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Martinón-Torres F, Salamanca de la Cueva I, Horn M, Westerholt S, Bosis S, Meyer N, Cheuvart B, Virk N, Jakes RW, Duchenne M, Van den Steen P. Disparate kinetics in immune response of two different Haemophilus influenzae type b conjugate vaccines: Immunogenicity and safety observations from a randomized controlled phase IV study in healthy infants and toddlers using a 2+1 schedule. Hum Vaccin Immunother 2024; 20:2342630. [PMID: 38687024 PMCID: PMC11062389 DOI: 10.1080/21645515.2024.2342630] [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: 01/19/2024] [Accepted: 04/10/2024] [Indexed: 05/02/2024] Open
Abstract
Since the introduction of Haemophilus Influenzae type b (Hib) conjugate vaccines, invasive Hib disease has strongly declined worldwide, yet continued control of Hib disease remains important. In Europe, currently three different hexavalent combination vaccines containing Hib conjugates are marketed. In this phase IV, single-blind, randomized, controlled, multi-country study (NCT04535037), we aimed to compare, in a 2 + 1 vaccination schedule, the immunogenicity and safety and show non-inferiority, as well as superiority, of DTPa-HBV-IPV/Hib (Ih group) versus DTaP5-HB-IPV-Hib (Va group) in terms of anti-polyribosylribitol phosphate (PRP) antibody geometric mean concentrations (GMCs) and proportion of participants reaching anti-PRP antibody concentrations greater than or equal to a threshold of 5 µg/mL. One month after the booster vaccination, the anti-PRP antibody GMC ratio (Ih group/Va group) was 0.917 (95% CI: 0.710-1.185), meeting the non-inferiority criteria. The difference in percentage of participants (Ih group - Va group) reaching GMCs ≥5 µg/mL was -6.3% (95% CI: -14.1% to 1.5%), not reaching the predefined non-inferiority threshold. Interestingly, a slightly higher post-booster antibody avidity was observed in the Ih group versus the Va group. Both vaccines were well tolerated, and no safety concerns were raised. This study illustrates the different kinetics of the anti-PRP antibody response post-primary and post-booster using the two vaccines containing different Hib conjugates and indicates a potential differential impact of concomitant vaccinations on the anti-PRP responses. The clinical implications of these differences should be further studied.
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MESH Headings
- Humans
- Haemophilus Vaccines/immunology
- Haemophilus Vaccines/adverse effects
- Haemophilus Vaccines/administration & dosage
- Antibodies, Bacterial/blood
- Infant
- Immunization Schedule
- Female
- Male
- Single-Blind Method
- Vaccines, Conjugate/immunology
- Vaccines, Conjugate/administration & dosage
- Vaccines, Conjugate/adverse effects
- Haemophilus influenzae type b/immunology
- Vaccines, Combined/immunology
- Vaccines, Combined/administration & dosage
- Vaccines, Combined/adverse effects
- Haemophilus Infections/prevention & control
- Haemophilus Infections/immunology
- Hepatitis B Vaccines/immunology
- Hepatitis B Vaccines/administration & dosage
- Hepatitis B Vaccines/adverse effects
- Poliovirus Vaccine, Inactivated/immunology
- Poliovirus Vaccine, Inactivated/administration & dosage
- Poliovirus Vaccine, Inactivated/adverse effects
- Diphtheria-Tetanus-Pertussis Vaccine/immunology
- Diphtheria-Tetanus-Pertussis Vaccine/administration & dosage
- Diphtheria-Tetanus-Pertussis Vaccine/adverse effects
- Child, Preschool
- Immunogenicity, Vaccine
- Europe
- Polysaccharides
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Affiliation(s)
- Federico Martinón-Torres
- Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain
- Genetics, Vaccines and Infectious Diseases Research Group (GENvip), Instituto de Investigación Sanitaria de Santiago, Universidad de Santiago de Compostela, Santiago de Compostela, Spain
- Consorcio Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Michael Horn
- Praxis Dr. med. Michael Horn, Bayern, Schoenau am Koenigssee, Germany
| | - Soeren Westerholt
- Praxis für Kinder und Jugendmedizin Drs. Westerholt/Matyas, Wolfsburg, Germany
| | - Samantha Bosis
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy
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Muhoza P, Danovaro-Holliday MC, Diallo MS, Murphy P, Sodha SV, Requejo JH, Wallace AS. Routine Vaccination Coverage - Worldwide, 2020. MMWR Morb Mortal Wkly Rep 2021; 70:1495-1500. [PMID: 34710074 PMCID: PMC8553029 DOI: 10.15585/mmwr.mm7043a1] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
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Jones FK, Mensah K, Heraud JM, Randriatsarafara FM, Metcalf CJE, Wesolowski A. The Challenge of Achieving Immunity Through Multiple-Dose Vaccines in Madagascar. Am J Epidemiol 2021; 190:2085-2093. [PMID: 34023892 DOI: 10.1093/aje/kwab145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 05/09/2021] [Accepted: 05/13/2021] [Indexed: 12/11/2022] Open
Abstract
Administration of many childhood vaccines requires that multiple doses be delivered within a narrow time window to provide adequate protection and reduce disease transmission. Accurately quantifying vaccination coverage is complicated by limited individual-level data and multiple vaccination mechanisms (routine and supplementary vaccination programs). We analyzed 12,541 vaccination cards from 6 districts across Madagascar for children born in 2015 and 2016. For 3 vaccines-pentavalent diphtheria-tetanus-pertussis-hepatitis B-Haemophilus influenzae type b vaccine (DTP-HB-Hib; 3 doses), 10-valent pneumococcal conjugate vaccine (PCV10; 3 doses), and rotavirus vaccine (2 doses)-we used dates of vaccination and birth to estimate coverage at 1 year of age and timeliness of delivery. Vaccination coverage at age 1 year for the first dose was consistently high, with decreases for subsequent doses (DTP-HB-Hib: 91%, 81%, and 72%; PCV10: 82%, 74%, and 64%; rotavirus: 73% and 63%). Coverage levels between urban districts and their rural counterparts did not differ consistently. For each dose of DTP-HB-Hib, the overall percentage of individuals receiving late doses was 29%, 7%, and 6%, respectively; estimates were similar for other vaccines. Supplementary vaccination weeks, held to help children who had missed routine care to catch up, did not appear to increase the likelihood of being vaccinated. Maintaining population-level immunity with multiple-dose vaccines requires a robust stand-alone routine immunization program.
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Abstract
In this retrospective cohort study, the response to routinely administered Haemophilus influenzae type B vaccine, pneumococcal and pertussis vaccinations in 27 children exposed to antitumor necrosis factor alpha (anti-TNFα) during pregnancy was measured. The overall vaccination response seems comparable for children exposed to anti-TNFα and healthy infants. After primary vaccination series, inadequate response was present in some patients and might be related to exposure to anti-TNFα.
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Affiliation(s)
| | | | - Lyanne W Rövekamp
- Department of Pediatrics, Haga Teaching Hospital, Juliana Children's Hospital, The Hague
| | - Gertjan J A Driessen
- Department of Pediatrics, Haga Teaching Hospital, Juliana Children's Hospital, The Hague
- Department of Pediatrics, Maastricht University Medical Center, Maastricht, The Netherlands
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5
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Kirkby K, Bergen N, Schlotheuber A, Sodha SV, Danovaro-Holliday MC, Hosseinpoor AR. Subnational inequalities in diphtheria-tetanus-pertussis immunization in 24 countries in the African Region. Bull World Health Organ 2021; 99:627-639. [PMID: 34475600 PMCID: PMC8381099 DOI: 10.2471/blt.20.279232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 06/10/2021] [Accepted: 06/10/2021] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To analyse subnational inequality in diphtheria-tetanus-pertussis (DTP) immunization dropout in 24 African countries using administrative data on receipt of the first and third vaccine doses (DTP1 and DTP3, respectively) collected by the Joint Reporting Process of the World Health Organization and the United Nations Children's Fund. METHODS Districts in each country were grouped into quintiles according to the proportion of children who dropped out between DTP1 and DTP3 (i.e. the dropout rate). We used six summary measures to quantify inequalities in dropout rates between districts and compared rates with national dropout rates and DTP1 and DTP3 immunization coverage. FINDINGS The median dropout rate across countries was 2.4% in quintiles with the lowest rate and 14.6% in quintiles with the highest rate. In eight countries, the difference between the highest and lowest quintiles was 14.9 percentage points or more. In most countries, underperforming districts in the quintile with the highest rate tended to lag disproportionately behind the others. This divergence was not evident from looking only at national dropout rates. Countries with the largest inequalities in absolute subnational dropout rate tended to have lower estimated national DTP1 and DTP3 immunization coverage. CONCLUSION There were marked inequalities in DTP immunization dropout rates between districts in most countries studied. Monitoring dropout at the subnational level could help guide immunization interventions that address inequalities in underserved areas, thereby improving overall DTP3 coverage. The quality of administrative data should be improved to ensure accurate and timely assessment of geographical inequalities in immunization.
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Affiliation(s)
- Katherine Kirkby
- Department of Data and Analytics, World Health Organization, 20 Avenue Appia, 1211, Geneva, Switzerland
| | - Nicole Bergen
- Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Anne Schlotheuber
- Department of Data and Analytics, World Health Organization, 20 Avenue Appia, 1211, Geneva, Switzerland
| | - Samir V Sodha
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | | | - Ahmad Reza Hosseinpoor
- Department of Data and Analytics, World Health Organization, 20 Avenue Appia, 1211, Geneva, Switzerland
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Dhingra MS, Namazova-Baranova L, Arredondo-Garcia JL, Kim KH, Limkittikul K, Jantarabenjakul W, Perminova O, Kobashi IAR, Bae CW, Ojeda J, Park J, Chansinghakul D, B'Chir S, Neveu D, Bonaparte M, Jordanov E. Immunogenicity and safety of a quadrivalent meningococcal tetanus toxoid-conjugate vaccine administered concomitantly with other paediatric vaccines in toddlers: a phase III randomised study. Epidemiol Infect 2021; 149:e90. [PMID: 33814028 PMCID: PMC8080229 DOI: 10.1017/s0950268821000698] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 03/05/2021] [Accepted: 03/17/2021] [Indexed: 11/07/2022] Open
Abstract
Invasive meningococcal disease has high morbidity and mortality, with infants and young children among those at greatest risk. This phase III, open-label, randomised study in toddlers aged 12-23 months evaluated the immunogenicity and safety of meningococcal tetanus toxoid-conjugate vaccine (MenACYW-TT), a tetanus toxoid conjugated vaccine against meningococcal serogroups A, C, W and Y, when coadministered with paediatric vaccines (measles, mumps and rubella [MMR]; varicella [V]; 6-in-1 combination vaccine against diphtheria, tetanus, pertussis, polio, hepatitis B and Haemophilus influenzae type b [DTaP-IPV-HepB-Hib] and pneumococcal conjugate vaccine [PCV13])(NCT03205371). Immunogenicity to each meningococcal serogroup was assessed by serum bactericidal antibody assay using human complement (hSBA). Vaccine safety profiles were described up to 30 days post-vaccination. A total of 1183 participants were enrolled. The proportion with seroprotection (hSBA ≥1:8) to each meningococcal serogroup at Day 30 was comparable between the MenACYW-TT and MenACYW-TT + MMR + V groups (≥92 and ≥96%, respectively), between the MenACYW-TT and MenACYW-TT + DTaP-IPV-HepB-Hib groups (≥90% for both) and between the MenACYW-TT and MenACYW-TT + PCV13 groups (≥91 and ≥84%, respectively). The safety profiles of MenACYW-TT, and MMR + V, DTaP-IPV-HepB-Hib, and PCV13, with or without MenACYW-TT, were generally comparable. Coadministration of MenACYW-TT with paediatric vaccines in toddlers had no clinically relevant effect on the immunogenicity and safety of any of the vaccines.
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Affiliation(s)
- M. S. Dhingra
- Global Clinical Sciences, Sanofi Pasteur, Swiftwater, PA, USA
| | - L. Namazova-Baranova
- Institute of Pediatrics, Central Clinical Hospital of the Russian Academy of Science, Moscow, Russia
| | | | - K.-H. Kim
- Department of Pediatrics, Ewha Woman's University College of Medicine, Seoul, South Korea
| | - K. Limkittikul
- Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - W. Jantarabenjakul
- Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - O. Perminova
- City Children Clinical Outpatient Hospital #5, Perm, Russia
| | | | - C.-W. Bae
- Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - J. Ojeda
- Global Clinical Sciences, Sanofi Pasteur, Mexico City, Mexico
| | - J. Park
- Global Clinical Sciences, Sanofi Pasteur, Singapore, Singapore
| | | | - S. B'Chir
- Global Biostatistical Sciences, Sanofi Pasteur, Marcy l'Etoile, France
| | - D. Neveu
- Global Pharmacovigilance, Sanofi Pasteur, Swiftwater, PA, USA
| | - M. Bonaparte
- Global Clinical Immunology, Sanofi Pasteur, Swiftwater, PA, USA
| | - E. Jordanov
- Global Clinical Sciences, Sanofi Pasteur, Swiftwater, PA, USA
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Seither R, McGill MT, Kriss JL, Mellerson JL, Loretan C, Driver K, Knighton CL, Black CL. Vaccination Coverage with Selected Vaccines and Exemption Rates Among Children in Kindergarten - United States, 2019-20 School Year. MMWR Morb Mortal Wkly Rep 2021; 70:75-82. [PMID: 33476312 PMCID: PMC7821768 DOI: 10.15585/mmwr.mm7003a2] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
State and local school vaccination requirements serve to protect students against vaccine-preventable diseases (1). This report summarizes data collected by state and local immunization programs* on vaccination coverage among children in kindergarten (kindergartners) in 48 states, exemptions for kindergartners in 49 states, and provisional enrollment and grace period status for kindergartners in 28 states for the 2019-20 school year, which was more than halfway completed when most schools moved to virtual learning in the spring because of the coronavirus 2019 (COVID-19) pandemic. Nationally, vaccination coverage† was 94.9% for the state-required number of doses of diphtheria and tetanus toxoids, and acellular pertussis vaccine (DTaP); 95.2% for 2 doses of measles, mumps, and rubella vaccine (MMR); and 94.8% for the state-required number of varicella vaccine doses. Although 2.5% of kindergartners had an exemption from at least one vaccine,§ another 2.3% were not up to date for MMR and did not have a vaccine exemption. Schools and immunization programs can work together to ensure that undervaccinated students are caught up on vaccinations in preparation for returning to in-person learning. This follow-up is especially important in the current school year, in which undervaccination is likely higher because of disruptions in vaccination during the ongoing COVID-19 pandemic (2-4).
