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Jamison AF, McCormick BJJ, Hussain E, Thomas ED, Azam SI, Hansen CL, Rasmussen ZA. Determinants of vaccine coverage and timeliness in a northern Pakistani village. PLoS One 2022; 17:e0263712. [PMID: 35176050 PMCID: PMC8853560 DOI: 10.1371/journal.pone.0263712] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 01/25/2022] [Indexed: 11/19/2022] Open
Abstract
The incidence of vaccine preventable disease in Pakistan remains high despite a long-standing Expanded Program on Immunization (EPI). We describe vaccine completeness, timeliness and determinants of coverage from a remote rural cohort (2012–2014). Vaccination histories were taken from EPI records. Vaccination was complete if all doses were received according to the EPI schedule and timely if doses were not ≥3 days early or ≥ 28 days late. Three models are presented: a multivariable logistic regression of household demographic and socioeconomic factors associated with complete vaccination, a multivariable mixed effects logistic regression assessing whether or not the vaccine was administered late (versus on-time), and a mixed effects multivariable Poisson regression model analysing the interval (in days) between vaccine doses. Of 959 enrolled children with full vaccination histories, 88.2 and 65.1% were fully vaccinated following either the pentavalent or DPT/HBV schedules if measles was excluded; coverage dropped to 50.0 and 27.1% when both doses of measles were included. Sixty-four (6.7%) were unvaccinated. Coverage and timeliness declined with subsequent doses. Migrating into the village after 1995 (95%CI 1.88 to 5.17) was associated with late vaccination. Being male, having an older father, and having parents with at least some formal education reduced the likelihood of a late dose. The interval between doses was consistent at 5 weeks (compared with the 4 weeks recommended by EPI). None of the socio-demographic variables were related to the likelihood of receiving full coverage. Vaccine coverage in Oshikhandass was higher than national averages. Measles vaccine coverage and timeliness were low; special consideration should be paid to this vaccine. The local vaccination schedule differed from the EPI, but the consistency suggests good local administration.
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Affiliation(s)
- Alexandra F. Jamison
- Division of International Epidemiology and Population Studies, Fogarty International Center, Bethesda, MD, United States of America
| | | | - Ejaz Hussain
- Administration Department, Karakoram International University, Gilgit, Gilgit-Baltistan, Pakistan
| | - Elizabeth D. Thomas
- Division of International Epidemiology and Population Studies, Fogarty International Center, Bethesda, MD, United States of America
| | - Syed Iqbal Azam
- Department of Community Health Sciences, Aga Khan University, Karachi, Sindh, Pakistan
| | - Chelsea L. Hansen
- Division of International Epidemiology and Population Studies, Fogarty International Center, Bethesda, MD, United States of America
| | - Zeba A. Rasmussen
- Division of International Epidemiology and Population Studies, Fogarty International Center, Bethesda, MD, United States of America
- * E-mail:
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Vásquez WF, Trudeau JM. Will Americans Get Vaccinated? Predicting COVID-19 Vaccine Uptake Rates Under Contingent Scenarios. Value Health 2021; 24:1543-1550. [PMID: 34711354 PMCID: PMC8339597 DOI: 10.1016/j.jval.2021.05.007] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 05/10/2021] [Accepted: 05/23/2021] [Indexed: 06/02/2023]
Abstract
OBJECTIVES Amid a pandemic, vaccines represent a promising solution for mitigating public health and economic crises, and an improved understanding of individuals' vaccination intentions is crucial to design optimal immunization campaigns. This study predicts uptake rates for different COVID-19 vaccine specifications and identifies personal characteristics that moderate an individual's responsiveness to vaccine attributes. METHODS We developed an online survey with contingent specifications of a COVID-19 vaccine, varying in effectiveness, risks of side effects, duration of immunity, and out-of-pocket cost. Using population-averaged logit models, we estimated vaccine uptake rates that account for uncertainty, heterogeneity across respondents, and interactions between vaccine and personal characteristics. RESULTS We obtained 3047 completed surveys. The highest uptake rate for an annual vaccine, 62%, is predicted when vaccine effectiveness is 80% to 90%, side effects are minimal, and the vaccine is provided at zero cost, with decreases seen in the uptake rate for less effective vaccines, for example, 50% for 50% to 60% effectiveness. Moreover, we found that Americans' response to vaccine effectiveness depends on their self-reported concern, that is, concerned respondents report a higher willingness to get vaccinated. Our findings also indicate that COVID-19 vaccine uptake rates decrease with vaccine cost and that responsiveness to vaccine cost is moderated by income. CONCLUSIONS Although providing the COVID-19 vaccine at zero cost will motivate many individuals to get vaccinated, a policy focused exclusively on vaccine cost may not be enough to reach herd immunity thresholds. Although those concerned with COVID-19 will participate, further evidence is needed on how to incentivize participation among the unconcerned (43%) to prevent further pandemic spread.
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Affiliation(s)
| | - Jennifer M Trudeau
- Department of Business Economics, Sacred Heart University, Fairfield, CT, USA.
