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Kallay R, Doshi RH, Muhoza P, Choi MJ, Legand A, Aberle-Grasse E, Bagayoko A, Hyde TB, Formenty P, Costa A. Use of Ebola Vaccines - Worldwide, 2021-2023. MMWR Morb Mortal Wkly Rep 2024; 73:360-364. [PMID: 38662631 PMCID: PMC11065462 DOI: 10.15585/mmwr.mm7316a1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Abstract
Ebola virus disease (Ebola) is a rare but severe illness in humans, with an average case fatality rate of approximately 50%. Two licensed vaccines are currently available against Orthoebolavirus zairense, the virus that causes Ebola: the 1-dose rVSVΔG-ZEBOV-GP (ERVEBO [Merck]) and the 2-dose regimen of Ad26.ZEBOV and MVA-BN-Filo (Zabdeno/Mvabea [Johnson & Johnson]). The Strategic Advisory Group of Experts on Immunization recommends the use of 1-dose ERVEBO during Ebola outbreaks, and in 2021, a global stockpile of ERVEBO was established to ensure equitable, timely, and targeted access to vaccine doses for future Ebola outbreaks. This report describes the use of Ebola vaccines and the role of the stockpile developed and managed by the International Coordinating Group (ICG) on Vaccine Provision during 2021-2023. A total of 145,690 doses have been shipped from the ICG stockpile since 2021. However, because outbreaks since 2021 have been limited and rapidly contained, most doses (139,120; 95%) shipped from the ICG stockpile have been repurposed for preventive vaccination of high-risk groups, compared with 6,570 (5%) used for outbreak response. Repurposing doses for preventive vaccination could be prioritized in the absence of Ebola outbreaks to prevent transmission and maximize the cost-efficiency and benefits of the stockpile.
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Doshi RH, Mukadi PK, Casey RM, Kizito GM, Gao H, Nguete U B, Laven J, Sabi L, Kaba DK, Muyembe-Tamfum JJ, Hyde TB, Ahuka-Mundeke S, Staples JE. Immunological response to fractional-dose yellow fever vaccine administered during an outbreak in Kinshasa, Democratic Republic of the Congo: results 5 years after vaccination from a prospective cohort study. Lancet Infect Dis 2024:S1473-3099(23)00809-5. [PMID: 38335976 DOI: 10.1016/s1473-3099(23)00809-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 12/03/2023] [Accepted: 12/14/2023] [Indexed: 02/12/2024]
Abstract
BACKGROUND In 2016, outbreaks of yellow fever in Angola and the Democratic Republic of the Congo led to a global vaccine shortage. A fractional dose of 17DD yellow fever vaccine (containing one-fifth [0·1 ml] of the standard dose) was used during a pre-emptive mass campaign in August, 2016, in Kinshasa, Democratic Republic of the Congo among children aged 2 years and older and non-pregnant adults (ie, those aged 18 years and older). 1 year following vaccination, 97% of participants were seropositive; however, the long-term durability of the immune response is unknown. We aimed to conduct a prospective cohort study and invited participants enrolled in the previous evaluation to return 5 years after vaccination to assess durability of the immune response. METHODS Participants returned to one of six health facilities in Kinshasa in 2021, where study staff collected a brief medical history and blood specimen. We assessed neutralising antibody titres against yellow fever virus using a plaque reduction neutralisation test with a 50% cutoff (PRNT50). Participants with a PRNT50 titre of 10 or higher were considered seropositive. The primary outcome was the proportion of participants seropositive at 5 years. FINDINGS Among the 764 participants enrolled, 566 (74%) completed the 5-year visit. 5 years after vaccination, 539 (95·2%, 95% CI 93·2-96·7) participants were seropositive, including 361 (94·3%, 91·5-96·2) of 383 who were seronegative and 178 (97·3%, 93·8-98·8) of 183 who were seropositive at baseline. Geometric mean titres (GMTs) differed significantly across age groups for those who were initially seronegative with the lowest GMT among those aged 2-5 years and highest among those aged 13 years and older. INTERPRETATION A fractional dose of the 17DD yellow fever vaccine induced an immunologic response with detectable titres at 5 years among the majority of participants in the Democratic Republic of the Congo. These findings support the use of fractional-dose vaccination for outbreak prevention with the potential for sustained immunity. FUNDING Gavi, the Vaccine Alliance through the CDC Foundation. TRANSLATION For the French translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Reena H Doshi
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Patrick K Mukadi
- Centers for Disease Control and Prevention Foundation, Atlanta, GA, USA; Department of Clinical Tropical Medicine, Institute of Tropical Medicine, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan
| | - Rebecca M Casey
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Gabriel M Kizito
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | - Hongjiang Gao
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Beatrice Nguete U
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Janeen Laven
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, USA
| | - Lilliane Sabi
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | - Didine K Kaba
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | | | - Terri B Hyde
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Steve Ahuka-Mundeke
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | - J Erin Staples
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, USA
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Casey RM, Akaba H, Hyde TB, Bloem P. Covid-19 pandemic and equity of global human papillomavirus vaccination: descriptive study of World Health Organization-Unicef vaccination coverage estimates. BMJ Med 2024; 3:e000726. [PMID: 38293682 PMCID: PMC10826539 DOI: 10.1136/bmjmed-2023-000726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 12/07/2023] [Indexed: 02/01/2024]
Abstract
Objective To analyse progress in global vaccination against human papillomavirus (HPV) during the covid-19 pandemic, with a particular focus on equity. Design Descriptive study of World Health Organization-Unicef vaccination coverage estimates. Setting WHO-Unicef estimates of global, regional, and national HPV vaccination coverage, before (2010-19) and during (2020-21) the covid-19 pandemic. Participants Girls aged 9-14 years who received a HPV vaccine globally before (12.3 million in 2019) and during (2020-21) the covid-19 pandemic (10.6 million in 2021). Main outcome measures Mean programme and population adjusted coverage for first dose HPV vaccine (HPV1) by country, country income (World Bank income categories), sex, and WHO region, before (2010-19) and during (2020-21) the covid-19 pandemic, based on WHO-Unicef estimates of HPV vaccination coverage. Annual number of national HPV vaccine programme introduced since the first HPV vaccine licence was granted in 2006, based on data reported to WHO-Unicef. Number of girls vaccinated before (2019) versus during (2020-21) the covid-19 pandemic period. Results Mean coverage of HPV vaccination programmes among girls decreased from 65% in 2010-19 to 50% in 2020-21 in low and middle income countries compared with an increase in high income countries from 61% to 69% for the same periods. Population adjusted HPV1 coverage was higher among girls in high income countries before and during the covid-19 pandemic than in girls in low and middle income countries. During the covid-19 pandemic, population adjusted HPV1 coverage among boys in high income countries was higher and remained higher than coverage among girls in low and middle income countries. Globally, 23 countries recorded a severe reduction in their HPV programme (≥50% reduction in coverage), and another 3.8 million girls globally did not receive a HPV vaccine in countries with existing HPV vaccination programmes in 2020-21 compared with 2019. A reduction was seen in the annual rate of new introductions of national HPV vaccine programmes during 2020-21, affecting countries in all income categories, followed by an increase in introductions during 2022. During the second half of 2023, several low and middle income countries with large birth cohorts and a high relative burden of cervical cancer have yet to introduce HPV vaccination. Conclusions Although HPV vaccines have been available for more than 15 years, global HPV vaccination coverage is low. During the covid-19 pandemic period (2020-21 globally), worsening coverage, delayed introductions of national vaccine programmes, and an increase in missed girls globally (ie, girls who did not receive a HPV vaccine compared with the previous year in countries with an existing HPV vaccination programme) that disproportionately affected girls in low and middle income countries were found. Urgent and innovative recovery efforts are needed to accelerate national introduction of HPV vaccination programmes and achieve high coverage of HPV vaccination worldwide.
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Affiliation(s)
| | - Hiroki Akaba
- Immunization, Vaccines and Biologicals Department, World Health Organization, Geneva, Switzerland
| | - Terri B Hyde
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Paul Bloem
- Immunization, Vaccines and Biologicals Department, World Health Organization, Geneva, Switzerland
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Jennings MC, Sauer M, Manchester C, Soeters HM, Shimp L, Hyde TB, Parashar U, Burgess C, Castro B, Hossein I, Othepa M, Payne DC, Tate JE, Walldorf J, Privor-Dumm L, Richart V, Santosham M. Supporting evidence-based rotavirus vaccine introduction decision-making and implementation: Lessons from 8 Gavi-eligible countries. Vaccine 2024; 42:8-16. [PMID: 38042696 PMCID: PMC10733863 DOI: 10.1016/j.vaccine.2023.11.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 11/05/2023] [Accepted: 11/17/2023] [Indexed: 12/04/2023]
Abstract
Despite the 2009 World Health Organization recommendation that all countries introduce rotavirus vaccines (RVV) into their national immunization programs, just 81 countries had introduced RVV by the end of 2015, leaving millions of children at risk for rotavirus morbidity and mortality. In response, the Rotavirus Accelerated Vaccine Introduction Network (RAVIN) was established in 2016 to provide support to eight Gavi-eligible countries that had yet to make an RVV introduction decision and/or had requested technical assistance with RVV preparations: Afghanistan, Bangladesh, Benin, Cambodia, Democratic Republic of Congo, Lao People's Democratic Republic, Myanmar, and Nepal. During 2016-2020, RAVIN worked with country governments and partners to support evidence-based immunization decision-making, RVV introduction preparation and implementation, and multilateral coordination. By the September 2020 program close-out, five of the eight RAVIN focus countries successfully introduced RVV into their routine childhood immunization programs. We report on the RAVIN approach, describe how the project responded collectively to an evolving RVV product landscape, synthesize common characteristics of the RAVIN country experiences, highlight key lessons learned, and outline the unfinished agenda to inform future new vaccine introduction efforts by countries and global partners.
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Affiliation(s)
- Mary Carol Jennings
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA; International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Molly Sauer
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA; International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
| | | | - Heidi M Soeters
- U.S. Centers for Disease Control and Prevention, Atlanta, USA
| | - Lora Shimp
- JSI Research and Training Institute, Arlington, USA
| | - Terri B Hyde
- U.S. Centers for Disease Control and Prevention, Atlanta, USA
| | - Umesh Parashar
- U.S. Centers for Disease Control and Prevention, Atlanta, USA
| | | | - Brian Castro
- JSI Research and Training Institute, Arlington, USA
| | | | | | - Daniel C Payne
- U.S. Centers for Disease Control and Prevention, Atlanta, USA
| | | | - Jenny Walldorf
- U.S. Centers for Disease Control and Prevention, Atlanta, USA
| | - Lois Privor-Dumm
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA; International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | | | - Mathuram Santosham
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA; International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
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Boppana SB, van Boven M, Britt WJ, Gantt S, Griffiths PD, Grosse SD, Hyde TB, Lanzieri TM, Mussi-Pinhata MM, Pallas SE, Pinninti SG, Rawlinson WD, Ross SA, Vossen ACTM, Fowler KB. Vaccine value profile for cytomegalovirus. Vaccine 2023; 41 Suppl 2:S53-S75. [PMID: 37806805 DOI: 10.1016/j.vaccine.2023.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 04/28/2023] [Accepted: 06/02/2023] [Indexed: 10/10/2023]
Abstract
Cytomegalovirus (CMV) is the most common infectious cause of congenital malformation and a leading cause of developmental disabilities such as sensorineural hearing loss (SNHL), motor and cognitive deficits. The significant disease burden from congenital CMV infection (cCMV) led the US National Institute of Medicine to rank CMV vaccine development as the highest priority. An average of 6.7/1000 live births are affected by cCMV, but the prevalence varies across and within countries. In contrast to other congenital infections such as rubella and toxoplasmosis, the prevalence of cCMV increases with CMV seroprevalence rates in the population. The true global burden of cCMV disease is likely underestimated because most infected infants (85-90 %) have asymptomatic infection and are not identified. However, about 7-11 % of those with asymptomatic infection will develop SNHL throughout early childhood. Although no licensed CMV vaccine exists, several candidate vaccines are in development, including one currently in phase 3 trials. Licensure of one or more vaccine candidates is feasible within the next five years. Various models of CMV vaccine strategies employing different target populations have shown to provide substantial benefit in reducing cCMV. Although CMV can cause end-organ disease with significant morbidity and mortality in immunocompromised individuals, the focus of this vaccine value profile (VVP) is on preventing or reducing the cCMV disease burden. This CMV VVP provides a high-level, comprehensive assessment of the currently available data to inform the potential public health, economic, and societal value of CMV vaccines. The CMV VVP was developed by a working group of subject matter experts from academia, public health groups, policy organizations, and non-profit organizations. All contributors have extensive expertise on various elements of the CMV VVP and have described the state of knowledge and identified the current gaps. The VVP was developed using only existing and publicly available information.
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Affiliation(s)
- Suresh B Boppana
- Departments of Pediatrics and Microbiology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Michiel van Boven
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, and Julius Center for Health Sciences and Primary Care, Department of Epidemiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - William J Britt
- Departments of Pediatrics, Microbiology, and Neurobiology, Heersink School of Medicine, University of Alabama at Birmingham, USA
| | - Soren Gantt
- Centre de recherche du CHU Sainte-Justine, Montréal, QC H3T 1C5, Canada
| | - Paul D Griffiths
- Emeritus Professor of Virology, University College London, United Kingdom
| | - Scott D Grosse
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | - Terri B Hyde
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Tatiana M Lanzieri
- Measles, Rubella, and Cytomegalovirus Epidemiology Team, Viral Vaccine Preventable Diseases Branch / Division of Viral Diseases. National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Marisa M Mussi-Pinhata
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Brazil
| | - Sarah E Pallas
- Global Immunization Division, Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329-4027, USA
| | - Swetha G Pinninti
- Departments of Pediatrics and Microbiology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - William D Rawlinson
- Serology and Virology Division, NSW Health Pathology Randwick, Prince of Wales Hospital, Sydney, Australia; School of Biotechnology and Biomolecular Sciences, and School of Medical Sciences, University of New South Wales, Sydney, Australia
| | - Shannon A Ross
- Departments of Pediatrics and Microbiology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ann C T M Vossen
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Karen B Fowler
- Departments of Pediatrics and Epidemiology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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Doshi RH, Garbern SC, Kulkarni S, Perera SM, Fleming MK, Muhayangabo RF, Ombeni AB, Tchoualeu DD, Kallay R, Song E, Powell J, Gainey M, Glenn B, Mutumwa RM, Hans Bateyi Mustafa S, Earle-Richardson G, Gao H, Abad N, Soke GN, Fitter DL, Hyde TB, Prybylski D, Levine AC, Jalloh MF, Mbong EN. Ebola vaccine uptake and attitudes among healthcare workers in North Kivu, Democratic Republic of the Congo, 2021. Front Public Health 2023; 11:1080700. [PMID: 37559741 PMCID: PMC10408297 DOI: 10.3389/fpubh.2023.1080700] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 06/19/2023] [Indexed: 08/11/2023] Open
Abstract
Introduction During the 2018-2020 Ebola virus disease (EVD) outbreak in the eastern part of the Democratic Republic of the Congo (DRC), prevention and control measures, such as Ebola vaccination were challenging by community mistrust. We aimed to understand perceptions regarding Ebola vaccination and identify determinants of Ebola vaccine uptake among HCWs. Methods In March 2021, we conducted a cross-sectional survey among 438 HCWs from 100 randomly selected health facilities in three health zones (Butembo, Beni, Mabalako) affected by the 10th EVD outbreak in North Kivu, DRC. HCWs were eligible if they were ≥ 18 years and were working in a health facility during the outbreak. We used survey logistic regression to assess correlates of first-offer uptake (i.e., having received the vaccine the first time it was offered vs. after subsequent offers). Results Of the 438 HCWs enrolled in the study, 420 (95.8%) reported that they were eligible and offered an Ebola vaccine. Among those offered vaccination, self-reported uptake of the Ebola vaccine was 99.0% (95% confidence interval (CI) [98.5-99.4]), but first-offer uptake was 70.2% (95% CI [67.1, 73.5]). Nearly all HCWs (94.3%; 95% CI [92.7-95.5]) perceived themselves to be at risk of contracting EVD. The most common concern was that the vaccine would cause side effects (65.7%; 95% CI [61.4-69.7]). In the multivariable analysis, mistrust of the vaccine source or how the vaccine was produced decreased the odds of first-time uptake. Discussion Overall uptake of the Ebola vaccine was high among HCWs, but uptake at the first offer was substantially lower, which was associated with mistrust of the vaccine source. Future Ebola vaccination efforts should plan to make repeated vaccination offers to HCWs and address their underlying mistrust in the vaccines, which can, in turn, improve community uptake.
