, G1E 7G9, Canada.,Department of Social and Preventive Medicine, Laval University, Quebec, Canada.,CHU de Québec-Université Laval, Quebec, Canada
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Westrick SC, Patterson BJ, Kader MS, Rashid S, Buck PO, Rothholz MC. National survey of pharmacy-based immunization services. Vaccine 2018; 36:5657-5664. [PMID: 30049631 DOI: 10.1016/j.vaccine.2018.07.027] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 07/12/2018] [Accepted: 07/13/2018] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Pharmacists in the United States (U.S.) are authorized to administer vaccines. This study described: how and to what extent immunization services are offered, promoted, and documented in community pharmacies; reasons for referral to other locations for vaccination; and perceived barriers to immunization services. METHODS A mixed-mode (mail/electronic) survey of a stratified random sample of 1999 nationally-representative community pharmacies in the U.S. was conducted in April-July 2017. Survey instrument development was informed by validated scales and 10 in-depth interviews with community pharmacists; content and face validity were ensured via pre- (n = 5) and pilot-tests (n = 26) among community pharmacists. Potential non-response bias was investigated and descriptive statistics were used to analyze survey responses. RESULTS Of the 1999 community pharmacies, 119 pharmacies were deemed ineligible. Of those eligible pharmacies, complete responses were provided by 292 respondents, each representing a unique pharmacy (15.5% response rate). Respondents were evenly split male/female (52.5/47.5%) and about half were pharmacy managers (51.3%). The majority (79.5%) reported offering at least one type of vaccine in 2016, with the most commonly administered vaccine types (average doses in 2016) being: Influenza (484), Pneumococcal 13-valent conjugate (55), Herpes Zoster (41), and Pneumococcal polysaccharide (39). Two-thirds (66.7%) of immunizing pharmacies provided adolescent vaccinations. Most frequently reported referral reasons were patients' insurance not covering vaccine administration at the pharmacy and patients' age not within approved protocol, policy or state law. The majority of respondents did not perceive organizational and environmental factors as barriers; however, they reported patient-related factors, especially cost and insurance coverage, as important barriers. CONCLUSIONS The majority of U.S. community pharmacies reported offering at least one type of vaccine. The scope of pharmacy engagement in immunization services varied in terms of how and to what extent they were offered and documented. Addressing patient-related barriers is needed to further enhance pharmacy-based immunization services.
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Affiliation(s)
| | | | - Mohammad S Kader
- Auburn University, 020 James E. Foy Hall, Auburn, AL 36849, USA.
| | - Sanuwar Rashid
- Auburn University, 020 James E. Foy Hall, Auburn, AL 36849, USA.
| | | | - Mitchel C Rothholz
- American Pharmacists Association, 2215 Constitution Ave, NW, Washington, DC 20037, USA.
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Konwea PE, David FA, Ogunsile SE. Determinants of compliance with child immunization among mothers of children under five years of age in Ekiti State, Nigeria. JOURNAL OF HEALTH RESEARCH 2018. [DOI: 10.1108/jhr-05-2018-024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose
Vaccine preventable diseases are major threats to the health and well-being of children under five years of age. They contribute a great deal to childhood illnesses and disabilities, and are accountable for a high percentage of childhood mortality worldwide. In Nigeria, the government has made a lot of effort to provide immunizations against these childhood diseases. It is however sad to note that many children still do not complete their routine immunization. The purpose of this paper is to determine factors which influence mothers’ compliance with childhood immunization.
Design/methodology/approach
This was a descriptive study carried out among 600 mothers of under-five children randomly selected from nine postnatal clinics in Ekiti State between January and August 2016. A self-structured validated questionnaire containing items to explore demographic characteristics of respondents, compliance with child immunization (Cronbach’s α=0.92) and determinants of compliance (Cronbach’s α=0.83) was the instrument for data collection. Multiple regression analysis was used to identify determinants of mothers’ compliance with childhood immunization.
Findings
The level of compliance of mothers with childhood immunization was high (80 percent). The two factors which contributed significantly to mothers’ compliance were the mothers’ knowledge of childhood immunization (β weight= 0.243) and mothers’ educational status (β weight=0.169). Mothers with tertiary education had the highest level of compliance (76.8 percent).
Originality/value
Having good knowledge of childhood immunization and a high educational status positively influence a mothers’ compliance with child immunization.
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Seth R, Akinboyo I, Chhabra A, Qaiyum Y, Shet A, Gupte N, Jain AK, Jain SK. Mobile Phone Incentives for Childhood Immunizations in Rural India. Pediatrics 2018; 141:e20173455. [PMID: 29540571 PMCID: PMC5869335 DOI: 10.1542/peds.2017-3455] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES Young children in resource-poor settings remain inadequately immunized. We evaluated the role of compliance-linked incentives versus mobile phone messaging to improve childhood immunizations. METHODS Children aged ≤24 months from a rural community in India were randomly assigned to either a control group or 1 of 2 study groups. A cloud-based, biometric-linked software platform was used for positive identification, record keeping for all groups, and delivery of automated mobile phone reminders with or without compliance-linked incentives (Indian rupee Rs30 or US dollar $0.50 of phone talk time) for the study groups. Immunization coverage was analyzed by using multivariable Poisson regression. RESULTS Between July 11, 2016, and July 20, 2017, 608 children were randomly assigned to the study groups. Five hundred and forty-nine (90.3%) children fulfilled eligibility criteria, with a median age of 5 months; 51.4% were girls, 83.6% of their mothers had no schooling, and they were in the study for a median duration of 292 days. Median immunization coverage at enrollment was 33% in all groups and increased to 41.7% (interquartile range [IQR]: 23.1%-69.2%), 40.1% (IQR: 30.8%-69.2%), and 50.0% (IQR: 30.8%-76.9%) by the end of the study in the control group, the group with mobile phone reminders, and the compliance-linked incentives group, respectively. The administration of compliance-linked incentives was independently associated with improvement in immunization coverage and a modest increase in timeliness of immunizations. CONCLUSIONS Compliance-linked incentives are an important intervention for improving the coverage and timeliness of immunizations in young children in resource-poor settings.