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Sandmann F, Ramsay M, Edmunds WJ, Choi YH, Jit M. How to Prevent Vaccines Falling Victim to Their Own Success: Intertemporal Dependency of Incidence Levels on Indirect Effects in Economic Reevaluations. Value Health 2021; 24:1391-1399. [PMID: 34593161 PMCID: PMC9525135 DOI: 10.1016/j.jval.2021.03.022] [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] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 03/03/2021] [Accepted: 03/17/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Incremental cost-effectiveness analyses may inform the optimal choice of healthcare interventions. Nevertheless, for many vaccines, benefits fluctuate with incidence levels over time. Reevaluating a vaccine after it has successfully decreased incidences may eventually cause a disease resurgence if switching to a vaccine with lower indirect benefits. Decisions may successively alternate between vaccines alongside repeated rises and falls in incidence and when indirect effects from historic use are ignored. Our suggested proposal aims to prevent suboptimal decision making. METHODS We used a conceptual model of demand to illustrate alternating decisions between vaccines because of time-varying levels of indirect effects. Similar to the concept of subsidies, we propose internalizing the indirect effects achievable with vaccines. In a case study over 60 years, we simulated a hypothetical 10-year reevaluation of 2 oncogenic human papillomavirus vaccines, of which only 1 protects additionally against anogenital warts. RESULTS Our case study showed that the vaccine with additional warts protection is initially valued higher than the vaccine without additional warts protection. After 10 years, this differential decreases because of declines in warts incidence, which supports switching to the nonwarts vaccine that causes a warts resurgence eventually. Instead, pricing the indirect effects separately supports continuing with the warts vaccine. CONCLUSIONS Ignoring how the observed incidences depend on the indirect effects achieved with a particular vaccine may lead to repeated changes in vaccines at successive reevaluations, with unintended resurgences, economic inefficiencies, and eroding vaccine confidence. We propose internalizing indirect effects to prevent vaccines falling victim to their own success.
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Affiliation(s)
- Frank Sandmann
- Statistics, Modelling, and Economics Department, National Infection Service, Public Health England, London, UK; Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
| | - Mary Ramsay
- Immunisation and Countermeasures Department, National Infection Service, Public Health England, London, UK
| | - W John Edmunds
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Yoon H Choi
- Statistics, Modelling, and Economics Department, National Infection Service, Public Health England, London, UK
| | - Mark Jit
- Statistics, Modelling, and Economics Department, National Infection Service, Public Health England, London, UK; Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK; School of Public Health, University of Hong Kong, Hong Kong SAR, China
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Glampson B, Brittain J, Kaura A, Mulla A, Mercuri L, Brett SJ, Aylin P, Sandall T, Goodman I, Redhead J, Saravanakumar K, Mayer EK. Assessing COVID-19 Vaccine Uptake and Effectiveness Through the North West London Vaccination Program: Retrospective Cohort Study. JMIR Public Health Surveill 2021; 7:e30010. [PMID: 34265740 PMCID: PMC8451961 DOI: 10.2196/30010] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 07/01/2021] [Accepted: 07/08/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND On March 11, 2020, the World Health Organization declared SARS-CoV-2, causing COVID-19, as a pandemic. The UK mass vaccination program commenced on December 8, 2020, vaccinating groups of the population deemed to be most vulnerable to severe COVID-19 infection. OBJECTIVE This study aims to assess the early vaccine administration coverage and outcome data across an integrated care system in North West London, leveraging a unique population-level care data set. Vaccine effectiveness of a single dose of the Oxford/AstraZeneca and Pfizer/BioNTech vaccines were compared. METHODS A retrospective cohort study identified 2,183,939 individuals eligible for COVID-19 vaccination between December 8, 2020, and February 24, 2021, within a primary, secondary, and community care integrated care data set. These data were used to assess vaccination hesitancy across ethnicity, gender, and socioeconomic deprivation measures (Pearson product-moment correlations); investigate COVID-19 transmission related to vaccination hubs; and assess the early effectiveness of COVID-19 vaccination (after a single dose) using time-to-event analyses with multivariable Cox regression analysis to investigate if vaccination independently predicted positive SARS-CoV-2 in those vaccinated compared to those unvaccinated. RESULTS In this study, 5.88% (24,332/413,919) of individuals declined and did not receive a vaccination. Black or Black British individuals had the highest rate of declining a vaccine at 16.14% (4337/26,870). There was a strong negative association between socioeconomic deprivation and rate of declining vaccination (r=-0.94; P=.002) with 13.5% (1980/14,571) of individuals declining vaccination in the most deprived areas compared to 0.98% (869/9609) in the least. In the first 6 days after vaccination, 344 of 389,587 (0.09%) individuals tested positive for SARS-CoV-2. The rate increased to 0.13% (525/389,243) between days 7 and 13, before then gradually falling week on week. At 28 days post vaccination, there was a 74% (hazard ratio 0.26, 95% CI 0.19-0.35) and 78% (hazard ratio 0.22, 95% CI 0.18-0.27) reduction in risk of testing positive for SARS-CoV-2 for individuals that received the Oxford/AstraZeneca and Pfizer/BioNTech vaccines, respectively, when compared with unvaccinated individuals. A very low proportion of hospital admissions were seen in vaccinated individuals who tested positive for SARS-CoV-2 (288/389,587, 0.07% of all patients vaccinated) providing evidence for vaccination effectiveness after a single dose. CONCLUSIONS There was no definitive evidence to suggest COVID-19 was transmitted as a result of vaccination hubs during the vaccine administration rollout in North West London, and the risk of contracting COVID-19 or becoming hospitalized after vaccination has been demonstrated to be low in the vaccinated population. This study provides further evidence that a single dose of either the Pfizer/BioNTech vaccine or the Oxford/AstraZeneca vaccine is effective at reducing the risk of testing positive for COVID-19 up to 60 days across all age groups, ethnic groups, and risk categories in an urban UK population.