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Affiliation(s)
- Reena H. Doshi
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Stephanie C. Garbern
- Department of Emergency Medicine, Brown University, Providence, RI, United States
| | - Shibani Kulkarni
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | - Monica K. Fleming
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | | | | | - Ruth Kallay
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | | | | | - Bailey Glenn
- James A. Ferguson Infectious Disease Program, Baltimore, MD, United States
| | | | | | - Giulia Earle-Richardson
- National Center for Emerging and Zoonotic Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Hongjiang Gao
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Neetu Abad
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Gnakub Norbert Soke
- Division of Global Health Protection, Centers for Disease Control and Prevention, Kinshasa, Democratic Republic of Congo
| | - David L. Fitter
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Terri B. Hyde
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Dimitri Prybylski
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Adam C. Levine
- International Medical Corps, Washington, DC, United States
- International Medical Corps, Goma, Democratic Republic of Congo
| | - Mohamed F. Jalloh
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Eta Ngole Mbong
- International Medical Corps, Goma, Democratic Republic of Congo
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Kaur G, Casey RM, Patel JC, Bloem P, Walldorf JA, Hyde TB. Status of New Vaccine Introduction - Worldwide, 2016-2021. MMWR Morb Mortal Wkly Rep 2023; 72:746-750. [PMID: 37410663 DOI: 10.15585/mmwr.mm7227a2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
This report describes the status of introductions globally for eight World Health Organization (WHO)-recommended new and underutilized vaccines, comprising 10 individual vaccine antigens. By 2021, among 194 countries worldwide, 33 (17%) provided all of these 10 WHO-recommended antigens as part of their routine immunization schedules; only one low-income country had introduced all of these recommended vaccines. Universal hepatitis B birth dose; human papillomavirus vaccine; rotavirus vaccine; and diphtheria, tetanus, and pertussis-containing vaccine first booster dose have been introduced by 57%, 59%, 60%, and 72% of all countries worldwide, respectively. Pneumococcal conjugate vaccine, rubella-containing vaccine, measles-containing vaccine second dose, and Haemophilus influenzae type b vaccine have been introduced by 78%, 89%, 94%, and 99% of all countries, respectively. The annual rate of new vaccine introductions declined precipitously when the COVID-19 pandemic started, from 48 in 2019 to 15 in 2020 before rising to 26 in 2021. Increased efforts to accelerate new and underutilized vaccine introductions are urgently needed to improve universal equitable access to all recommended vaccines to achieve the global Immunization Agenda 2021-2030 (IA2030) targets.
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Soeters HM, Doshi RH, Fleming M, Adegoke OJ, Ajene U, Aksnes BN, Bennett S, Blau EF, Carlton JG, Clements S, Conklin L, Dahlke M, Duca LM, Feldstein LR, Gidudu JF, Grant G, Hercules M, Igboh LS, Ishizumi A, Jacenko S, Kerr Y, Konne NM, Kulkarni S, Kumar A, Lafond KE, Lam E, Longley AT, McCarron M, Namageyo-Funa A, Ortiz N, Patel JC, Perry RT, Prybylski D, Reddi P, Salman O, Sciarratta CN, Shragai T, Siddula A, Sikare E, Tchoualeu DD, Traicoff D, Tuttle A, Victory KR, Wallace A, Ward K, Wong MKA, Zhou W, Schluter WW, Fitter DL, Mounts A, Bresee JS, Hyde TB. CDC's COVID-19 International Vaccine Implementation and Evaluation Program and Lessons from Earlier Vaccine Introductions. Emerg Infect Dis 2022; 28:S208-S216. [PMID: 36502382 DOI: 10.3201/eid2813.212123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The US Centers for Disease Control and Prevention (CDC) supports international partners in introducing vaccines, including those against SARS-CoV-2 virus. CDC contributes to the development of global technical tools, guidance, and policy for COVID-19 vaccination and has established its COVID-19 International Vaccine Implementation and Evaluation (CIVIE) program. CIVIE supports ministries of health and their partner organizations in developing or strengthening their national capacities for the planning, implementation, and evaluation of COVID-19 vaccination programs. CIVIE's 7 priority areas for country-specific technical assistance are vaccine policy development, program planning, vaccine confidence and demand, data management and use, workforce development, vaccine safety, and evaluation. We discuss CDC's work on global COVID-19 vaccine implementation, including priorities, challenges, opportunities, and applicable lessons learned from prior experiences with Ebola, influenza, and meningococcal serogroup A conjugate vaccine introductions.
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Velasquez-Portocarrero DE, Wang X, Cortese MM, Snider CJ, Anand A, Costantini VP, Yunus M, Aziz AB, Haque W, Parashar U, Sisay Z, Soeters HM, Hyde TB, Jiang B, Zaman K. Head-to-head comparison of the immunogenicity of RotaTeq and Rotarix rotavirus vaccines and factors associated with seroresponse in infants in Bangladesh: a randomised, controlled, open-label, parallel, phase 4 trial. Lancet Infect Dis 2022; 22:1606-1616. [PMID: 35961362 DOI: 10.1016/s1473-3099(22)00368-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/03/2022] [Accepted: 05/18/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND A head-to-head comparison of the most widely used oral rotavirus vaccines has not previously been done, particularly in a high child mortality setting. We therefore aimed to compare the immunogenicity of RotaTeq (Merck, Kenilworth, NJ, USA) and Rotarix (GlaxoSmithKline, Rixensart, Belgium) rotavirus vaccines in the same population and examined risk factors for low seroresponse. METHODS We did a randomised, controlled, open-label, parallel, phase 4 trial in urban slums within Mirpur and Mohakahli (Dhaka, Bangladesh). We enrolled eligible participants who were healthy infants aged 6 weeks and full-term (ie, >37 weeks' gestation). We randomly assigned participants (1:1), using block randomisation via a computer-generated electronic allocation with block sizes of 8, 16, 24, and 32, to receive either three RotaTeq vaccine doses at ages 6, 10, and 14 weeks or two Rotarix doses at ages 6 and 10 weeks without oral poliovirus vaccine. Coprimary outcomes were the rotavirus-specific IgA seroconversion in both vaccines, and the comparison of the rotavirus IgA seroconversion by salivary secretor phenotype in each vaccine arm. Seroconversion at age 18 weeks in the RotaTeq arm and age of 14 weeks in the Rotarix arm was used to compare the complete series of each vaccine. Seroconversion at age 14 weeks was used to compare two RotaTeq doses versus two Rotarix doses. Seroconversion at age 22 weeks was used to compare the immunogenicity at the same age after receiving the full vaccine series. Safety was assessed for the duration of study participation. This study is registered with ClinicalTrials.gov, NCT02847026. FINDINGS Between Sept 1 and Dec 8, 2016, a total of 1144 infants were randomly assigned to either the RotaTeq arm (n=571) or Rotarix arm (n=573); 1080 infants (531 in the RotaTeq arm and 549 in the Rotarix arm) completed the study. Rotavirus IgA seroconversion 4 weeks after the full series occurred in 390 (73%) of 531 infants age 18 weeks in the RotaTeq arm and 354 (64%) of 549 infants age 14 weeks in the Rotarix arm (p=0·01). At age 14 weeks, 4 weeks after two doses, RotaTeq recipients had lower seroconversion than Rotarix recipients (268 [50%] of 531 vs 354 [64%] of 549; p<0·0001). However, at age 22 weeks, RotaTeq recipients had higher seroconversion than Rotarix recipients (394 [74%] of 531 vs 278 [51%] of 549; p<0·0001). Among RotaTeq recipients, seroconversion 4 weeks after the third dose was higher than after the second dose (390 [73%] of 531 vs 268 [50%] of 531; p<0·0001]. In the RotaTeq arm, rotavirus IgA seroconversion was lower in non-secretors than in secretors at ages 14 weeks (p=0·08), 18 weeks (p=0·01), and 22 weeks (p=0·02). Similarly, in the Rotarix arm, rotavirus IgA seroconversion was lower in non-secretors than in secretors at ages 14 weeks (p=0·02) and 22 weeks (p=0·01). 65 (11%) of 571 infants had adverse events in the RotaTeq arm compared with 63 (11%) of 573 infants in the Rotarix arm; no adverse events were attributed to the use of either vaccine. One death due to aspiration occurred in the RotaTeq arm, which was not related to the vaccine. INTERPRETATION RotaTeq induced a higher magnitude and longer duration of rotavirus IgA response than Rotarix in this high child mortality setting. Additional vaccination strategies should be evaluated to overcome the suboptimal performance of current oral rotavirus vaccines in these settings. FUNDING US Centers for Disease Control and Prevention.
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Affiliation(s)
| | - Xiaoqian Wang
- US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - Abhijeet Anand
- US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Md Yunus
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Asma B Aziz
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Warda Haque
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Umesh Parashar
- US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Zufan Sisay
- US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Heidi M Soeters
- US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Terri B Hyde
- US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Baoming Jiang
- US Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Khalequ Zaman
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
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10
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Aksnes BN, Walldorf JA, Nkwenkeu SF, Zoma RL, Mirza I, Tarbangdo F, Fall S, Hien S, Ky C, Kambou L, Diallo AO, Aké FH, Hatcher C, Patel JC, Novak RT, Hyde TB, Medah I, Soeters HM, Jalloh MF. Vaccination information, motivations, and barriers in the context of meningococcal serogroup A conjugate vaccine introduction: A qualitative assessment among caregivers in Burkina Faso, 2018. Vaccine 2021; 39:6370-6377. [PMID: 34579975 PMCID: PMC8519392 DOI: 10.1016/j.vaccine.2021.09.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 09/13/2021] [Accepted: 09/14/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND In March 2017, Burkina Faso introduced meningococcal serogroup A conjugate vaccine (MACV) into the Expanded Programme on Immunization. MACV is administered to children aged 15-18 months, concomitantly with the second dose of measles-containing vaccine (MCV2). One year after MACV introduction, we assessed the sources and content of immunization information available to caregivers and explored motivations and barriers that influence their decision to seek MACV for their children. METHODS Twenty-four focus group discussions (FGDs) were conducted with caregivers of children eligible for MACV and MCV2. Data collection occurred in February-March 2018 in four purposively selected districts, each from a separate geographic region; within each district, caregivers were stratified into groups based on whether their children were unvaccinated or vaccinated with MACV. FGDs were recorded and transcribed. Transcripts were coded and analyzed using qualitative content analysis. RESULTS We identified many different sources and content of information about MACV and MCV2 available to caregivers. Healthcare workers were most commonly cited as the main sources of information; caregivers also received information from other caregivers in the community. Caregivers' motivations to seek MACV for their children were driven by personal awareness, engagements with trusted messengers, and perceived protective benefits of MACV against meningitis. Barriers to MACV and MCV2 uptake were linked to the unavailability of vaccines, immunization personnel not providing doses, knowledge gaps about the 15-18 month visit, practical constraints, past negative experiences, sociocultural influences, and misinformation, including misunderstanding about the need for MCV2. CONCLUSIONS MACV and MCV2 uptake may be enhanced by addressing vaccination barriers and effectively communicating vaccination information and benefits through trusted messengers such as healthcare workers and other caregivers in the community. Educating healthcare workers to avoid withholding vaccines, likely due to fear of wastage, may help reduce missed opportunities for vaccination.
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Affiliation(s)
| | - Jenny A Walldorf
- Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | | | - Robert L Zoma
- Institut National de Statistique et Démographie, Ouagadougou, Burkina Faso
| | | | | | | | | | - Cesaire Ky
- Ministère de la Santé, Ouagadougou, Burkina Faso
| | | | | | | | - Cynthia Hatcher
- Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - Jaymin C Patel
- Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - Ryan T Novak
- Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - Terri B Hyde
- Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - Isaïe Medah
- Ministère de la Santé, Ouagadougou, Burkina Faso
| | - Heidi M Soeters
- Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA.
| | - Mohamed F Jalloh
- Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
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11
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Doshi RH, Fleming M, Mukoka AK, Carter RJ, Hyde TB, Choi M, Nzaji MK, Bateyi SH, Christie A, Nichol ST, Damon IK, Beach M, Musenga EM, Fitter DL. Vaccination of contacts of Ebola virus disease survivors to prevent further transmission. Lancet Glob Health 2020; 8:e1455-e1456. [PMID: 33220205 PMCID: PMC10662388 DOI: 10.1016/s2214-109x(20)30454-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 10/06/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Reena H Doshi
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA.
| | - Monica Fleming
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | | | - Rosalind J Carter
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Terri B Hyde
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Mary Choi
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - Athalia Christie
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Stuart T Nichol
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Inger K Damon
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Michael Beach
- Division of Foodborne, Waterborne and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - David L Fitter
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
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12
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Turner P, Leab P, Ly S, Sao S, Miliya T, Heffelfinger JD, Batmunkh N, Lessa FC, Walldorf JA, Hyde TB, Ork V, Hossain MS, Gould KA, Hinds J, Cooper BS, Ngoun C, Turner C, Day NPJ. Impact of 13-Valent Pneumococcal Conjugate Vaccine on Colonization and Invasive Disease in Cambodian Children. Clin Infect Dis 2020; 70:1580-1588. [PMID: 31175819 PMCID: PMC7145996 DOI: 10.1093/cid/ciz481] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 06/05/2019] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Cambodia introduced the 13-valent pneumococcal conjugate vaccine (PCV13) in January 2015 using a 3 + 0 dosing schedule and no catch-up campaign. We investigated the effects of this introduction on pneumococcal colonization and invasive disease in children aged <5 years. METHODS There were 6 colonization surveys done between January 2014 and January 2018 in children attending the outpatient department of a nongovernmental pediatric hospital in Siem Reap. Nasopharyngeal swabs were analyzed by phenotypic and genotypic methods to detect pneumococcal serotypes and antimicrobial resistance. Invasive pneumococcal disease (IPD) data for January 2012-December 2018 were retrieved from hospital databases. Pre-PCV IPD data and pre-/post-PCV colonization data were modelled to estimate vaccine effectiveness (VE). RESULTS Comparing 2014 with 2016-2018, and using adjusted prevalence ratios, VE estimates for colonization were 16.6% (95% confidence interval [CI] 10.6-21.8) for all pneumococci and 39.2% (95% CI 26.7-46.1) for vaccine serotype (VT) pneumococci. There was a 26.0% (95% CI 17.7-33.0) decrease in multidrug-resistant pneumococcal colonization. The IPD incidence was estimated to have declined by 26.4% (95% CI 14.4-35.8) by 2018, with a decrease of 36.3% (95% CI 23.8-46.9) for VT IPD and an increase of 101.4% (95% CI 62.0-145.4) for non-VT IPD. CONCLUSIONS Following PCV13 introduction into the Cambodian immunization schedule, there have been declines in VT pneumococcal colonization and disease in children aged <5 years. Modelling of dominant serotype colonization data produced plausible VE estimates.
