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Souza JFA, Silva TPRD, Silva TMRD, Amaral CD, Ribeiro EEN, Vimieiro AM, Oliveira MMMD, Matozinhos FP. [Vaccination coverage in children under one year of age in Minas Gerais state, Brazil]. CIENCIA & SAUDE COLETIVA 2022; 27:3659-3667. [PMID: 36000652 DOI: 10.1590/1413-81232022279.07302022] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/16/2022] [Indexed: 11/22/2022] Open
Abstract
The scope of this article is to analyze vaccination coverage rates in children under one year of age during the period from 2015 to 2020 in the state of Minas Gerais (MG). It involved an ecological, time-series study on vaccination coverage in children under 1 year of age, considering the 28 Regional Health Management/Superintendencies (GRS/SRS) of MG as the unit of analysis. The following immunobiological vaccine coverage was analyzed: Bacillus Calmette and Guérin, human rotavirus, pneumococcal 10, pentavalent, meningococcus C, yellow fever, and polio vaccines. The Prais-Winsten autoregressive model was employed for trend analysis. The year 2020 stands out, as it presented the lowest proportion of GRS and SRS that reached the recommended vaccine coverage goals for the immunobiologicals analyzed. Regarding the analysis of the coverage trend, 8 of the 28 GRS/SRS showed a decreasing trend for at least 5 of the 7 immunobiologicals evaluated. We observed a downward trend in the vaccination coverage of at least five immunobiologicals in eight of the GRS/SRS, with emphasis on the Pentavalent vaccine, which showed a downward trend in vaccination coverage in 60.71% of the GRS and SRS.
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Affiliation(s)
- Janaina Fonseca Almeida Souza
- Secretaria de Estado da Saúde de Minas Gerais. Rodovia Papa João Paulo II 4143, Serra Vede. 31630-900 Belo Horizonte MG Brasil.
| | - Thales Philipe Rodrigues da Silva
- Programa de Pós-Graduação em Enfermagem, Departamento de Enfermagem Materno-Infantil e Saúde Pública, Escola de Enfermagem, Universidade Federal de Minas Gerais (UFMG). Belo Horizonte MG Brasil
| | | | - Carolina Dourado Amaral
- Secretaria de Estado da Saúde de Minas Gerais. Rodovia Papa João Paulo II 4143, Serra Vede. 31630-900 Belo Horizonte MG Brasil.
| | - Elice Eliane Nobre Ribeiro
- Secretaria de Estado da Saúde de Minas Gerais. Rodovia Papa João Paulo II 4143, Serra Vede. 31630-900 Belo Horizonte MG Brasil.
| | - Aline Mendes Vimieiro
- Secretaria de Estado da Saúde de Minas Gerais. Rodovia Papa João Paulo II 4143, Serra Vede. 31630-900 Belo Horizonte MG Brasil.
| | | | - Fernanda Penido Matozinhos
- Departamento de Enfermagem Materno-Infantil e Saúde Pública, Escola de Enfermagem, UFMG. Belo Horizonte MG Brasil
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Shen AK, Sobczyk EA, Coyle R, Tirmal A, Hannan C. How ready was the US vaccination infrastructure and network of immunization information systems for COVID-19 vaccination campaigns: Recommendations to strengthen the routine vaccination program and prepare for the next pandemic. Hum Vaccin Immunother 2022; 18:2088010. [PMID: 35796624 PMCID: PMC9621060 DOI: 10.1080/21645515.2022.2088010] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) pandemic vaccination campaigns globally have been unlike any effort in history. In the United States, the success of these efforts, in part, has hinged on the timely capture and reporting of an unprecedented amount of data from a significantly greater number of administering providers than for routine vaccinations. The pandemic response has highlighted the need to explore the status and value of vaccination data as the critical glue that connects all aspects of the upstream US vaccine development and downstream vaccination delivery system. In this review, we examine immunization information systems and the role that data and staffing play in pandemic responses. We offer three strategic recommendations—regarding funding, expanded provider enrollment, and data reporting—informed by a literature review, a survey and focus group from a convenience sample of 22 immunization jurisdictions, and the vision for enhanced data flow to improve future pandemic responses and routine vaccination.