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Affiliation(s)
- Ben Glampson
- National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare National Health Service Trust, London, United Kingdom
| | - James Brittain
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Amit Kaura
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Abdulrahim Mulla
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Luca Mercuri
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Stephen J Brett
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Paul Aylin
- School of Public Health, Imperial College London, London, United Kingdom
| | - Tessa Sandall
- North West London Collaboration of Clinical Commissioning Groups, London, United Kingdom
| | - Ian Goodman
- North West London Collaboration of Clinical Commissioning Groups, London, United Kingdom
| | - Julian Redhead
- National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare National Health Service Trust, London, United Kingdom
| | - Kavitha Saravanakumar
- North West London Collaboration of Clinical Commissioning Groups, London, United Kingdom
| | - Erik K Mayer
- National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare National Health Service Trust, London, United Kingdom
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
- National Institute for Health Research Imperial Patient Safety Translational Research Centre, Imperial College Healthcare National Health Service Trust, London, United Kingdom
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Akerele A, Uba B, Aduloju M, Etamesor S, Umar JA, Adeoye OB, Enyojo A, Josiah F, Ayandipo E, Olaoye I, Adegoke OJ, Sidney S, Bagana M, Bassey O, Ghiselli ME, Ndadilnasiya W, Bolu O, Shuaib F. Improving routine immunization data quality using daily short message system reporting platform: An experience from Nasarawa state, Nigeria. PLoS One 2021; 16:e0255563. [PMID: 34411136 PMCID: PMC8376034 DOI: 10.1371/journal.pone.0255563] [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: 07/29/2020] [Accepted: 07/19/2021] [Indexed: 11/19/2022] Open
Abstract
Routine immunization (RI) delivery was declared a public health concern in Nigeria in 2017 because of persistently low immunization coverage rates reported in independent surveys. However, administrative coverage rates remain high, suggesting serious data quality issues. We posit that a shorter timespan between service provision and data reporting can improve the monitoring of RI data, and developed a short message system (SMS) text reporting strategy to generate daily RI data points from health facilities (HFs). The goal was to assess whether daily data collection produces complete, reliable and internally consistent data points. The SMS reporting platform was piloted between December 2017 and April 2018 in two Local Government Areas (LGAs, equivalent to districts) of Nasarawa state, Nigeria. The 145 healthcare workers from 55 HFs received one mobile phone and pre-configured SIM card, and were trained to send data through predefined codes. Healthcare workers compiled the data after each vaccination session and transmitted them via SMS. We analyzed completeness, number of weekly sessions, and supportive supervision conducted. During the pilot phase, we received data from 85% (n = 47) of the 55 HFs. We expected 66 fixed-post sessions and 30 outreach sessions per week, but received data for 33 fixed-post and 8 outreach weekly session on average. More HFs reported on Tuesdays compared to other days of the week. When assessing internal consistency, we observed that the reported number of children vaccinated was sometimes higher than the number of doses available from opening a given number of vaccine vials. When found, this discrepancy was noted for all antigens during fixed-post and outreach vaccination sessions. Despite these initial discrepancies, transmitting RI data sessions via texting is feasible and can provide real-time updates to the performance of the RI services at the HF level.
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Affiliation(s)
| | - Belinda Uba
- African Field Epidemiology Network, Abuja, Nigeria
| | | | | | - Jamila A. Umar
- National Primary Health Care Development Agency, Abuja, Nigeria
| | | | - Ameh Enyojo
- African Field Epidemiology Network, Abuja, Nigeria
| | | | | | - Itse Olaoye
- African Field Epidemiology Network, Abuja, Nigeria
| | | | - Sampson Sidney
- Sydani Initiative for International Development, Abuja, Nigeria
| | - Murtala Bagana
- National Primary Health Care Development Agency, Abuja, Nigeria
| | - Okposen Bassey
- National Primary Health Care Development Agency, Abuja, Nigeria
| | | | | | - Omotayo Bolu
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Faisal Shuaib
- National Primary Health Care Development Agency, Abuja, Nigeria
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Affiliation(s)
- Chukwudi A Nnaji
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town 7925, South Africa; Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa.
| | - Duduzile Ndwandwe
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Maia Lesosky
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town 7925, South Africa
| | - Hassan Mahomed
- Western Cape Provincial Department of Health, Cape Town, South Africa; Division of Health Systems and Public Health, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Charles S Wiysonge
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town 7925, South Africa; Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa; Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
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Murphy M, Serowoky ML, Grant SM. Nurse-Led Model of Care That Helps a Community Heal: Curbside Immunizations With Assistance in Social Determinants. Nurs Adm Q 2021; 45:219-225. [PMID: 34060505 DOI: 10.1097/naq.0000000000000471] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The COVID-19 pandemic has overwhelmed communities. Physical, emotional, and financial struggles have heightened, especially with our vulnerable populations. People have been afraid to return to their provider's office. For children, there has been an interruption of well-visits and immunizations. As the nation saw a decline in immunization uptake, a pilot nurse-led program was designed to increase vaccinations and address the social determinant needs during a global pandemic. The purpose of this article is to describe the planning and implementation of a curbside immunization event. The Logic model was used as a framework to ensure an efficient and replicable process. Initial observations showed an overall increase in immunization uptake and 97% of participants current with recommended vaccinations. Most parents (93%) would attend again and recommend it to others. They also felt that infection control precautions helped make the care delivered safe and efficient. Social determinants of health were assessed and addressed. This method of vaccine delivery is a viable model going into the future. Others may replicate this model, and it may also serve as a platform regarding flu or COVID-19 vaccine distribution.
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Affiliation(s)
- Maureen Murphy
- Beaumont Health, River Rouge, Michigan (Ms Murphy); University of Detroit Mercy, Detroit, Michigan (Ms Murphy and Dr Serowoky); and Beaumont Health, Southfield, Michigan (Dr Grant)
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Abstract
This qualitative improvement study investigates COVID-19 vaccine approvals at 3 medicine regulatory agencies in the US, EU, and Canada, characterizing and contrasting regulatory review times, and analyzing the clinical evidence supporting authorization.