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Virta M, Soininen A, Patel DM, Petit C, Tabar C, Lyabis O. Persistence of Hepatitis B Immune Memory Until 6 Years of Age Following Hexavalent DTaP-IPV-HB-PRP~T Vaccination in a 3-, 5- and 11- to 12-month Schedule and Response to a Subsequent Hepatitis B Challenge Vaccination. Pediatr Infect Dis J 2021; 40:e28-e30. [PMID: 33284254 DOI: 10.1097/inf.0000000000002954] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Anti-hepatitis B (HBs) antibody persistence and hepatitis B challenge were evaluated at 6 years of age following vaccination of fully liquid DTaP-IPV-HB-PRP~T or reconstituted DTaP-IPV-HB//PRP~T at 3, 5, 11-12 months of age. At 6 years, 53.8% and 73.5% had seroprotective anti-HBs antibodies (≥10 mIU/mL), increasing to 96.7% and 95.9% postchallenge, confirming a strong anamnestic response in primed vaccinees.
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Affiliation(s)
- Miia Virta
- From the Vaccine Research Center, Faculty of Medicine and Health Technology, Tampere University, Tampere
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Hefele L, Syphan S, Xayavong D, Homsana A, Kleine D, Chanthavilay P, Nouanthong P, Xaydalasouk K, Phathammavong O, Billamay S, Xeuatvongsa A, Reinharz D, Black AP, Muller CP. Timeliness of immunisation with the pentavalent vaccine at different levels of the health care system in the Lao People's Democratic Republic: A cross-sectional study. PLoS One 2020; 15:e0242502. [PMID: 33290386 PMCID: PMC7723256 DOI: 10.1371/journal.pone.0242502] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 11/03/2020] [Indexed: 12/03/2022] Open
Abstract
Background The timely administration of vaccines is considered to be important for both individual and herd immunity. In this study, we investigated the timeliness of the diphtheria-tetanus-whole cell pertussis-hepatitis B-Haemophilus influenzae type b (pentavalent) vaccine, scheduled at 6, 10 and 14 weeks of age in the Lao People’s Democratic Republic. We also investigated factors associated with delayed immunization. Methods 1162 children aged 8–28 months who had received the full course of the pentavalent vaccine at different levels of the health care system were enrolled. Vaccination dates documented in hospital records and/or immunisation cards were recorded. Age at vaccination and time intervals between doses were calculated. Predictors for timely completion with the pentavalent vaccine at 24 weeks were assessed by bivariate and multivariable analyses. Results Several discrepancies in dates between vaccination documents were observed. In general, vaccination with the pentavalent vaccine was found to be delayed, especially in health care settings below the provincial hospital level. Compared to the central hospital level, less participants who were vaccinated at the district/health center level received the third dose by 16 (48% at the central hospital level vs. 7.1% at the district and 12.4% at the health center level) and 24 weeks of age (94.4% at the central hospital level vs 64.6% at the district-outreach and 57.4% at the health center level) respectively. In logistic regression analyses, lower education level of the mother as well as vaccination by outreach service, were independently associated with delayed completion of vaccination. Conclusion We observed a general delay of vaccination, especially at lower ranked facilities, which correlated with indicators of poor access to health services. This highlights the need for further improving health equity in rural areas. Age-appropriate vaccination should become a quality indicator for the national immunization programme. In addition, we recommend further training of the health care staff regarding the importance of reliable documentation of dates.
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Affiliation(s)
- Lisa Hefele
- Lao-Lux Laboratory, Institut Pasteur du Laos, Vientiane, Lao PDR
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Grand-Duchy of Luxembourg
- * E-mail:
| | | | | | - Anousin Homsana
- Lao Tropical and Public Health Institute, Vientiane, Lao PDR
| | - Daria Kleine
- Lao-Lux Laboratory, Institut Pasteur du Laos, Vientiane, Lao PDR
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Grand-Duchy of Luxembourg
| | | | | | | | | | | | - Anonh Xeuatvongsa
- Expanded Programme on Immunisation, Vientiane, Lao People’s Democratic Republic
| | - Daniel Reinharz
- Lao Tropical and Public Health Institute, Vientiane, Lao PDR
- Département de Médecine Sociale et Préventive, Université Laval, Québec, Canada
| | - Antony P. Black
- Lao-Lux Laboratory, Institut Pasteur du Laos, Vientiane, Lao PDR
| | - Claude P. Muller
- Lao-Lux Laboratory, Institut Pasteur du Laos, Vientiane, Lao PDR
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Grand-Duchy of Luxembourg
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Abreu TC, Boshuizen H, Mollema L, Berbers GAM, Korthals Altes H. Association between season of vaccination and antibody levels against infectious diseases. Epidemiol Infect 2020; 148:e276. [PMID: 33148351 PMCID: PMC7770373 DOI: 10.1017/s0950268820002691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 10/02/2020] [Accepted: 10/15/2020] [Indexed: 11/19/2022] Open
Abstract
Vaccination has reduced the disease burden of vaccine-preventable diseases. However, the extent to which seasonal cycles of immunity could influence vaccine-induced immunity is not well understood. A national cross-sectional serosurveillance study performed in the Netherlands (Pienter-2) yielded data to investigate whether season of vaccination was associated with antibody responses induced by DT-IPV (diphtheria, tetanus and poliomyelitis), MMR (measles, mumps and rubella) and meningococcus C (MenC) vaccines in children. In total, 434 children met the inclusion criteria to study DT-IPV immunity, 811 for MMR and 311 for MenC. Differences in log(antibody levels) by season of vaccination were investigated with linear multivariable regression analyses. Seroconversion rates varied according to season of vaccination for rubella (90% of autumn-vaccinated children vs. 99% of winter-vaccinated had concentrations above cut-off levels). Summer-vaccinated boys showed a slower decline of tetanus antibodies (6% per month), in comparison with winter-vaccinated boys. In conclusion, season of vaccination showed little association with immunological protection. However, a number of associations were seen with a P-value of about 0.03; and adding data from a just-completed nationwide serological study might add more power to the current study. Further immunological and longitudinal investigations could help understand the mechanisms of seasonal influence in vaccine-induced responses.
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Affiliation(s)
- T. C. Abreu
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - H. Boshuizen
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - L. Mollema
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - G. A. M. Berbers
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - H. Korthals Altes
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
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11
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Khoury A, Cahill JD. Tetanus Vaccination 2020 and Collateral Protections against Pertussis and Diphtheria. R I Med J (2013) 2020; 103:38-40. [PMID: 32752564] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Tetanus is a life-threatening but vaccine-preventable disease caused by the toxin of the bacterium Clostridium tetani and is characterized by muscle spasms and autonomic nervous system dysfunction. It is prevented through vaccination with tetanus toxoid, but because the causative agent is widespread in the environment, eradication is impossible. Therefore, efforts to reduce incidence are aimed at reaching elimination, rather than eradication. This article reviews the pathogenesis, clinical manifestation and treatment of tetanus, and summarizes all recommendations from CDC's Advisory Committee on Immunization Practices (ACIP) regarding prevention and control of tetanus in the United States.
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Affiliation(s)
- Alexandre Khoury
- Internal medicine and emergency medicine, PGY6, Icahn School of Medicine at Mount Sinai
| | - John D Cahill
- Assistant Professor of Medicine and Emergency Medicine, Icahn School of Medicine at Mount Sinai; Adjunct Professor of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI
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Alhassan JAK, Wariri O, Onuwabuchi E, Mark G, Kwarshak Y, Dase E. Access to skilled attendant at birth and the coverage of the third dose of diphtheria-tetanus-pertussis vaccine across 14 West African countries - an equity analysis. Int J Equity Health 2020; 19:78. [PMID: 32487158 PMCID: PMC7268225 DOI: 10.1186/s12939-020-01204-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 05/26/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Universal Health Coverage (UHC) remains a critical public health goal that continues to elude many countries of the global south. As countries strive for its attainment, it is important to track progress in various subregions of the world to understand current levels and mechanisms of progress for shared learning. Our aim was to compare multidimensional equity gaps in access to skilled attendant at birth (SAB) and coverage of the third dose of Diphtheria-Tetanus-Pertussis (DTP3) across 14 West African countries. METHODS The study was a cross sectional comparative analysis that used publicly available, nationally representative health surveys. We extracted data from Demographic and Health Surveys, and Multiple Indicator Cluster Surveys conducted between 2010 and 2017 in Benin, Burkina Faso, Cote d' Ivoire, The Gambia, Ghana, Guinea, Guinea Bissau, Liberia, Mali, Niger, Nigeria, Senegal, Sierra Leone and Togo. The World Health Organization's Health Equity Assessment Toolkit (HEAT Plus) software was used to evaluate current levels of intra-country equity in access to SAB and DTP3 coverage across four equity dimensions (maternal education, location of residence, region within a country and family wealth status). RESULTS There was a general trend of higher levels of coverage for DTP3 compared to access to SAB in the subregion. Across the various dimensions of equity, more gaps appear to have been closed in the subregion for DTP3 compared to SAB. The analysis revealed that countries such as Sierra Leone, Liberia and Ghana have made substantial progress towards equitable access for the two outcomes compared to others such as Nigeria, Niger and Guinea. CONCLUSION In the race towards UHC, equity should remain a priority and comparative progress should be consistently tracked to enable the sharing of lessons. The West African subregion requires adequate government financing and continued commitment to move toward UHC and close health equity gaps.
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Affiliation(s)
- Jacob Albin Korem Alhassan
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, Canada
- African Population and Health Policy Initiative, Gombe, Nigeria
| | - Oghenebrume Wariri
- African Population and Health Policy Initiative, Gombe, Nigeria
- Medical Research Council (MRC) Unit The Gambia, London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Egwu Onuwabuchi
- African Population and Health Policy Initiative, Gombe, Nigeria
- Department of Obstetrics and Gynaecology, Federal Teaching Hospital, Gombe, Nigeria
| | - Godwin Mark
- Department of One Health, The University of Edinburgh, Royal (Dick) School of Veterinary Studies, Edinburgh, Scotland UK
| | - Yakubu Kwarshak
- Department of Global Health and Management, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland UK
| | - Eseoghene Dase
- African Population and Health Policy Initiative, Gombe, Nigeria
- Department of Obstetrics and Gynaecology, Federal Teaching Hospital, Gombe, Nigeria
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Olivera I, Grau C, Dibarboure H, Torres JP, Mieres G, Lazarov L, Alvarez FP, Yescas JGL. Valuing the cost of improving Chilean primary vaccination: a cost minimization analysis of a hexavalent vaccine. BMC Health Serv Res 2020; 20:295. [PMID: 32272920 PMCID: PMC7147015 DOI: 10.1186/s12913-020-05115-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 12/04/2019] [Accepted: 03/17/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The phased withdrawal of oral polio vaccine (OPV) and the introduction of inactivated poliovirus vaccine (IPV) is central to the polio 'end-game' strategy. METHODS We analyzed the cost implications in Chile of a switch from the vaccination scheme consisting of a pentavalent vaccine with whole-cell pertussis component (wP) plus IPV/OPV vaccines to a scheme with a hexavalent vaccine with acellular pertussis component (aP) and IPV (Hexaxim®) from a societal perspective. Cost data were collected from a variety of sources including national estimates and previous vaccine studies. All costs were expressed in 2017 prices (US$ 1.00 = $Ch 666.26). RESULTS The overall costs associated with the vaccination scheme (4 doses of pentavalent vaccine plus 1 dose IPV and 3 doses OPV) from a societal perspective was estimated to be US$ 12.70 million, of which US$ 8.84 million were associated with the management of adverse events related to wP. In comparison, the cost associated with the 4-dose scheme with a hexavalent vaccine (based upon the PAHO reference price) was US$ 19.76 million. The cost of switching to the hexavalent vaccine would be an additional US$ 6.45 million. Overall, depending on the scenario, the costs of switching to the hexavalent scheme would range from an additional US$ 2.62 million to US$ 6.45 million compared with the current vaccination scheme. CONCLUSIONS The switch to the hexavalent vaccine schedule in Chile would lead to additional acquisition costs, which would be partially offset by improved logistics, and a reduction in adverse events associated with the current vaccines.