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Affiliation(s)
| | | | | | | | - Anita Shet
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; and
| | - Nikhil Gupte
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ajay K. Jain
- Department of Pediatrics, Cardinal Glennon Children's Medical Center, Saint Louis University School of Medicine, St Louis, Missouri
| | - Sanjay K. Jain
- Departments of Pediatrics and,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; and
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Mor Z, Amit Aharon A, Sheffer R, Nehama H. Growth, developmental achievements and vaccines timeliness of undocumented migrant children from Eritrea compared with Israelis. PLoS One 2018. [PMID: 29518105 PMCID: PMC5843265 DOI: 10.1371/journal.pone.0193219] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Introduction Israel has absorbed >40,000 Eritrean undocumented migrants since 2007, while the majority live in the southern neighborhoods of Tel-Aviv. As non-citizens and citizens infants in Israel receive free preventive treatment at the mother and child health clinics (MCHC), this study aimed to compare development and growth achievements between children of Eritrean mothers (CE) to children of Israeli mothers (CI), and assess their compliance to routine follow-up and vaccination-timeliness. Methods This cohort study included all Israeli-born CE between 2009 and 2011, compared with a random sample of CI and treated at the same MCHC and followed-up to the age of 30-months. Dependent outcomes included anthropometric measurements, developmental achievements and adherence to immunization schedule. Results Of all 271 CE who were compared with 293 CI, no statistically significant differences were found in birth anthropometric measurements. Yet, CE had increased weight and length than CI after reaching one year of age (p<0.05). CE were more likely to fail in tests assessing fine-motor skills, linguistic and socio-emotional domains than CI, while no statistical difference was found in gross-motor achievements. At the end of follow-up, 203 (74.9%) of the CE and 271 (74.1%) of the CI completed the vaccination schedule, p = 0.9. Conclusion CE had greater anthropometric measurements than CI after one year of age, and showed higher impairments in fine motor, linguistic and socio-emotional domains. Adherence to vaccination was similar. The inequalities in child health should be responded in the MCTC, and Eritrean mothers should be trained with the current recommendations for child well-being.
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Affiliation(s)
- Zohar Mor
- Tel Aviv Department of Health, Tel Aviv, Israel
- Sackler Faculty of Medicine, School of Public Health, Tel Aviv University, Tel Aviv, Israel
- * E-mail:
| | - Anat Amit Aharon
- Sackler Faculty of Medicine, Nursing Department, Tel-Aviv University, Tel Aviv, Israel
- The Department of Public Health, Tel Aviv Municipality, Tel Aviv, Israel
| | | | - Haim Nehama
- The Department of Public Health, Tel Aviv Municipality, Tel Aviv, Israel
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Périnet S, Kiely M, De Serres G, Gilbert NL. Delayed measles vaccination of toddlers in Canada: Associated socio-demographic factors and parental knowledge, attitudes and beliefs. Hum Vaccin Immunother 2018; 14:868-874. [PMID: 29211621 PMCID: PMC5893185 DOI: 10.1080/21645515.2017.1412899] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Delaying vaccination increases the period of vulnerability of children against vaccine-preventable diseases. We used a nationally representative sample of Canadian two-year-old children to explore factors associated with delays in the uptake of the first dose of measles-containing vaccine, recommended in Canada for children at 12 months of age. Distribution of delays was determined using data from the 2013 Childhood National Immunization Coverage Survey. Logistic regression was used to examine sociodemographic factors and knowledge, attitudes and beliefs (KAB) associated with the two outcomes of interest: delays of one to six months (vaccination at 13 to 18 months of age) and delays of seven to 18 months (vaccination at 19 to 23 months of age). Overall, 69% (95% confidence interval [CI] 67–71) of children received their first valid dose on time. Twenty-nine percent (95% CI 27–31) and 11% (95% CI 9–12) of children were unvaccinated before turning 13 and 16 months of age, respectively. Factors associated with delays of one to six months were being a girl, being born outside Canada, and the jurisdiction of residence. Being from a single-parent family, being born outside Canada and the jurisdiction of residence were associated with delays of seven to 18 months, suggesting that potential barriers might be at play. Associations between KAB and vaccination delays indicate that vaccine hesitancy could contribute to measles vaccination delays in Canada. Barriers in accessing vaccination services and the role of vaccine hesitancy in timely vaccination must be better understood to reduce vaccination delays in toddlers in Canada.