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Affiliation(s)
- Mark P. Lythgoe
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Paul Middleton
- Department of Metabolism, Digestion and Reproduction, Imperial College London, St Mary’s Hospital, United Kingdom
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Affiliation(s)
- Radhika Gharpure
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Anita Patel
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ruth Link-Gelles
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia
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Bruun T, Salamanca BV, Bekkevold T, Døllner H, Gibory M, Gilje AM, Haarr E, Kran AMB, Leegaard TM, Nakstad B, Nordbø SA, Rojahn A, Størdal K, Flem E. Impact of the Rotavirus Vaccination Program in Norway After Four Years With High Coverage. Pediatr Infect Dis J 2021; 40:368-374. [PMID: 33399430 DOI: 10.1097/inf.0000000000003020] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 01/01/2023]
Abstract
BACKGROUND Use of rotavirus vaccines worldwide since 2006 has led to a significant impact on the burden of rotavirus disease. However, only a third of European countries have introduced rotavirus vaccination in their immunization programs. In October 2014, rotavirus vaccination was introduced for Norwegian infants under strict age restrictions. Exclusive use of the monovalent rotavirus vaccine (RV1) and high vaccination coverage from the beginning enabled evaluation of the impact of this vaccine during the first 4 years after introduction. METHODS Prospective laboratory-based surveillance among children <5 years of age hospitalized for acute gastroenteritis at 5 Norwegian hospitals was used to assess the vaccine effectiveness of 2 vaccine doses against rotavirus hospitalization in a case-control study. We used community controls selected from the national population-based immunization registry, and test-negative controls recruited through hospital surveillance. We also assessed the vaccine impact by using time-series analysis of retrospectively collected registry data on acute gastroenteritis in primary and hospital care during 2009-2018. RESULTS Vaccine effectiveness against rotavirus-confirmed hospitalization was 76% (95% confidence interval [CI]: 34%-91%) using test-negative controls, and 75% (95% CI: 44%-88%) using community controls. In the postvaccine period, acute gastroenteritis hospitalizations in children <5 years were reduced by 45% compared with the prevaccine years (adjusted incidence rate ratios 0.55; 95% CI: 0.49-0.61). Reduction in hospitalizations was also seen in cohorts not eligible for vaccination. Rates in primary care decreased to a lesser degree. CONCLUSIONS Four years after introduction of rotavirus vaccination in the national childhood immunization program, we recorded a substantial reduction in the number of children hospitalized for acute gastroenteritis in Norway, attributable to a high vaccine effectiveness.
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Affiliation(s)
- Tone Bruun
- From the Departments of Infection Control and Vaccines
| | | | - Terese Bekkevold
- Infectious Disease Epidemiology and Modelling, Norwegian Institute of Public Health, Oslo
| | - Henrik Døllner
- Children's Department, St. Olavs University Hospital
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim
| | - Moustafa Gibory
- Department of Virology, Norwegian Institute of Public Health, Oslo; Departments of
| | | | - Elisebet Haarr
- Medical Microbiology, Stavanger University Hospital, Stavanger
| | | | - Truls M Leegaard
- Department of Microbiology and Infection Control, Akershus University Hospital, Lørenskog
- Institute of Clinical Medicine-Campus Ahus, Division of Medicine and Laboratory Sciences, University of Oslo, Oslo
| | - Britt Nakstad
- Institute of Clinical Medicine-Campus Ahus, Division of Medicine and Laboratory Sciences, University of Oslo, Oslo
| | - Svein Arne Nordbø
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim
- Department of Medical Microbiology, St. Olavs University Hospital, Trondheim
| | - Astrid Rojahn
- Department of Pediatrics, Oslo University Hospital, Oslo
| | - Ketil Størdal
- Department of Pediatrics, Østfold Hospital Trust, Fredrikstad, Norway. Anne-Marte Bakken Kran, MD, PhD, is currently at the Department of Infectious Disease Registries, Norwegian Institute of Public Health, Oslo, Norway. Elmira Flem, MD, PhD, is currently at MSD Norway, Drammen, Norway
| | - Elmira Flem
- Infectious Disease Epidemiology and Modelling, Norwegian Institute of Public Health, Oslo
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Wagai JN, Rhoda D, Prier M, Trimmer MK, Clary CB, Oteri J, Okposen B, Adeniran A, Danovaro-Holliday C, Cutts F. Implementing WHO guidance on conducting and analysing vaccination coverage cluster surveys: Two examples from Nigeria. PLoS One 2021; 16:e0247415. [PMID: 33635913 PMCID: PMC7909665 DOI: 10.1371/journal.pone.0247415] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 02/08/2021] [Indexed: 11/18/2022] Open
Abstract
In 2015, the World Health Organization substantially revised its guidance for vaccination coverage cluster surveys (revisions were finalized in 2018) and has since developed a set of accompanying resources, including definitions for standardized coverage indicators and software (named the Vaccination Coverage Quality Indicators—VCQI) to calculate them.–The current WHO vaccination coverage survey manual was used to design and conduct two nationally representative vaccination coverage surveys in Nigeria–one to assess routine immunization and one to measure post-measles campaign coverage. The primary analysis for both surveys was conducted using VCQI. In this paper, we describe those surveys and highlight some of the analyses that are facilitated by the new resources. In addition to calculating coverage of each vaccine-dose by age group, VCQI analyses provide insight into several indicators of program quality such as crude coverage versus valid doses, vaccination timeliness, missed opportunities for simultaneous vaccination, and, where relevant, vaccination campaign coverage stratified by several parameters, including the number of previous doses received. The VCQI software furnishes several helpful ways to visualize survey results. We show that routine coverage of all vaccines is far below targets in Nigeria and especially low in northeast and northwest zones, which also have highest rates of dropout and missed opportunities for vaccination. Coverage in the 2017 measles campaign was higher and showed less geospatial variation than routine coverage. Nonetheless, substantial improvement in both routine program performance and campaign implementation will be needed to achieve disease control goals.