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Affiliation(s)
- Ignacio Olivera
- Centro de Investigaciones Económicas, CINVE, Salud, Montevideo, Uruguay
| | - Carlos Grau
- Centro de Investigaciones Económicas, CINVE, Salud, Montevideo, Uruguay
| | | | - Juan Pablo Torres
- Chile Departamento de Pediatría y Cirugía Infantil Oriente, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Gustavo Mieres
- Centro de Investigaciones Económicas, CINVE, Salud, Montevideo, Uruguay
| | - Luis Lazarov
- Centro de Investigaciones Económicas, CINVE, Salud, Montevideo, Uruguay
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14
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Fröberg J, van der Maas NAT, de Melker HE. [Introduction of pertussis vaccination during pregnancy]. Ned Tijdschr Geneeskd 2020; 164:D4630. [PMID: 32392010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Pertussis is an endemic disease in the Netherlands. In order to protect infants under 6 months of age, women can be vaccinated during pregnancy with a DTaP(-IPV) booster vaccine. After this so-called maternal vaccination, pertussis antibodies are passed through the placenta to the unborn child, who will be protected after birth. The vaccine is offered as a part of the national vaccination programme (Rijksvaccinatieprogramma, RVP) since 16 December 2019. Children of maternally vaccinated women will follow a different vaccination schedule, namely the 3-5-11-months schedule. This schedule change applies to the DTaP-IPV-HiB-HepB combination vaccine and the 10-valent pneumococcal (PCV10) vaccine. High-risk groups and children of unvaccinated mothers will follow the 2-3-5-11 months schedule. Maternal vaccination is offered from 22 weeks of gestation in the Netherlands. This timing is logistically feasible. We have seen that women already got themselves actively vaccinated during pregnancy before the inclusion of the vaccine in the RVP.
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Affiliation(s)
- J Fröberg
- RIVM, Centrum Infectieziektebestrijding, afd. Epidemiologie en Surveillance van Infectieziekten, Bilthoven
- Contact: J. Fröberg
| | - N A T van der Maas
- RIVM, Centrum Infectieziektebestrijding, afd. Epidemiologie en Surveillance van Infectieziekten, Bilthoven
| | - H E de Melker
- RIVM, Centrum Infectieziektebestrijding, afd. Epidemiologie en Surveillance van Infectieziekten, Bilthoven
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Abstract
BACKGROUND Despite the significant role played by vaccines in global health, concerns over vaccine safety have increased tremendously over the years. There have been occasions where vaccines have caused rare, adverse reactions some of which have led to hospitalizations and even death. It is therefore important to establish the safety profile of routinely used vaccines in order to allay fears pertaining to their use. OBJECTIVES This review was aimed at pooling together the safety data of selected vaccines used for routine immunization in Africa, a region of the world with paucity of vaccine safety data. METHODS Adverse Events Following Immunization safety data was searched for rotavirus, yellow fever, measles, rubella, tuberculosis (Bacillus Calmette Guerin-BCG), pneumococcal, Haemophilus Influenza type b, polio, meningococcal and the influenza A (H1N1) vaccines in PUBMED, Google Scholar, Clinical trials.gov and Cochrane controlled register of trials databases. RESULTS A total of twenty-four serious AEFIs and twenty-three minor AEFIs were identified from the review. The strength of association between AEFIs and vaccine was high for tuberculosis vaccine and moderate for all other vaccines. CONCLUSION Even though AEFIs (including mild and severe) were identified in the review, all the vaccines studied were generally well tolerated.
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Affiliation(s)
- Peter Yamoah
- School of Pharmacy, University of Health and Allied Sciences, Ghana
- College of Health Sciences, University of KwaZulu Natal, Durban, South Africa
| | - Varsha Bangalee
- College of Health Sciences, University of KwaZulu Natal, Durban, South Africa
| | - Frasia Oosthuizen
- College of Health Sciences, University of KwaZulu Natal, Durban, South Africa
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Fadlyana E, Dhamayanti M, Tarigan R, Mulia Sari R, Sjafri Bachtiar N, Kartasasmita CB, Rusmil K. Immunogenicity and safety profile of a primary dose of bivalent oral polio vaccine given simultaneously with DTwP-Hb-Hib and inactivated poliovirus vaccine at the 4th visit in Indonesian infants. Vaccine 2020; 38:1962-1967. [PMID: 31982261 DOI: 10.1016/j.vaccine.2020.01.007] [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: 08/12/2019] [Revised: 12/24/2019] [Accepted: 01/05/2020] [Indexed: 11/19/2022]
Abstract
In this study, we aimed to evaluate the immunological protectivity of infants following four doses of bivalent oral polio vaccine (bOPV; Bio Farma), which were given simultaneously with DTwP-Hb-Hib (Pentabio®), along with one dose of inactivated poliovirus vaccine (IPV) at the fourth visit. A total of 143 newborn infants who fulfilled the inclusion criteria were enrolled and completed the study. Subjects received the first dose of bOPV at birth. On days 60, 90 and 120, bOPV was given simultaneously with Pentabio®. On day 120, one dose of IPV was also administered. Serum samples for serology analysis were collected before the first dose of bOPV (at day 0), before the second dose of bOPV (at day 60) and 30 days after the last dose of bOPV. In addition, the intensity, duration and relationship of each adverse event to the trial vaccines were assessed. Seroprotection rates after the fourth dose of bOPV were 100%, 91.6% and 99.3% for poliovirus P1, P2 and P3, respectively. Seroconversion rates after the fourth dose of bOPV were 100.0%, 93.3% and 100% for poliovirus P1, P2 and P3, respectively. There were no severe adverse events, and systemic reactions were generally mild during the 1-28 day post-vaccination period. Collectively, our findings indicate that bOPV given simultaneously with Pentabio® and one dose of IPV at the 4th visit was immunogenic and well tolerated.
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Affiliation(s)
- Eddy Fadlyana
- Department of Child Health, Faculty of Medicine Universitas Padjadjaran/Hasan Sadikin Hospital, Bandung, Indonesia.
| | - Meita Dhamayanti
- Department of Child Health, Faculty of Medicine Universitas Padjadjaran/Hasan Sadikin Hospital, Bandung, Indonesia
| | - Rodman Tarigan
- Department of Child Health, Faculty of Medicine Universitas Padjadjaran/Hasan Sadikin Hospital, Bandung, Indonesia
| | | | | | - Cissy B Kartasasmita
- Department of Child Health, Faculty of Medicine Universitas Padjadjaran/Hasan Sadikin Hospital, Bandung, Indonesia
| | - Kusnandi Rusmil
- Department of Child Health, Faculty of Medicine Universitas Padjadjaran/Hasan Sadikin Hospital, Bandung, Indonesia
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17
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Abstract
The US Advisory Committee on Immunization Practices recommends that infants beginning at birth receive several vaccines directed against a variety of infectious diseases that currently pose threats of morbidity and mortality to infants and those around them, including the 3-dose hepatitis B (HepB) series. The first dose is due at birth. This series protects against maternal-infant transmission of the HepB virus and against exposure the rest of the infant's life. At age 2 months infants are to receive not only their second dose of HepB vaccine but also a series of vaccines directed against diphtheria, tetanus, pertussis, pneumococcus, rotavirus, poliovirus, and Haemophilus influenzae type b. At 4 months, infants are to repeat those vaccines except for the HepB vaccine. At age 6 months infants are to finish the HepB series and receive the third doses of the other vaccines received at 2 and 4 months except for the rotavirus vaccine, depending on the brand used. Also, starting at 6 months, depending on the time of year, infants are to begin a 2-dose series against influenza separated by 28 days. Each of these vaccines is due at a time when the vaccine works to protect against an immediate risk and to provide long-term protection. These vaccine-preventable diseases vary in terms of the nature of exposure, the form of the morbidity, the risk of mortality, and the ability of routine vaccination to prevent or ameliorate harm.
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Affiliation(s)
- Robert M Jacobson
- Department of Pediatric and Adolescent Medicine and Department of Health Sciences Research, Mayo Clinic, Rochester, MN.
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18
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Abebe AM, Wudu Kassaw M, Zemariam AB, Estifanos Shewangashaw N. Coverage, Opportunity, and Challenges of Expanded Program on Immunization among 12-23-Month-Old Children in Woldia Town, Northeast Ethiopia, 2018. Biomed Res Int 2019; 2019:5302307. [PMID: 31976321 PMCID: PMC6955143 DOI: 10.1155/2019/5302307] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 11/14/2019] [Accepted: 12/09/2019] [Indexed: 12/04/2022]
Abstract
BACKGROUND Each year, immunization averts an estimated 2-3 million deaths from diphtheria, tetanus, pertussis, and measles. In 2011, nearly 107 million infants (83%) worldwide received at least 3 doses of DTP vaccine; however, approximately 22.4 million failed to receive 3 doses, and this causes large numbers of children susceptible to vaccine-preventable diseases and death. Nearly 8.4 million received at least 1 DTP dose. The aim of this was to assess coverage, opportunity, and challenges of EPI among children of age 12-23 months in Woldia town, Amhara region, Northeast Ethiopia. METHOD In this mixed community-based cross-sectional study, 389 study subjects were selected by using a multistage sampling method. Interviewer-administered structured questioners were used. Data were entered and analyzed using SPSS Version 20 and presented by using tables and figures. Documented/recorded file from the qualitative data were transcribed into word narrative. Finally, it was presented by thematic analysis. RESULT A total of 389 mothers/caretakers were interviewed. Based on vaccination card and mothers/caretakers' recall, 385 (99%) of the children took at least a single dose of vaccine. From total children, 4 (1%) were not immunized at all, 44 (11.3%) were partially immunized, and 343 (87.7%) were fully immunized. The dropout rate was 9% for BCG to measles, 2.4% for Penta1 to Penta3, 8.3% for penta1 to measles, and 1.6% for pcv1 to Pcv3. A qualitative study revealed that workload, shortage of vaccine, and noncompliance of the mother/caretaker for the next scheduled date was the major challenge faced by health professionals and health extension workers. CONCLUSION Vaccination coverage was low compared with the Millennium Development Goals target. It is important to increase and maintain the immunization level to the intended target. Thus, the town health office and concerned stakeholders need to work more to improve the performance of the expanded program on immunization in this area.
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Affiliation(s)
- Ayele Mamo Abebe
- Department of Nursing, Debre Birhan Health Sciences College, Debre Birhan 37, Amhara, Ethiopia
| | - Mesfin Wudu Kassaw
- Department of Nursing, College of Health Sciences, Woldia University, Amhara, Ethiopia
| | - Alemu Birara Zemariam
- Department of Nursing, College of Health Sciences, Woldia University, Amhara, Ethiopia
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Guan J, Ma C, Ma HL, Wang HR, Liu SQ. [Vaccine loss related to the expanded immunization program in Xinjiang Uygur Autonomous Region, 2016-2017]. Zhonghua Liu Xing Bing Xue Za Zhi 2019; 40:1590-1594. [PMID: 32062921 DOI: 10.3760/cma.j.issn.0254-6450.2019.12.016] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Objective: To assess the vaccine loss related to the Expanded Program on Immunization (EPI) in Xinjiang Uygur Autonomous Region so as to improve the management of vaccines. Methods: A total of 135 vaccination clinics were randomly selected, using a stratified cluster sampling method. In each clinic, data on vaccination was collected between 2016 and 2017, including the number of doses in routine immunization program and supplementary immunization activities (i.e., vaccine doses in vials that were opened for use) on polio vaccine, number of doses administered to children and the number of doses discarded (e.g., expired vaccine or broken vials that had not been opened for use), etc. Coefficient on vaccine loss was calculated with the following equation: vaccine loss coefficient=(number of vaccine doses used)/(number of vaccine doses administered). The vaccine discard rate appeared as: number of vaccine doses discarded)/number of vaccine doses used. Results: For vaccines in single-dose vials [diphtheria-tetanus-pertussis vaccine (DTaP) and trivalent oral polio virus vaccine (tOPV)], the loss coefficients appeared as 1.00 and 1.02, respectively. For vaccines in multi-dose vials [bivalent oral polio vaccine (bOPV), group A meningococcal polysaccharide vaccine (MPV-A), diphtheria-tetanus combined vaccine (DT) and bacilli Calmette-Guérin (BCG) vaccine], the loss coefficients were 1.58, 1.67, 1.68, and 3.02, respectively. The coefficients of EPI vaccine loss in urban, rural, and pastoral area vaccination clinics ranged between 1.00-2.84, 1.00-3.71, and 1.00-2.27, respectively. Loss coefficients ranged between 1.00-3.00, 1.00- 4.41, and 1.00-1.94, respectively, were seen in township clinics, village clinics, and decentralized vaccination clinics. Coefficients on larger vaccine loss were associated with longer intervals between clinic sessions and with fewer vaccinations administrations per day. Conclusions: In Xinjiang, coefficients on the loss of multi-dose EPI vaccines were high. The coefficients on loss were different from the levels of region and types of clinics, and time interval between clinic sessions. Programs on refining the management and distribution of EPI vaccines, to minimize the vaccine loss were recommended.