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Affiliation(s)
- Simone Périnet
- a Centre for Immunization and Respiratory Infectious Diseases, Public Health Agency of Canada , Ontario Canada.,b Département de médecine sociale et préventive , Université de Montréal , Montréal , Québec , Canada
| | - Marilou Kiely
- c Institut national de santé publique du Québec, Québec , Canada.,d Département de médecine sociale et préventive , Université Laval , Québec , Québec , Canada
| | - Gaston De Serres
- c Institut national de santé publique du Québec, Québec , Canada.,d Département de médecine sociale et préventive , Université Laval , Québec , Québec , Canada
| | - Nicolas L Gilbert
- a Centre for Immunization and Respiratory Infectious Diseases, Public Health Agency of Canada , Ontario Canada.,b Département de médecine sociale et préventive , Université de Montréal , Montréal , Québec , Canada
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Mithal P, Simmons P, Cornelissen T, Wong H, Pillai Riddell R, McMurtry CM, Burry L, Stephens D, Taddio A. To look or not to look during vaccination: A pilot randomized trial. Can J Pain 2018; 2:1-8. [PMID: 35005359 PMCID: PMC8730672 DOI: 10.1080/24740527.2017.1412254] [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: 11/29/2022]
Abstract
Background Clinicians commonly advise patients to look away from the needle during vaccinations; however, this recommendation is not evidence based. Aim The aim of this study was to determine whether looking at the needle versus looking away affects pain and fear during vaccinations in adults. Methods This was a pilot randomized two-group parallel trial with university students receiving influenza vaccinations. Participants were stratified according to their initial needle-looking preference and randomly assigned to either look at versus away from the needle. Participants self-reported their pain and fear during vaccination. Results Of the 184 subjects who agreed to participate, 160 were enrolled; 66% were female. A three-way analysis of variance (ANOVA; Looking allocation assignment × Looking preference × Sex) revealed a significant main effect of looking allocation assignment on fear (P = 0.025); those who were randomized to look had higher fear scores than those who were randomized to look away. There was also a significant main effect of looking preference on fear (P < 0.001); those who preferred to look away had higher fear scores than those who preferred to look. There was no evidence of an effect of looking allocation assignment or looking preference on pain. There was a significant main effect of sex on fear and pain, with females reporting higher pain and fear scores than males (P = 0.017 and P = 0.001, respectively). There were no significant interactions. Conclusion These preliminary findings suggest that advising individuals to look away from the needle reduces fear. A larger trial including more individuals and a different population is recommended to confirm the results.
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Affiliation(s)
- Priyanjali Mithal
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Pamela Simmons
- Health and Wellness Centre, University of Toronto, Toronto, Ontario, Canada
| | - Tessa Cornelissen
- Health and Wellness Centre, University of Toronto, Toronto, Ontario, Canada
| | - Horace Wong
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | | | - C Meghan McMurtry
- Department of Psychology, University of Guelph, Guelph, Ontario, Canada
| | - Lisa Burry
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Derek Stephens
- Child Health Evaluative Services, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Anna Taddio
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.,Child Health Evaluative Services, The Hospital for Sick Children, Toronto, Ontario, Canada
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Bailly AC, Gras P, Lienhardt JF, Requillart JC, Vié-le-Sage F, Martinot A, Dubos F. Timeliness of vaccination in infants followed by primary-care pediatricians in France. Hum Vaccin Immunother 2017; 14:1018-1023. [PMID: 29182420 DOI: 10.1080/21645515.2017.1409318] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Vaccination status is more often evaluated by up-to-date vaccination coverage rather than timeliness of immunization. Delaying vaccination may be dangerous during infancy. The aim of this study was to identify the importance of potentially dangerous vaccination delay (previously defined) and determinants of these delays. We conducted a national, prospective, vaccination survey in June 2014, with primary care pediatricians. Children, 2 to 24 months of age, were included. Data about vaccination were extracted from their health books. Additional data were collected through a standardized questionnaire. Vaccine coverage rate and timeliness were calculated. Variables associated with a potentially dangerous vaccination delay as previously defined were determined by a multivariable analysis. Among the 443 included children (mean age 10.8 months, 49% males), 13% to 58% of vaccine doses according to vaccine type were done with a potentially dangerous delay. Globally, 47% of children had at least one potentially dangerous immunization delay. We identified two risk factors of potentially dangerous delayed immunization globally: an increasing age of the child (adjusted odds ratio: 1.2, 95% confidence interval [CI]: 1.1-1.3, p < 10-3), and a working mother (adjusted OR: 2.4, 95% CI: 1.2-4.7, p = 0.01). Despite a good vaccine coverage rate, a large number of children had a potentially dangerous vaccination delay. A high level of vigilance regarding these immunization delays, and particularly to the patients sharing the risk factors of immunization delay identified here, can increase quality and effectiveness of the vaccine protection.