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Affiliation(s)
| | - Dale Rhoda
- Biostat Global Consulting, Worthington, OH, United States of America
| | - Mary Prier
- Biostat Global Consulting, Worthington, OH, United States of America
| | - Mary Kay Trimmer
- Biostat Global Consulting, Worthington, OH, United States of America
| | - Caitlin B. Clary
- Biostat Global Consulting, Worthington, OH, United States of America
| | - Joseph Oteri
- National Primary Health Care Development Agency, Abuja, Nigeria
| | - Bassey Okposen
- National Primary Health Care Development Agency, Abuja, Nigeria
| | | | | | - Felicity Cutts
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Cantu C, Koch K, Cancino RS. Longitudinal, multidisciplinary, resident-driven intervention to increase immunisation rates for Medicaid, low-income and uninsured patients. BMJ Open Qual 2020; 9:bmjoq-2020-000986. [PMID: 33028656 PMCID: PMC7542614 DOI: 10.1136/bmjoq-2020-000986] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 08/22/2020] [Accepted: 09/13/2020] [Indexed: 11/04/2022] Open
Abstract
Introduction More payers are closely linking reimbursement to high-value care outcomes such as immunisation rates. Despite this, there remain high rates of pneumonia and influenza-related hospitalisations generating hospital expenditures as high as $11 000 per hospitalisation. Vaccinating the public is an integral part of preventing poor health and utilisation outcomes and is particularly relevant to high-risk patients. As part of a multidisciplinary effort between family and internal medicine residency programmes, our goal was to improve vaccination rates to an average of 76% of eligible Medicaid, low-income and uninsured (MLIU) patients at an academic primary care practice. Methods The quality improvement project was completed over 3 months by three primary care resident groups. The setting was a suburban academic primary care practice and eligible patients were 18 years of age or older. Our aim was to increase immunisation rates of pneumococcal, influenza, varicella, herpes zoster virus and tetanus and diphtheria vaccination. There were 1690 patients eligible for the vaccination composite metric. Data were derived from the electronic health record and administrative data. Interventions Cohort 1 developed an initial intervention that consisted of a vaccine questionnaire for patients to complete while in the waiting room. Cohort 2 modified questionnaire after reviewing results from initial intervention. Cohort 3 recommended elimination of questionnaire and implementation of a bundled intervention approach. Results There were minimal improvements in patient immunisation rates after using a patient-directed paper questionnaire. After implementation of multiple interventions via an improvement bundle, there were improvements in immunisation rates which were sustained and the result of special cause variation. Conclusion A key to improving immunisation rates for MLIU patients in this clinic was developing relationships with faculty and staff stakeholders. We received feedback from all the medical staff and then applied it to the interventions and made an impact in the average of vaccinations.
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Affiliation(s)
- Cynthia Cantu
- Department of Medicine, University of Texas Health San Antonio, San Antonio, Texas, United States
| | - Kristopher Koch
- Department of Medicine, University of Texas Health San Antonio, San Antonio, Texas, United States
| | - Ramon S Cancino
- Department of Family and Community Medicine, University of Texas Health San Antonio, San Antonio, Texas, United States
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Li AJ, Tabu C, Shendale S, Sergon K, Okoth PO, Mugoya IK, Machekanyanga Z, Onuekwusi IU, Sanderson C, Ogbuanu IU. Assessment of missed opportunities for vaccination in Kenyan health facilities, 2016. PLoS One 2020; 15:e0237913. [PMID: 32817630 PMCID: PMC7440639 DOI: 10.1371/journal.pone.0237913] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 01/17/2020] [Accepted: 08/05/2020] [Indexed: 11/20/2022] Open
Abstract
Background In November 2016, the Kenya National Vaccines and Immunization Programme conducted an assessment of missed opportunities for vaccination (MOV) using the World Health Organization (WHO) MOV methodology. A MOV includes any contact with health services during which an eligible individual does not receive all the vaccine doses for which he or she is eligible. Methods The MOV assessment in Kenya was conducted in 10 geographically diverse counties, comprising exit interviews with caregivers and knowledge, attitudes, and practices (KAP) surveys with health workers. On the survey dates, which covered a 4-day period in November 2016, all health workers and caregivers visiting the selected health facilities with children <24 months of age were eligible to participate. Health facilities (n = 4 per county) were purposively selected by size, location, ownership, and performance. We calculated the proportion of MOV among children eligible for vaccination and with documented vaccination histories (i.e., from a home-based record or health facility register), and stratified MOV by age and reason for visit. Timeliness of vaccine doses was also calculated. Results We conducted 677 age-eligible children exit interviews and 376 health worker KAP surveys. Of the 558 children with documented vaccination histories, 33% were visiting the health facility for a vaccination visit and 67% were for other reasons. A MOV was seen in 75% (244/324) of children eligible for vaccination with documented vaccination histories, with 57% (186/324) receiving no vaccinations. This included 55% of children visiting for a vaccination visit and 93% visiting for non-vaccination visits. Timeliness for multi-dose vaccine series doses decreased with subsequent doses. Among health workers, 25% (74/291) were unable to correctly identify the national vaccination schedule for vaccines administered during the first year of life. Among health workers who reported administering vaccines as part of their daily work, 39% (55/142) reported that they did not always have the materials they needed for patients seeking immunization services, such as vaccines, syringes, and vaccination recording documents. Conclusions The MOV assessment in Kenya highlighted areas of improvement that could reduce MOV. The results suggest several interventions including standardizing health worker practices, implementing an orientation package for all health workers, and developing a stock management module to reduce stock-outs of vaccines and vaccination-related supplies. To improve vaccination coverage and equity in all counties in Kenya, interventions to reduce MOV should be considered as part of an overall immunization service improvement plan.
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Affiliation(s)
- Anyie J. Li
- ASPPH/CDC Allan Rosenfield Global Health Fellowship and PHI/CDC Global Health Fellowship, Atlanta, GA, United States of America
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
- * E-mail:
| | - Collins Tabu
- National Vaccines and Immunization Program, Ministry of Health Kenya, Nairobi, Kenya
| | - Stephanie Shendale
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Headquarters, Geneva, Switzerland
| | - Kibet Sergon
- World Health Organization Kenya, Country Office, Nairobi, Kenya
| | | | | | - Zorodzai Machekanyanga
- Inter-Country Support Team (IST)–East and Southern Africa, World Health Organization, Harare, Zimbabwe
| | | | - Colin Sanderson
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Ikechukwu Udo Ogbuanu
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Headquarters, Geneva, Switzerland
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Abstract
Background. We suggest and examine a behavioral approach to increasing seasonal influenza vaccine uptake. Our idea combines behavioral effects generated by a dominated option, together with more traditional tools, such as providing information and recommendations. Methods. Making use of the seasonal nature of the flu, our treatments present participants with 2 options to receive the shot: early in the season, which is recommended and hence "attractive," or later. Three additional layers are examined: 1) mentioning that the vaccine is more likely to run out of stock late in the season, 2) the early shot is free while the late one costs a fee, and 3) the early shot carries a monetary benefit. We compare vaccination intentions in these treatments to those of a control group who were invited to receive the shot regardless of timing. Results. Using a sample of the Israeli adult population (n = 3271), we found positive effects of all treatments on vaccination intentions, and these effects were significant for 3 of the 4 treatments. In addition, the vast majority of those who are willing to vaccinate intend to get the early shot. Conclusions. Introducing 2 options to get vaccinated against influenza (early or late) positively affects intentions to receive the flu shot. In addition, this approach nudges participants to take the shot in early winter, a timing that has been shown to be more cost-effective.