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Affiliation(s)
- Paul Turner
- Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, United Kingdom
| | - Phana Leab
- Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap
| | - Sokeng Ly
- Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap
| | - Sena Sao
- Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap
| | - Thyl Miliya
- Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap
| | - James D Heffelfinger
- Regional Office for the Western Pacific, World Health Organization, Manila, Philippines
| | - Nyambat Batmunkh
- Regional Office for the Western Pacific, World Health Organization, Manila, Philippines
| | | | | | - Terri B Hyde
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Vichit Ork
- National Immunisation Program, Ministry of Health, Cambodia
| | | | - Katherine A Gould
- Institute for Infection and Immunity, St George’s, University of London, United Kingdom
- Bacterial Microarray Group at St George’s Bioscience, London Bioscience Innovation Centre, United Kingdom
| | - Jason Hinds
- Institute for Infection and Immunity, St George’s, University of London, United Kingdom
- Bacterial Microarray Group at St George’s Bioscience, London Bioscience Innovation Centre, United Kingdom
| | - Ben S Cooper
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, United Kingdom
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Chanpheaktra Ngoun
- Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap
| | - Claudia Turner
- Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, United Kingdom
| | - Nicholas P J Day
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, United Kingdom
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
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13
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Nkwenkeu SF, Jalloh MF, Walldorf JA, Zoma RL, Tarbangdo F, Fall S, Hien S, Combassere R, Ky C, Kambou L, Diallo AO, Krishnaswamy A, Aké FH, Hatcher C, Patel JC, Medah I, Novak RT, Hyde TB, Soeters HM, Mirza I. Health workers' perceptions and challenges in implementing meningococcal serogroup a conjugate vaccine in the routine childhood immunization schedule in Burkina Faso. BMC Public Health 2020; 20:254. [PMID: 32075630 PMCID: PMC7031928 DOI: 10.1186/s12889-020-8347-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 02/12/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Meningococcal serogroup A conjugate vaccine (MACV) was introduced in 2017 into the routine childhood immunization schedule (at 15-18 months of age) in Burkina Faso to help reduce meningococcal meningitis burden. MACV was scheduled to be co-administered with the second dose of measles-containing vaccine (MCV2), a vaccine already in the national schedule. One year following the introduction of MACV, an assessment was conducted to qualitatively examine health workers' perceptions of MACV introduction, identify barriers to uptake, and explore opportunities to improve coverage. METHODS Twelve in-depth interviews were conducted with different cadres of health workers in four purposively selected districts in Burkina Faso. Districts were selected to include urban and rural areas as well as high and low MCV2 coverage areas. Respondents included health workers at the following levels: regional health managers (n = 4), district health managers (n = 4), and frontline healthcare providers (n = 4). All interviews were recorded, transcribed, and thematically analyzed using qualitative content analysis. RESULTS Four themes emerged around supply and health systems barriers, demand-related barriers, specific challenges related to MACV and MCV2 co-administration, and motivations and efforts to improve vaccination coverage. Supply and health systems barriers included aging cold chain equipment, staff shortages, overworked and poorly trained staff, insufficient supplies and financial resources, and challenges with implementing community outreach activities. Health workers largely viewed MACV introduction as a source of motivation for caregivers to bring their children for the 15- to 18-month visit. However, they also pointed to demand barriers, including cultural practices that sometimes discourage vaccination, misconceptions about vaccines, and religious beliefs. Challenges in co-administering MACV and MCV2 were mainly related to reluctance among health workers to open multi-dose vials unless enough children were present to avoid wastage. CONCLUSIONS To improve effective administration of vaccines in the second-year of life, adequate operational and programmatic planning, training, communication, and monitoring are necessary. Moreover, clear policy communication is needed to help ensure that health workers do not refrain from opening multi-dose vials for small numbers of children.
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Affiliation(s)
| | - Mohamed F. Jalloh
- U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329 USA
| | - Jenny A. Walldorf
- U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329 USA
| | - Robert L. Zoma
- Institut National de Statistique et Démographie, Ouagadougou, Burkina Faso
| | | | - Soukeynatou Fall
- UNICEF Ouagadougou, 01 PO Box 3420, Ouagadougou 01, Burkina Faso
| | - Sansan Hien
- UNICEF Ouagadougou, 01 PO Box 3420, Ouagadougou 01, Burkina Faso
| | | | - Cesaire Ky
- Ministère de la Santé, Ouagadougou, Burkina Faso
| | | | | | | | | | - Cynthia Hatcher
- U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329 USA
| | - Jaymin C. Patel
- U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329 USA
| | - Isaïe Medah
- Ministère de la Santé, Ouagadougou, Burkina Faso
| | - Ryan T. Novak
- U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329 USA
| | - Terri B. Hyde
- U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329 USA
| | - Heidi M. Soeters
- U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329 USA
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14
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Mantel C, Chu SY, Hyde TB, Lambach P. Seasonal influenza vaccination in middle-income countries: Assessment of immunization practices in Belarus, Morocco, and Thailand. Vaccine 2020; 38:212-219. [PMID: 31699507 PMCID: PMC6961110 DOI: 10.1016/j.vaccine.2019.10.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 10/09/2019] [Accepted: 10/10/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Vaccines for the control of seasonal influenza are recommended by the World Health Organization (WHO) for use in specific risk groups, but their use requires operational considerations that may challenge immunization programs. Several middle-income countries have recently implemented seasonal influenza vaccination. Early program evaluation following vaccine introduction can help ascertain positive lessons learned and areas for improvement. METHODS An influenza vaccine post-introduction evaluation (IPIE) tool was developed jointly by WHO and the U.S. Centers for Disease Control and Prevention to provide a systematic approach to assess influenza vaccine implementation processes. The tool was used in 2017 in three middle-income countries: Belarus, Morocco and Thailand. RESULTS Data from the three countries highlighted a number of critical factors: Health workers (HWs) are a key target group, given their roles as key influencers of acceptance by other groups, and for ensuring vaccine delivery and improved coverage. Despite WHO recommendations, pregnant women were not always prioritized and may present unique challenges for acceptance. Target group denominators need to be better defined, and vaccine coverage should be validated with vaccine distribution data, including from the private sector. There is a need for strengthening adverse events reporting and for addressing potential vaccine hesitancy through the establishment of risk communication plans. The assessments led to improvements in the countries' influenza vaccination programs, including a revision of policies, changes in vaccine management and coverage estimation, enhanced strategies for educating HWs and intensified collaboration between departments involved in implementing seasonal influenza vaccination. CONCLUSION The IPIE tool was found useful for delineating operational strengths and weaknesses of seasonal influenza vaccination programs. HWs emerged as a critical target group to be addressed in follow-up action. Findings from this study can help direct influenza vaccination programs in other countries, as well as contribute to pandemic preparedness efforts. The updated IPIE tool is available on the WHO website http://www.who.int/immunization/research/development/influenza/en/index1.html.
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Affiliation(s)
| | - Susan Y Chu
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Terri B Hyde
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Philipp Lambach
- Initiative for Vaccine Research, World Health Organization, Geneva, Switzerland
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15
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Zoma RL, Walldorf JA, Tarbangdo F, Patel JC, Diallo AO, Nkwenkeu SF, Kambou L, Nikiema M, Ouedraogo A, Bationo AB, Ouili R, Badolo H, Sawadogo G, Akshaya K, Hatcher C, Hyde TB, Aké F, Novak RT, Wannemuehler K, Mirza I, Medah I, Soeters HM. Evaluation of the Impact of Meningococcal Serogroup A Conjugate Vaccine Introduction on Second-Year-of-Life Vaccination Coverage in Burkina Faso. J Infect Dis 2019; 220:S233-S243. [PMID: 31671442 PMCID: PMC10718265 DOI: 10.1093/infdis/jiz304] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND After successful meningococcal serogroup A conjugate vaccine (MACV) campaigns since 2010, Burkina Faso introduced MACV in March 2017 into the routine Expanded Programme for Immunization schedule at age 15-18 months, concomitantly with second-dose measles-containing vaccine (MCV2). We examined MCV2 coverage in pre- and post-MACV introduction cohorts to describe observed changes regionally and nationally. METHODS A nationwide household cluster survey of children 18-41 months of age was conducted 1 year after MACV introduction. Coverage was assessed by verification of vaccination cards or recall. Two age groups were included to compare MCV2 coverage pre-MACV introduction (30-41 months) versus post-MACV introduction (18-26 months). RESULTS In total, 15 925 households were surveyed; 7796 children were enrolled, including 3684 30-41 months of age and 3091 18-26 months of age. Vaccination documentation was observed for 86% of children. The MACV routine coverage was 58% (95% confidence interval [CI], 56%-61%) with variation by region (41%-76%). The MCV2 coverage was 62% (95% CI, 59%-65%) pre-MACV introduction and 67% (95% CI, 64%-69%) post-MACV introduction, an increase of 4.5% (95% CI, 1.3%-7.7%). Among children who received routine MACV and MCV2, 93% (95% CI, 91%-94%) received both at the same visit. Lack of caregiver awareness about the 15- to 18-month visit and vaccine unavailability were common reported barriers to vaccination. CONCLUSIONS A small yet significant increase in national MCV2 coverage was observed 1 year post-MACV introduction. The MACV/MCV2 coadministration was common. Findings will help inform strategies to strengthen second-year-of-life immunization coverage, including to address the communication and vaccine availability barriers identified.
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Affiliation(s)
- Robert L. Zoma
- Institut National de Statistique et Démographie, Ouagadougou, Burkina Faso
| | | | | | - Jaymin C. Patel
- Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | | | | | | | | | - Arnaud Ouedraogo
- Institut National de Statistique et Démographie, Ouagadougou, Burkina Faso
| | | | - Romeo Ouili
- Ministère de la Santé, Ouagadougou, Burkina Faso
| | | | | | | | - Cynthia Hatcher
- Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Terri B. Hyde
- Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | | | - Ryan T. Novak
- Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | | | | | - Isaïe Medah
- Ministère de la Santé, Ouagadougou, Burkina Faso
| | - Heidi M. Soeters
- Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
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16
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Casey RM, Harris JB, Ahuka-Mundeke S, Dixon MG, Kizito GM, Nsele PM, Umutesi G, Laven J, Kosoy O, Paluku G, Gueye AS, Hyde TB, Ewetola R, Sheria GKM, Muyembe-Tamfum JJ, Staples JE. Immunogenicity of Fractional-Dose Vaccine during a Yellow Fever Outbreak - Final Report. N Engl J Med 2019; 381:444-454. [PMID: 29443626 PMCID: PMC7064153 DOI: 10.1056/nejmoa1710430] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND In 2016, the response to a yellow fever outbreak in Angola and the Democratic Republic of Congo led to a global shortage of yellow fever vaccine. As a result, a fractional dose of the 17DD yellow fever vaccine (containing one fifth [0.1 ml] of the standard dose) was offered to 7.6 million children 2 years of age or older and nonpregnant adults in a preemptive campaign in Kinshasa. The goal of this study was to assess the immune response to the fractional dose in a large-scale campaign. METHODS We recruited participants in four age strata at six vaccination sites. We assessed neutralizing antibody titers against yellow fever virus in blood samples obtained before vaccination and at 1 month and 1 year after vaccination, using a plaque reduction neutralization test with a 50% cutoff (PRNT50). Participants with a PRNT50 titer of 10 or higher were considered to be seropositive. Those with a baseline titer of less than 10 who became seropositive at follow-up were classified as having undergone seroconversion. Participants who were seropositive at baseline and who had an increase in the titer by a factor of 4 or more at follow-up were classified as having an immune response. RESULTS Among 716 participants who completed the 1-month follow-up, 705 (98%; 95% confidence interval [CI], 97 to 99) were seropositive after vaccination. Among 493 participants who were seronegative at baseline, 482 (98%; 95% CI, 96 to 99) underwent seroconversion. Among 223 participants who were seropositive at baseline, 148 (66%; 95% CI, 60 to 72) had an immune response. Lower baseline titers were associated with a higher probability of having an immune response (P<0.001). Among 684 participants who completed the 1-year follow-up, 666 (97%; 95% CI, 96 to 98) were seropositive for yellow fever antibody. The distribution of titers among the participants who were seronegative for yellow fever antibody at baseline varied significantly among age groups at 1 month and at 1 year (P<0.001 for both comparisons). CONCLUSIONS A fractional dose of the 17DD yellow fever vaccine was effective at inducing seroconversion in participants who were seronegative at baseline. Titers remained above the threshold for seropositivity at 1 year after vaccination in nearly all participants who were seropositive at 1 month after vaccination. These findings support the use of fractional-dose vaccination for outbreak control. (Funded by the U.S. Agency for International Development and the Centers for Disease Control and Prevention.).
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Affiliation(s)
- Rebecca M Casey
- From the Global Immunization Division (R.M.C., J.B.H., M.G.D., G.U., G.P., T.B.H.) and the Epidemic Intelligence Service (R.M.C.), Centers for Disease Control and Prevention (CDC), Atlanta; Institut National de Recherche Biomédicale (S.A.-M., P.M.N., G.M.K., J.-J.M.-T.), Division of Global Health Protection (A.S.G.), Division of Global HIV and Tuberculosis (R.E.), CDC, and Programme Elargi de Vaccination, Ministère de la Santé (G.K.M.S.) - all in Kinshasa, Democratic Republic of Congo; and the Division of Vector-Borne Diseases, CDC, Fort Collins, CO (J.L., O.K., J.E.S.)
| | - Jennifer B Harris
- From the Global Immunization Division (R.M.C., J.B.H., M.G.D., G.U., G.P., T.B.H.) and the Epidemic Intelligence Service (R.M.C.), Centers for Disease Control and Prevention (CDC), Atlanta; Institut National de Recherche Biomédicale (S.A.-M., P.M.N., G.M.K., J.-J.M.-T.), Division of Global Health Protection (A.S.G.), Division of Global HIV and Tuberculosis (R.E.), CDC, and Programme Elargi de Vaccination, Ministère de la Santé (G.K.M.S.) - all in Kinshasa, Democratic Republic of Congo; and the Division of Vector-Borne Diseases, CDC, Fort Collins, CO (J.L., O.K., J.E.S.)
| | - Steve Ahuka-Mundeke
- From the Global Immunization Division (R.M.C., J.B.H., M.G.D., G.U., G.P., T.B.H.) and the Epidemic Intelligence Service (R.M.C.), Centers for Disease Control and Prevention (CDC), Atlanta; Institut National de Recherche Biomédicale (S.A.-M., P.M.N., G.M.K., J.-J.M.-T.), Division of Global Health Protection (A.S.G.), Division of Global HIV and Tuberculosis (R.E.), CDC, and Programme Elargi de Vaccination, Ministère de la Santé (G.K.M.S.) - all in Kinshasa, Democratic Republic of Congo; and the Division of Vector-Borne Diseases, CDC, Fort Collins, CO (J.L., O.K., J.E.S.)
| | - Meredith G Dixon
- From the Global Immunization Division (R.M.C., J.B.H., M.G.D., G.U., G.P., T.B.H.) and the Epidemic Intelligence Service (R.M.C.), Centers for Disease Control and Prevention (CDC), Atlanta; Institut National de Recherche Biomédicale (S.A.-M., P.M.N., G.M.K., J.-J.M.-T.), Division of Global Health Protection (A.S.G.), Division of Global HIV and Tuberculosis (R.E.), CDC, and Programme Elargi de Vaccination, Ministère de la Santé (G.K.M.S.) - all in Kinshasa, Democratic Republic of Congo; and the Division of Vector-Borne Diseases, CDC, Fort Collins, CO (J.L., O.K., J.E.S.)
| | - Gabriel M Kizito
- From the Global Immunization Division (R.M.C., J.B.H., M.G.D., G.U., G.P., T.B.H.) and the Epidemic Intelligence Service (R.M.C.), Centers for Disease Control and Prevention (CDC), Atlanta; Institut National de Recherche Biomédicale (S.A.-M., P.M.N., G.M.K., J.-J.M.-T.), Division of Global Health Protection (A.S.G.), Division of Global HIV and Tuberculosis (R.E.), CDC, and Programme Elargi de Vaccination, Ministère de la Santé (G.K.M.S.) - all in Kinshasa, Democratic Republic of Congo; and the Division of Vector-Borne Diseases, CDC, Fort Collins, CO (J.L., O.K., J.E.S.)
| | - Pierre M Nsele
- From the Global Immunization Division (R.M.C., J.B.H., M.G.D., G.U., G.P., T.B.H.) and the Epidemic Intelligence Service (R.M.C.), Centers for Disease Control and Prevention (CDC), Atlanta; Institut National de Recherche Biomédicale (S.A.-M., P.M.N., G.M.K., J.-J.M.-T.), Division of Global Health Protection (A.S.G.), Division of Global HIV and Tuberculosis (R.E.), CDC, and Programme Elargi de Vaccination, Ministère de la Santé (G.K.M.S.) - all in Kinshasa, Democratic Republic of Congo; and the Division of Vector-Borne Diseases, CDC, Fort Collins, CO (J.L., O.K., J.E.S.)