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Affiliation(s)
- J Guan
- Immunization Program Department, Xinjiang Uygur Autonomous Region Center for Disease Control and Prevention, Urumqi 830011, China
| | - C Ma
- Chinese Field Epidemiology Training Program, National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - H L Ma
- Chinese Field Epidemiology Training Program, National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - H R Wang
- Immunization Program Department, Fukang Center for Disease Control and Prevention, Changji 831500, China
| | - S Q Liu
- Immunization Program Department, Xinyuan Center for Disease Control and Prevention, Yili 835800, China
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Mekonnen ZA, Tilahun B, Alemu K, Were M. Effect of mobile phone text message reminders on improving completeness and timeliness of routine childhood vaccinations in North-West, Ethiopia: a study protocol for randomised controlled trial. BMJ Open 2019; 9:e031254. [PMID: 31694849 PMCID: PMC6858152 DOI: 10.1136/bmjopen-2019-031254] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 10/12/2019] [Accepted: 10/16/2019] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Non-attendance and delay in vaccination schedules remain a big challenge to healthcare workers. With the continuous growth of mobile network coverage and exponential penetration of mobile devices in the developing world, adoption of short message service has been shown to increase attendance for health services by targeting participant characteristics such as forgetfulness. Therefore, the aim of this trial is to determine the effect of mobile text message reminders on completeness and timeliness of childhood vaccination in North-West, Ethiopia. METHODS AND ANALYSIS A two-arm, parallel, superiority, randomised controlled trial study will be employed. The study arms are the intervention group (text message reminders plus routine care) and the control group (routine care only). Mother-infant pairs will be randomised to one of the groups during enrolment. The trial will consider a sample size of 434 mother-infant pairs with 1:1 allocation ratio. Mothers assigned to the intervention group will receive text message reminder 1 day before the scheduled vaccination visit at 6 weeks, 10 weeks, 14 weeks and at 9 months. Initially, descriptive statistics will be computed. For the primary outcome log-binomial regression model will be used to identify associated factors, and relative risk with 95% CI will be reported. Primarily, iIntention-to-treat analysis principle will be applied. STATA V.14 software will be used for the analysis. ETHICS AND DISSEMINATION This study obtained ethical approval from the University of Gondar Institutional Ethical Review Board. The trial findings on the effectiveness of mobile text message reminders in improving vaccination uptake will help to inform decision makers on the use of mobile health interventions in developing countries like Ethiopia. The scientific findings of the trial will also be published in reputable journals. TRIAL REGISTRATION NUMBER PACTR201901533237287.
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Affiliation(s)
- Zeleke Abebaw Mekonnen
- Health Informatics, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
| | - Binyam Tilahun
- Health Informatics, University of Gondar, Gondar, Ethiopia
| | - Kassahun Alemu
- Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Martin Were
- Institute of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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22
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Seither R, Loretan C, Driver K, Mellerson JL, Knighton CL, Black CL. Vaccination Coverage with Selected Vaccines and Exemption Rates Among Children in Kindergarten - United States, 2018-19 School Year. MMWR Morb Mortal Wkly Rep 2019; 68:905-912. [PMID: 31622283 PMCID: PMC6802678 DOI: 10.15585/mmwr.mm6841e1] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
State and local school vaccination requirements exist to ensure that students are protected against vaccine-preventable diseases (1). This report summarizes data collected by state and local immunization programs* on vaccination coverage among children in kindergarten in 49 states, exemptions for kindergartners in 50 states, and provisional enrollment and grace period status for kindergartners in 30 states. Nationally, vaccination coverage† was 94.9% for the state-required number of doses of diphtheria and tetanus toxoids, and acellular pertussis vaccine (DTaP); 94.7% for 2 doses of measles, mumps, and rubella vaccine (MMR); and 94.8% for the state-required doses of varicella vaccine. Whereas 2.5% of kindergartners had an exemption from at least one vaccine,§ 2.8% of kindergartners were not up to date for MMR and did not have a vaccine exemption. Nearly all states could achieve the recommended ≥95% MMR coverage if all nonexempt kindergartners were vaccinated in accordance with local and state vaccination policies.
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Noh JW, Kim YM, Akram N, Yoo KB, Cheon J, Lee LJ, Kwon YD, Stekelenburg J. Determinants of timeliness in early childhood vaccination among mothers with vaccination cards in Sindh province, Pakistan: a secondary analysis of cross-sectional survey data. BMJ Open 2019; 9:e028922. [PMID: 31537561 PMCID: PMC6756351 DOI: 10.1136/bmjopen-2019-028922] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 08/21/2019] [Accepted: 09/05/2019] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE Untimely vaccination refers to receiving the given dose before (early) or after (delayed) the recommended time window. The purpose of this study was to assess the extent of timeliness of childhood vaccinations and examine the determinants of vaccination timeliness in Sindh province, Pakistan. DESIGN Cross-sectional analysis of data from the 2013 and 2014 Maternal and Child Health Program Indicator Surveys. SETTING Community-based maternal and child health surveys. PARTICIPANTS Among 10 200 respondents of Maternal and Child Health Program Indicator Surveys, 1143 women who had a live birth in the 2 years preceding the survey were included. OUTCOMES At the participants' home, an interviewer asked mothers to show their children's vaccination cards, which contained information regarding vaccinations. Children's vaccination status was categorised into timely or early/delayed compared with vaccination schedule. A logistic regression analysis using Firth's penalised likelihood was performed to identify factors associated with timeliness of vaccinations. RESULTS 238 children (20.8% of children who received a full set of basic vaccinations) received all vaccinations on schedule among children who received a full set of basic vaccinations. The percentages of timely vaccinations ranged from 2.3% for second measles vaccination to 89.3% for bacillus Calmette-Guérin. Child's age and place of delivery were associated with timely vaccinations. Older child age and institutional delivery were associated with decreased timely vaccination rate. CONCLUSIONS Home-based vaccination record is a key tool to improve the timeliness of vaccinations. The redesigned vaccination cards, the new electronic registries for vaccination card information and the vaccination tracking system to remind the second/third vaccination visits may be helpful to improve timely vaccinations for children under 2 years old.
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Affiliation(s)
- Jin-Won Noh
- Department of Health Administration, Dankook University, Cheonan, Korea (the Republic of)
- Global Health Unit, Department of Health Sciences, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Young-Mi Kim
- Jhpiego, Johns Hopkins University, Baltimore, Maryland, USA
| | - Nabeel Akram
- Jhpiego, Johns Hopkins University, Baltimore, Maryland, USA
| | - Ki Bong Yoo
- Department of Health Administration, Department of Information & Statistics, Yonsei University, Wonju, Korea (the Republic of)
| | - Jooyoung Cheon
- College of Nursing, Sungshin Women's University, Seongbuk-gu, Korea (the Republic of)
| | - Lena J Lee
- National Institutes of Health Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Young Dae Kwon
- Department of Humanities and Social Medicine, Catholic University of Korea College of Medicine, Seoul, Korea (the Republic of)
| | - Jelle Stekelenburg
- Global Health Unit, Department of Health Sciences, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
- Obstetrics and Gynaecology, Medisch Centrum Leeuwarden, Leeuwarden, The Netherlands
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Fougère Y, El Houss S, Suris JC, Rouvenaz-Defago S, Miletto D, Von der Weid L, Willen F, Williams-Smith JA, Gehri M, Crisinel PA. Single doses of diphtheria-tetanus-pertussis and poliomyelitis vaccines are sufficient to generate a booster-type response to tetanus in most migrant children. Vaccine 2019; 37:6441-6446. [PMID: 31522805 DOI: 10.1016/j.vaccine.2019.08.089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 06/16/2019] [Revised: 08/27/2019] [Accepted: 08/31/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Immunization coverage for three doses of the diphtheria-tetanus-pertussis and poliomyelitis vaccines in infants is high worldwide, therefore despite the lack of documentation of past vaccinations, most migrant children do not require complete revaccination. Our strategy was to administer a single dose of a tetanus toxoid containing vaccine (TTCV) to migrant children followed by anti-tetanus toxoid (TT) serology to determine whether additional vaccine doses were required. Our goal was to estimate the basic TTCV coverage and to identify potential determinants of the vaccination response. METHODS Newly arrived migrant children were prospectively enrolled between October 2014 and August 2017. We included patients aged 1-18 years with no proof of past vaccinations who accepted a single dose of TTCV. Anti-TT serology was performed after 4-6 weeks, and an anti-TT level ≥ 1 IU/mL was considered a booster-type antibody response with no need for additional doses of TTCV. Potential determinants of the vaccination response were identified using univariate and multivariate linear regression analyses. RESULTS Two hundred and eight children were eligible for analysis. The mean age of the children was 9 (±4.5) years and 100 (48%) were female. The majority (n = 129, 62%) of the children came from the WHO Eastern Mediterranean region. Only three patients (1.4%) required additional vaccine doses. A Syrian origin (p < 0.001) and direct arrival primarily by airplane into Switzerland without transiting through other European countries (p = 0.029) associated with higher anti-TT levels in a multivariate regression model (multiple r2 = 0.210, p < 0.001). CONCLUSION A single dose of TTCV is enough to generate long-term protection in most migrant children. In the context of high basic vaccination coverage, the strategy, which consists of administration of a single dose of TTCV followed by anti-TT serology, can be considered where serotesting is available and economical.
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Affiliation(s)
- Yves Fougère
- Service of Pediatrics, Department Women-Mother-Child, Lausanne University Hospital, Switzerland.
| | - Samir El Houss
- Service of Pediatrics, Department Women-Mother-Child, Lausanne University Hospital, Switzerland
| | - Joan-Carles Suris
- Service of Pediatrics, Department Women-Mother-Child, Lausanne University Hospital, Switzerland
| | - Sylvie Rouvenaz-Defago
- Service of Pediatrics, Department Women-Mother-Child, Lausanne University Hospital, Switzerland
| | - Damien Miletto
- Service of Pediatrics, Department Women-Mother-Child, Lausanne University Hospital, Switzerland
| | - Lucie Von der Weid
- Service of Pediatrics, Department Women-Mother-Child, Lausanne University Hospital, Switzerland
| | - Fanny Willen
- Service of Pediatrics, Department Women-Mother-Child, Lausanne University Hospital, Switzerland
| | | | - Mario Gehri
- Service of Pediatrics, Department Women-Mother-Child, Lausanne University Hospital, Switzerland
| | - Pierre Alex Crisinel
- Unit of Pediatric Infectious Diseases and Vaccinology, Department Women-Mother-Child, Lausanne University Hospital, Switzerland
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Marefiaw TA, Yenesew MA, Mihirete KM. Age-appropriate vaccination coverage and its associated factors for pentavalent 1-3 and measles vaccine doses, in northeast Ethiopia: A community-based cross-sectional study. PLoS One 2019; 14:e0218470. [PMID: 31419230 PMCID: PMC6697368 DOI: 10.1371/journal.pone.0218470] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 06/03/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In Ethiopia, there are limited studies on age-appropriate vaccinations that children received at the recommended specific ages. Therefore, we assessed age-appropriate vaccinations coverage and its associated factors among children 12 to 23 months of age in Menz Lalo district, northeast Ethiopia. METHODS A community-based cross-sectional study was conducted in Menz Lalo district from March to April/2018 among 417 mothers/caregivers with children 12 to 23 months of age using simple random sampling technique. Data were collected using a pretested structured questionnaire. Information about children's vaccination status was collected from vaccination cards. Age-appropriate vaccination coverage was measured using World Health Organization vaccination schedule recommendation. Data was entered into Epi-Info7 software and exported to SPSS-20 for analysis. Four consecutive logistic regression models were performed to identify factors associated with age-inappropriate vaccinations. A P-value of ≤ 0.05 was considered to state statistically significant associations. RESULTS Age-appropriate vaccination coverage was 39.1% (95% CI: 34.3 to 44) for pentavalent 1, 36.3% (95% CI: 31.6 to 41.5) for pentavalent 2, 30.3% (95% CI: 25.6 to 35) for pentavalent 3 and 26.4% (95% CI: 21.7 to 31) for measles vaccine doses. Age-inappropriate pentavalent 1-3 vaccinations was associated with being male sex (AOR: 0.47, 95% CI: 0.29-0.74), lack of telephone (AOR: 2.2, 95% CI: 1.4-3.6), lack of usual caretaker (AOR: 2.6, 95% CI: 1.3-5.2), unplanned pregnancy (AOR: 1.9, 95% CI: 1.1-3.5), missing pregnant women's conference (AOR: 2.7, 95% CI: 1.3-5.7), decreasing birth order (AOR: 0.34, 95% CI: 0.17-0.68) and insufficient knowledge (AOR: 2.7, 95% CI: 1.6-4.4). CONCLUSION The proportions of age-appropriate vaccination coverage were low in the study area. Modifiable factors were associated with age-inappropriate vaccinations. Vaccination interventions should consider identified modifiable factors to improve age-appropriate vaccinations coverage.