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Affiliation(s)
| | - Adi Sarid
- Tel Aviv University and Sarid Research Services, Tel Aviv, IL, Israel
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Rill V, Steffen B, Wicker S. Evaluation of a vaccination seminar in regard to medical students' attitudes and their theoretical and practical vaccination-specific competencies. GMS J Med Educ 2020; 37:Doc38. [PMID: 32685666 PMCID: PMC7346291 DOI: 10.3205/zma001331] [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] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 02/17/2020] [Accepted: 04/15/2020] [Indexed: 06/11/2023]
Abstract
Aim: Despite having a generally positive attitude toward vaccinations, medical students show gaps in their own immunization histories and knowledge about vaccinations. Future practicing physicians will be confronted with the need to evaluate protective immunity and make vaccination recommendations. This study aims to investigate the extent to which a seminar on the topic of vaccination can improve students' attitudes, knowledge and practical skills in interpreting vaccination certificates. Project description: Two different one-hour seminars were developed and integrated into the required clinical curriculum. A third of the students attended a theory-based seminar; the other two-thirds completed a predominantly practice-based seminar. The theoretical seminar consisted of a lecture on the principles and theoretical aspects of immunization. In the practical seminar, the curricular content was case-based and taught using fictive examples of vaccination certificates. Before the seminar was held, a voluntary and anonymous survey of the students was conducted regarding their attitudes toward and knowledge of immunization. At the conclusion of the seminar, the students' ability to understand vaccination certificates was tested. After completing the seminar, all of the participants received a link to participate in a voluntary online survey to evaluate the seminar. Results: Of the 149 seminar attendees in the 2017/18 winter semester, 148 participated in the study. Attitude: Students have a positive attitude toward vaccinations. Regardless of the type of seminar attended, the agreement with statements on vaccination could be significantly increased primarily among students who already at the start of the seminar expressed a high degree of agreement. Students vaccinated against influenza showed significantly stronger agreement than unvaccinated students. Knowledge: Regardless of teaching format, students' knowledge about vaccination topics could be increased. For those vaccinated against influenza, the mean value for agreement with the statement, "The vaccination of healthcare workers prevents nosocomial transmission of diseases," saw an increase on a five-point Likert scale from 3.97 to 4.4 (p<0.001; R=0.67). For the unvaccinated students, the mean value rose from 4.04 to 4.19 (p=0.06; R=0.29). Practical skills: The students who attended the theory-based seminar tended to score higher on interpreting vaccination certificates than those who attended the practical seminar; however, this difference was not statistically significant. Seminar evaluation: The online evaluation was completed by 18% of the participants. The theoretical seminar received the grade of 2.9 based on the conventional German academic grading scale; the practical seminar received 1.9. This difference is statistically significant (p=0.02). Conclusion: Precisely for skeptical students it was only possible to minimally change existing views with a seminar that offers very brief instruction. Attendees of the theoretical seminar tended to score somewhat higher on interpreting vaccination certificates than those who took the practical seminar. The practical seminar was rated significantly better on the course evaluation than the theoretical one. The advantage that the students attending the theoretical seminar had can be explained best by the structured review of the current vaccination recommendations as part of the seminar, which should, as a consequence, be integrated into the practical seminar.
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Affiliation(s)
- Vera Rill
- Universitätsklinikum Frankfurt, Betriebsärztlicher Dienst, Frankfurt a. M., Germany
| | - Björn Steffen
- Universitätsklinikum Frankfurt, Zentrum der Inneren Medizin, Hämatologie und Onkologie, Frankfurt a. M., Germany
| | - Sabine Wicker
- Universitätsklinikum Frankfurt, Betriebsärztlicher Dienst, Frankfurt a. M., Germany
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Varghese L, Ezat Wan Puteh S, Schecroun N, Jahis R, Van Vlaenderen I, Standaert BA. Applying a Constrained Optimization Portfolio Model to Aid Prioritization of Public Health Interventions in Malaysia. Value Health Reg Issues 2020; 21:172-180. [PMID: 32044690 DOI: 10.1016/j.vhri.2019.11.001] [Citation(s) in RCA: 5] [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: 06/28/2019] [Accepted: 11/17/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Countries have constrained healthcare budgets and must prioritize new interventions depending on health goals and time frame. This situation is relevant in the sphere of national immunization programs, for which many different vaccines are proposed, budgets are limited, and efficient choices must be made in the order of vaccine introduction. METHODS A constrained optimization (CO) model for infectious diseases was developed in which different intervention types (prophylaxis and treatment) were combined for consideration in Malaysia. Local experts defined their priority public health issues: pneumococcal disease, dengue, hepatitis B and C, rotavirus, neonatal pertussis, and cholera. Epidemiological, cost, and effectiveness data were informed from local or regionally published literature. The model aimed to maximize quality-adjusted life-year (QALY) gain through the reduction of events in each of the different diseases, under budget and intervention coverage constraints. The QALY impact of the interventions was assessed over 2 periods: lifetime and 20 years. The period of investment was limited to 15 years. RESULTS The assessment time horizon influenced the prioritization of interventions maximizing QALY gain. The incremental health gains compared with a uninformed prioritization were large for the first 8 years and declined thereafter. Rotaviral and pneumococcal vaccines were identified as key priorities irrespective of time horizon, hepatitis B immune prophylaxis and hepatitis C treatment were priorities with the lifetime horizon, and dengue vaccination replaced these with the 20-year horizon. CONCLUSIONS CO modeling is a useful tool for making economically efficient decisions within public health programs for the control of infectious diseases by helping prioritize the selection of interventions to maximize health gain under annual budget constraints.