| | - Grace Umutesi
- From the Global Immunization Division (R.M.C., J.B.H., M.G.D., G.U., G.P., T.B.H.) and the Epidemic Intelligence Service (R.M.C.), Centers for Disease Control and Prevention (CDC), Atlanta; Institut National de Recherche Biomédicale (S.A.-M., P.M.N., G.M.K., J.-J.M.-T.), Division of Global Health Protection (A.S.G.), Division of Global HIV and Tuberculosis (R.E.), CDC, and Programme Elargi de Vaccination, Ministère de la Santé (G.K.M.S.) - all in Kinshasa, Democratic Republic of Congo; and the Division of Vector-Borne Diseases, CDC, Fort Collins, CO (J.L., O.K., J.E.S.)
| | - Janeen Laven
- From the Global Immunization Division (R.M.C., J.B.H., M.G.D., G.U., G.P., T.B.H.) and the Epidemic Intelligence Service (R.M.C.), Centers for Disease Control and Prevention (CDC), Atlanta; Institut National de Recherche Biomédicale (S.A.-M., P.M.N., G.M.K., J.-J.M.-T.), Division of Global Health Protection (A.S.G.), Division of Global HIV and Tuberculosis (R.E.), CDC, and Programme Elargi de Vaccination, Ministère de la Santé (G.K.M.S.) - all in Kinshasa, Democratic Republic of Congo; and the Division of Vector-Borne Diseases, CDC, Fort Collins, CO (J.L., O.K., J.E.S.)
| | - Olga Kosoy
- From the Global Immunization Division (R.M.C., J.B.H., M.G.D., G.U., G.P., T.B.H.) and the Epidemic Intelligence Service (R.M.C.), Centers for Disease Control and Prevention (CDC), Atlanta; Institut National de Recherche Biomédicale (S.A.-M., P.M.N., G.M.K., J.-J.M.-T.), Division of Global Health Protection (A.S.G.), Division of Global HIV and Tuberculosis (R.E.), CDC, and Programme Elargi de Vaccination, Ministère de la Santé (G.K.M.S.) - all in Kinshasa, Democratic Republic of Congo; and the Division of Vector-Borne Diseases, CDC, Fort Collins, CO (J.L., O.K., J.E.S.)
| | - Gilson Paluku
- From the Global Immunization Division (R.M.C., J.B.H., M.G.D., G.U., G.P., T.B.H.) and the Epidemic Intelligence Service (R.M.C.), Centers for Disease Control and Prevention (CDC), Atlanta; Institut National de Recherche Biomédicale (S.A.-M., P.M.N., G.M.K., J.-J.M.-T.), Division of Global Health Protection (A.S.G.), Division of Global HIV and Tuberculosis (R.E.), CDC, and Programme Elargi de Vaccination, Ministère de la Santé (G.K.M.S.) - all in Kinshasa, Democratic Republic of Congo; and the Division of Vector-Borne Diseases, CDC, Fort Collins, CO (J.L., O.K., J.E.S.)
| | - Abdou S Gueye
- From the Global Immunization Division (R.M.C., J.B.H., M.G.D., G.U., G.P., T.B.H.) and the Epidemic Intelligence Service (R.M.C.), Centers for Disease Control and Prevention (CDC), Atlanta; Institut National de Recherche Biomédicale (S.A.-M., P.M.N., G.M.K., J.-J.M.-T.), Division of Global Health Protection (A.S.G.), Division of Global HIV and Tuberculosis (R.E.), CDC, and Programme Elargi de Vaccination, Ministère de la Santé (G.K.M.S.) - all in Kinshasa, Democratic Republic of Congo; and the Division of Vector-Borne Diseases, CDC, Fort Collins, CO (J.L., O.K., J.E.S.)
| | - Terri B Hyde
- From the Global Immunization Division (R.M.C., J.B.H., M.G.D., G.U., G.P., T.B.H.) and the Epidemic Intelligence Service (R.M.C.), Centers for Disease Control and Prevention (CDC), Atlanta; Institut National de Recherche Biomédicale (S.A.-M., P.M.N., G.M.K., J.-J.M.-T.), Division of Global Health Protection (A.S.G.), Division of Global HIV and Tuberculosis (R.E.), CDC, and Programme Elargi de Vaccination, Ministère de la Santé (G.K.M.S.) - all in Kinshasa, Democratic Republic of Congo; and the Division of Vector-Borne Diseases, CDC, Fort Collins, CO (J.L., O.K., J.E.S.)
| | - Raimi Ewetola
- From the Global Immunization Division (R.M.C., J.B.H., M.G.D., G.U., G.P., T.B.H.) and the Epidemic Intelligence Service (R.M.C.), Centers for Disease Control and Prevention (CDC), Atlanta; Institut National de Recherche Biomédicale (S.A.-M., P.M.N., G.M.K., J.-J.M.-T.), Division of Global Health Protection (A.S.G.), Division of Global HIV and Tuberculosis (R.E.), CDC, and Programme Elargi de Vaccination, Ministère de la Santé (G.K.M.S.) - all in Kinshasa, Democratic Republic of Congo; and the Division of Vector-Borne Diseases, CDC, Fort Collins, CO (J.L., O.K., J.E.S.)
| | - Guylain K M Sheria
- From the Global Immunization Division (R.M.C., J.B.H., M.G.D., G.U., G.P., T.B.H.) and the Epidemic Intelligence Service (R.M.C.), Centers for Disease Control and Prevention (CDC), Atlanta; Institut National de Recherche Biomédicale (S.A.-M., P.M.N., G.M.K., J.-J.M.-T.), Division of Global Health Protection (A.S.G.), Division of Global HIV and Tuberculosis (R.E.), CDC, and Programme Elargi de Vaccination, Ministère de la Santé (G.K.M.S.) - all in Kinshasa, Democratic Republic of Congo; and the Division of Vector-Borne Diseases, CDC, Fort Collins, CO (J.L., O.K., J.E.S.)
| | - Jean-Jacques Muyembe-Tamfum
- From the Global Immunization Division (R.M.C., J.B.H., M.G.D., G.U., G.P., T.B.H.) and the Epidemic Intelligence Service (R.M.C.), Centers for Disease Control and Prevention (CDC), Atlanta; Institut National de Recherche Biomédicale (S.A.-M., P.M.N., G.M.K., J.-J.M.-T.), Division of Global Health Protection (A.S.G.), Division of Global HIV and Tuberculosis (R.E.), CDC, and Programme Elargi de Vaccination, Ministère de la Santé (G.K.M.S.) - all in Kinshasa, Democratic Republic of Congo; and the Division of Vector-Borne Diseases, CDC, Fort Collins, CO (J.L., O.K., J.E.S.)
| | - J Erin Staples
- From the Global Immunization Division (R.M.C., J.B.H., M.G.D., G.U., G.P., T.B.H.) and the Epidemic Intelligence Service (R.M.C.), Centers for Disease Control and Prevention (CDC), Atlanta; Institut National de Recherche Biomédicale (S.A.-M., P.M.N., G.M.K., J.-J.M.-T.), Division of Global Health Protection (A.S.G.), Division of Global HIV and Tuberculosis (R.E.), CDC, and Programme Elargi de Vaccination, Ministère de la Santé (G.K.M.S.) - all in Kinshasa, Democratic Republic of Congo; and the Division of Vector-Borne Diseases, CDC, Fort Collins, CO (J.L., O.K., J.E.S.)
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17
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Lopez AL, Harris JB, Raguindin PF, Aldaba J, Morales M, Sylim P, Wannemuehler K, Wallace A, Ehlman DC, Hyde TB, Fox KK, Nyambat B, Ducusin MJ, Hampton LM. Introduction of inactivated poliovirus vaccine in the Philippines: Effect on health care provider and infant caregiver attitudes and practices. Vaccine 2018; 36:7399-7407. [PMID: 30431003 PMCID: PMC7673670 DOI: 10.1016/j.vaccine.2018.09.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 09/13/2018] [Accepted: 09/14/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND The introduction of inactivated poliovirus vaccine (IPV) to the Philippines' national immunization schedule meant the addition of a third injectable vaccine at a child's 14-week immunization visit. Although previous studies have shown that providing multiple vaccines at the same time affected neither the risk of severe adverse events nor vaccine efficacy, concerns were raised that providing three injections at a single visit, with two injections in one leg, might be unacceptable to health care providers (HCP) and infant caregivers. METHODS We conducted pre- and post-IPV introduction surveys on the acceptance and acceptability of the additional injectable vaccine in three of the Philippines' 17 administrative regions. Regions 3 and 6 were included in the pre-introduction phase and Regions 3, 6 and 10 were included in the post-introduction phase. Thirty public health centers (PHCs) were randomly sampled from each region. HCPs and infant caregivers were interviewed. In addition, vaccination records from a minimum of 20 eligible children pre-introduction and 10 children post-introduction per PHC were reviewed. RESULTS AND DISCUSSION We interviewed 89 HCPs and 286 infant caregivers during the pre-introduction phase and 137 HCPs and 455 caregivers during the post-introduction phase. Among 986 vaccination records reviewed post-introduction, 84% (n = 826) of children received all three recommended injections at one visit, with a range from 61% (209/342) in Region 10 to 100% (328/328) in Region 3. The proportion of HCPs reporting that they had administered three or more injectable vaccines and the proportion of caregivers that would be comfortable with their child receiving three or more injectable vaccines at one visit increased from pre- to post-introduction (p < 0.0001 for both). Eighty-seven percent of HCPs that had administered three or more injectable vaccines post-introduction reported being comfortable or very comfortable with the number of vaccines they had administered.
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Affiliation(s)
- Anna Lena Lopez
- Institute of Child Health and Human Development, National Institutes of Health, University of the Philippines Manila, Philippines.
| | - Jennifer B Harris
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, United States
| | - Peter Francis Raguindin
- Institute of Child Health and Human Development, National Institutes of Health, University of the Philippines Manila, Philippines
| | - Josephine Aldaba
- Institute of Child Health and Human Development, National Institutes of Health, University of the Philippines Manila, Philippines
| | - Merrylle Morales
- Institute of Child Health and Human Development, National Institutes of Health, University of the Philippines Manila, Philippines
| | - Patrick Sylim
- National Telehealth Center, National Institutes of Health, University of the Philippines Manila, Philippines
| | - Kathleen Wannemuehler
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, United States
| | - Aaron Wallace
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, United States
| | - Daniel C Ehlman
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, United States
| | - Terri B Hyde
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, United States
| | - Kimberley K Fox
- World Health Organization, Regional Office for the Western Pacific, Philippines
| | - Batmunkh Nyambat
- World Health Organization, Regional Office for the Western Pacific, Philippines
| | - Maria Joyce Ducusin
- Family Health Office, Disease Prevention and Control Bureau, Department of Health, Manila, Philippines
| | - Lee M Hampton
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, United States
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18
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Suragh TA, Lamprianou S, MacDonald NE, Loharikar AR, Balakrishnan MR, Benes O, Hyde TB, McNeil MM. Cluster anxiety-related adverse events following immunization (AEFI): An assessment of reports detected in social media and those identified using an online search engine. Vaccine 2018; 36:5949-5954. [PMID: 30172632 DOI: 10.1016/j.vaccine.2018.08.064] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 08/22/2018] [Accepted: 08/25/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Adverse events following immunization (AEFI) arising from anxiety have rarely been reported as a cluster(s) in the setting of a mass vaccination program. Reports of clusters of anxiety-related AEFIs are understudied. Social media and the web may be a resource for public health investigators. METHODS We searched Google and Facebook separately from Atlanta and Geneva to identify reports of cluster anxiety-related AEFIs. We reviewed a sample of reports summarizing year, country/setting, vaccine involved, patient symptoms, clinical management, and impact to vaccination programs. RESULTS We found 39 reports referring to 18 unique cluster events. Some reports were only found based on the geographic location from where the search was performed. The most common vaccine implicated in reports was human papillomavirus (HPV) vaccine (48.7%). The majority of reports (97.4%) involved children and vaccination programs in school settings or as part of national vaccination campaigns. Five vaccination programs were reportedly halted because of these cluster events. In this study, we identified 18 cluster events that were not published in traditional scientific peer-reviewed literature. CONCLUSIONS Social media and online search engines are useful resources for identifying reports of cluster anxiety-related AEFIs and the geographic location of the researcher is an important factor to consider when conducting these studies. Solely relying upon traditional peer-reviewed journals may seriously underestimate the occurrence of such cluster events.
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Affiliation(s)
- Tiffany A Suragh
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, United States.
| | | | | | - Anagha R Loharikar
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Oleg Benes
- World Health Organization, Regional Office for Europe, Copenhagen, Denmark
| | - Terri B Hyde
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Michael M McNeil
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, United States
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19
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Walldorf JA, Date KA, Sreenivasan N, Harris JB, Hyde TB. Lessons Learned from Emergency Response Vaccination Efforts for Cholera, Typhoid, Yellow Fever, and Ebola. Emerg Infect Dis 2018; 23. [PMID: 29155670 PMCID: PMC5711321 DOI: 10.3201/eid2313.170550] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Countries must be prepared to respond to public health threats associated with emergencies, such as natural disasters, sociopolitical conflicts, or uncontrolled disease outbreaks. Rapid vaccination of populations vulnerable to epidemic-prone vaccine-preventable diseases is a major component of emergency response. Emergency vaccination planning presents challenges, including how to predict resource needs, expand vaccine availability during global shortages, and address regulatory barriers to deliver new products. The US Centers for Disease Control and Prevention supports countries to plan, implement, and evaluate emergency vaccination response. We describe work of the Centers for Disease Control and Prevention in collaboration with global partners to support emergency vaccination against cholera, typhoid, yellow fever, and Ebola, diseases for which a new vaccine or vaccine formulation has played a major role in response. Lessons learned will help countries prepare for future emergencies. Integration of vaccination with emergency response augments global health security through reducing disease burden, saving lives, and preventing spread across international borders.
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20
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Senkomago V, Duran D, Loharikar A, Hyde TB, Markowitz LE, Unger ER, Saraiya M. CDC Activities for Improving Implementation of Human Papillomavirus Vaccination, Cervical Cancer Screening, and Surveillance Worldwide. Emerg Infect Dis 2018; 23. [PMID: 29155666 PMCID: PMC5711299 DOI: 10.3201/eid2313.170603] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Cervical cancer incidence and mortality rates are high, particularly in developing countries. Most cervical cancers can be prevented by human papillomavirus (HPV) vaccination, screening, and timely treatment. The US Centers for Disease Control and Prevention (CDC) provides global technical assistance for implementation and evaluation of HPV vaccination pilot projects and programs and laboratory-related HPV activities to assess HPV vaccines. CDC collaborates with global partners to develop global cervical cancer screening recommendations and manuals, implement screening, create standardized evaluation tools, and provide expertise to monitor outcomes. CDC also trains epidemiologists in cancer prevention through its Field Epidemiology Training Program and is working to improve cancer surveillance by supporting efforts of the World Health Organization in developing cancer registry hubs and assisting countries in estimating costs for developing population-based cancer registries. These activities contribute to the Global Health Security Agenda action packages to improve immunization, surveillance, and the public health workforce globally.
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Teresa Aguado M, Barratt J, Beard JR, Blomberg BB, Chen WH, Hickling J, Hyde TB, Jit M, Jones R, Poland GA, Friede M, Ortiz JR. Report on WHO meeting on immunization in older adults: Geneva, Switzerland, 22-23 March 2017. Vaccine 2018; 36:921-931. [PMID: 29336923 PMCID: PMC5865389 DOI: 10.1016/j.vaccine.2017.12.029] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 12/11/2017] [Indexed: 12/30/2022]
Abstract
Many industrialized countries have implemented routine immunization policies for older adults, but similar strategies have not been widely implemented in low- and middle-income countries (LMICs). In March 2017, the World Health Organization (WHO) convened a meeting to identify policies and activities to promote access to vaccination of older adults, specifically in LMICs. Participants included academic and industry researchers, funders, civil society organizations, implementers of global health interventions, and stakeholders from developing countries with adult immunization needs. These experts reviewed vaccine performance in older adults, the anticipated impact of adult vaccination programs, and the challenges and opportunities of building or strengthening an adult and older adult immunization platforms. Key conclusions of the meeting were that there is a need for discussion of new opportunities for vaccination of all adults as well as for vaccination of older adults, as reflected in the recent shift by WHO to a life-course approach to immunization; that immunization in adults should be viewed in the context of a much broader model based on an individual's abilities rather than chronological age; and that immunization beyond infancy is a global priority that can be successfully integrated with other interventions to promote healthy ageing. As WHO is looking ahead to a global Decade of Healthy Ageing starting in 2020, it will seek to define a roadmap for interdisciplinary collaborations to integrate immunization with improving access to preventive and other healthcare interventions for adults worldwide.