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Affiliation(s)
- Tefera Alemu Marefiaw
- Amhara Public Health Institute, Public Health Emergency Management Directorate, Dessie, Ethiopia
- * E-mail:
| | - Muluken Azage Yenesew
- Department of Environmental Health, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Kebadnew Mulatu Mihirete
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
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Mosser JF, Gagne-Maynard W, Rao PC, Osgood-Zimmerman A, Fullman N, Graetz N, Burstein R, Updike RL, Liu PY, Ray SE, Earl L, Deshpande A, Casey DC, Dwyer-Lindgren L, Cromwell EA, Pigott DM, Shearer FM, Larson HJ, Weiss DJ, Bhatt S, Gething PW, Murray CJL, Lim SS, Reiner RC, Hay SI. Mapping diphtheria-pertussis-tetanus vaccine coverage in Africa, 2000-2016: a spatial and temporal modelling study. Lancet 2019; 393:1843-1855. [PMID: 30961907 PMCID: PMC6497987 DOI: 10.1016/s0140-6736(19)30226-0] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 12/19/2018] [Accepted: 01/15/2019] [Indexed: 01/29/2023]
Abstract
BACKGROUND Routine childhood vaccination is among the most cost-effective, successful public health interventions available. Amid substantial investments to expand vaccine delivery throughout Africa and strengthen administrative reporting systems, most countries still require robust measures of local routine vaccine coverage and changes in geographical inequalities over time. METHODS This analysis drew from 183 surveys done between 2000 and 2016, including data from 881 268 children in 49 African countries. We used a Bayesian geostatistical model calibrated to results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2017, to produce annual estimates with high-spatial resolution (5 × 5 km) of diphtheria-pertussis-tetanus (DPT) vaccine coverage and dropout for children aged 12-23 months in 52 African countries from 2000 to 2016. FINDINGS Estimated third-dose (DPT3) coverage increased in 72·3% (95% uncertainty interval [UI] 64·6-80·3) of second-level administrative units in Africa from 2000 to 2016, but substantial geographical inequalities in DPT coverage remained across and within African countries. In 2016, DPT3 coverage at the second administrative (ie, district) level varied by more than 25% in 29 of 52 countries, with only two (Morocco and Rwanda) of 52 countries meeting the Global Vaccine Action Plan target of 80% DPT3 coverage or higher in all second-level administrative units with high confidence (posterior probability ≥95%). Large areas of low DPT3 coverage (≤50%) were identified in the Sahel, Somalia, eastern Ethiopia, and in Angola. Low first-dose (DPT1) coverage (≤50%) and high relative dropout (≥30%) together drove low DPT3 coverage across the Sahel, Somalia, eastern Ethiopia, Guinea, and Angola. INTERPRETATION Despite substantial progress in Africa, marked national and subnational inequalities in DPT coverage persist throughout the continent. These results can help identify areas of low coverage and vaccine delivery system vulnerabilities and can ultimately support more precise targeting of resources to improve vaccine coverage and health outcomes for African children. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Jonathan F Mosser
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - William Gagne-Maynard
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Puja C Rao
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | | | - Nancy Fullman
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Nicholas Graetz
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Roy Burstein
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Rachel L Updike
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Patrick Y Liu
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Sarah E Ray
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Lucas Earl
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Aniruddha Deshpande
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Daniel C Casey
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Laura Dwyer-Lindgren
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Elizabeth A Cromwell
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA
| | - David M Pigott
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA
| | | | - Heidi Jane Larson
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Samir Bhatt
- Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK
| | | | - Christopher J L Murray
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA
| | - Stephen S Lim
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA.
| | - Robert C Reiner
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA
| | - Simon I Hay
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA.
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Utazi CE, Thorley J, Alegana VA, Ferrari MJ, Takahashi S, Metcalf CJE, Lessler J, Cutts FT, Tatem AJ. Mapping vaccination coverage to explore the effects of delivery mechanisms and inform vaccination strategies. Nat Commun 2019; 10:1633. [PMID: 30967543 PMCID: PMC6456602 DOI: 10.1038/s41467-019-09611-1] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 03/21/2019] [Indexed: 12/02/2022] Open
Abstract
The success of vaccination programs depends largely on the mechanisms used in vaccine delivery. National immunization programs offer childhood vaccines through fixed and outreach services within the health system and often, additional supplementary immunization activities (SIAs) are undertaken to fill gaps and boost coverage. Here, we map predicted coverage at 1 × 1 km spatial resolution in five low- and middle-income countries to identify areas that are under-vaccinated via each delivery method using Demographic and Health Surveys data. We compare estimates of the coverage of the third dose of diphtheria-tetanus-pertussis-containing vaccine (DTP3), which is typically delivered through routine immunization (RI), with those of measles-containing vaccine (MCV) for which SIAs are also undertaken. We find that SIAs have boosted MCV coverage in some places, but not in others, particularly where RI had been deficient, as depicted by DTP coverage. The modelling approaches outlined here can help to guide geographical prioritization and strategy design.
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Affiliation(s)
- C Edson Utazi
- WorldPop, School of Geography and Environmental Science, University of Southampton, Southampton, SO17 1BJ, UK.
- Southampton Statistical Sciences Research Institute, University of Southampton, Southampton, SO17 1BJ, UK.
| | - Julia Thorley
- WorldPop, School of Geography and Environmental Science, University of Southampton, Southampton, SO17 1BJ, UK
| | - Victor A Alegana
- WorldPop, School of Geography and Environmental Science, University of Southampton, Southampton, SO17 1BJ, UK
- Flowminder Foundation, Stockholm SE, 11355, Sweden
| | - Matthew J Ferrari
- Center for Infectious Disease Dynamics, The Pennsylvania State University, State College, PA, 16802, USA
| | - Saki Takahashi
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, NJ, 08544, USA
| | - C Jessica E Metcalf
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, NJ, 08544, USA
| | - Justin Lessler
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Felicity T Cutts
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Andrew J Tatem
- WorldPop, School of Geography and Environmental Science, University of Southampton, Southampton, SO17 1BJ, UK
- Flowminder Foundation, Stockholm SE, 11355, Sweden
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Abstract
BACKGROUND DTaP5-HB-IPV-Hib is a fully liquid, hexavalent vaccine containing a 5-antigen pertussis component, approved since 2016 in Europe [Vaxelis; DTaP5-HB-IPV-Hib vaccine: Diphtheria, tetanus, pertussis (5 acellular components: pertussis toxoid [PT], filamentous haemagglutinin [FHA], pertactin (PRN), and fimbriae Types 2 and 3 [FIM]), hepatitis B (recombinant DNA: rDNA), poliomyelitis (inactivated) and Haemophilus influenzae type b conjugate vaccine (adsorbed); MCM Vaccine B.V., The Netherlands] for primary and booster vaccination in infants and toddlers against diphtheria, tetanus, pertussis, hepatitis B, poliomyelitis and invasive diseases caused by Haemophilus influenzae type b. The comparator vaccine (control) was INFANRIX hexa (GlaxoSmithKline Biologics S.A., Rixensart, Belgium) (DTaP3-IPV-HepB/Hib) in European studies and PENTACEL (DTaP5-IPV/Hib) (Sanofi Pasteur, Swiftwater, PA) in US studies. METHODS Data from 6 studies were integrated and analyzed to provide a comprehensive safety profile. Numbers and proportions of subjects with adverse events (AEs) were summarized by treatment group. Group differences in proportion of AEs were calculated. RESULTS Among the DTaP5-HB-IPV-Hib (N = 5223) and 2295 control (N = 2295) groups, solicited injection-site and systemic AEs were very common. Serious AEs were reported by 3.9% of DTaP5-HB-IPV-Hib and 3.7% of control subjects. Vaccine-related serious AEs occurred infrequently, 0.2% for both groups. Most AEs were mild-to-moderate and did not lead to subject withdrawal. Group differences for solicited systemic AEs were small (<3%) and not statistically significant, except for pyrexia (estimated difference 9.4% [95% CI: 6.7%-12%]). The difference was driven by the 2 US studies where the PENTACEL control group had a lower fever rate. Among European studies, there was no significant difference in rates of pyrexia between DTaP5-HB-IPV-Hib and INFANRIX hexa. CONCLUSIONS The safety of DTaP5-HB-IPV-Hib is consistent with the safety profile of its components and similar to comparator vaccines, including INFANRIX hexa. The vaccine provides a new, fully liquid and convenient hexavalent vaccination option for use with various vaccination schedules in Europe.
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Affiliation(s)
- Jin Xu
- From the Merck & Co., Inc., Kenilworth, NJ
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Shenton LM, Wagner AL, Bettampadi D, Masters NB, Carlson BF, Boulton ML. Factors Associated with Vaccination Status of Children Aged 12-48 Months in India, 2012-2013. Matern Child Health J 2019; 22:419-428. [PMID: 29285631 DOI: 10.1007/s10995-017-2409-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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] [Indexed: 12/22/2022]
Abstract
Objectives India has more unvaccinated children than any other country despite provision of free vaccines through the government's Universal Immunization Program. In this study, we calculated the proportion of children aged 12-48 months who were fully vaccinated, under-vaccinated, or who had not received any vaccines. Childhood, household, and sociocultural factors associated with under-vaccination and non-vaccination were evaluated. Methods Using data from India's 4th District-level Health and Facility Survey, 2012-2013 (DLHS-4) and the 2012-2013 Annual Health Survey (AHS), we calculated the proportion of children who were non-vaccinated, under-vaccinated, or fully vaccinated with 1 dose of Bacillus Calmette-Guérin, 3 doses of oral polio vaccine, 3 doses of diphtheria-pertussis-tetanus, and 1 dose of measles-containing vaccine. The odds of full vaccination compared to non-vaccination and under-vaccination relative to various factors was assessed using a multivariable, multinomial logistic regression which accounted for survey design. Results Of 1,929,580 children aged 12-48 months, 59% were fully vaccinated, 34% were under-vaccinated, and 7% were non-vaccinated. Compared to children born in government institutions, children delivered in non-institutional settings with a skilled birth attendant present had higher odds of non-vaccination (OR 1.66) and those without a skilled attendant present had still greater odds of non-vaccination (OR 2.39) and under-vaccination (OR 1.11). Conclusions for Practice India's vaccination rates among children aged 12-48 months remains unacceptably low. The Indian government should encourage institutional delivery or birthing with a skilled attendant to ensure women receive adequate health education through antenatal care that includes the importance of childhood vaccination.
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Affiliation(s)
- Luke M Shenton
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA.
| | - Abram L Wagner
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
| | - Deepti Bettampadi
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
| | - Nina B Masters
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
| | - Bradley F Carlson
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
| | - Matthew L Boulton
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
- Division of Infectious Disease, Department of Internal Medicine, University of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA
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Walker EJ, MacDonald NE, Islam N, Le Saux N, Top KA, Fell DB. Completeness and timeliness of diphtheria-tetanus-pertussis, measles-mumps-rubella, and polio vaccines in young children with chronic health conditions: A systematic review. Vaccine 2019; 37:1725-1735. [PMID: 30814030 DOI: 10.1016/j.vaccine.2019.02.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 10/19/2018] [Revised: 01/23/2019] [Accepted: 02/06/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To systematically review literature on uptake and timeliness of diphtheria-tetanus-pertussis, measles-mumps-rubella, and/or polio-containing vaccines ininfants who were born preterm, with a low birth weight, and/or with chronic health conditions that were diagnosed within the first 6 months of life. METHODS Using a standardized search strategy developed by a medical librarian, records were extracted from MEDLINE, Embase, Database of Abstracts of Reviews of Effects, and CINAHL up to May 8, 2018. RESULTS Out of the 1997 records that were screened, we identified 21 studies that met inclusion criteria. Eleven studies assessed vaccine coverage and/or timeliness in preterm infants, 6 in low birth weight infants, and 7 in children with chronic health conditions. Estimates of coverage in these populations were highly variable, ranging from 40% to 100% across the vaccines and population groups. CONCLUSIONS There is a lack of studies reporting coverage and timeliness of routine immunizations in special populations of children. POLICY IMPLICATIONS Our review suggests a need for improved surveillance of immunization status in special populations of infants, as wellas aneed for standardization of reporting practices.
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Affiliation(s)
| | - Noni E MacDonald
- Dalhousie University, Halifax, NS, Canada; Canadian Centre for Vaccinology, Halifax, NS, Canada
| | | | - Nicole Le Saux
- Division of Infectious Diseases, University of Ottawa, Ottawa, ON, Canada; Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Karina A Top
- Dalhousie University, Halifax, NS, Canada; Canadian Centre for Vaccinology, Halifax, NS, Canada
| | - Deshayne B Fell
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.
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Aliabadi N, Wikswo ME, Tate JE, Cortese MM, Szilagyi PG, Staat MA, Weinberg GA, Halasa NB, Boom JA, Selvarangan R, Englund JA, Azimi PH, Klein EJ, Moffatt ME, Harrison CJ, Sahni LC, Stewart LS, Bernstein DI, Parashar UD, Payne DC. Factors Associated With Rotavirus Vaccine Coverage. Pediatrics 2019; 143:e20181824. [PMID: 30655333 DOI: 10.1542/peds.2018-1824] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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] [Accepted: 11/19/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Rotavirus vaccines (RVVs) were included in the US immunization program in 2006 and are coadministered with the diphtheria-tetanus-acellular pertussis (DTaP) vaccine, yet their coverage lags behind DTaP. We assessed timing, initiation, and completion of the RVV series among children enrolled in active gastroenteritis surveillance at 7 US medical institutions during 2014-2016. METHODS We compared coverage and timing of each vaccine series and analyzed characteristics associated with RVV initiation and completion. We report odds ratios (ORs) and 95% confidence intervals (CIs) from multivariable logistic regression models. RESULTS We enrolled 10 603 children. In 2015, ≥1 dose coverage was 91% for RVV and 97% for DTaP. Seven percent of children received their first DTaP vaccine at age ≥15 weeks versus 4% for RVV (P ≤ .001). Recent birth years (2013-2016) were associated with higher odds of RVV initiation (OR = 5.72; 95% CI 4.43-7.39), whereas preterm birth (OR = 0.32; 95% CI 0.24-0.41), older age at DTaP initiation (OR 0.85; 95% CI 0.80-0.91), income between $50 000 and $100 000 (OR = 0.56; 95% CI 0.40-0.78), and higher maternal education (OR = 0.52; 95% CI 0.36-0.74) were associated with lower odds. Once RVV was initiated, recent birth years (2013-2016; OR = 1.57 [95% CI 1.32-1.88]) and higher maternal education (OR = 1.31; 95% CI 1.07-1.60) were associated with higher odds of RVV completion, whereas preterm birth (OR = 0.76; 95% CI 0.62-0.94), African American race (OR = 0.82; 95% CI 0.70-0.97) and public or no insurance (OR = 0.75; 95% CI 0.60-0.93) were associated with lower odds. Regional differences existed. CONCLUSIONS RVV coverage remains lower than that for the DTaP vaccine. Timely DTaP administration may help improve RVV coverage.