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Affiliation(s)
| | | | - Nadia Schecroun
- Keyrus Biopharma c/o GSK, Health Economics Department, Wavre, Belgium
| | - Rohani Jahis
- Ministry of Health, Disease Control Division, Putrajaya, Malaysia
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18
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Masresha BG, Luce R, Weldegebriel G, Katsande R, Gasasira A, Mihigo R. The impact of a prolonged ebola outbreak on measles elimination activities in Guinea, Liberia and Sierra Leone, 2014-2015. Pan Afr Med J 2020; 35:8. [PMID: 32373259 PMCID: PMC7196330 DOI: 10.11604/pamj.supp.2020.35.1.19059] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [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: 05/07/2019] [Accepted: 01/05/2020] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Guinea, Sierra Leone and Liberia have attained significant reduction in measles incidence between 2004 and 2013. The Ebola outbreak in 2014-2015 in West Africa caused significant disruption of the health service delivery in the three worst affected countries. The magnitude of the impact on the immunization program has not been well documented. METHODS We reviewed national routine immunization administrative coverage data as well as measles surveillance performance and measles epidemiology in the years before, during and after the EVD outbreak in Guinea, Liberia, Sierra Leone. RESULTS Both Liberia and Guinea experienced a sharp decline of more than 25% in the monthly number of children vaccinated against measles in 2014 and 2015 as compared to the previous years, while there was no reported decline in Sierra Leone. Guinea and Liberia experienced a decline in measles surveillance activity and performance indicators in 2014 and 2015. During this period, there was an increase in measles incidence and a decline in the mean age of measles cases reported in Liberia and Sierra Leone. Guinea started reporting high measles incidence in 2016. All three countries organized measles supplemental immunization activities by June 2015. Liberia achieved 99% administrative coverage, while Guinea and Sierra Leone attained 90.6% and 97.2% coverage respectively. There were no severe adverse events reported during these mass vaccination activities. The disruptive effect of the Ebola outbreak on immunization services was especially evident in Guinea and Liberia. Our review of the reported administrative vaccination coverage at national level does not show significant decline in measles first dose vaccination coverage in Sierra Leone as compared to other reports. This may be due to inaccuracies in coverage monitoring and data quality problems. The increases in measles transmission and incidence in these three countries can be explained by the rapid accumulation of susceptible children. Despite the organization of mass vaccination activities, measles incidence through 2017 has remained higher than the pre-Ebola period in all three countries. CONCLUSION The Ebola outbreak in West Africa significantly affected measles vaccination coverage rates in two of the three worst affected countries, and led to persistent gaps in coverage, along with high measles incidence that was documented until two years after the end of the Ebola outbreak. Liberia and Sierra Leone have demonstrated coverage improvements after the end of the Ebola outbreak.
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Affiliation(s)
| | - Richard Luce
- WHO, Inter-country team for Western Africa, Ouagadougou, Burkina Faso
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19
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Masresha BG, Weldegebriel G, Lebo E, Chakauya J, Fussum D. The distribution and use of feedback bulletins among national immunization program management teams in East and Southern Africa. Pan Afr Med J 2020; 35:4. [PMID: 32373255 PMCID: PMC7195914 DOI: 10.11604/pamj.supp.2020.35.1.19062] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 09/20/2019] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Immunization program monitoring includes numerous activities, some of which include monitoring of vaccination coverage, surveillance performance and epidemiological patterns. The provision of timely, high quality and actionable feedback is an essential component of strengthening health systems. Within the African region of the WHO, various bulletins are produced and disseminated regularly to provide feedback on the performance of immunization programs and vaccine preventable disease control initiatives. METHODS The 2019 annual national immunization program managers' meeting for countries in the eastern and southern African subregion was held in Asmara from 18 - 20 March 2019. A survey questionnaire was administered to the participants representing the national programs and in-country partners across the 20 countries. RESULTS On average, the 75 respondents receive 1.8 e-mailed feedback bulletins monthly. Twenty-three (31%) respondents receive 3 or more written feedback bulletins per month, and 72% receive the bulletins regularly. On a scale of 1 - 5 (from lowest to highest), 87% participants rated the relevance of the bulletins they receive at 4 - 5. Only 19% of the respondents responded that the results are discussed within the national immunization program, and 14% stated that action points are generated based on the feedback received. Fifty-nine (79%) respondents want to receive more frequent feedback on routine immunization performance. Among the EPI program managers and the EPI program data managers, the access to these feedback bulletins was quite limited. Even though the primary objective of the bulletins is to initiate discussions and action based on the provided feedback, such discussions do not happen regularly at country level. The programmatic use and advocacy value of the bulletins is not optimal. CONCLUSION We recommend integrating program feedback, regularly updating the distribution lists, the additional use of instant messaging platforms for distribution, as well as online posting of the bulletins for wider availability.