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Affiliation(s)
| | - Jane Barratt
- International Federation on Ageing, Toronto, Canada.
| | - John R Beard
- Ageing and Life Course, World Health Organization, Geneva, Switzerland.
| | - Bonnie B Blomberg
- Department of Microbiology and Immunology, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Wilbur H Chen
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, MD, USA.
| | | | - Terri B Hyde
- Vaccine Introduction Team, Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Mark Jit
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, United Kingdom; Modelling and Economics Unit, Public Health England, London, United Kingdom.
| | | | - Gregory A Poland
- Mayo Vaccine Research Group, Mayo Clinic and Foundation, Rochester, MN, USA.
| | - Martin Friede
- Initiative for Vaccine Research, World Health Organization, Geneva, Switzerland.
| | - Justin R Ortiz
- Initiative for Vaccine Research, World Health Organization, Geneva, Switzerland.
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22
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Loharikar A, Suragh TA, MacDonald NE, Balakrishnan MR, Benes O, Lamprianou S, Hyde TB, McNeil MM. Anxiety-related adverse events following immunization (AEFI): A systematic review of published clusters of illness. Vaccine 2018; 36:299-305. [PMID: 29198916 PMCID: PMC10874769 DOI: 10.1016/j.vaccine.2017.11.017] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 11/06/2017] [Accepted: 11/07/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Clusters of anxiety-related adverse events following immunization (AEFI) have been observed in several countries and have disrupted country immunization programs. We conducted a systematic literature review to characterize these clusters, to generate prevention and management guidance for countries. METHODS We searched seven peer-reviewed databases for English language reports of anxiety-related AEFI clusters (≥2 persons) with pre-specified keywords across 4 categories: symptom term, cluster term, vaccine term, and cluster AEFI phenomenon term/phrase. All relevant reports were included regardless of publication date, case-patient age, or vaccine. Two investigators independently reviewed abstracts and identified articles for full review. Data on epidemiologic/clinical information were extracted from full text review including setting, vaccine implicated, predominant case-patient symptoms, clinical management, community and media response, and outcome/impact on the vaccination program. RESULTS Of 1472 abstracts reviewed, we identified eight published clusters, from all six World Health Organization (WHO) regions except the African Region. Seven clusters occurred among children in school settings, and one was among adult military reservists. The size and nature of these clusters ranged from 7 patients in one school to 806 patients in multiple schools. Patients' symptoms included dizziness, headache, and fainting with rapid onset after vaccination. Implicated vaccines included tetanus (2), tetanus-diphtheria (1), hepatitis B (1), oral cholera (1), human papillomavirus (1), and influenza A (H1N1)pdm09 (2). In each report, all affected individuals recovered rapidly; however, vaccination program disruption was noted in some instances, sometimes for up to one year. CONCLUSIONS Anxiety-related AEFI clusters can be disruptive to vaccination programs, reducing public trust in immunizations and impacting vaccination coverage; response efforts to restore public confidence can be resource intensive. Health care providers should have training on recognition and clinical management of anxiety-related AEFI; public health authorities should have plans to prevent and effectively manage anxiety-related AEFI clusters. Prompt management of these occurrences can be even more important in an era of social media, in which information is rapidly spread.
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Affiliation(s)
- Anagha Loharikar
- Global Immunization Division, Centers for Disease Control and Prevention, United States.
| | - Tiffany A Suragh
- Immunization Safety Office, Centers for Disease Control and Prevention, United States
| | | | | | - Oleg Benes
- World Health Organization, European Region, Denmark
| | | | - Terri B Hyde
- Global Immunization Division, Centers for Disease Control and Prevention, United States
| | - Michael M McNeil
- Immunization Safety Office, Centers for Disease Control and Prevention, United States
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23
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Tohme RA, Francois J, Cavallaro KF, Paluku G, Yalcouye I, Jackson E, Wright T, Adrien P, Katz MA, Hyde TB, Faye P, Kimanuka F, Dietz V, Vertefeuille J, Lowrance D, Dahl B, Patel R. Expansion of Vaccination Services and Strengthening Vaccine-Preventable Diseases Surveillance in Haiti, 2010-2016. Am J Trop Med Hyg 2017; 97:28-36. [PMID: 29064356 PMCID: PMC5676636 DOI: 10.4269/ajtmh.16-0802] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Following the 2010 earthquake, Haiti was at heightened risk for vaccine-preventable diseases (VPDs) outbreaks due to the exacerbation of long-standing gaps in the vaccination program and subsequent risk of VPD importation from other countries. Therefore, partners supported the Haitian Ministry of Health and Population to improve vaccination services and VPD surveillance. During 2010–2016, three polio, measles, and rubella vaccination campaigns were implemented, achieving a coverage > 90% among children and maintaining Haiti free of those VPDs. Furthermore, Haiti is on course to eliminate maternal and neonatal tetanus, with 70% of communes achieving tetanus vaccine two-dose coverage > 80% among women of childbearing age. In addition, the vaccine cold chain storage capacity increased by 91% at the central level and 285% at the department level, enabling the introduction of three new vaccines (pentavalent, rotavirus, and pneumococcal conjugate vaccines) that could prevent an estimated 5,227 deaths annually. Haiti moved from the fourth worst performing country in the Americas in 2012 to the sixth best performing country in 2015 for adequate investigation of suspected measles/rubella cases. Sentinel surveillance sites for rotavirus diarrhea and meningococcal meningitis were established to estimate baseline rates of those diseases prior to vaccine introduction and to evaluate the impact of vaccination in the future. In conclusion, Haiti significantly improved vaccination services and VPD surveillance. However, high dependence on external funding and competing vaccination program priorities are potential threats to sustaining the improvements achieved thus far. Political commitment and favorable economic and legal environments are needed to maintain these gains.
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Affiliation(s)
- Rania A Tohme
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jeannot Francois
- Direction du Program Elargi de Vaccination (DPEV), Ministry of Public Health and Population, Port-au-Prince, Haiti
| | - Kathleen F Cavallaro
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Gilson Paluku
- Pan American Health Organization, Port-au-Prince, Haiti
| | | | | | - Tracie Wright
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Paul Adrien
- Direction d'Épidémiologie, de Laboratoire et de Recherche (DELR), Ministry of Public Health and Population, Port-au-Prince, Haiti
| | - Mark A Katz
- Centers for Disease Control and Prevention, Port-au-Prince, Haiti
| | - Terri B Hyde
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Pape Faye
- Pan American Health Organization, Port-au-Prince, Haiti
| | | | - Vance Dietz
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - John Vertefeuille
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - David Lowrance
- Centers for Disease Control and Prevention, Port-au-Prince, Haiti
| | - Benjamin Dahl
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Roopal Patel
- Centers for Disease Control and Prevention, Port-au-Prince, Haiti
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Preza I, Subaiya S, Harris JB, Ehlman DC, Wannemuehler K, Wallace AS, Huseynov S, Hyde TB, Nelaj E, Bino S, Hampton LM. Acceptance of the Administration of Multiple Injectable Vaccines in a Single Immunization Visit in Albania. J Infect Dis 2017; 216:S146-S151. [PMID: 28838166 PMCID: PMC5853421 DOI: 10.1093/infdis/jiw570] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background. Albania introduced inactivated polio vaccine (IPV) into its immunization system in May 2014, increasing the maximum recommended number of injectable vaccines given in a single visit from 2 to 3. Methods. Health-care providers and caregivers were interviewed at 42 health facilities in Albania to assess knowledge, attitudes, and practices regarding injectable vaccine administration. Immunization register data were abstracted from December 2014 to July 2015 at the same facilities to explore the number of injectable vaccines children received during their 2- and 4-month visits. Results. The majority of children (87%) identified in the record review at either their 2- or 4-month immunization visit received all 3 injectable vaccines in a single visit. Almost all children who did not receive the vaccines in a single visit were subsequently fully immunized, most within a 2-week period. Over half of caregivers whose children got 3 or more injectable vaccines in a single visit reported being only comfortable with 1 or 2 injectable vaccines in a single visit. Conclusions. Despite most caregivers expressing hesitation regarding children receiving multiple injectable vaccines in a single visit, most children received vaccines according to the recommended schedule. Almost all children eventually received all recommended vaccines.
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Affiliation(s)
- Iria Preza
- Institute of Public Health, Tirana, Albania
| | - Saleena Subaiya
- Epidemic Intelligence Service.,Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jennifer B Harris
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Daniel C Ehlman
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kathleen Wannemuehler
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Aaron S Wallace
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Shahin Huseynov
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Terri B Hyde
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Lee M Hampton
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia
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Walldorf JA, Cloessner EA, Hyde TB, MacNeil A. Considerations for use of Ebola vaccine during an emergency response. Vaccine 2017; 37:7190-7200. [PMID: 28890191 DOI: 10.1016/j.vaccine.2017.08.058] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 07/21/2017] [Accepted: 08/24/2017] [Indexed: 10/18/2022]
Abstract
Vaccination against Ebola virus disease is a tool that may limit disease transmission and deaths in future outbreaks, integrated within traditional Ebola outbreak prevention and control measures. Although a licensed Ebolavirus vaccine (EV) is not yet available, the 2014-2016 West African Ebola outbreak has accelerated EV clinical trials and given public health authorities in Guinea, Liberia, and Sierra Leone experience with implementation of emergency ring vaccination. As evidence supporting the use of EV during an outbreak response has become available, public health authorities in at-risk countries are considering how to integrate EV into future emergency Ebola responses and for prevention in high-risk groups, such as healthcare workers and frontline workers (HCW/FLWs), even before an EV is licensed. This review provides an overview of Ebola epidemiology, immunology, and evidence to inform regional and country-level decisions regarding EV delivery during an emergency response and to at-risk populations before a licensed vaccine is available and beyond. Countries or regions planning to use EV will need to assess factors such as the likelihood of a future Ebolavirus outbreak, the most likely species to cause an outbreak, the availability of a safe and effective EV (unlicensed or licensed) for the affected population, capacity to implement Ebola vaccination in conjunction with standard Ebola outbreak control measures, and availability of minimum essential resources and regulatory requirements to implement emergency Ebola vaccination. Potential emergency vaccination strategies for consideration include ring or geographically targeted community vaccination, HCW/FLW vaccination, and mass vaccination. The development of guidelines and protocols for Ebola vaccination will help ensure that activities are standardized, evidence-based, and well-coordinated with overall Ebola outbreak response efforts in the future.
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Affiliation(s)
- Jenny A Walldorf
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA 30329, United States.
| | - Emily A Cloessner
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA 30329, United States; Association of Schools and Programs of Public Health, 1900 M St NW Suite 710, Washington, DC 20036, United States.
| | - Terri B Hyde
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA 30329, United States.
| | - Adam MacNeil
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA 30329, United States.
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Dolan SB, Patel M, Hampton LM, Burnett E, Ehlman DC, Garon J, Cloessner E, Chmielewski E, Hyde TB, Mantel C, Wallace AS. Administering Multiple Injectable Vaccines During a Single Visit-Summary of Findings From the Accelerated Introduction of Inactivated Polio Vaccine Globally. J Infect Dis 2017; 216:S152-S160. [PMID: 28838188 PMCID: PMC5853974 DOI: 10.1093/infdis/jix054] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background. In 2013, the World Health Organization’s (WHO’s) Strategic Advisory Group of Experts (SAGE) recommended that all 126 countries using only oral polio vaccine (OPV) introduce at least 1 dose of inactivated polio vaccine (IPV) into their routine immunization schedules by the end of 2015. In many countries, the addition of IPV would necessitate delivery of multiple injectable vaccines (hereafter, “multiple injections”) during a single visit, with infants receiving IPV alongside pentavalent vaccine (which covers diphtheria, tetanus, and whole-cell pertussis; hepatitis B; and Haemophilus influenzae type b) and pneumococcal vaccine. Unanticipated concerns emerged from countries over acceptability of multiple injections, sites of administration, and safety. We contextualized the issues surrounding multiple injections by documenting concerns associated with administration of ≥3 injections, existing evidence in the published literature, and findings of a systematic review on administration practices and techniques. Methods. Concerns associated with multiple-injection visits were documented from meetings and personal communications with immunization program managers. Published literature on the acceptability of multiple injections by providers and caregivers was summarized, and a systematic review of the literature on administration practices was completed on the following topics: spacing between injection sites (ie, vaccine spacing), site of injection, route of injection, and procedural preparedness. WHO and United Nations Children’s Fund data from 2013–2015 were used to assess multiple-injection visits included in national immunization schedules. Results. Healthcare provider and caregiver attitudes and practices indicated concerns about infant pain, potential adverse effects, and uncertainty about vaccine effectiveness with multiple-injection visits. Published literature reinforced the record of safety and acceptance of the recommended schedule of IPV by the SAGE, but the evidence was largely from developed countries. Parental acceptance of multiple injections was associated with a positive provider recommendation to the caregiver. Findings of the systematic review identified that the intramuscular route is preferred over the subcutaneous route for vaccine administration and that the vastus lateralis muscle is preferred over the deltoid muscle for intramuscular injections. Recommendations on vaccine spacing and procedural preparedness were based on practical necessities, but comparative evidence was not identified. During 2013–2015, 85 countries added IPV to their immunization schedules, 46 (55%) of which adopted a schedule resulting in 3 injectable vaccines being administered in a single visit. Conclusion. The multiple-injection experience identified gaps in guidance for future vaccine introductions. Global partner organizations quickly mobilized to assess, document, and communicate the existing global experience on multiple-injection visits. This evidence-based approach provided reassurance to opinion leaders, health workers, and professional societies, thus encouraging uptake of IPV as a second or third injection in an accelerated manner globally.
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Affiliation(s)
- Samantha B Dolan
- Global Immunization Division, Centers for Disease Control and Prevention
| | - Manish Patel
- Global Immunization Division, Centers for Disease Control and Prevention.,Task Force for Global Health, Decatur, Georgia
| | - Lee M Hampton
- Global Immunization Division, Centers for Disease Control and Prevention
| | - Eleanor Burnett
- Global Immunization Division, Centers for Disease Control and Prevention
| | - Daniel C Ehlman
- Global Immunization Division, Centers for Disease Control and Prevention
| | - Julie Garon
- Emory University School of Medicine, Atlanta
| | - Emily Cloessner
- Global Immunization Division, Centers for Disease Control and Prevention
| | | | - Terri B Hyde
- Global Immunization Division, Centers for Disease Control and Prevention
| | - Carsten Mantel
- Department of Immunization, Vaccines, and Biologicals, World Health Organization,Geneva, Switzerland
| | - Aaron S Wallace
- Global Immunization Division, Centers for Disease Control and Prevention
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27
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Heffelfinger JD, Li X, Batmunkh N, Grabovac V, Diorditsa S, Liyanage JB, Pattamadilok S, Bahl S, Vannice KS, Hyde TB, Chu SY, Fox KK, Hills SL, Marfin AA. Japanese Encephalitis Surveillance and Immunization - Asia and Western Pacific Regions, 2016. MMWR Morb Mortal Wkly Rep 2017; 66:579-583. [PMID: 28594790 PMCID: PMC5720240 DOI: 10.15585/mmwr.mm6622a3] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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28
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Childs L, François J, Choudhury A, Wannemuehler K, Dismer A, Hyde TB, Yen CY, Date KA, Juin S, Katz MA, Kantor EF, Routh J, Etheart M, Wright T, Adrien P, Tohme RA. Evaluation of Knowledge and Practices Regarding Cholera, Water Treatment, Hygiene, and Sanitation Before and After an Oral Cholera Vaccination Campaign-Haiti, 2013-2014. Am J Trop Med Hyg 2016; 95:1305-1313. [PMID: 27799642 DOI: 10.4269/ajtmh.16-0555] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 09/08/2016] [Indexed: 11/07/2022] Open
Abstract
In 2013, the Government of Haiti implemented its first oral cholera vaccine (OCV) campaign in Petite Anse, an urban setting, and Cerca Carvajal, a rural commune. We conducted and compared responses to two independent cross-sectional knowledge and practices household surveys pre- (N = 297) and post- (N = 302) OCV campaign in Petite Anse. No significant differences in knowledge about causes, symptoms, and prevention of cholera were noted. Compared with precampaign respondents, fewer postcampaign respondents reported treating (66% versus 27%, P < 0.001) and covering (96% versus 89%, P = 0.02) their drinking water. Compared with precampaign, postcampaign survey household observations showed increased availability of soap (16.2% versus 34.5%, P = 0.001) and handwashing stations (14.7% versus 30.1%, P = 0.01), but no significant changes in handwashing practices were reported. Although there was no change in knowledge, significant decreases in water treatment practices necessary for cholera and other diarrheal diseases prevention were noted in the postcampaign survey. Future OCV campaigns in Haiti should be used as an opportunity to emphasize the importance of maintaining good water, sanitation, and hygiene practices, and include a comprehensive, integrated approach for cholera control.