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Affiliation(s)
- Negar Aliabadi
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia;
| | - Mary E Wikswo
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jacqueline E Tate
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Margaret M Cortese
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Peter G Szilagyi
- School of Medicine and Dentistry, University of Rochester, Rochester, New York
- University of California, Los Angeles, Los Angeles, California
| | | | - Geoffrey A Weinberg
- School of Medicine and Dentistry, University of Rochester, Rochester, New York
| | | | - Julie A Boom
- Texas Children's Hospital, Houston, Texas
- Baylor College of Medicine, Houston, Texas
| | | | | | - Parvin H Azimi
- University of California, San Francisco Benioff Children's Hospital Oakland, Oakland, California
| | | | | | | | | | | | | | - Umesh D Parashar
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Daniel C Payne
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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Hammanyero KI, Bawa S, Braka F, Bassey BE, Fatiregun A, Warigon C, Yehualashet YG, Tegene SG, Banda R, Korir C, Erbeto TB, Chukwuji M, Mkanda P, Adamu US, Nsubuga P. Lessons learnt from implementing community engagement interventions in mobile hard-to-reach (HTR) projects in Nigeria, 2014-2015. BMC Public Health 2018; 18:1306. [PMID: 30541514 PMCID: PMC6292166 DOI: 10.1186/s12889-018-6193-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The year 2014 was a turning point for polio eradication in Nigeria. Confronted with the challenges of increased numbers of polio cases detected in rural, hard-to-reach (HTR), and security-compromised areas of northern Nigeria, the Nigeria polio program introduced the HTR project in four northern states to provide immunization and maternal and child health services in these communities. The project was set up to improve population immunity, increase oral polio vaccine (OPV) and other immunization uptake, and to support Nigeria's efforts to interrupt polio transmission by 2015. Furthermore, the project also aimed to create demand for these services which were often unavailable in the HTR areas. To this end, the program developed a community engagement (CE) strategy to create awareness about the services being provided by the project. The term HTR is operationally defined as geographically difficult terrain, with any of the following criteria: having inter-ward/inter-Local Government Area/interstate borders, scattered households, nomadic population, or waterlogged/riverine area, with no easy to access to healthcare facilities and insecurity. METHODS We evaluated the outcome of CE activities in Kano, Bauchi, Borno, and Yobe states to examine the methods and processes that helped to increase OPV and third pentavalent (penta3) immunization coverage in areas of implementation. We also assessed the number of community engagers who mobilized caregivers to vaccination posts and the service satisfaction for the performance of the community engagers. RESULTS Penta3 coverage was at 22% in the first quarter of project implementation and increased to 62% by the fourth quarter of project implementation. OPV coverage also increased from 54% in the first quarter to 76% in the last quarter of the 1-year project implementation. CONCLUSIONS The systematic implementation of a CE strategy that focused on planning and working with community structures and community engagers in immunization activities assisted in increasing OPV and penta3 immunization coverage.
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Affiliation(s)
| | - Samuel Bawa
- World Health Organization, Country Representative Office, Abuja, Nigeria
| | - Fiona Braka
- World Health Organization, Country Representative Office, Abuja, Nigeria
| | - Bassey Enya Bassey
- World Health Organization, Country Representative Office, Abuja, Nigeria
| | - Akinola Fatiregun
- World Health Organization, Country Representative Office, Abuja, Nigeria
| | - Charity Warigon
- World Health Organization, Country Representative Office, Abuja, Nigeria
| | | | - Sisay Gashu Tegene
- World Health Organization, Country Representative Office, Abuja, Nigeria
| | - Richard Banda
- World Health Organization, Country Representative Office, Abuja, Nigeria
| | - Charles Korir
- World Health Organization, Country Representative Office, Abuja, Nigeria
| | | | - Martin Chukwuji
- World Health Organization, Country Representative Office, Abuja, Nigeria
| | - Pascal Mkanda
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | - Usman Saidu Adamu
- National Primary Health Care Development Agency (NPHCDA), Abuja, Nigeria
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Brown DW. Definition and use of "valid" district level vaccination coverage to monitor Global Vaccine Action Plan (GVAP) achievement: evidence for revisiting the district indicator. J Glob Health 2018; 8:020404. [PMID: 30023051 PMCID: PMC6030671 DOI: 10.7189/jogh.08.020404] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The Global Vaccine Action Plan (GVAP) Monitoring and Accountability Framework includes an indicator to reach 90% national vaccination coverage and 80% vaccination coverage in every district or equivalent administrative unit with three doses of diphtheria-tetanus-pertussis containing vaccines (DTP) across all 194 country signatories to GVAP by 2020. Assessment of progress against the district indicator component requires GVAP defined "valid" coverage. GVAP defines district coverage "valid" if the WHO and UNICEF estimate of national immunization coverage for DTP3 in the most recent year is 1) ≥90%, or 2) is identical to the reported national administrative coverage for DTP3 (regardless of coverage level). We draw attention to the potential disconnect that currently exists between GVAP vaccination coverage indicators and the practical capacity to monitor progress against those indicators. METHODS We obtained national and aggregated district coverage data for the third dose of DTP containing vaccine (DTP3) for 194 countries for 2016 from publicly available databases maintained by the World Health Organization (WHO). We reviewed district line lists of coverage data for 96 countries for which district line lists of DTP3 coverage were available and categorized the district coverage values using the same groupings used by the GVAP Monitoring Framework. In doing so, we also tracked the number of districts with reported coverage >100%. RESULTS In 2016, at least one district with DTP3 coverage value >100% was reported in the line lists of 76 of the 96 countries. Agreement in district coverage categories across each of five coverage groupings (<50%, 50-79%, 80-89%, 90-94%, ≥95%) was observed in 43 of the 96 countries. In 2016, 46 of 194 countries were classified as achieving both national DTP3 coverage ≥90% and DTP3 coverage ≥80% in every district, thereby achieving the GVAP target. Among these 46 countries, 22 countries reported district line-listing coverage data. We identified 10 of the 22 countries that reported at least one district with DTP3 coverage >100% ranging from 8% of districts in Sri Lanka to 97% of districts in Bangladesh. Seven countries reported at least 25% of the total districts had DTP3 coverage >100%. CONCLUSIONS The observations of disparate district coverage from a subset of countries reporting district line lists of coverage data are a concern for the current GVAP approach ascribing the achievement of "valid" district coverage data. Our review of district line lists of coverage data does not support a current GVAP assumption that the district coverage values ≥80% fall between 80% and 100% (inclusive). We hope these results spur a review of the current approach to assess the GVAP coverage target of ≥90% national DTP3 coverage and ≥80% DTP3 coverage in all districts.
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Affiliation(s)
- David W Brown
- Brown Consulting Group International, LLC, Cornelius, North Carolina, USA
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Khan J, Shil A, Prakash R. Exploring the spatial heterogeneity in different doses of vaccination coverage in India. PLoS One 2018; 13:e0207209. [PMID: 30485291 PMCID: PMC6261550 DOI: 10.1371/journal.pone.0207209] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 10/27/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Despite the universalization of immunization against the six vaccine-preventable diseases (VPDs), the coverage of full immunization among the children under age five has remained a challenge globally. The 2015-16 National Family Health Survey (NFHS) indicated large disparity in the coverage of different vaccination doses (BCG, Polio, DPT and Measles) including full immunization across the districts of India. The spatial distribution of poor performing districts in terms of vaccination and the district level spatial, contextual determinants contributing to the low coverage have been poorly studied. Using the recent household survey (NFHS, 2015-16), this study examined the spatial heterogeneity and the factors associated with low vaccination coverage among the children aged 12-23 months across India. DATA AND METHODS This study used the data from fourth round of National Family Health Survey conducted in 2015-16. District-level prevalence of each of the vaccination doses including full immunization, were analysed. Moran's I, Univariate and Bivariate LISA, Ordinary least square (OLS) and spatial models were employed to achieve the overall aim of the study. RESULTS At the national level, the prevalence of full immunization was 62 percent. Specific vaccination coverage for BCG, three doses of polio, three doses of DPT and measles were 92, 73, 78 and 81 percent, respectively. The value of the bivariate Moran's I statistics confirmed the spatial dependence between specific vaccination and the set of independent variables. District-level prevalence of the specific vaccine and full immunization showed significant spatial clustering across India. The adjusted coefficients from the spatial error model confirmed that district-level proportion of utilization of post-natal care, institutional births, neonatal tetanus protection of the last birth, women's education and coverage of health insurance showed statistically significant association with every doses of vaccination coverage. CONCLUSION The full and specific immunization coverage was considerably low in the geographical hotspots as compared to the national coverage. Maternal and child health care services utilization, financial assistance to the mothers through JSY scheme and mother's education were found to determine full immunization as well as the specific vaccination coverage. Appropriate intervention should be designed to reduce the geographical disparity in the coverage of specific and full immunization across India and thus safeguard child health protecting the children from the vaccine preventable diseases across the geography.
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Affiliation(s)
- Junaid Khan
- International Institute for Population Sciences (IIPS), Mumbai, India
- * E-mail:
| | - Apurba Shil
- International Institute for Population Sciences (IIPS), Mumbai, India
| | - Ravi Prakash
- Karnataka Health Promotion Trust (KHPT), Bangalore, India
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VanderEnde K, Gacic-Dobo M, Diallo MS, Conklin LM, Wallace AS. Global Routine Vaccination Coverage - 2017. MMWR Morb Mortal Wkly Rep 2018; 67:1261-1264. [PMID: 30439873 PMCID: PMC6290803 DOI: 10.15585/mmwr.mm6745a2] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Endorsed by the World Health Assembly in 2012, the Global Vaccine Action Plan 2011-2020 (GVAP) (1) calls on all countries to reach ≥90% national coverage with all vaccines in the country's national immunization schedule by 2020. This report updates previous reports (2,3) and presents global, regional, and national vaccination coverage estimates and trends as of 2017. It also describes the number of infants surviving to age 1 year (surviving infants) who did not receive the third dose of diphtheria and tetanus toxoids and pertussis-containing vaccine (DTP3), a key indicator of immunization program performance (4,5), with a focus on the countries with the highest number of children who did not receive DTP3 in 2017. Based on the World Health Organization (WHO) and United Nations Children's Fund (UNICEF) estimates, global DTP3 coverage increased from 79% in 2007 to 84% in 2010, and has remained stable from 2010 to 2017 (84% to 85%). In 2017, among the 19.9 million children who did not receive DTP3 in the first year of life, 62% (12.4 million) lived in 10 countries. From 2007 to 2017, the number of children who had not received DTP3 decreased in five of these 10 countries and remained stable or increased in the other five. Similar to DTP3 coverage, global coverage with the first measles-containing vaccine dose (MCV1) increased from 80% in 2007 to 84% in 2010, and has remained stable from 2010 to 2017 (84% to 85%). Coverage with the third dose of polio vaccine (Pol3) has remained stable at 84%-85% since 2010. From 2007 to 2017, estimated global coverage with the second MCV dose (MCV2) increased from 33% to 67%, as did coverage with the completed series of rotavirus (2% to 28%), pneumococcal conjugate (PCV) (4% to 44%), rubella (26% to 52%), Haemophilus influenzae type b (Hib) (25% to 72%) and hepatitis B (HepB) (birth dose: 24% to 43%; 3-dose series: 63% to 84%) vaccines. Targeted, context-specific strategies are needed to reach and sustain high vaccination coverage, particularly in countries with the highest number of unvaccinated children.
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Mellerson JL, Maxwell CB, Knighton CL, Kriss JL, Seither R, Black CL. Vaccination Coverage for Selected Vaccines and Exemption Rates Among Children in Kindergarten - United States, 2017-18 School Year. MMWR Morb Mortal Wkly Rep 2018; 67:1115-1122. [PMID: 30307904 PMCID: PMC6181259 DOI: 10.15585/mmwr.mm6740a3] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Acharya P, Kismul H, Mapatano MA, Hatløy A. Individual- and community-level determinants of child immunization in the Democratic Republic of Congo: A multilevel analysis. PLoS One 2018; 13:e0202742. [PMID: 30138459 PMCID: PMC6107214 DOI: 10.1371/journal.pone.0202742] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Accepted: 08/08/2018] [Indexed: 11/19/2022] Open
Abstract
Understanding modifiable determinants of full immunization of children provide a valuable contribution to immunization programs and help reduce disease, disability, and death. This study is aimed to assess the individual and community-level determinants of full immunization coverage among children in the Democratic Republic of Congo. This study used data from the Demographic and Health Survey 2013–14 from the Democratic Republic of Congo. Data regarding total 3,366 children between 12 and 23 months of age were used in this study. Children who were immunized with one dose of BCG, three doses of polio, three doses of DPT, and a dose of measles vaccine was considered fully immunized. Descriptive statistics were calculated for the prevalence and distribution of full immunization coverage. Two-level multilevel logistic regression analysis, with individual-level (level 1) characteristics nested within community-level (level 2) characteristics, was used to assess the individual- and community-level determinants of full immunization coverage. This study found that about 45.3% [95%CI: 42.02, 48.52] of children aged 12–23 months were fully immunized in the DRC. The results confirmed immunization coverage varied and ranged between 5.8% in Mongala province to 70.6% in Nord-Kivu province. Results from multilevel analysis revealed that, four Antenatal Care (ANC) visits [AOR: 1.64; 95%CI: 1.23, 2.18], institutional delivery [AOR: 2.37; 95%CI: 1.52, 3.72], and Postnatal Care (PNC) service utilization [AOR: 1.43; 95%CI: 1.04, 1.95] were statistically significantly associated with the full immunization coverage. Similarly, children of mothers with secondary or higher education [AOR: 1.32; 95%CI: 1.00, 1.81] and from the richest wealth quintile [AOR: 1.96; 95%CI: 1.18, 3.27] had significantly higher odds of being fully immunized compared to their counterparts whose mothers were relatively poorer and less educated. Among the community-level characteristics, residents of the community with a higher rate of institutional delivery [AOR: 2.36; 95%CI: 1.59, 3.51] were found to be positively associated with the full immunization coverage. Also, the random effect result found about 35% of the variation in immunization coverage among the communities was attributed to community-level factors.The Democratic Republic of Congo has a noteworthy gap in full immunization coverage. Modifiable factors–particularly health service utilization including four ANC visits, institutional delivery, and postnatal visits–had a strong positive effect on full immunization coverage. The study underlines the importance of promoting immunization programs tailored to the poor and women with little education.