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Affiliation(s)
| | - Pauline Gras
- a CHRU Lille, Pediatric Emergency & Infectious Diseases Unit , Lille , France.,b Univ. Lille, Faculty of Medicine , Lille , France
| | | | | | - François Vié-le-Sage
- c AFPA, Association Française de Pédiatrie Ambulatoire , Saint-Germain-en-Laye , France
| | - Alain Martinot
- a CHRU Lille, Pediatric Emergency & Infectious Diseases Unit , Lille , France.,b Univ. Lille, Faculty of Medicine , Lille , France.,d Univ. Lille, EA2694, Public Health: Epidemiology & Quality of Care , Lille , France
| | - François Dubos
- a CHRU Lille, Pediatric Emergency & Infectious Diseases Unit , Lille , France.,b Univ. Lille, Faculty of Medicine , Lille , France.,d Univ. Lille, EA2694, Public Health: Epidemiology & Quality of Care , Lille , France
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Abstract
A comparative descriptive study was conducted to determine the effectiveness of text messages with pictures compared with plain text messages or verbal reminders in improving measles, mumps, and rubella immunization compliance in the rural areas of the Philippines. We found that text messaging with or without pictures is a feasible and useful tool in measles, mumps, rubella immunization compliance for childhood immunization. Texting with pictures (n = 23), however, was no more effective than plain text messaging (n = 19) or verbal reminder (n = 17) in improving measles, mumps, and rubella immunization compliance. Compared with parents who received verbal reminders alone, either type of text reminders was linked to parents bringing their child for measles, mumps, and rubella immunization on a timelier basis, as defined by the difference between the scheduled visit and the actual visit, although this was not statistically significant. Mobile technology that uses text reminders for immunization can potentially improve the communication process between parent, the public health nurse, and healthcare provider. Future studies can explore the application of plain text messages or text messages with pictures to improve compliance more broadly for maternal and child healthcare especially in rural areas of developing countries and may be a helpful tool for health promotion for this population.
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38
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Effective nutrition education and communication for sustainable maternal and child health. Proc Nutr Soc 2017; 76:504-515. [PMID: 28662730 DOI: 10.1017/s0029665117001070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Maternal and child health (MCH) consists of an interdependent reproductive system that collectively determines the survival of the mother during childbirth, and determines the health and survival of the child. This interdependency underscores the importance of appropriate and timely interventions during pregnancy through the first 1000 d at the minimum. The Millennium Development Goals (MDG) recommended the use of the continuum of care for the development of interventions by addressing all the stages of MCH. The purpose of the present paper is to review the factors that contributed to the attainment of the MDG 4 and MDG 5 by analysing the interventions conducted by the countries that achieved at least 5·0 and 5·5 %, respectively, and determine the level of their intervention based on the MCH conceptual framework. Out of the eighteen selected countries discussed, fifteen countries achieved their target for either MDG 4 or MDG 5 or both, while three countries did not achieve their target. The countries that were more likely to achieve their targets addressed the societal, underlying and direct causes, and implemented country wide policies. In contrast, the countries that did not succeed were more likely to address the direct causes with poor policy implementation. Understanding the motivation and limitations of the target population, including nutrition education and targeting behaviour change has the potential to result in sustainable MCH. This information has the potential to enlighten the policymakers as we progress to the sustainable development goals, specifically goals 2 and 3.
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Setiawan D, Luttjeboer J, Pouwels KB, Wilschut JC, Postma MJ. Immunogenicity and safety of human papillomavirus (HPV) vaccination in Asian populations from six countries: a meta-analysis. Jpn J Clin Oncol 2017; 47:265-276. [PMID: 28042137 DOI: 10.1093/jjco/hyw192] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 12/05/2016] [Indexed: 11/14/2022] Open
Abstract
Cervical cancer is a serious public-health problem in Asian countries. Since human papillomavirus (HPV) infection is the main risk factor for cervical cancer, HPV vaccination is considered a promising strategy to prevent cervical cancer. However, comprehensive immunogenicity and safety information for Asian populations is lacking. We searched four electronic databases including PubMed, EMBASE, Cochrane Library, and clinicaltrials.gov. We reviewed selected manuscripts and extracted the pooled relative risk (RR) from immunogenicity and safety information on HPV vaccination among women in Asian countries. We identified two quadrivalent-vaccine studies and eight bivalent-vaccine studies conducted in Asian countries. Analysis across these studies suggested that the HPV vaccines significantly enhanced HPV16- and HPV18-specific antibody among both uninfected (RR 85.69; 95% confidence interval (CI) 31.51-233.04 and 62.77; 95% CI 37.4-105.51) and infected individuals (RR 8.60; 95% CI 6.95-10.64 and RR 8.13; 95% CI 5.96-11.11). Furthermore, HPV vaccination among Asian populations has a favorable safety profile, with only slightly higher risks of local (RR: 1.89; 95% CI 1.65-2.17) and systemic (RR: 1.33; 95% CI 1.18-1.50) adverse events in vaccinated individuals compared with controls. For Asian populations, HPV vaccines enhance the level of HPV16- and HPV18-specific antibodies for both uninfected and infected individuals. Also, the risk of adverse events related to vaccination are acceptable. More data are needed to establish vaccine efficacy with regard to prevention of HPV infection and further outcomes including cervical intraepithelial neoplasia (CIN) and cervical cancer.