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Affiliation(s)
- Angela K Shen
- Vaccine Education Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Leonard David Institute, University of Pennsylvania, Philadelphia, PA, USA.,Perelman School of Medicine, Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, PA, USA.,Immunize.org, St. Paul, MN, USA
| | | | - Rebecca Coyle
- American Immunization Registry Association, Washington, DC, USA
| | - Amber Tirmal
- Philadelphia Department of Public Health, Philadelphia, PA, USA
| | - Claire Hannan
- Association of Immunization Managers, Washington, DC, USA
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Secor AM, Mtenga H, Richard J, Bulula N, Ferriss E, Rathod M, Ryman TK, Werner L, Carnahan E. Added Value of Electronic Immunization Registries in Low- and Middle-Income Countries: Observational Case Study in Tanzania. JMIR Public Health Surveill 2022; 8:e32455. [PMID: 35060919 PMCID: PMC8817222 DOI: 10.2196/32455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 10/15/2021] [Accepted: 10/15/2021] [Indexed: 12/04/2022] Open
Abstract
Background There is growing interest and investment in electronic immunization registries (EIRs) in low- and middle-income countries. EIRs provide ready access to patient- and aggregate-level service delivery data that can be used to improve patient care, identify spatiotemporal trends in vaccination coverage and dropout, inform resource allocation and program operations, and target quality improvement measures. The Government of Tanzania introduced the Tanzania Immunization Registry (TImR) in 2017, and the system has since been rolled out in 3736 facilities in 15 regions. Objective The aims of this study are to conceptualize the additional ways in which EIRs can add value to immunization programs (beyond measuring vaccine coverage) and assess the potential value-add using EIR data from Tanzania as a case study. Methods This study comprised 2 sequential phases. First, a comprehensive list of ways EIRs can potentially add value to immunization programs was developed through stakeholder interviews. Second, the added value was evaluated using descriptive and regression analyses of TImR data for a prioritized subset of program needs. Results The analysis areas prioritized through stakeholder interviews were population movement, missed opportunities for vaccination (MOVs), continuum of care, and continuous quality improvement. The included TImR data comprised 958,870 visits for 559,542 patients from 2359 health facilities. Our analyses revealed that few patients sought care outside their assigned facility (44,733/810,568, 5.52% of applicable visits); however, this varied by region; facility urbanicity, type, ownership, patient volume, and duration of TImR system use; density of facilities in the immediate area; and patient age. Analyses further showed that MOVs were highest among children aged <12 months (215,576/831,018, 25.94% of visits included an MOV and were applicable visits); however, there were few significant differences based on other individual or facility characteristics. Nearly half (133,337/294,464, 45.28%) of the children aged 12 to 35 months were fully vaccinated or had received all doses except measles-containing vaccine–1 of the 14-dose under-12-month schedule (ie, through measles-containing vaccine–1), and facility and patient characteristics associated with dropout varied by vaccine. The continuous quality improvement analysis showed that most quality issues (eg, MOVs) were concentrated in <10% of facilities, indicating the potential for EIRs to target quality improvement efforts. Conclusions EIRs have the potential to add value to immunization stakeholders at all levels of the health system. Individual-level electronic data can enable new analyses to understand service delivery or care-seeking patterns, potential risk factors for underimmunization, and where challenges occur. However, to achieve this potential, country programs need to leverage and strengthen the capacity to collect, analyze, interpret, and act on the data. As EIRs are introduced and scaled in low- and middle-income countries, implementers and researchers should continue to share real-world examples and build an evidence base for how EIRs can add value to immunization programs, particularly for innovative uses.