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Affiliation(s)
- Pawan Acharya
- Nepal Development Society, Bharatpur, Chitwan, Nepal
- * E-mail:
| | - Hallgeir Kismul
- Centre for International Health, University of Bergen, Bergen, Norway
| | - Mala Ali Mapatano
- Department of Nutrition, School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Anne Hatløy
- Fafo, Institute for Labour and Social Research, Oslo, Norway
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Özer M, Fidrmuc J, Eryurt MA. Maternal education and childhood immunization in Turkey. Health Economics 2018; 27:1218-1229. [PMID: 29790241 PMCID: PMC6055740 DOI: 10.1002/hec.3770] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 04/03/2018] [Accepted: 04/04/2018] [Indexed: 06/08/2023]
Abstract
We study the causal effect of maternal education on childhood immunization rates. We use the Compulsory Education Law of 1997, and the differentiation in its implementation across regions, as instruments for schooling of young mothers in Turkey. The Compulsory Education Law increased the compulsory years of schooling of those born after 1986 from 5 to 8 years. We find that education of mothers increases the probability of completing the full course of diphtheria, pertussis, and tetanus and Hepatitis B vaccinations for their children. The results are robust to variations in regression specification and including various individual and community variables.
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Affiliation(s)
- Mustafa Özer
- Faculty of Economics and Administrative Science, Kilis Yedi Aralık University, Kilis, Turkey
- Economics and Finance Department, University of Portsmouth, Portsmouth, UK
| | - Jan Fidrmuc
- Department of Economics and Finance and CEDI, Brunel University, Uxbridge, UK
- University of Social and Administrative Affairs, Havířov, Czech Republic
- Institute for Strategy and Analysis (ISA), Government Office of the Slovak Republic
- CESifo Munich, Germany
| | - Mehmet Ali Eryurt
- Institute of Population Studies, Hacettepe University, Ankara, Turkey
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Carmona Martinez A, Prymula R, Miranda Valdivieso M, Otero Reigada MDC, Merino Arribas JM, Brzostek J, Szenborn L, Ruzkova R, Horn MR, Jackowska T, Centeno-Malfaz F, Traskine M, Dobbelaere K, Borys D. Immunogenicity and safety of 11- and 12-valent pneumococcal non-typeable Haemophilus influenzae protein D-conjugate vaccines (11vPHiD-CV, 12vPHiD-CV) in infants: Results from a phase II, randomised, multicentre study. Vaccine 2018; 37:176-186. [PMID: 30054160 DOI: 10.1016/j.vaccine.2018.07.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 03/18/2018] [Revised: 06/24/2018] [Accepted: 07/11/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND We assessed 2 investigational 11- and 12-valent vaccines, containing capsular polysaccharides of 10 serotypes as in the pneumococcal non-typeable Haemophilus influenzae protein D-conjugate vaccine (PHiD-CV) and CRM197-conjugated capsular polysaccharides of serotypes 19A (11-valent) or 19A and 6A (12-valent). METHODS In this phase II, partially-blind, multicentre study (NCT01204658), healthy infants were randomised (1:1:1:1) to receive 11vPHiD-CV, 12vPHiD-CV, PHiD-CV, or 13-valent CRM197-conjugate pneumococcal vaccine (PCV13), at 2, 3, and 4 (primary series), and 12-15 months of age (booster dose), co-administered with DTPa-HBV-IPV/Hib. Confirmatory objectives assessed non-inferiority of investigational vaccines to comparators (PHiD-CV for common serotypes; PCV13 for 19A and 6A), in terms of percentage of infants with pneumococcal antibody concentrations ≥0.2 μg/mL and antibody geometric mean concentrations, post-primary vaccination. Reactogenicity and safety were assessed. RESULTS 951 children received ≥1 primary dose, 919 a booster dose. Pre-defined immunological non-inferiority criteria were met simultaneously for 9/11 11vPHiD-CV serotypes (all except 23F and 19A) and 10/12 12vPHiD-CV serotypes (all except 19A and 6A); thus, non-inferiority objectives were reached. For each PHiD-CV serotype, percentages of children with antibody concentrations ≥0.2 µg/mL were ≥96.7% post-primary (except 6B [≥75.2%] and 23F [≥81.1%]), and ≥98.1% post-booster vaccination. For each PHiD-CV serotype except serotype 1, ≥81.0% and ≥93.9% of children had opsonophagocytic activity titres ≥8, post-primary and booster vaccination. AEs incidence was similar across all groups. SAEs were reported for 117 children (29 in the 11vPHiD-CV group, 26 in the 12vPHiD-CV group, 38 in the PHiD-CV group and 24 in the PCV13 group); 4 SAEs were considered vaccination-related. No fatal events were recorded. CONCLUSION Addition of 19A and 6A CRM197-conjugates did not alter immunogenicity of the PHiD-CV conjugates; for both investigational vaccines post-booster immune responses to 10 common serotypes appeared similar to those elicited by PHiD-CV. Safety and reactogenicity profiles of the investigational vaccines were comparable to PHiD-CV. Clinical trial registry: NCT01204658.
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Affiliation(s)
| | - Roman Prymula
- Department of Social Medicine, Faculty of Medicine in Hradec Králové, Charles University in Prague, Šimkova 870, 500 38 Hradec Králové, Czech Republic.
| | | | | | | | - Jerzy Brzostek
- Health Care Establishment in Debica, Infectious Diseases Outpatient Clinic, ul. Krakowska 91, 39-200 Debica, Poland.
| | - Leszek Szenborn
- Department of Paediatric Infectious Diseases, Wroclaw Medical University, 2-2A, Chalubinskiego, 50-368 Wroclaw, Poland.
| | - Renata Ruzkova
- Pediatric Office Dr. Renata Ruzkova, Kladenska 53, Medicentrum 6, s.r.o., 160 00 Prague, Czech Republic.
| | - Michael R Horn
- Pediatric Office Dr. Med. Michael Horn, Achenweg 1, 83471 Schönau am Königssee, Germany.
| | - Teresa Jackowska
- Department of Pediatrics, Centre of Postgraduate Medical Education, ul. Marymoncka 99/103, 01-813 Warsaw, Poland.
| | - Fernando Centeno-Malfaz
- Department of Pediatrics, Rio Hortega University Hospital, Calle Dulzaina, 2, 47012 Valladolid, Spain.
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Abstract
BACKGROUND Nowadays whooping cough (pertussis) represents one of the most prevalent vaccine-preventable diseases in Western countries; even more, it is currently on rise. In many countries, the use of acellular pertussis adult vaccine in combination with tetanus and diphtheria toxoids (Tdap) is recommended for women during pregnancy to protect newborns in the first months of life, when they are too young to be vaccinated. In Italy, vaccination of women during the third trimester of pregnancy is included in the national immunization programme (PNPV 2017-2019), though up to now, this vaccination strategy has not been efficiently implemented. OBJECTIVE In view of the public health importance of pertussis, particularly in young infants, we undertook this review to summarise the existing evidence on immunogenicity, effectiveness, safety and uptake of pertussis vaccine in expectant mothers to protect newborns from pertussis. CONCLUSION There is an increasing evidence that supports the safety, immunogenicity and effectiveness of Triaxis® e Boostrix® pertussis vaccination during pregnancy to protect infants before they receive their primary immunisations. In particular, both vaccines showed 90% effectiveness in the reduction of pertussis disease and hospitalization in newborns, with 95% effectiveness in the reduction of deaths. In Italy, the implementation of antenatal vaccination against pertussis is needed to narrow the gap between the recommendation of the PNPV and the prevention strategies actually offered by the public health system. To reach a good level of vaccine coverage, providers' recommendations are critical. Hence, extensive education of vaccine givers and all primary and secondary healthcare professionals who have any contact with pregnant women is needed.
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Affiliation(s)
- S Mazzilli
- Department of Transational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy
| | - L Tavoschi
- Department of Transational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy
| | - P L Lopalco
- Department of Transational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy
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Orsi A, Azzari C, Bozzola E, Chiamenti G, Chirico G, Esposito S, Francia F, Lopalco P, Prato R, Russo R, Villani A, Franco E. Hexavalent vaccines: characteristics of available products and practical considerations from a panel of Italian experts. J Prev Med Hyg 2018; 59:E107-E119. [PMID: 30083617 PMCID: PMC6069402] [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] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 05/30/2018] [Indexed: 06/08/2023]
Abstract
Combination vaccines represent a valuable technological innovation in the field of infectious disease prevention and public health, because of their great health and economic value from the individual, societal, and healthcare system perspectives. In order to increase parents' and healthcare professionals' confidence in the vaccination programs and maintain their benefits to society, more information about the benefits of innovative vaccination tools such as combination vaccines is needed. Purpose of this work is an examination of available hexavalent vaccines, that protect against Diphtheria, Tetanus, Pertussis, Poliomyelitis, Hepatitis B and Haemophilus influenzae type b infections. From the epidemiological updates of vaccine preventable diseases to the vaccine development cycle, from the immunogenicity of antigenic components to the safety and co-administration with other vaccines, several aspects of available hexavalent vaccines are discussed and deepened. Also a number of practical considerations on schedules, age of employment, strategies for vaccination recovery, vaccination in at-risk births are issued, based on the recommendations of Italian Ministry of Health, Italian Society of Pharmacology (SIF), Italian Society for Pediatrics (SIP), Italian Federation of Family Paediatricians (FIMP) and Italian Society of Hygiene, Preventive Medicine and Public Health (SItI).
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Affiliation(s)
- A. Orsi
- Department of Health Sciences, University of Genoa, “Ospedale Policlinico San Martino IRCCS” Teaching Hospital, Genoa, Italy
| | - C. Azzari
- Pediatric Immunology Unit “Anna Meyer” Hospital, University of Florence, Italy
| | - E. Bozzola
- Bambino Gesù Children Hospital, Pediatric and Infectious Diseases Unit, Rome, Italy
| | - G. Chiamenti
- Italian Federation of Family Paediatricians (FIMP), Verona, Italy
| | - G. Chirico
- Neonatal Intensive Care Unit, ASST Spedali Civili, Children Hospital of Brescia, Italy
| | - S. Esposito
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, University of Perugia, Italy
| | - F. Francia
- Italian Society of Hygiene, Preventive Medicine and Public Health (SitI) and Department of Public Health, Local Health Authority of Bologna, Italy
| | - P. Lopalco
- Hygiene and Epidemiology section, Department of Translational Research, New Technologies in Medicine and Surgery, University of Pisa, Italy
| | - R. Prato
- Department of Medical and Surgical Sciences, University of Foggia, Italy
| | - R. Russo
- Maternity and Pediatrics Services, Local Health Authority of Benevento, Italy
| | - A. Villani
- Bambino Gesù Children Hospital, Pediatric and Infectious Diseases Unit, Rome, Italy
- Italian Society for Pediatrics (SIP)
| | - E. Franco
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
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Lopes SRC, Perin JLR, Prass TS, Carvalho SMD, Lessa SC, Dórea JG. Adverse Events Following Immunization in Brazil: Age of Child and Vaccine-Associated Risk Analysis Using Logistic Regression. Int J Environ Res Public Health 2018; 15:ijerph15061149. [PMID: 29865181 PMCID: PMC6025605 DOI: 10.3390/ijerph15061149] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 05/25/2018] [Accepted: 05/29/2018] [Indexed: 01/06/2023]
Abstract
Objective: Vaccines are effective in controlling and eradicating infectious diseases. However, adverse events following immunization (AEFI) can occur in susceptible individuals. The objective of this study was to analyze the Brazilian AEFI database and compare eight vaccines in order to profile risks of AEFIs related to the mandated pediatric schedule of immunization, considering the age and sex of the child, type of vaccine, and reported adverse events. Methods: We analyzed the Brazilian AEFI database integrating reports between 2005 and 2010 for children less than 10-years old immunized with eight mandated vaccines: diphtheria, pertussis, tetanus, Haemophilus influenzae type b (TETRA); diphtheria, tetanus, and pertussis (DTP); Bacillus Calmette–Guerin (BCG); oral poliovirus vaccine (OPV); measles, mumps, and rubella (MMR); oral rotavirus vaccine (ORV); hepatitis B (HB); and yellow fever (YF). We compared the children’s age regarding types of AEFI, evaluated AEFI factors associated with the chance of hospitalization of the child, and estimated the chance of notification of an AEFI as a function of the type of vaccine. In total, 47,105 AEFIs were observed for the mandated vaccines. Results: The highest AEFI rate was for the TETRA vaccine and the lowest was for the OPV vaccine, with 60.1 and 2.3 events per 100,000 inoculations, respectively. The TETRA vaccine showed the highest rate of hypotonic hyporesponsive episode, followed by convulsion and fever. The MMR and YF vaccines were associated with generalized rash. BCG was associated with enlarged lymph glands but showed the largest negative (protective) association with hyporesponsive events and seizures. Compared with children aged 5–9-years old, young children (<1 year) showed significantly higher odds of hospitalization. Conclusions: The Brazilian AEFI registry is useful to compare the magnitude and certain characteristics of adverse events associated with mandated pediatric vaccines.