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Affiliation(s)
- Didik Setiawan
- Unit of PharmacoEpidemiology & Pharmacoeconomics (PE2), Department of Pharmacy, University of Groningen, Groningen, The Netherlands.,Faculty of Pharmacy, University of Muhammadiyah Purwokerto, Purwokerto, Indonesia
| | - Jos Luttjeboer
- Unit of PharmacoEpidemiology & Pharmacoeconomics (PE2), Department of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Koen B Pouwels
- Unit of PharmacoEpidemiology & Pharmacoeconomics (PE2), Department of Pharmacy, University of Groningen, Groningen, The Netherlands.,Modelling and Economics Unit, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - Jan C Wilschut
- Department of Medical Microbiology, University Medical Center Groningen, University of Groningen, Groningen
| | - Maarten J Postma
- Unit of PharmacoEpidemiology & Pharmacoeconomics (PE2), Department of Pharmacy, University of Groningen, Groningen, The Netherlands.,Institute of Science in Healthy Aging & healthcaRE (SHARE), University Medical Center Groningen (UMCG), Groningen.,Department of Epidemiology, UMCG, Groningen, The Netherlands
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Nicoli F, Appay V. Immunological considerations regarding parental concerns on pediatric immunizations. Vaccine 2017; 35:3012-3019. [PMID: 28465096 DOI: 10.1016/j.vaccine.2017.04.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 03/31/2017] [Accepted: 04/12/2017] [Indexed: 01/10/2023]
Abstract
Despite the fundamental role of vaccines in the decline of infant mortality, parents may decide to decline vaccination for their own children. Many factors may influence this decision, such as the belief that the infant immune system is weakened by vaccines, and concerns have been raised about the number of vaccines and the early age at which they are administered. Studies focused on the infant immune system and its reaction to immunizations, summarized in this review, show that vaccines can overcome those suboptimal features of infant immune system that render them more at risk of infections and of their severe manifestations. In addition, many vaccines have been shown to improve heterologous innate and adaptive immunity resulting in lower mortality rates for fully vaccinated children. Thus, multiple vaccinations are necessary and not dangerous, as infants can respond to several antigens as well as when responding to single stimuli. Current immunization schedules have been developed and tested to avoid vaccine interference, improve benefits and reduce side effects compared to single administrations. The infant immune system is therefore capable, early after birth, of managing several antigenic challenges and exploits them to prompt its development.
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Affiliation(s)
- Francesco Nicoli
- Sorbonne Universités, UPMC Univ Paris 06, DHU FAST, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), F-75013 Paris, France; INSERM, U1135, CIMI-Paris, F-75013 Paris, France.
| | - Victor Appay
- Sorbonne Universités, UPMC Univ Paris 06, DHU FAST, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), F-75013 Paris, France; INSERM, U1135, CIMI-Paris, F-75013 Paris, France; International Research Center of Medical Sciences (IRCMS), Kumamoto University, Kumamoto 860-0811, Japan
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Ernst KD. Electronic Alerts Improve Immunization Rates in Two-month-old Premature Infants Hospitalized in the Neonatal Intensive Care Unit. Appl Clin Inform 2017; 8:206-213. [PMID: 28246672 DOI: 10.4338/aci-2016-09-ra-0156] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 12/11/2016] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To determine if an electronic alert improves 2 month immunization rates in infants remaining hospitalized in the neonatal intensive care unit. METHODS Institutional Review Board-approved retrospective chart review of 261 infants with birth weights <2 kg and still hospitalized at ≥ 58 days. Charts were reviewed between 2009 and 2013, before and after the 2011 electronic alert was instituted in the electronic medical record from days 56 to 67 to remind providers that immunizations were due. Order and administration dates of two-month vaccine components (Diphtheria, Haemophilus influenza B, Hepatitis B, Pertussis, Pneumococcal, Polio, Tetanus) were determined, and infants were considered fully immunized, partially immunized, or unimmunized by day 90 or discharge, whichever came first. RESULTS After the alert, the timing of vaccine orders decreased from day 67 to day 61 (p<0.0001) and vaccine administration decreased from day 71 to day 64 (p<0.0001). Missing vaccine orders decreased from 14% [17/121] to 3% [4/140] (p=0.001) with missing administrations decreasing from 21% [26/121] to 4% [6/140] (p<0.0001). Fully immunized rates increased from 71% [86/121] to 94% [132/140] (p<0.0001). CONCLUSIONS A significant improvement in immunization rates in two-month-old infants in the neonatal intensive care unit occurred by 90 days after implementing an alert in the electronic medical record.