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Affiliation(s)
| | | | - John Richard
- PATH, Dar es Salaam, United Republic of Tanzania
| | - Ngwegwe Bulula
- Immunization and Vaccine Development Program, Ministry of Health, Community Development, Gender, Elderly and Children, Dar es Salaam, United Republic of Tanzania
| | | | | | - Tove K Ryman
- Bill & Melinda Gates Foundation, Seattle, WA, United States
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Lindstrand A, Cherian T, Chang-Blanc D, Feikin D, O'Brien KL. The World of Immunization: Achievements, Challenges, and Strategic Vision for the Next Decade. J Infect Dis 2021; 224:S452-S467. [PMID: 34590130 PMCID: PMC8482029 DOI: 10.1093/infdis/jiab284] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Immunization is among the most cost-effective public health interventions available and is estimated to have averted at least 37 million deaths between 2000 and 2019. Since the establishment of the Expanded Programme on Immunization in 1974, global vaccination coverage increased and the coverage gap between rich and poor countries decreased. Creation of Gavi, the Vaccine Alliance, in 2000 allowed the poorest countries in the world to benefit from new, life-saving vaccines and expand the breadth of protection against an increasing number of vaccine-preventable diseases. Despite this progress, inequities in access to and uptake of vaccines persist. Opportunities to realize the full potential of vaccines are within reach but require focused, tailored and committed action by Governments and immunization stakeholders. The Immunization Agenda 2030 provides a framework for action during the next decade to attain a world where everyone, everywhere, at every age fully benefits from vaccines for good health and well-being.
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Affiliation(s)
- Ann Lindstrand
- Immunization Vaccines and Biologicals Department, World Health Organization, Geneva, Switzerland
| | | | - Diana Chang-Blanc
- Immunization Vaccines and Biologicals Department, World Health Organization, Geneva, Switzerland
| | - Daniel Feikin
- Immunization Vaccines and Biologicals Department, World Health Organization, Geneva, Switzerland
| | - Katherine L O'Brien
- Immunization Vaccines and Biologicals Department, World Health Organization, Geneva, Switzerland
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A Call for a Reform of the Influenza Immunization Program in Mexico: Epidemiologic and Economic Evidence for Decision Making. Vaccines (Basel) 2021; 9:vaccines9030286. [PMID: 33808916 PMCID: PMC8003748 DOI: 10.3390/vaccines9030286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 03/03/2021] [Accepted: 03/11/2021] [Indexed: 11/17/2022] Open
Abstract
Limited information is available to determine the effectiveness of Mexico's national influenza vaccination guidelines and inform policy updates. We aim to propose reforms to current influenza vaccination policies based on our analysis of cost-effectiveness studies. This cross-sectional epidemiological study used influenza case, death, discharge and hospitalization data from several influenza seasons and applied a one-year decision-analytic model to assess cost-effectiveness. The primary health outcome was influenza cases avoided; secondary health outcomes were influenza-related events associated with case reduction. By increasing vaccination coverage to 75% in the population aged 12-49 years with risk factors (diabetes, high blood pressure, morbid obesity, chronic renal failure, asthma, pregnancy), and expanding universal vaccination coverage to school-aged children (5-11 years) and adults aged 50-59 years, 7142-671,461 influenza cases; 1-15 deaths; 7615-262,812 healthcare visits; 2886-154,143 emergency room admissions and 2891-97,637 hospitalizations could be prevented (ranges correspond to separate age and risk factor groups), with a net annual savings of 3.90 to 111.99 million USD. Such changes to the current vaccination policy could potentially result in significant economic and health benefits. These data could be used to inform the revision of a vaccination policy in Mexico with substantial social value.