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Affiliation(s)
- Lana Childs
- Emory University Rollins School of Public Health Earn and Learn Program, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Alina Choudhury
- Emory University Rollins School of Public Health Earn and Learn Program, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Amber Dismer
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Terri B Hyde
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Catherine Y Yen
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kashmira A Date
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Stanley Juin
- Centers for Disease Control and Prevention, Port-au-Prince, Haiti
| | - Mark A Katz
- Centers for Disease Control and Prevention, Port-au-Prince, Haiti
| | | | - Janell Routh
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Melissa Etheart
- Centers for Disease Control and Prevention, Port-au-Prince, Haiti
| | - Tracie Wright
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Paul Adrien
- Ministry of Public Health and Population, Port-au-Prince, Haiti
| | - Rania A Tohme
- Centers for Disease Control and Prevention, Atlanta, Georgia.
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29
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Idoko OT, Hampton LM, Mboizi RB, Agbla SC, Wallace AS, Harris JB, Sowe D, Ehlman DC, Kampmann B, Ota MO, Hyde TB. Acceptance of multiple injectable vaccines in a single immunization visit in The Gambia pre and post introduction of inactivated polio vaccine. Vaccine 2016; 34:5034-5039. [PMID: 27570237 DOI: 10.1016/j.vaccine.2016.07.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 07/12/2016] [Accepted: 07/15/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND As the World Health Organization (WHO) currently recommends that children be protected against 11 different pathogens, it is becoming increasingly necessary to administer multiple injectable vaccines during a single immunization visit. In this study we assess Gambian healthcare providers' and infant caregivers' attitudes and practices related to the administration of multiple injectable vaccines to a child at a single immunization visit before and after the 2015 introduction of inactivated polio vaccine (IPV). IPV introduction increased the number of injectable vaccines recommended for the 4-month immunization visit from two to three in The Gambia. METHODS We conducted a cross-sectional questionnaire-based survey before and after the introduction of IPV at 4months of age in a representative sample of all health facilities providing immunizations in The Gambia. Healthcare providers who administer vaccines at the selected health facilities and caregivers who brought infants for their 4month immunization visit were surveyed. FINDINGS Prior to IPV introduction, 9.9% of healthcare providers and 35.7% of infant caregivers expressed concern about a child receiving more than 2 injections in a single visit. Nevertheless, 98.8% and 90.9% of infants received all required vaccinations for the visit before and after IPV introduction, respectively. The only reason why vaccines were not received was vaccine stock-outs. Infant caregivers generally agreed that vaccinators could be trusted to provide accurate information regarding the number of vaccines that a child needed. CONCLUSION Healthcare providers and infant caregivers in this resource limited setting accepted an increase in the number of injectable vaccines administered at a single visit even though some expressed concerns about the increase.
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Affiliation(s)
| | - Lee M Hampton
- Global Immunization Division, Centres for Disease Control and Prevention, Atlanta, USA
| | - Robert B Mboizi
- Vaccines and Immunity Theme, Medical Research Council Unit, Gambia
| | - Schadrac C Agbla
- Vaccines and Immunity Theme, Medical Research Council Unit, Gambia
| | - Aaron S Wallace
- Global Immunization Division, Centres for Disease Control and Prevention, Atlanta, USA
| | - Jennifer B Harris
- Global Immunization Division, Centres for Disease Control and Prevention, Atlanta, USA
| | - Dawda Sowe
- Ministry of Health and Social Welfare, Banjul, Gambia
| | - Daniel C Ehlman
- Global Immunization Division, Centres for Disease Control and Prevention, Atlanta, USA
| | - Beate Kampmann
- Vaccines and Immunity Theme, Medical Research Council Unit, Gambia; Academic Department of Paediatrics, Imperial College London, UK
| | - Martin O Ota
- WHO Regional Office for Africa, Brazaville, Congo
| | - Terri B Hyde
- Global Immunization Division, Centres for Disease Control and Prevention, Atlanta, USA
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30
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Tohme RA, François J, Wannemuehler K, Iyengar P, Dismer A, Adrien P, Hyde TB, Marston BJ, Date K, Mintz E, Katz MA. Oral Cholera Vaccine Coverage, Barriers to Vaccination, and Adverse Events following Vaccination, Haiti, 2013. Emerg Infect Dis 2015; 21:984-91. [PMID: 25988350 PMCID: PMC4451924 DOI: 10.3201/eid2106.141797] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
In 2013, the first government-led oral cholera vaccination (OCV) campaign in Haiti was implemented in Petite Anse and Cerca Carvajal. To evaluate vaccination coverage, barriers to vaccination, and adverse events following vaccination, we conducted a cluster survey. We enrolled 1,121 persons from Petite Anse and 809 persons from Cerca Carvajal, categorized by 3 age groups (1-4, 5-14, >15 years). Two-dose OCV coverage was 62.5% in Petite Anse and 76.8% in Cerca Carvajal. Two-dose coverage was lowest among persons >15 years of age. In Cerca Carvajal, coverage was significantly lower for male than female respondents (69% vs. 85%; p<0.001). No major adverse events were reported. The main reason for nonvaccination was absence during the campaign. Vaccination coverage after this campaign was acceptable and comparable to that resulting from campaigns implemented by nongovernmental organizations. Future campaigns should be tailored to reach adults who are not available during daytime hours.
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31
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Cavallaro KF, Sandhu HS, Hyde TB, Johnson BW, Fischer M, Mayer LW, Clark TA, Pallansch MA, Yin Z, Zuo S, Hadler SC, Diorditsa S, Hasan ASMM, Bose AS, Dietz V. Expansion of syndromic vaccine preventable disease surveillance to include bacterial meningitis and Japanese encephalitis: evaluation of adapting polio and measles laboratory networks in Bangladesh, China and India, 2007-2008. Vaccine 2015; 33:1168-75. [PMID: 25597940 PMCID: PMC4830482 DOI: 10.1016/j.vaccine.2015.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 12/30/2014] [Accepted: 01/05/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Surveillance for acute flaccid paralysis with laboratory confirmation has been a key strategy in the global polio eradication initiative, and the laboratory platform established for polio testing has been expanded in many countries to include surveillance for cases of febrile rash illness to identify measles and rubella cases. Vaccine-preventable disease surveillance is essential to detect outbreaks, define disease burden, guide vaccination strategies and assess immunization impact. Vaccines now exist to prevent Japanese encephalitis (JE) and some etiologies of bacterial meningitis. METHODS We evaluated the feasibility of expanding polio-measles surveillance and laboratory networks to detect bacterial meningitis and JE, using surveillance for acute meningitis-encephalitis syndrome in Bangladesh and China and acute encephalitis syndrome in India. We developed nine syndromic surveillance performance indicators based on international surveillance guidelines and calculated scores using supervisory visit reports, annual reports, and case-based surveillance data. RESULTS Scores, variable by country and targeted disease, were highest for the presence of national guidelines, sustainability, training, availability of JE laboratory resources, and effectiveness of using polio-measles networks for JE surveillance. Scores for effectiveness of building on polio-measles networks for bacterial meningitis surveillance and specimen referral were the lowest, because of differences in specimens and techniques. CONCLUSIONS Polio-measles surveillance and laboratory networks provided useful infrastructure for establishing syndromic surveillance and building capacity for JE diagnosis, but were less applicable for bacterial meningitis. Laboratory-supported surveillance for vaccine-preventable bacterial diseases will require substantial technical and financial support to enhance local diagnostic capacity.
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Affiliation(s)
- Kathleen F Cavallaro
- Global Immunization Division, United States Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Hardeep S Sandhu
- Global Immunization Division, United States Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Terri B Hyde
- Global Immunization Division, United States Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Barbara W Johnson
- Division of Vector-Borne Diseases, United States Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Marc Fischer
- Division of Vector-Borne Diseases, United States Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Leonard W Mayer
- Division of Bacterial Diseases, United States Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Thomas A Clark
- Division of Bacterial Diseases, United States Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mark A Pallansch
- Division of Viral Diseases, United States Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Zundong Yin
- National Immunization Programme, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
| | - Shuyan Zuo
- World Health Organization, Beijing, People's Republic of China
| | | | | | | | - Anindya S Bose
- National Polio Surveillance Project, World Health Organization, New Delhi, India
| | - Vance Dietz
- Global Immunization Division, United States Centers for Disease Control and Prevention, Atlanta, GA, USA
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32
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Yen C, Hyde TB, Costa AJ, Fernandez K, Tam JS, Hugonnet S, Huvos AM, Duclos P, Dietz VJ, Burkholder BT. The development of global vaccine stockpiles. Lancet Infect Dis 2015; 15:340-7. [PMID: 25661473 DOI: 10.1016/s1473-3099(14)70999-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Global vaccine stockpiles, in which vaccines are reserved for use when needed for emergencies or supply shortages, have effectively provided countries with the capacity for rapid response to emergency situations, such as outbreaks of yellow fever and meningococcal meningitis. The high cost and insufficient supply of many vaccines, including oral cholera vaccine and pandemic influenza vaccine, have prompted discussion on expansion of the use of vaccine stockpiles to address a wider range of emerging and re-emerging diseases. However, the decision to establish and maintain a vaccine stockpile is complex and must take account of disease and vaccine characteristics, stockpile management, funding, and ethical concerns, such as equity. Past experience with global vaccine stockpiles provide valuable information about the processes for their establishment and maintenance. In this Review we explored existing literature and stockpile data to discuss the lessons learned and to inform the development of future vaccine stockpiles.
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Affiliation(s)
- Catherine Yen
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Terri B Hyde
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Katya Fernandez
- Pandemic and Epidemic Diseases Department, WHO, Geneva, Switzerland
| | - John S Tam
- Department of Immunization, Vaccines and Biologicals, WHO, Geneva, Switzerland
| | | | - Anne M Huvos
- Pandemic and Epidemic Diseases Department, WHO, Geneva, Switzerland
| | - Philippe Duclos
- Department of Immunization, Vaccines and Biologicals, WHO, Geneva, Switzerland
| | - Vance J Dietz
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Dollard SC, Keyserling H, Radford K, Amin MM, Stowell J, Winter J, Schmid DS, Cannon MJ, Hyde TB. Cytomegalovirus viral and antibody correlates in young children. BMC Res Notes 2014; 7:776. [PMID: 25367101 PMCID: PMC4236479 DOI: 10.1186/1756-0500-7-776] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 10/14/2014] [Indexed: 11/10/2022] Open
Abstract
Background Young, healthy children shedding cytomegalovirus (CMV) in urine and saliva appear to be the leading source of CMV in primary infection of pregnant women. Findings We screened 48 children 6 months – 5 years old for CMV IgG and measured levels of CMV IgG, IgM and IgG avidity antibodies, frequency of CMV shedding, and viral loads in blood, urine, and saliva. Thirteen of the 48 children (27%) were CMV IgG positive, among whom 3 were also CMV IgM positive with evidence of recent primary infection. Nine of the 13 seropositive children (69%) were shedding 102-105 copies/ml of CMV DNA in one or more bodily fluid. Among seropositive children, low IgG antibody titer (1:20–1:80) was associated with the absence of shedding (p = 0.014), and enrollment in daycare was associated with the presence of CMV shedding (p = 0.037). Conclusions CMV antibody profiles correlated with CMV shedding. The presence of CMV IgM more often represents primary infection in children than in adults. Correlating antibodies with primary infection and viral shedding in healthy children adds to the understanding of CMV infection in children that can inform the prevention of CMV transmission to pregnant women.
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Affiliation(s)
- Sheila C Dollard
- Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30333, USA.
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34
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Hyde TB, Sato HK, Hao L, Flannery B, Zheng Q, Wannemuehler K, Ciccone FH, de Sousa Marques H, Weckx LY, Sáfadi MA, de Oliveira Moraes E, Pinhata MM, Olbrich Neto J, Bevilacqua MC, Tabith Junior A, Monteiro TA, Figueiredo CA, Andrus JK, Reef SE, Toscano CM, Castillo-Solorzano C, Icenogle JP. Identification of Serologic Markers for School-Aged Children With Congenital Rubella Syndrome. J Infect Dis 2014; 212:57-66. [PMID: 25362195 DOI: 10.1093/infdis/jiu604] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 10/21/2014] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Congenital rubella syndrome (CRS) case identification is challenging in older children since laboratory markers of congenital rubella virus (RUBV) infection do not persist beyond age 12 months. METHODS We enrolled children with CRS born between 1998 and 2003 and compared their immune responses to RUBV with those of their mothers and a group of similarly aged children without CRS. Demographic data and sera were collected. Sera were tested for anti-RUBV immunoglobulin G (IgG), IgG avidity, and IgG response to the 3 viral structural proteins (E1, E2, and C), reflected by immunoblot fluorescent signals. RESULTS We enrolled 32 children with CRS, 31 mothers, and 62 children without CRS. The immunoblot signal strength to C and the ratio of the C signal to the RUBV-specific IgG concentration were higher (P < .029 for both) and the ratio of the E1 signal to the RUBV-specific IgG concentration lower (P = .001) in children with CRS, compared with their mothers. Compared with children without CRS, children with CRS had more RUBV-specific IgG (P < .001), a stronger C signal (P < .001), and a stronger E2 signal (P ≤ .001). Two classification rules for children with versus children without CRS gave 100% specificity with >65% sensitivity. CONCLUSIONS This study was the first to establish classification rules for identifying CRS in school-aged children, using laboratory biomarkers. These biomarkers should allow improved burden of disease estimates and monitoring of CRS control programs.
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Affiliation(s)
- Terri B Hyde
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - LiJuan Hao
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Brendan Flannery
- Centers for Disease Control and Prevention, Atlanta, Georgia Pan American Health Organization, Washington, D. C
| | - Qi Zheng
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | | | | | | | | | | | - Maria Cecilia Bevilacqua
- Audiology Research Center, Hospital for Rehabilitation of Cranofacial Abnormalities, USP, Bauru, Brazil
| | - Alfredo Tabith Junior
- Division of Education and Rehabilitation for Communication Disturbances, Catholic University of São Paulo
| | | | | | - Jon K Andrus
- Pan American Health Organization, Washington, D. C
| | - Susan E Reef
- Centers for Disease Control and Prevention, Atlanta, Georgia
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Date KA, Bentsi-Enchill AD, Fox KK, Abeysinghe N, Mintz ED, Khan MI, Sahastrabuddhe S, Hyde TB. Typhoid Fever surveillance and vaccine use - South-East Asia and Western Pacific regions, 2009-2013. MMWR Morb Mortal Wkly Rep 2014; 63:855-60. [PMID: 25275329 PMCID: PMC4584874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Typhoid fever is a serious, systemic infection resulting in nearly 22 million cases and 216,500 deaths annually, primarily in Asia. Safe water, adequate sanitation, appropriate personal and food hygiene, and vaccination are the most effective strategies for prevention and control. In 2008, the World Health Organization (WHO) recommended use of available typhoid vaccines to control endemic disease and outbreaks and strengthening of typhoid surveillance to improve disease estimates and identify high-risk populations (e.g., persons without access to potable water and adequate sanitation). This report summarizes the status of typhoid surveillance and vaccination programs in the WHO South-East Asia (SEAR) and Western Pacific regions (WPR) during 2009-2013, after the revised WHO recommendations. Data were obtained from the WHO/United Nations Children's Fund (UNICEF) Joint Reporting Form on Immunization, a supplemental survey of surveillance and immunization program managers, and published literature. During 2009-2013, 23 (48%) of 48 countries and areas of SEAR (11) and WPR (37) collected surveillance or notifiable disease data on typhoid cases, with most surveillance activities established before 2008. Nine (19%) countries reported implementation of typhoid vaccination programs or recommended vaccine use during 2009-2013. Despite the high incidence, typhoid surveillance is weak in these two regions, and vaccination efforts have been limited. Further progress toward typhoid fever prevention and control in SEAR and WPR will require country commitment and international support for enhanced surveillance, targeted use of existing vaccines and availability of newer vaccines integrated within routine immunization programs, and integration of vaccination with safe water, sanitation, and hygiene measures.