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Affiliation(s)
- Kimberly D Ernst
- Kimberly D. Ernst, MD, MSMI, The University of Oklahoma Health Sciences Center, Section of Neonatal-Perinatal Medicine, 1200 Everett Drive, 7th Floor North Pavilion, Oklahoma City, OK 73104, USA, Telephone: (405) 271-5215 Fax: (405) 271-1236, E-mail:
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Schweitzer A, Akmatov MK, Krause G. Hepatitis B vaccination timing: results from demographic health surveys in 47 countries. Bull World Health Organ 2017; 95:199-209G. [PMID: 28250533 PMCID: PMC5328113 DOI: 10.2471/blt.16.178822] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 10/25/2016] [Accepted: 11/28/2016] [Indexed: 12/13/2022] Open
Abstract
Objective To examine the impact of hepatitis B vaccination schedules and types of vaccines on hepatitis B vaccination timing. Methods We used data for 211 643 children from demographic and health surveys in 47 low- and middle-income countries (median study year 2012). Data were from vaccination cards and maternal interviews. We grouped countries according to the vaccination schedule and type of vaccine used (monovalent or combination). For each country, we calculated hepatitis B vaccination coverage and timely receipt of vaccine doses. We used multivariable logistic regression models to study the effect of vaccination schedules and types on vaccination delay. Findings Substantial delays in vaccination were observed even in countries with fairly high coverage of all doses. Median delay was 1.0 week (interquartile range, IQR: 0.3 to 3.6) for the first dose (n = 108 626 children) and 3.7 weeks (IQR: 1.4 to 9.3) for the third dose (n = 101 542). We observed a tendency of lower odds of delays in vaccination schedules starting at 6 and at 9 weeks of age. For the first vaccine dose, we recorded lower odds of delays for combination vaccines than for monovalent vaccines (adjusted odds ratio, aOR: 0.76, 95% confidence interval, CI: 0.71 to 0.81). Conclusion Wide variations in hepatitis B vaccination coverage and adherence to vaccination schedules across countries underscore the continued need to strengthen national immunization systems. Timely initiation of the vaccination process might lead to timely receipt of successive doses and improved overall coverage. We suggest incorporating vaccination timing as a performance indicator of vaccination programmes to complement coverage metrics.
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Affiliation(s)
- Aparna Schweitzer
- Helmholtz Centre for Infection Research (HZI), Inhoffenstraße 7, Brunswick 38124, Germany
| | - Manas K Akmatov
- Helmholtz Centre for Infection Research (HZI), Inhoffenstraße 7, Brunswick 38124, Germany
| | - Gérard Krause
- Helmholtz Centre for Infection Research (HZI), Inhoffenstraße 7, Brunswick 38124, Germany
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Le Roux K, Akin-Olugbade O, Katzen LS, Laurenzi C, Mercer N, Tomlinson M, Rotheram-Borus MJ. Immunisation coverage in the rural Eastern Cape - are we getting the basics of primary care right? Results from a longitudinal prospective cohort study. S Afr Med J 2016; 107:52-55. [PMID: 28112092 PMCID: PMC5659717 DOI: 10.7196/samj.2016.v107.i1.11242] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Immunisations are one of the most cost-effective public health interventions available and South Africa (SA) has implemented a comprehensive immunisation schedule. However, there is disagreement about the level of immunisation coverage in the country and few studies document the immunisation coverage in rural areas. OBJECTIVE To examine the successful and timely delivery of immunisations to children during the first 2 years of life in a deeply rural part of the Eastern Cape Province of SA. METHODS From January to April 2013, a cohort of sequential births (N=470) in the area surrounding Zithulele Hospital in the OR Tambo District of the Eastern Cape was recruited and followed up at home at 3, 6, 9, 12 and 24 months post birth, up to May 2015. Immunisation coverage was determined using Road-to-Health cards. RESULTS The percentages of children with all immunisations up to date at the time of interview were: 48.6% at 3 months, 73.3% at 6 months, 83.9% at 9 months, 73.3% at 12 months and 73.2% at 24 months. Incomplete immunisations were attributed to stock-outs (56%), lack of awareness of the immunisation schedule or of missed immunisations by the mother (16%) and lack of clinic attendance by the mother (19%). Of the mothers who had visited the clinic for baby immunisations, 49.8% had to make multiple visits because of stock-outs. Measles coverage (of at least one dose) was 85.2% at 1 year and 96.3% by 2 years, but 20.6% of babies had not received a second measles dose (due at 18 months) by 2 years. Immunisations were often given late, particularly the 14-week immunisations. CONCLUSIONS Immunisation rates in the rural Eastern Cape are well below government targets and indicate inadequate provision of basic primary care. Stock-outs of basic childhood immunisations are common and are, according to mothers, the main reason for their children's immunisations not being up to date. There is still much work to be done to ensure that the basics of disease prevention are being delivered at rural clinics in the Eastern Cape, despite attempts to re-engineer primary healthcare in SA.
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Affiliation(s)
- K Le Roux
- Visiting research scholar, Center for Health and Wellbeing, Woodrow Wilson School, Princeton University, New Jersey, USA; Primary Healthcare Directorate, University of Cape Town, South Africa; Zithulele Hospital, Eastern Cape, South Africa.
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Swallow W, Roberts JC. An Evidence-Based Project Demonstrating Increased School Immunization Compliance Following a School Nurse-Initiated Vaccine Compliance Strategy. J Sch Nurs 2016; 32:385-389. [PMID: 27573417 DOI: 10.1177/1059840516665216] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
During the 2012-2013 school year, only 66% of students at a Northern Indiana High School were in compliance with school immunization requirements. We report here successful implementation of evidence-based, time, and cost-effective methods aimed at increasing school immunization compliance. A three-stage strategy initiated by the school nurse was employed. In the first stage, letters were sent home with students, indicating the lack of compliance with school immunization laws. The next stage involved a second letter sent home with the student which contained immunization information from the Indiana State Department of Health, appointment information, and a copy of the student's immunization record. In the final stage, letters were sent home via e-mail and phone calls were used for follow-up. At each stage, students and parents were given an explanation of exclusion and a date when exclusion would apply. Postintervention, vaccine compliance was 99.6%, exceeding both national and state averages.