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Jalloh MF, Namageyo-Funa A, Gleason B, Wallace AS, Friedman M, Sesay T, Ocansey D, Jalloh MS, Feldstein LR, Conklin L, Hersey S, Singh T, Kaiser R. Assessment of VaxTrac electronic immunization registry in an urban district in Sierra Leone: Implications for data quality, defaulter tracking, and policy. Vaccine 2020; 38:6103-6111. [PMID: 32753291 PMCID: PMC10869104 DOI: 10.1016/j.vaccine.2020.07.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 07/12/2020] [Accepted: 07/14/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND In 2016, the Sierra Leone Ministry of Health and Sanitation (MoHS) piloted VaxTrac, an electronic immunization registry (EIR), in an urban district to improve management of vaccination records and tracking of children who missed scheduled doses. We aimed to document lessons learned to inform decision-making on VaxTrac and similar EIRs' future use. METHODS Ten out of 50 urban health facilities that implemented VaxTrac were purposively selected for inclusion in a rapid mixed-method assessment from November to December 2017. For a one-month period, records of six scheduled vaccine doses among children < 2 years old in VaxTrac were abstracted and compared to three paper-based records (register of under-two children, daily tally sheet, and monthly summary form). We used the under-two register as the reference gold standard for comparison purposes. We interviewed and observed 10 heath workers, one from each selected facility, who were using VaxTrac. RESULTS Overall, VaxTrac captured < 65% of the vaccine doses reported in the paper-based sources, but in the largest health facility VaxTrac captured the highest number of doses. Two additional notable patterns emerged: 1) the aggregated data sources reported higher doses administered compared to the under-two register and VaxTrac; 2) data sources that need real-time data capture during the vaccination session reported fewer doses administered compared to the monthly HF2 summary form. Health workers expressed that the EIR helped them to shorten the time to manage, summarize, and report vaccination records. Workflows for data entry in VaxTrac were inconsistent among facilities and rarely integrated into existing processes. Data sharing restrictions contributed to duplicate records. CONCLUSION Although VaxTrac helped to shorten the time to manage, summarize, and report vaccination records, data sharing restrictions coupled with inconsistent and inefficient workflows were major implementation challenges. Readiness-to-introduce and sustainability should be carefully considered before implementing an EIR.
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Affiliation(s)
- Mohamed F Jalloh
- Immunization Systems Branch, Global Immunization Division, U.S. Centers for Disease Control and Prevention, Atlanta, United States.
| | - Apophia Namageyo-Funa
- Strategic Information and Workforce Development Branch, Global Immunization Division, U.S. Centers for Disease Control and Prevention, Atlanta, United States
| | - Brigette Gleason
- Sierra Leone Country Office, Division of Global Health Protection, U.S. Centers for Disease Control and Prevention, Freetown, Sierra Leone
| | - Aaron S Wallace
- Immunization Systems Branch, Global Immunization Division, U.S. Centers for Disease Control and Prevention, Atlanta, United States
| | - Michael Friedman
- Sierra Leone Country Office, Division of Global Health Protection, U.S. Centers for Disease Control and Prevention, Freetown, Sierra Leone
| | - Tom Sesay
- Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone
| | | | | | - Leora R Feldstein
- Immunization Systems Branch, Global Immunization Division, U.S. Centers for Disease Control and Prevention, Atlanta, United States
| | - Laura Conklin
- Immunization Systems Branch, Global Immunization Division, U.S. Centers for Disease Control and Prevention, Atlanta, United States
| | - Sara Hersey
- Sierra Leone Country Office, Division of Global Health Protection, U.S. Centers for Disease Control and Prevention, Freetown, Sierra Leone
| | - Tushar Singh
- Sierra Leone Country Office, Division of Global Health Protection, U.S. Centers for Disease Control and Prevention, Freetown, Sierra Leone
| | - Reinhard Kaiser
- Sierra Leone Country Office, Division of Global Health Protection, U.S. Centers for Disease Control and Prevention, Freetown, Sierra Leone