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Affiliation(s)
- Kashmira A. Date
- Global Immunization Division, Center for Global Health, CDC,Corresponding authors: Kashmira A. Date, , 404-639-8913; Adwoa D. Bentsi-Enchill, , +41 22-7911154
| | - Adwoa D. Bentsi-Enchill
- Immunization, Vaccines, and Biologicals, World Health Organization,Corresponding authors: Kashmira A. Date, , 404-639-8913; Adwoa D. Bentsi-Enchill, , +41 22-7911154
| | - Kimberley K. Fox
- Regional Office for the Western Pacific, World Health Organization
| | | | - Eric D. Mintz
- Division of Foodborne, Waterborne and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - M. Imran Khan
- Coalition Against Typhoid Secretariat, Sabin Vaccine Institute, Washington, DC
| | | | - Terri B. Hyde
- Global Immunization Division, Center for Global Health, CDC
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Wallace AS, Mantel C, Mayers G, Mansoor O, Gindler JS, Hyde TB. Experiences with provider and parental attitudes and practices regarding the administration of multiple injections during infant vaccination visits: lessons for vaccine introduction. Vaccine 2014; 32:5301-10. [PMID: 25092632 DOI: 10.1016/j.vaccine.2014.07.076] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 07/11/2014] [Accepted: 07/21/2014] [Indexed: 11/30/2022]
Abstract
INTRODUCTION An increasing proportion of childhood immunization visits include administration of multiple injections. Future introduction of vaccines to protect against multiple diseases will further increase the number of injections at routine immunization childhood visits, particularly in developing countries that are still scaling up introductions. Parental and healthcare provider attitudes toward multiple injections may affect acceptance of recommended vaccines, and understanding these attitudes may help to inform critical decisions about vaccine introduction. METHODS We conducted a systematic review of the literature to examine factors underlying reported parental and healthcare provider concerns and practices related to administration of multiple injections during childhood vaccination visits. RESULTS Forty-four articles were identified; 42 (95%) were from high income countries, including 27 (61%) from the USA. Providers and parents report concerns about multiple injections, which tend to increase with increasing numbers of injections. Common parental and provider concerns included apprehension about the pain experienced by the child, worry about potential side effects, and uncertainty about vaccine effectiveness. Multiple studies reported that a positive provider recommendation to the parent and a high level of concern about the severity of the target disease were significantly associated with parental acceptance of all injections. Providers often significantly overestimated parental concerns about multiple injections. DISCUSSION Providers may play a critical role in the decision for a child to receive all recommended injections. Their overestimation of parental concerns may lead them to postpone recommended vaccinations, which may result in extra visits and delayed vaccination. More research is needed on interventions to overcome provider and parental concern about multiple injections, particularly in developing countries.
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Affiliation(s)
- Aaron S Wallace
- Global Immunization Division, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS-A04, Atlanta, GA 30329, United States.
| | - Carsten Mantel
- Immunizations, Vaccines and Biologicals Programme, World Health Organization, Geneva, Switzerland
| | - Gill Mayers
- Immunizations, Vaccines and Biologicals Programme, World Health Organization, Geneva, Switzerland
| | - Osman Mansoor
- United National Children's Fund, New York, NY, United States
| | - Jacqueline S Gindler
- Global Immunization Division, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS-A04, Atlanta, GA 30329, United States
| | - Terri B Hyde
- Global Immunization Division, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS-A04, Atlanta, GA 30329, United States
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Tohme RA, François J, Wannemuehler K, Magloire R, Danovaro-Holliday MC, Flannery B, Cavallaro KF, Fitter DL, Purcell N, Dismer A, Tappero JW, Vertefeuille JF, Hyde TB. Measles and rubella vaccination coverage in Haiti, 2012: progress towards verifying and challenges to maintaining measles and rubella elimination. Trop Med Int Health 2014; 19:1105-15. [PMID: 25041586 DOI: 10.1111/tmi.12335] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES We conducted a nationwide survey to assess measles containing vaccine (MCV) coverage among children aged 1-9 years in Haiti and identify factors associated with vaccination before and during the 2012 nationwide supplementary immunisation activities (SIA). METHODS Haiti was stratified into five geographic regions (Metropolitan Port-au-Prince, North, Centre, South and West), 40 clusters were randomly selected in each region, and 35 households were selected per cluster. RESULTS Among the 7000 visited households, 75.8% had at least one child aged 1-9 years; of these, 5279 (99.5%) households consented to participate in the survey. Of 9883 children enrolled, 91% received MCV before and/or during the SIA; 31% received MR for the first time during the SIA, and 50.7% received two doses of MCV (one before and one during the 2012 SIA). Among the 1685 unvaccinated children during the SIA, the primary reason of non-vaccination was caregivers not being aware of the SIA (31.0%). Children aged 1-4 years had significantly lower MR SIA coverage than those aged 5-9 years (79.5% vs. 84.8%) (P < 0.0001). A higher proportion of children living in the West (12.3%) and Centre (11.2%) regions had never been vaccinated than in other regions (4.8-9.1%). Awareness, educational level of the mother and region were significantly associated with MR vaccination during and before the SIA (P < 0.001). CONCLUSIONS The 2012 SIA successfully increased MR coverage; however, to maintain measles and rubella elimination, coverage needs to be further increased among children aged 1-4 years and in regions with lower coverage.
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Affiliation(s)
- Rania A Tohme
- Global Immunization Division, US Centers for Disease Control and Prevention, Atlanta, GA, USA
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Yen C, Tate JE, Hyde TB, Cortese MM, Lopman BA, Jiang B, Glass RI, Parashar UD. Rotavirus vaccines: current status and future considerations. Hum Vaccin Immunother 2014; 10:1436-48. [PMID: 24755452 DOI: 10.4161/hv.28857] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Rotavirus is the leading cause of severe diarrhea among children<5 years worldwide. Currently licensed rotavirus vaccines have been efficacious and effective, with many countries reporting substantial declines in diarrheal and rotavirus-specific morbidity and mortality. However, the full public health impact of these vaccines has not been realized. Most countries, including those with the highest disease burden, have not yet introduced rotavirus vaccines into their national immunization programs. Research activities that may help inform vaccine introduction decisions include (1) establishing effectiveness, impact, and safety for rotavirus vaccines in low-income settings; (2) identifying potential strategies to improve performance of oral rotavirus vaccines in developing countries, such as zinc supplementation; and (3) pursuing alternate approaches to oral vaccines, such as parenteral immunization. Policy- and program-level barriers, such as financial implications of new vaccine introductions, should be addressed to ensure that countries are able to make informed decisions regarding rotavirus vaccine introduction.
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Affiliation(s)
- Catherine Yen
- Division of Viral Diseases; Centers for Disease Control and Prevention; Atlanta, GA USA; Global Immunization Division; Centers for Disease Control and Prevention; Atlanta, GA USA
| | - Jacqueline E Tate
- Division of Viral Diseases; Centers for Disease Control and Prevention; Atlanta, GA USA
| | - Terri B Hyde
- Global Immunization Division; Centers for Disease Control and Prevention; Atlanta, GA USA
| | - Margaret M Cortese
- Division of Viral Diseases; Centers for Disease Control and Prevention; Atlanta, GA USA
| | - Benjamin A Lopman
- Division of Viral Diseases; Centers for Disease Control and Prevention; Atlanta, GA USA
| | - Baoming Jiang
- Division of Viral Diseases; Centers for Disease Control and Prevention; Atlanta, GA USA
| | - Roger I Glass
- Fogarty International Center; National Institutes of Health; Bethesda, MD USA
| | - Umesh D Parashar
- Division of Viral Diseases; Centers for Disease Control and Prevention; Atlanta, GA USA
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Scobie HM, Nilles E, Kama M, Kool JL, Mintz E, Wannemuehler KA, Hyde TB, Dawainavesi A, Singh S, Korovou S, Jenkins K, Date K. Impact of a targeted typhoid vaccination campaign following cyclone Tomas, Republic of Fiji, 2010. Am J Trop Med Hyg 2014; 90:1031-8. [PMID: 24710618 DOI: 10.4269/ajtmh.13-0728] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
After a category 4 cyclone that caused extensive population displacement and damage to water and sanitation infrastructure in Fiji in March 2010, a typhoid vaccination campaign was conducted as part of the post-disaster response. During June-December 2010, 64,015 doses of typhoid Vi polysaccharide vaccine were administered to persons ≥ 2 years of age, primarily in cyclone-affected areas that were typhoid endemic. Annual typhoid fever incidence decreased during the post-campaign year (2011) relative to preceding years (2008-2009) in three subdivisions where a large proportion of the population was vaccinated (incidence rate ratios and 95% confidence intervals: 0.23, 0.13-0.41; 0.24, 0.14-0.41; 0.58, 0.40-0.86), and increased or remained unchanged in 12 subdivisions where little to no vaccination occurred. Vaccination played a role in reducing typhoid fever incidence in high-incidence areas after a disaster and should be considered in endemic settings, along with comprehensive control measures, as recommended by the World Health Organization.
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Affiliation(s)
- Heather M Scobie
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Office of Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of Pacific Technical Support, World Health Organization, Suva, Fiji; Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Fiji Centre for Communicable Disease Control, Suva, Fiji; Health Information Unit, Ministry of Health, Suva, Fiji; Fiji Ministry of Health, Labasa, Fiji; Fiji Health Sector Improvement Program, Ministry of Health, Suva, Fiji
| | - Eric Nilles
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Office of Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of Pacific Technical Support, World Health Organization, Suva, Fiji; Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Fiji Centre for Communicable Disease Control, Suva, Fiji; Health Information Unit, Ministry of Health, Suva, Fiji; Fiji Ministry of Health, Labasa, Fiji; Fiji Health Sector Improvement Program, Ministry of Health, Suva, Fiji
| | - Mike Kama
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Office of Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of Pacific Technical Support, World Health Organization, Suva, Fiji; Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Fiji Centre for Communicable Disease Control, Suva, Fiji; Health Information Unit, Ministry of Health, Suva, Fiji; Fiji Ministry of Health, Labasa, Fiji; Fiji Health Sector Improvement Program, Ministry of Health, Suva, Fiji
| | - Jacob L Kool
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Office of Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of Pacific Technical Support, World Health Organization, Suva, Fiji; Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Fiji Centre for Communicable Disease Control, Suva, Fiji; Health Information Unit, Ministry of Health, Suva, Fiji; Fiji Ministry of Health, Labasa, Fiji; Fiji Health Sector Improvement Program, Ministry of Health, Suva, Fiji
| | - Eric Mintz
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Office of Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of Pacific Technical Support, World Health Organization, Suva, Fiji; Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Fiji Centre for Communicable Disease Control, Suva, Fiji; Health Information Unit, Ministry of Health, Suva, Fiji; Fiji Ministry of Health, Labasa, Fiji; Fiji Health Sector Improvement Program, Ministry of Health, Suva, Fiji
| | - Kathleen A Wannemuehler
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Office of Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of Pacific Technical Support, World Health Organization, Suva, Fiji; Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Fiji Centre for Communicable Disease Control, Suva, Fiji; Health Information Unit, Ministry of Health, Suva, Fiji; Fiji Ministry of Health, Labasa, Fiji; Fiji Health Sector Improvement Program, Ministry of Health, Suva, Fiji
| | - Terri B Hyde
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Office of Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of Pacific Technical Support, World Health Organization, Suva, Fiji; Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Fiji Centre for Communicable Disease Control, Suva, Fiji; Health Information Unit, Ministry of Health, Suva, Fiji; Fiji Ministry of Health, Labasa, Fiji; Fiji Health Sector Improvement Program, Ministry of Health, Suva, Fiji
| | - Akanisi Dawainavesi
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Office of Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of Pacific Technical Support, World Health Organization, Suva, Fiji; Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Fiji Centre for Communicable Disease Control, Suva, Fiji; Health Information Unit, Ministry of Health, Suva, Fiji; Fiji Ministry of Health, Labasa, Fiji; Fiji Health Sector Improvement Program, Ministry of Health, Suva, Fiji
| | - Sheetalpreet Singh
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Office of Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of Pacific Technical Support, World Health Organization, Suva, Fiji; Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Fiji Centre for Communicable Disease Control, Suva, Fiji; Health Information Unit, Ministry of Health, Suva, Fiji; Fiji Ministry of Health, Labasa, Fiji; Fiji Health Sector Improvement Program, Ministry of Health, Suva, Fiji
| | - Samuel Korovou
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Office of Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of Pacific Technical Support, World Health Organization, Suva, Fiji; Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Fiji Centre for Communicable Disease Control, Suva, Fiji; Health Information Unit, Ministry of Health, Suva, Fiji; Fiji Ministry of Health, Labasa, Fiji; Fiji Health Sector Improvement Program, Ministry of Health, Suva, Fiji
| | - Kylie Jenkins
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Office of Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of Pacific Technical Support, World Health Organization, Suva, Fiji; Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Fiji Centre for Communicable Disease Control, Suva, Fiji; Health Information Unit, Ministry of Health, Suva, Fiji; Fiji Ministry of Health, Labasa, Fiji; Fiji Health Sector Improvement Program, Ministry of Health, Suva, Fiji
| | - Kashmira Date
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Office of Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of Pacific Technical Support, World Health Organization, Suva, Fiji; Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Fiji Centre for Communicable Disease Control, Suva, Fiji; Health Information Unit, Ministry of Health, Suva, Fiji; Fiji Ministry of Health, Labasa, Fiji; Fiji Health Sector Improvement Program, Ministry of Health, Suva, Fiji
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Toscano CM, Vijayaraghavan M, Salazar-Bolaños HM, Bolaños-Acuña HM, Ruiz-González AI, Barrantes-Solis T, Fernández-Vargas I, Panero MS, de Oliveira LH, Hyde TB. Cost analysis of an integrated vaccine-preventable disease surveillance system in Costa Rica. Vaccine 2014; 31 Suppl 3:C88-93. [PMID: 23777698 DOI: 10.1016/j.vaccine.2013.05.036] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2012] [Revised: 04/30/2013] [Accepted: 05/08/2013] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Following World Health Organization recommendations set forth in the Global Framework for Immunization Monitoring and Surveillance, Costa Rica in 2009 became the first country to implement integrated vaccine-preventable disease (iVPD) surveillance, with support from the U.S. Centers for Disease Control and Prevention (CDC) and the Pan American Health Organization (PAHO). As surveillance for diseases prevented by new vaccines is integrated into existing surveillance systems, these systems could cost more than routine surveillance for VPDs targeted by the Expanded Program on Immunization. OBJECTIVES We estimate the costs associated with establishing and subsequently operating the iVPD surveillance system at a pilot site in Costa Rica. METHODS We retrospectively collected data on costs incurred by the institutions supporting iVPD surveillance during the preparatory (January 2007 through August 2009) and implementation (September 2009 through August 2010) phases of the iVPD surveillance project in Costa Rica. These data were used to estimate costs for personnel, meetings, infrastructure, office equipment and supplies, transportation, and laboratory facilities. Costs incurred by each of the collaborating institutions were also estimated. RESULTS During the preparatory phase, the estimated total cost was 128,000 U.S. dollars (US$), including 64% for personnel costs. The preparatory phase was supported by CDC and PAHO. The estimated cost for 1 year of implementation was US$ 420,000, including 58% for personnel costs, 28% for laboratory costs, and 14% for meeting, infrastructure, office, and transportation costs combined. The national reference laboratory and the PAHO Costa Rica office incurred 64% of total costs, and other local institutions supporting iVPD surveillance incurred the remaining 36%. CONCLUSIONS Countries planning to implement iVPD surveillance will require adequate investments in human resources, laboratories, data management, reporting, and investigation. Our findings will be valuable for decision makers and donors planning and implementing similar strategies in other countries.