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Affiliation(s)
| | - Jill C Roberts
- Department of Environmental and Occupational Health, University of South Florida, Tampa, FL, USA
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Gras P, Bailly AC, Lagrée M, Dervaux B, Martinot A, Dubos F. What timing of vaccination is potentially dangerous for children younger than 2 years? Hum Vaccin Immunother 2016; 12:2046-2052. [PMID: 27215704 DOI: 10.1080/21645515.2016.1157239] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Vaccine-preventable diseases still occur although measured coverage rates at 2 y of age are high. The occurrence of these diseases may be explained in part by untimely, that is, late vaccination. Our objective was to identify potentially dangerous vaccination delays for each dose of each vaccine in children younger than 2 y. A 3-round Delphi process was conducted by e-mail. We recruited 37 French experts in vaccines for children: 16 from the Infovac-France group and 21 from the French study group for pediatric infectious diseases. Items were generated by a literature review for the 10 vaccine doses recommended before 2 y of age. Item reduction in round 1 and 2 and any consensus in round 3 used a 70% consensus cutoff. The mean participation rate was 79%. Delays that should not be exceeded were identified for all vaccine doses. The 70% consensus was reached for 6 of the 10 vaccine doses: 15 d after the recommended date for the first 2 doses of the diphtheria-tetanus-acellular pertussis-inactivated polio vaccine/Haemophilus influenzae b vaccine and for the second dose of the pneumococcal conjugate vaccine, 1 month for the meningococcal C vaccine and for the first dose of the measles-mumps-rubella vaccine, and 11 y of age for completion of the hepatitis B vaccination. This Delphi process identified potentially dangerous vaccination delays for children to the age of 2 y. These can be used as new indicators in further studies of vaccine effectiveness and can help to improve the quality of vaccine protection in children.
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Affiliation(s)
- Pauline Gras
- a Univ. Lille, CHU Lille, Pediatric Emergency Unit & Infectious Diseases , Lille , France
| | - Anne-Charlotte Bailly
- a Univ. Lille, CHU Lille, Pediatric Emergency Unit & Infectious Diseases , Lille , France
| | - Marion Lagrée
- a Univ. Lille, CHU Lille, Pediatric Emergency Unit & Infectious Diseases , Lille , France.,b Groupe de Pathologie Infectieuse Pédiatrique (GPIP) , France
| | - Benoit Dervaux
- c Univ. Lille, CHU Lille , Department of Economy & Management , Lille , France.,d Univ. Lille, EA2694, Public Health: Epidemiology & Quality of Care , Lille , France
| | - Alain Martinot
- a Univ. Lille, CHU Lille, Pediatric Emergency Unit & Infectious Diseases , Lille , France.,b Groupe de Pathologie Infectieuse Pédiatrique (GPIP) , France.,d Univ. Lille, EA2694, Public Health: Epidemiology & Quality of Care , Lille , France
| | - François Dubos
- a Univ. Lille, CHU Lille, Pediatric Emergency Unit & Infectious Diseases , Lille , France.,b Groupe de Pathologie Infectieuse Pédiatrique (GPIP) , France.,d Univ. Lille, EA2694, Public Health: Epidemiology & Quality of Care , Lille , France
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Hu T, Decker SL, Chou SY. Medicaid Pay for Performance Programs and Childhood Immunization Status. Am J Prev Med 2016; 50:S51-S57. [PMID: 27102859 PMCID: PMC7375194 DOI: 10.1016/j.amepre.2016.01.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 01/07/2016] [Accepted: 01/21/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Although pay for performance (P4P) programs are being increasingly used by state Medicaid programs to provide incentives for managed care plans to provide high-quality care, no national study has examined the effects of these plans on commonly targeted outcomes such as childhood immunization rates. METHODS Information from the 1999-2011 National Immunization Survey combined with information on state Medicaid P4P programs from the Centers for Medicare and Medicaid Services was used to study the effect of Medicaid P4P programs on the immunization status of children aged 19-35 months. Difference-in-difference-in-difference models were used to study whether adoption of Medicaid P4P programs was associated with higher immunization rates among Medicaid-eligible children relative to non-Medicaid eligible children within states that adopted Medicaid P4P programs compared with states that did not. Linear probability models were used in all estimations, and models controlled for demographic factors. RESULTS The study found no overall effect of Medicaid P4P on the chance that children aged 19-35 months had completed the 4:3:1:3:3:1 vaccination series. However, there was a 4 percentage point increase in the chance that a child 19-23 months had completed the series. CONCLUSIONS This study provides some evidence that Medicaid P4P programs may be helpful in improving childhood vaccination rates. Further study of the effects on other targeted outcomes as well as the effects of different P4P program designs may increase understanding of the potential role of these programs in improving the quality of health care.