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Affiliation(s)
- Sílvia R C Lopes
- Institute of Mathematics, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre RS 91509-900, Brazil.
| | - João L R Perin
- Management and Technical Support, StatSoft South America, Porto Alegre RS 90040-190 Brazil.
| | - Taiane S Prass
- Statistics Department, Federal University of Santa Maria (UFSM), Santa Maria RS 97105-900, Brazil.
| | | | - Sérgio C Lessa
- National Research Council (CNPq), COAGR/CGAPB, Brasília 71605-001, Brazil.
| | - José G Dórea
- Faculty of Health Sciences, University of Brasília, Brasília 70919-970, Brazil.
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Tippins A, Murthy N, Meghani M, Solsman A, Apaisam C, Basilius M, Eckert M, Judicpa P, Masunu Y, Pistotnik K, Pedro D, Sasamoto J, Underwood JM. Vaccination Coverage Among Children Aged 2 Years — U.S. Affiliated Pacific Islands, April–October, 2016. MMWR Morb Mortal Wkly Rep 2018; 67:579-584. [PMID: 29795077 PMCID: PMC6433335 DOI: 10.15585/mmwr.mm6720a3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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Abstract
OBJECTIVE To compare anti-HBs titers between term low birth weight (1800-2499 g) infants and normal birthweight infants, 6 weeks after last dose of primary immunization with pentavalent vaccine, and to study adverse events following immunization (AEFI) with pentavalent vaccine. DESIGN Cohort study. SETTING Tertiary-care hospital predominantly catering to urban poor population of East Delhi. PARTICIPANTS 265 low birthweight (1800-2499 g) and 265 normal birthweight (2500-4000 g) infants. Monovalent Hepatitis B vaccine was administered within 24 hours of birth followed by three primary doses of pentavalent vaccine at 6, 10 and 14 weeks. Anti-HBs titers were estimated after 6 weeks of third dose of pentavalent vaccine. Adverse events following immunization (AEFI) month were observed for a month after each dose of pentavalent vaccine. MAIN OUTCOME MEASURES Anti HBs antibody titers after 6 weeks of primary immunization, and AEFI. RESULTS 443 (83.5%) infants (225 low birthweight and 218 normal birthweight infants) completed the follow-up. Seroprotection against hepatitis B virus was achieved in both groups after pentavalent vaccine administration. Anti HBs GMTs in low birthweight infants (194.8 mIU/mL) and normal birthweight infants (204.2 mIU/mL) were comparable (P = 0.17). No serious adverse events were observed in either group. CONCLUSIONS Three primary doses of pentavalent vaccine administered along with zero dose of Hepatitis B vaccine at birth provide good seroprotection. The vaccine appears to be safe in both low birth weight and normal birthweight infants born at term.
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Affiliation(s)
- Chandrika Verma
- Department of Pediatrics, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - M M Faridi
- Department of Pediatrics, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India. Correspondence to: Dr MMA Faridi, B-14, G-4, Vivek Vihar Phase-1, Delhi 110 095.
| | - Manish Narang
- Department of Pediatrics, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Iqbal R Kaur
- Department of Microbiology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
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Boef AGC, van der Klis FRM, Berbers GAM, Buisman AM, Sanders EAM, Kemmeren JM, van der Ende A, de Melker HE, Rots NY, Knol MJ. Differences by sex in IgG levels following infant and childhood vaccinations: An individual participant data meta-analysis of vaccination studies. Vaccine 2017; 36:400-407. [PMID: 29223483 DOI: 10.1016/j.vaccine.2017.11.070] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 11/21/2017] [Accepted: 11/23/2017] [Indexed: 01/07/2023]
Abstract
BACKGROUND If immune responses to vaccination differ between males and females, sex-specific vaccination schedules may be indicated. We systematically reanalysed childhood vaccination studies conducted in The Netherlands for sex-differences in IgG-responses. To assess the impact of potential sex-differences in IgG-responses, we explored sex-differences in vaccine failure/effectiveness and reactogenicity. METHODS Six studies with IgG-measurements for 1577 children following infant pneumococcal (PCV7/PCV10/PCV13) and/or DTaP-IPV-Hib(-HepB) vaccinations, or the pre-school DTaP-IPV booster were included. We performed one-stage individual participant data meta-analyses per time-point of the effect of sex on IgG levels against pneumococcal serotypes, diphtheria toxoid, tetanus toxoid, pertussis Ptx/FHA/Prn and Hib-PRP using linear mixed models. Using existing study data, we compared reactogenicity after PCV7/PCV10 and DTaP-IPV-Hib(-HepB) vaccination in girls and boys. Vaccine failure/effectiveness was compared between girls and boys for invasive pneumococcal disease (IPD), invasive Hib disease and pertussis using notification data. RESULTS For pneumococcal vaccination, the geometric mean concentration ratio of IgG levels in girls versus boys pooled across serotypes was 1.15 (95%CI 0.91-1.45) 1 month following the primary series, 1.16 (1.02-1.32) at age 8 months, 1.12 (1.02-1.23) pre-booster (age 11 months) and 0.99 (0.89-1.10) post-booster (age 12 months). Diphtheria toxoid, tetanus toxoid, pertussis Ptx/FHA/Prn and Hib-PRP IgG levels did not differ between girls and boys, except for Hib post-booster (1.24; 95%CI 1.01-1.52) and tetanus before pre-school booster (0.71; 0.53-0.95). We found no difference between boys and girls in reactogenicity at age 4 or 11 months or in vaccine failure/effectiveness for IPD, invasive Hib disease or pertussis. CONCLUSION For most vaccine antigens investigated, there were no consistent differences in vaccine-induced IgG levels. Vaccine-induced pneumococcal IgG levels were slightly higher in girls, but only between the primary series and the 11-month booster. These results, along with similar reactogenicity and vaccine failure/effectiveness, support the uniform infant vaccination schedule in the Dutch national immunisation programme.
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Affiliation(s)
- Anna G C Boef
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Fiona R M van der Klis
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Guy A M Berbers
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Anne-Marie Buisman
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Elisabeth A M Sanders
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands; Department of Pediatric Immunology and Infectious Diseases, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jeanet M Kemmeren
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Arie van der Ende
- Netherlands Reference Laboratory of Bacterial Meningitis, Academic Medical Center, Amsterdam, The Netherlands
| | - Hester E de Melker
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Nynke Y Rots
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Mirjam J Knol
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
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Feldstein LR, Mariat S, Gacic-Dobo M, Diallo MS, Conklin LM, Wallace AS. Global Routine Vaccination Coverage, 2016. MMWR Morb Mortal Wkly Rep 2017; 66:1252-1255. [PMID: 29145357 PMCID: PMC5726243 DOI: 10.15585/mmwr.mm6645a3] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Seither R, Calhoun K, Street EJ, Mellerson J, Knighton CL, Tippins A, Underwood JM. Vaccination Coverage for Selected Vaccines, Exemption Rates, and Provisional Enrollment Among Children in Kindergarten - United States, 2016-17 School Year. MMWR Morb Mortal Wkly Rep 2017; 66:1073-1080. [PMID: 29023430 PMCID: PMC5657930 DOI: 10.15585/mmwr.mm6640a3] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Tielemans SMAJ, de Melker HE, Hahné SJM, Boef AGC, van der Klis FRM, Sanders EAM, van der Sande MAB, Knol MJ. Non-specific effects of measles, mumps, and rubella (MMR) vaccination in high income setting: population based cohort study in the Netherlands. BMJ 2017; 358:j3862. [PMID: 28855159 PMCID: PMC5576097 DOI: 10.1136/bmj.j3862] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Objectives To investigate whether measles, mumps, and rubella (MMR) vaccine has positive non-specific effects in a high income setting and to compare rates of hospital admissions for infections between children aged ≤2 years who received live MMR vaccine and those who received an inactivated vaccine against diphtheria, tetanus, pertussis, polio, and Haemophilus influenzae type b (DTaP-IPV-Hib) as their most recent vaccination.Design Nationwide population based cohort study.Setting In the Netherlands, DTaP-IPV-Hib+pneumococcal vaccination (PCV) is recommended at ages 2, 3, 4, and 11 months and MMR + meningococcal C (MenC) vaccination at age 14 months. Data from the national vaccine register were linked to hospital admission data.Participants 1 096 594 children born in 2005-11 who received the first four DTaP-IPV-Hib+PCV vaccines.Main outcome measures Hazard ratio for admission to hospital for infection in children with MMR+MenC compared with the fourth DTaP-IPV-Hib+PCV as their most recent vaccination. Cox regression was performed with most recent vaccination as time dependent variable, adjusted for potential confounders. Analyses were repeated with admission for injuries or poisoning as a negative control outcome. In addition, rate of admission for infection was compared between the fourth and third DTaP-IPV-Hib+PCVas most recent vaccination.Results Having had MMR+MenC as the most recent vaccination was associated with a hazard ratio of 0.62 (95% confidence interval 0.57 to 0.67) for admission to hospital for infection and 0.84 (0.73 to 0.96) for injuries or poisoning, compared with the fourth DTaP-IPV-Hib+PCV as most recent vaccination. The fourth DTaP-IPV-Hib+PCV as most recent vaccination was associated with a hazard ratio of 0.69 (0.63 to 0.76) for admission to hospital for infection, compared with the third DTaP-IPV-Hib+PCV as most recent vaccination.Conclusions Healthy vaccinee bias could at least partly explain the observed lower rate of admission to hospital with infection after MMR vaccination. The lower rate is associated with receipt of any additional vaccine, not specifically MMR vaccine. This emphasises the caution required in the interpretation of findings from observational studies on non-specific effects of vaccination.
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Affiliation(s)
- Susanne M A J Tielemans
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, 3720 BA Bilthoven, Netherlands
| | - Hester E de Melker
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, 3720 BA Bilthoven, Netherlands
| | - Susan J M Hahné
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, 3720 BA Bilthoven, Netherlands
| | - Anna G C Boef
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, 3720 BA Bilthoven, Netherlands
| | - Fiona R M van der Klis
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, 3720 BA Bilthoven, Netherlands
| | - Elisabeth A M Sanders
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, 3720 BA Bilthoven, Netherlands
- Department of Paediatrics, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Marianne A B van der Sande
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, 3720 BA Bilthoven, Netherlands
- Julius Centre for Health Sciences and Primary Care, University Medical Centre, Utrecht, Netherlands
| | - Mirjam J Knol
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, 3720 BA Bilthoven, Netherlands
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Diana A. [2017 vaccination guidelines update and practical review of vaccination schedule for practitioners]. Rev Med Suisse 2017; 13:1436-1440. [PMID: 28837282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This article presents the 2017 revised immunization schedule published by the Swiss Federal Office of Public Health focusing notably on 1) acellular pertussis vaccinations before each pregnancy, 2) acellular pertussis booster every 10 years for all adults in regular contact with infants under 6 months, 3) DTPa-IPV booster with reduced diphtheria and pertussis antigen content possible from 4 years of age, when the combined DTPa-IPV vaccinations are not available. This paper also includes the main vaccination guideline updates published in recent years, for use by general practitioners, gynecologists, pediatricians and all other healthcare professionals involved in spreading information on vaccination guidelines. We also review the different vaccination information supports available for general practitioners and the public at large.
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Affiliation(s)
- Alessandro Diana
- Centre de pédiatrie - Clinique des Grangettes - 7, chemin des Grangettes, 1224 Chêne-Bougeries
- Médecin associé au Département Enfant et Adolescent, HUG, 1211 Genève 14
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Aaby P, Andersen A, Ravn H, Zaman K. Co-administration of BCG and Diphtheria-tetanus-pertussis (DTP) Vaccinations May Reduce Infant Mortality More Than the WHO-schedule of BCG First and Then DTP. A Re-analysis of Demographic Surveillance Data From Rural Bangladesh. EBioMedicine 2017; 22:173-180. [PMID: 28784413 PMCID: PMC5552225 DOI: 10.1016/j.ebiom.2017.07.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 06/24/2017] [Accepted: 07/13/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND WHO recommends BCG at birth and diphtheria-tetanus-pertussis (DTP)-containing vaccine at 6, 10 and 14weeks of age. However, BCG and DTP are often co-administered in low-income countries. The health implications have not been examined. SETTING We reanalysed data from Matlab, Bangladesh, to examine the influence of co-administration on mortality; 37,894 children born 1986-1999 were followed with registration of vaccinations and survival. METHODS Using Cox models, survival was analysed from 6weeks to 9months of age when measles vaccine is given; 712 children died in this age group. We calculated mortality rate ratios (MRR) for children starting the vaccination schedule with BCG-first, BCG+DTP1-first or DTP1-first. RESULTS Only 17% followed the WHO-schedule with BCG-first. Mortality was 16/1000 person-years for children who initiated the vaccination schedule with BCG+DTP1 but 32/1000 and 20/1000 for children who received BCG-first or DTP-first, respectively. Compared with BCG+DTP1-first and adjusting for background factors, the BCG-first-schedule was associated with 2-fold higher mortality (MRR=1.94 (1.42-2.63)). DTP1 administered after BCG-first was associated with higher mortality than receiving DTP1 with BCG (MRR=1.78 (1.03-3.03)). CONCLUSIONS Co-administration of BCG and DTP may further reduce mortality. Since all observational studies support this trend, co-administration of BCG and DTP should be tested in randomised trials.
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Affiliation(s)
- Peter Aaby
- Research Centre for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen S, Denmark; Bandim Health Project, Indepth Network, Apartado 861, Bissau, Guinea-Bissau.
| | - Andreas Andersen
- Research Centre for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen S, Denmark
| | - Henrik Ravn
- Research Centre for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen S, Denmark
| | - K Zaman
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
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