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Affiliation(s)
- C M Toscano
- Department of Community Health, Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Goiás, Brazil.
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Hyde TB, Andrus JK, Dietz VJ, Andrus JK, Hyde TB, Lee CE, Widdowson MA, Verani JR, Friedman C, Azziz-Baumgartner E, Lopez AS, Jumaan A, Dietz VJ. Critical issues in implementing a national integrated all-vaccine preventable disease surveillance system. Vaccine 2013; 31 Suppl 3:C94-8. [PMID: 23777699 DOI: 10.1016/j.vaccine.2013.05.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Revised: 04/29/2013] [Accepted: 05/08/2013] [Indexed: 11/18/2022]
Abstract
In 2007, the World Health Organization published the Global Framework for Immunization Monitoring and Surveillance (GFIMS) outlining measures to enhance national surveillance for vaccine preventable diseases (VPDs). The GFIMS emphasized that VPD surveillance should be integrated and placed in a 'unified framework' building upon the strengths of existing surveillance systems to prevent duplication of activities common to all surveillance systems and to minimize human resource and supply expenditures. Unfortunately, there was little experience in actually developing integrated VPD surveillance. We describe the process of developing operational guidance for ministries of health to implement such an integrated surveillance system for multiple VPDs.
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Affiliation(s)
- Terri B Hyde
- Global Immunization Division, US Centers for Disease Control and Prevention (CDC), 1600 Clifton Road NE, Atlanta, GA 30333, USA.
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Wang SA, Hyde TB, Mounier-Jack S, Brenzel L, Favin M, Gordon WS, Shearer JC, Mantel CF, Arora N, Durrheim D. New vaccine introductions: assessing the impact and the opportunities for immunization and health systems strengthening. Vaccine 2013; 31 Suppl 2:B122-8. [PMID: 23598473 PMCID: PMC4654564 DOI: 10.1016/j.vaccine.2012.10.116] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Revised: 10/12/2012] [Accepted: 10/31/2012] [Indexed: 02/07/2023]
Abstract
In 2010, global immunization partners posed the question, "Do new vaccine introductions (NVIs) have positive or negative impacts on immunization and health systems of countries?" An Ad-hoc Working Group was formed for WHO's Strategic Advisory Group of Experts on immunization (SAGE) to examine this question through five approaches: a published literature review, a grey literature review, in-depth interviews with regional and country immunization staff, in-depth studies of recent NVIs in 3 countries, and a statistical analysis of the impact of NVI on DTP3 coverage in 176 countries. The WHO Health System Framework of building blocks was used to organize the analysis of these data to assess potential areas of impact of NVI on health systems. In April 2012, the Ad-hoc Working Group presented its findings to SAGE. While reductions in disease burden and improvements in disease and adverse events surveillance, training, cold chain and logistics capacity and injection safety were commonly documented as beneficial impacts, opportunities for strengthening the broader health system were consistently missed during NVI. Weaknesses in planning for human and financial resource needs were highlighted as a concern. Where positive impacts on health systems following NVI occurred, these were often in areas where detailed technical guidance or tools and adequate financing were available. SAGE supported the Ad-hoc Working Group's conclusion that future NVI should explicitly plan to optimize and document the impact of NVI on broader health systems. Furthermore, opportunities for improving integration of delivery of immunization services, commodities, and messages with other parts of the health system should be actively sought with the recognition that integration is a bidirectional process. To avoid the gaps in planning for NVI that can compromise existing immunization and health systems, donors and partners should provide sufficient and timely support to facilitate country planning. Areas for future research were also identified. Finally, to support countries in using NVI as an opportunity to strengthen immunization and health systems, the WHO guidance for countries on new vaccine introduction is being updated to reflect ways this might be accomplished.
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Affiliation(s)
- Susan A. Wang
- World Health Organization, 20 Avenue Appia, 1204 Geneva, Switzerland
| | - Terri B. Hyde
- Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA 30333, USA
| | - Sandra Mounier-Jack
- London School of Hygiene and Tropical Medicine, Global Health Development, Public Health and Policy, 15–17 Tavistock Place, London WC1H 9SH, UK
| | - Logan Brenzel
- Cascadia Health and Development, 7A The Mews, Cascade, Port of Spain, Trinidad and Tobago
| | - Michael Favin
- Maternal and Child Health Integrated Program (MCHIP), 1776 Massachusetts Avenue, NW, Suite 300, Washington, DC 20036, USA
| | - W. Scott Gordon
- Program for Appropriate Technology for Health (PATH), P.O. Box 900922, Seattle, WA 98109, USA
| | - Jessica C. Shearer
- Centre for Health Economics and Policy Analysis, McMaster University, 1280 Main Street W, Hamilton, ON, Canada
| | - Carsten F. Mantel
- World Health Organization, 20 Avenue Appia, 1204 Geneva, Switzerland
| | - Narendra Arora
- The INCLEN Trust International & CHNRI, F-1/5, 2nd Floor, Okhla Industrial Area, Phase 1, New Delhi 110 020, India
| | - David Durrheim
- Hunter Medical Research Institute, Private Bag 10, Wallsend 2287, Australia
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Hyde TB, Dentz H, Wang SA, Burchett HE, Mounier-Jack S, Mantel CF. The impact of new vaccine introduction on immunization and health systems: a review of the published literature. Vaccine 2012; 30:6347-58. [PMID: 22940378 DOI: 10.1016/j.vaccine.2012.08.029] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Revised: 07/31/2012] [Accepted: 08/15/2012] [Indexed: 02/05/2023]
Abstract
We conducted a systematic review of the published literature to examine the impact of new vaccine introduction on countries' immunization and broader health systems. Six publication databases were searched using 104 vaccine and health system-related search terms. The search yielded 15,795 unique articles dating from December 31, 1911 to September 29, 2010. Based on review of the title and abstract, 654 (4%) of these articles were found to be potentially relevant and were referred for full review. After full review, 130 articles were found to be relevant and included in the analysis. These articles represented vaccines introduced to protect against 10 different diseases (hepatitis A, hepatitis B, Haemophilus influenzae type b disease, human papilloma virus infection, influenza, Japanese encephalitis, meningococcal meningitis, Streptococcus pneumoniae disease, rotavirus diarrhea and typhoid), in various formulations and combinations. Most reviewed articles (97 [75%]) reported experiences in high-income countries. New vaccine introduction was most efficient when the vaccine was introduced into an existing delivery platform and when introduced in combination with a vaccine already in the routine childhood immunization schedule (i.e., as a combination vaccine). New vaccine introduction did not impact coverage of vaccines already included in the routine childhood immunization schedule. The need for increased cold chain capacity was frequently reported. New vaccines facilitated the introduction and widespread use of auto-disable syringes into the immunization and the broader health systems. The importance of training and education for health care workers and social mobilization was frequently noted. There was evidence in high-income countries that new vaccine introduction was associated with reduced health-care costs. Future evaluations of new vaccine introductions should include the systematic and objective assessment of the impacts on a country's immunization system and broader health system, especially in lower-income countries.
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Affiliation(s)
- Terri B Hyde
- Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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Cohen AL, Hyde TB, Verani J, Watkins M. Integrating pneumonia prevention and treatment interventions with immunization services in resource-poor countries. Bull World Health Organ 2012; 90:289-94. [PMID: 22511825 DOI: 10.2471/blt.11.094029] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Revised: 11/10/2011] [Accepted: 12/07/2011] [Indexed: 11/27/2022] Open
Abstract
Pneumonia is a leading cause of morbidity and mortality worldwide. Effective vaccine and non-vaccine interventions to prevent and control pneumonia are urgently needed to reduce the global burden of the disease. This paper explores practical strategies and policies for integrating interventions to prevent and treat pneumonia with routine immunization services, and it investigates the challenges involved in such integration. The primary pneumonia prevention and treatment strategies that are implemented during routine childhood immunization visits are vaccination of children against the disease, caretaker education and referral of children to medical services when necessary.
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Affiliation(s)
- Adam L Cohen
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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Date KA, Vicari A, Hyde TB, Mintz E, Danovaro-Holliday MC, Henry A, Tappero JW, Roels TH, Abrams J, Burkholder BT, Ruiz-Matus C, Andrus J, Dietz V. Considerations for oral cholera vaccine use during outbreak after earthquake in Haiti, 2010-2011. Emerg Infect Dis 2012; 17:2105-12. [PMID: 22099114 PMCID: PMC3310586 DOI: 10.3201/eid1711.110822] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Oral cholera vaccines (OCVs) have been recommended in cholera-endemic settings and preemptively during outbreaks and complex emergencies. However, experience and guidelines for reactive use after an outbreak has started are limited. In 2010, after over a century without epidemic cholera, an outbreak was reported in Haiti after an earthquake. As intensive nonvaccine cholera control measures were initiated, the feasibility of OCV use was considered. We reviewed OCV characteristics and recommendations for their use and assessed global vaccine availability and capacity to implement a vaccination campaign. Real-time modeling was conducted to estimate vaccine impact. Ultimately, cholera vaccination was not implemented because of limited vaccine availability, complex logistical and operational challenges of a multidose regimen, and obstacles to conducting a campaign in a setting with population displacement and civil unrest. Use of OCVs is an option for cholera control; guidelines for their appropriate use in epidemic and emergency settings are urgently needed.
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Affiliation(s)
- Kashmira A Date
- Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
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Hickman CJ, Hyde TB, Sowers SB, Mercader S, McGrew M, Williams NJ, Beeler JA, Audet S, Kiehl B, Nandy R, Tamin A, Bellini WJ. Laboratory characterization of measles virus infection in previously vaccinated and unvaccinated individuals. J Infect Dis 2011; 204 Suppl 1:S549-58. [PMID: 21666212 DOI: 10.1093/infdis/jir106] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Waning immunity or secondary vaccine failure (SVF) has been anticipated by some as a challenge to global measles elimination efforts. Although such cases are infrequent, measles virus (MeV) infection can occur in vaccinated individuals following intense and/or prolonged exposure to an infected individual and may present as a modified illness that is unrecognizable as measles outside of the context of a measles outbreak. The immunoglobulin M response in previously vaccinated individuals may be nominal or fleeting, and viral replication may be limited. As global elimination proceeds, additional methods for confirming modified measles cases may be needed to understand whether SVF cases contribute to continued measles virus (MeV) transmission. In this report, we describe clinical symptoms and laboratory results for unvaccinated individuals with acute measles and individuals with SVF identified during MeV outbreaks. SVF cases were characterized by the serological parameters of high-avidity antibodies and distinctively high levels of neutralizing antibody. These parameters may represent useful biomarkers for classification of SVF cases that previously could not be confirmed as such using routine laboratory diagnostic techniques.
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Affiliation(s)
- Carole J Hickman
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
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Cannon MJ, Hyde TB, Schmid DS. Review of cytomegalovirus shedding in bodily fluids and relevance to congenital cytomegalovirus infection. Rev Med Virol 2011; 21:240-55. [PMID: 21674676 DOI: 10.1002/rmv.695] [Citation(s) in RCA: 217] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Revised: 04/01/2011] [Accepted: 04/05/2011] [Indexed: 12/12/2022]
Abstract
Congenital cytomegalovirus (CMV) infections are a leading cause of sensorineural hearing loss (SNHL) and neurological impairment. Congenital transmission of CMV can occur with maternal primary infection, reactivation, or reinfection during pregnancy. We reviewed studies of CMV shedding in bodily fluids (defined as CMV detected by culture or CMV DNA detected by polymerase chain reaction). Following diagnosis at birth, children with congenital CMV infection exhibited the highest prevalences of CMV shedding (median = 80%, number of sample population prevalences [N] = 6) and duration of shedding, with a steep decline by age five. Healthy children attending day care shed more frequently (median = 23%, N = 24) than healthy children not attending day care (median = 12%, N = 11). Peak shedding prevalences in children occurred at 1-2 years of age, confirming that young children are the key transmission risk for pregnant women. CMV shedding among children was more prevalent in urine specimens than in oral secretions (median prevalence difference = 11.5%, N = 12). Adults with risk factors such as STD clinic attendance had higher shedding prevalences (median = 22%, N = 20) than adults without risk factors (median = 7%, N = 44). In adults with risk factors, CMV was shed more frequently in urine; in adults without risk factors genital shedding was most common. The prevalence of CMV shedding in nine sample populations of pregnant women increased with advancing gestation. In seven sample populations of children with congenital CMV infection, higher viral load at birth was consistently associated with an elevated risk of SNHL. Higher CMV viral load at birth also consistently correlated with the presence of symptoms of congenital CMV at birth. Published 2011. This article is a US Government work and is in the public domain in the USA.
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Affiliation(s)
- Michael J Cannon
- National Center on Birth Defects and Developmental Disabilities, Atlanta, GA, USA.
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Cannon MJ, Schmid DS, Hyde TB. Review of cytomegalovirus seroprevalence and demographic characteristics associated with infection. Rev Med Virol 2010; 20:202-13. [PMID: 20564615 DOI: 10.1002/rmv.655] [Citation(s) in RCA: 908] [Impact Index Per Article: 64.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Cytomegalovirus establishes a lifelong latent infection following primary infection that can periodically reactivate with shedding of infectious virus. Primary infection, reactivation and reinfection during pregnancy can all lead to in utero transmission to the developing fetus. Congenital CMV infections are a major cause of permanent hearing loss and neurological impairment. In this literature review, we found that CMV infection was relatively common among women of reproductive age, with seroprevalence ranging from 45 to 100%. CMV seroprevalence tended to be highest in South America, Africa and Asia and lowest in Western Europe and United States. Within the United States, CMV seroprevalence showed substantial geographic variation as well, differing by as much as 30 percentage points between states, though differences might be explained by variation in the types of populations sampled. Worldwide, seroprevalence among non-whites tended to be 20-30 percentage points higher than that of whites (summary prevalence ratio (PR) = 1.59, 95% confidence interval (CI) = 1.57-1.61). Females generally had higher seroprevalences than males, although in most studies the differences were small (summary PR = 1.13, 95% CI = 1.11-1.14). Persons of lower socioeconomic status were more likely to be CMV seropositive (summary PR = 1.33, 95% CI = 1.32-1.35). Despite high seroprevalences in some populations, a substantial percentage of women of reproductive age are CMV seronegative and thus at risk of primary CMV infection during pregnancy. Future vaccine or educational campaigns to prevent primary infection in pregnant women may need to be tailored to suit the needs of different populations.
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Affiliation(s)
- Michael J Cannon
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA 30329, USA.
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Affiliation(s)
- Terri B Hyde
- National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA 30329, USA
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Hyde TB, Nandy R, Hickman CJ, Langidrik JR, Strebel PM, Papania MJ, Seward JF, Bellini WJ. Laboratory confirmation of measles in elimination settings: experience from the Republic of the Marshall Islands, 2003. Bull World Health Organ 2009; 87:93-8. [PMID: 19274360 DOI: 10.2471/blt.07.045484] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2007] [Accepted: 05/26/2008] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE To highlight the complications involved in interpreting laboratory tests of measles immunoglobulin M (IgM) for confirmation of infection during a measles outbreak in a highly vaccinated population after conducting a mass immunization campaign as a control measure. METHODS This case study was undertaken in the Republic of the Marshall Islands during a measles outbreak in 2003, when response immunization was conducted. A measles case was defined as fever and rash and one or more of cough, coryza or conjunctivitis. Between 13 July and 7 November 2003, serum samples were obtained from suspected measles cases for serologic testing and nasopharyngeal swabs were taken for viral isolation by reverse transcriptase polymerase chain reaction (RT-PCR). FINDINGS Specimens were collected from 201 suspected measles cases (19% of total): of the ones that satisfied the clinical case definition, 45% were IgM positive (IgM+) and, of these, 24% had received measles vaccination within the previous 45 days (up to 45 days after vaccination an IgM+ result could be due to either vaccination or wild-type measles infection). The proportion of IgM+ results varied with clinical presentation, the timing of specimen collection and vaccination status. Positive results on RT-PCR occurred in specimens from eight IgM-negative and four IgM+ individuals who had recently been vaccinated. CONCLUSION During measles outbreaks, limiting IgM testing to individuals who meet the clinical case definition and have not been recently vaccinated allows for measles to be confirmed while conserving resources.
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Affiliation(s)
- Terri B Hyde
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, United States of America.
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