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Affiliation(s)
- Tianyan Hu
- Department of Health Policy and Management, Florida International University, Miami, Florida
| | - Sandra L Decker
- Center for Financing, Access and Cost Trends, Agency for Health Research Quality, Rockville, Maryland.
| | - Shin-Yi Chou
- Department of Economics, Lehigh University, Bethlehem, Pennsylvania
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D’Ardenne KK, Darrow J, Furniss A, Chavez C, Hernandez H, Berman S, Asturias EJ. Use of rapid needs assessment as a tool to identify vaccination delays in Guatemala and Peru. Vaccine 2016; 34:1719-25. [DOI: 10.1016/j.vaccine.2016.01.060] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Revised: 01/24/2016] [Accepted: 01/25/2016] [Indexed: 10/22/2022]
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Wang E, Baras Y, Buttenheim AM. "Everybody just wants to do what's best for their child": Understanding how pro-vaccine parents can support a culture of vaccine hesitancy. Vaccine 2015; 33:6703-9. [PMID: 26518397 DOI: 10.1016/j.vaccine.2015.10.090] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 10/07/2015] [Accepted: 10/16/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Although a large majority of parents vaccinate their children, vaccine hesitancy has become more widespread. It is not well understood how this culture of vaccine hesitancy has emerged and how it influences parents' decisions about vaccine schedules. OBJECTIVE We sought to examine how attitudes and beliefs of parents who self-report as pro-vaccine are developed and contribute to immunization decisions, including delaying or spacing vaccines. METHODS Open-ended, in-depth interviews (N=23) were conducted with upper-middle class parents with young children living in Philadelphia. Interview data were coded and key themes identified related to vaccine decision-making. RESULTS Parents who sought out vaccine information were often overwhelmed by the quantity and ambiguity when interpreting that information, and, consequently, had to rely on their own instinct or judgment to make vaccine decisions. In particular, while parents in this sample did not refuse vaccines, and described themselves as pro-vaccine, they did frequently delay or space vaccines. This experience also generated sympathy for and tolerance of vaccine hesitancy in other parents. Parents also perceived minimal severe consequences for deviating from the recommended immunization schedule. CONCLUSION These findings suggest that the rise in and persistence of vaccine hesitancy and refusal are, in part, influenced by the conflicts in the information parents gather, making it difficult to interpret. Considerable deviations from the recommended vaccination schedule may manifest even within a pro-vaccine population due to this perceived ambiguity of available information and resulting tolerance for vaccine hesitancy.
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Affiliation(s)
- Eileen Wang
- Department of History and Sociology of Science, University of Pennsylvania, Suite 303 Claudia Cohen Hall, 249 S. 36th Street, Philadelphia, PA 19104, USA.
| | - Yelena Baras
- School of Nursing, University of Pennsylvania, 416 Fagin Hall, 418 Curie Blvd, Philadelphia, PA 19014, USA.
| | - Alison M Buttenheim
- School of Nursing, University of Pennsylvania, 416 Fagin Hall, 418 Curie Blvd, Philadelphia, PA 19014, USA.
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Akmatov MK, Kimani-Murage E, Pessler F, Guzman CA, Krause G, Kreienbrock L, Mikolajczyk RT. Evaluation of invalid vaccine doses in 31 countries of the WHO African Region. Vaccine 2014; 33:892-901. [PMID: 25523526 DOI: 10.1016/j.vaccine.2014.10.089] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 10/06/2014] [Accepted: 10/08/2014] [Indexed: 11/30/2022]
Abstract
We examined (a) the fraction of and extent to which vaccinations were administered earlier than recommended (age-invalid) or with too short intervals between vaccine doses (interval-invalid) in countries of the World Health Organisation (WHO) African Region and (b) individual- and community-level factors associated with invalid vaccinations using multilevel techniques. Data from the Demographic and Health Surveys conducted in the last 10 years in 31 countries were used. Information about childhood vaccinations was based on vaccination records (n=134,442). Invalid vaccinations (diphtheria, tetanus, pertussis [DTP1, DTP3] and measles-containing vaccine (MCV)) were defined using the WHO criteria. The median percentages of invalid DTP1, DTP3 and MCV vaccinations across all countries were 12.1% (interquartile range, 9.4-15.2%), 5.7% (5.0-7.6%), and 15.5% (10.0-18.1%), respectively. Of the invalid DTP1 vaccinations, 7.4% and 5.5% were administered at child's age of less than one and two weeks, respectively. In 12 countries, the proportion of invalid DTP3 vaccinations administered with an interval of less than two weeks before the preceding dose varied between 30% and 50%. In 13 countries, the proportion of MCV doses administered at child's age of less than six months varied between 20% and 45%. Community-level variables explained part of the variation in invalid vaccinations. Invalid vaccinations are common in African countries. Timing of childhood vaccinations should be improved to ensure an optimal protection against vaccine-preventable infections and to avoid unnecessary wastage in these economically deprived countries.
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Affiliation(s)
- Manas K Akmatov
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany; TWINCORE Centre for Experimental and Clinical Infection Research, Hannover, Germany.
| | | | - Frank Pessler
- TWINCORE Centre for Experimental and Clinical Infection Research, Hannover, Germany
| | - Carlos A Guzman
- Department of Vaccinology and Applied Microbiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Gérard Krause
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany; Hannover Medical School, Hannover, Germany
| | - Lothar Kreienbrock
- Department of Biometry, Epidemiology and Information Processing, University for Veterinary Medicine, Hanover, Germany
| | - Rafael T Mikolajczyk
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany; Hannover Medical School, Hannover, Germany
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Surkan PJ, Kiihl SF, Kozuki N, Vieira LMC. Social support of low-income Brazilian mothers related to time to completion of childhood vaccinations. Hum Vaccin Immunother 2014; 8:596-603. [DOI: 10.4161/hv.19203] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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