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Guimarães EADA, Morato YC, Carvalho DBF, Oliveira VCD, Pivatti VMS, Cavalcante RB, Gontijo TL, Dias TMR. Evaluation of the Usability of the Immunization Information System in Brazil: A Mixed-Method Study. Telemed J E Health 2020; 27:551-560. [PMID: 32673172 DOI: 10.1089/tmj.2020.0077] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Usability is a quality attribute that can evaluate the ease of use of user interfaces, based on standards called usability heuristics. Objective: To evaluate the usability components of the Brazilian Immunization Information System (IIS), focusing on the users and their interaction and agility with the interfaces. Materials and Methods: It was a concomitant and convergent mixed-method study that used a cross-sectional design for the quantitative approach and the indirect method of heuristic evaluation for the qualitative approach. Participants were 137 nursing professionals working in vaccination rooms, who completed a structured questionnaire on standards of usability quality, and 4 specialists in information technology, who used a semistructured form to carry out a software inspection. Descriptive and inferential statistics and the heuristic inspection were used for the analyses. Results: The evaluation resulted in 10 violated heuristics and identified 14 usability problems on the 68 screens of the IIS. The system presented simple usability problems (grade 2 severity), which can be repaired, with a low correction priority. The heuristics best evaluated were error prevention (3.03 ± 0.54) and help and documentation (3.00 ± 0.68); and the worst evaluated was visibility of system status, with a mean of 2.62 ± 0.55. Professionals with a technical education level presented a higher score on the scales for the recognition rather than recall heuristic when compared with the nurses (2.77 ± 0.49 vs. 3.67 ± 0.66, p = 0.003). Conclusion: The system provides easy access for users, however, has weaknesses in its ability to allow the users to easily achieve their goals of interaction with the interface.
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Affiliation(s)
| | - Ygor Colen Morato
- Federal University of São João del-Rei, Midwest Campus Dona Lindu, Divinópolis, Minas Gerais, Brazil
| | | | | | | | | | - Tarcísio Laerte Gontijo
- Federal University of São João del-Rei, Midwest Campus Dona Lindu, Divinópolis, Minas Gerais, Brazil
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Harrison K, Rahimi N, Danovaro-Holliday MC. Factors limiting data quality in the expanded programme on immunization in low and middle-income countries: A scoping review. Vaccine 2020; 38:4652-4663. [PMID: 32446834 DOI: 10.1016/j.vaccine.2020.02.091] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 01/18/2020] [Accepted: 02/19/2020] [Indexed: 11/25/2022]
Abstract
Few public health interventions can match the immense achievements of immunization in terms of mortality and morbidity reduction. However, progress in reaching global coverage goals and achieving universal immunization coverage have stalled; with key stakeholders concerned about the accuracy of reported coverage figures. Incomplete and incorrect data has made it challenging to obtain an accurate overview of immunization coverage, particularly in low- and middle-income countries (LMIC). To date, only one literature review concerning immunization data quality exists. However, it only included articles from Gavi-eligible countries, did not go deep into the characteristics of the data quality problems, and used a narrow 'data quality' definition. This scoping review builds upon that work; exploring the "state of data quality" in LMIC, factors affecting data quality in these settings and potential means to improve it. Only a small volume of literature addressing immunization data quality in LMIC was found and definitions of 'data quality' varied widely. Data quality was, on the whole, considered poor in the articles included. Coverage numerators were seen to be inflated for official reports and denominators were inaccurate and infrequently adjusted. Numerous factors related to these deficiencies were reported, including health information system fragmentation, overreliance on targets and poor data management processes. Factors associated with health workers were noted most frequently. Authors suggested that data quality could be improved by ensuring proper data collection tools, increasing workers' capacities and motivation through training and supervision, whilst also ensuring adequate and timely feedback on the data collected. The findings of this scoping review can serve as the basis to identify and address barriers to good quality immunization data in LMICs. Overcoming said barriers is essential if immunization's historic successes are to continue.
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Affiliation(s)
- Katherine Harrison
- Health Economics, Policy and Management, Karolinska Institutet, Research and Advocacy Intern, Shifo Foundation, Stockholm, Sweden.
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