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Affiliation(s)
| | | | - Emmaculate Lebo
- WHO Inter-country Team for Eastern and Southern Africa, Harare, Zimbabwe
| | - Jethro Chakauya
- WHO Inter-country Team for Eastern and Southern Africa, Harare, Zimbabwe
| | - Daniel Fussum
- WHO Inter-country Team for Eastern and Southern Africa, Harare, Zimbabwe
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20
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Masresha B, Luce R, Tanifum P, Lebo E, Dosseh A, Mihigo R. The African Region early experience with structures for the verification of measles elimination – a review. Pan Afr Med J 2020; 35:1. [PMID: 32373252 PMCID: PMC7195911 DOI: 10.11604/pamj.supp.2020.35.1.19061] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 08/15/2019] [Indexed: 11/23/2022] Open
Abstract
Substantial progress has been achieved in the last two decades with the implementation of measles control strategies in the African Region. Elimination of measles is defined as the absence of endemic transmission in a defined geographical region or country for at least 12 months, as documented by a well-performing surveillance system. The framework for documenting elimination outlines five lines of evidence that should be utilized in documenting and assessing progress towards measles elimination. In March 2017, the WHO regional office for Africa developed and disseminated regional guidelines for the verification of measles elimination. As of May 2019, fourteen countries in the African Region have established national verification committees and 8 of these have begun to document progress toward measles elimination. Inadequate awareness, concerns about multiple technical committees for immunization work, inadequate funding and human resources, as well as gaps in data quality and in the implementation of measles elimination strategies have been challenges that hindered the establishment and documentation of progress by national verification committees. We recommend continuous capacity building and advocacy, technical assistance and networking to improve the work around the documentation of country progress towards measles elimination in the African Region.
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Affiliation(s)
- Balcha Masresha
- WHO Regional Office for Africa, Brazzaville, Congo
- Corresponding author: Balcha Masresha, WHO Regional Office for Africa, Brazzaville, Congo ()
| | - Richard Luce
- WHO, Inter-country team for Western Africa, Ouagadougou, Burkina Faso
| | | | - Emmaculate Lebo
- WHO, Inter-country team for Eastern and Southern Africa, Harare, Zimbabwe
| | - Annick Dosseh
- WHO, Inter-country team for Western Africa, Ouagadougou, Burkina Faso
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21
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Abstract
The Advisory Committee on Immunization Practices (ACIP), a group of medical and public health experts, meets 3 times per year to develop recommendations for vaccine use in the United States. There usually are 15 voting members, but at the June 2019 meeting, only 14 were present; each member's term is 4 years. ACIP members and Centers for Disease Control and Prevention (CDC) staff discuss the epidemiology of vaccine-preventable diseases and vaccine research, effectiveness, safety data, and clinical trial results. Representatives from the American Academy of Pediatrics (AAP) (Y. A. M. and D. W. K.) and the Pediatric Infectious Diseases Society (S. T. O.) are present as liaisons to the ACIP. The ACIP met on June 26 to 27, 2019, to discuss the use of human papillomavirus (HPV) vaccine in adults, pneumococcal vaccines in adults, measles updates, zoster vaccine, influenza vaccines, hepatitis A virus (HAV) vaccines, meningococcal vaccines, and dengue vaccine.
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Affiliation(s)
- Sean T O'leary
- Department of Pediatrics, University of Colorado Anschutz Medical Campus
| | - Yvonne A Maldonado
- Department of Pediatrics, Stanford University School of Medicine, California
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22
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Navin MC, Attwell K. Vaccine mandates, value pluralism, and policy diversity. Bioethics 2019; 33:1042-1049. [PMID: 31389050 DOI: 10.1111/bioe.12645] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 05/01/2019] [Accepted: 05/15/2019] [Indexed: 06/10/2023]
Abstract
Political communities across the world have recently sought to tackle rising rates of vaccine hesitancy and refusal, by implementing coercive immunization programs, or by making existing immunization programs more coercive. Many academics and advocates of public health have applauded these policy developments, and they have invoked ethical reasons for implementing or strengthening vaccine mandates. Others have criticized these policies on ethical grounds, for undermining liberty, and as symptoms of broader government overreach. But such arguments often obscure or abstract away from the diverse values that are relevant to the ethical justifications of particular political communities' vaccine-mandate policies. We argue for an expansive conception of the normative issues relevant to deciding whether and how to establish or reform vaccine mandates, and we propose a schema by which to organize our thoughts about the ways in which different kinds of vaccine-mandate policies implicate various values.
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Affiliation(s)
- Mark C Navin
- Department of Philosophy, Oakland University, Michigan
| | - Katie Attwell
- Political Science and International Relations, University of Western Australia, Crawley, Australia
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23
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Printz C. Cancer centers issue call to action regarding the human papillomavirus vaccine. Cancer 2019; 124:4117. [PMID: 30475399 DOI: 10.1002/cncr.31805] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Rusnak JM, Glass PJ, Weaver SC, Sabourin CL, Glenn AM, Klimstra W, Badorrek CS, Nasar F, Ward LA. Approach to Strain Selection and the Propagation of Viral Stocks for Venezuelan Equine Encephalitis Virus Vaccine Efficacy Testing under the Animal Rule. Viruses 2019; 11:v11090807. [PMID: 31480472 PMCID: PMC6784384 DOI: 10.3390/v11090807] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 08/23/2019] [Accepted: 08/30/2019] [Indexed: 12/21/2022] Open
Abstract
Licensure of a vaccine to protect against aerosolized Venezuelan equine encephalitis virus (VEEV) requires use of the U.S. Food and Drug Administration (FDA) Animal Rule to assess vaccine efficacy as human studies are not feasible or ethical. An approach to selecting VEEV challenge strains for use under the Animal Rule was developed, taking into account Department of Defense (DOD) vaccine requirements, FDA Animal Rule guidelines, strain availability, and lessons learned from the generation of filovirus challenge agents within the Filovirus Animal Nonclinical Group (FANG). Initial down-selection to VEEV IAB and IC epizootic varieties was based on the DOD objective for vaccine protection in a bioterrorism event. The subsequent down-selection of VEEV IAB and IC isolates was based on isolate availability, origin, virulence, culture and animal passage history, known disease progression in animal models, relevancy to human disease, and ability to generate sufficient challenge material. Methods for the propagation of viral stocks (use of uncloned (wild-type), plaque-cloned, versus cDNA-cloned virus) to minimize variability in the potency of the resulting challenge materials were also reviewed. The presented processes for VEEV strain selection and the propagation of viral stocks may serve as a template for animal model development product testing under the Animal Rule to other viral vaccine programs. This manuscript is based on the culmination of work presented at the “Alphavirus Workshop” organized and hosted by the Joint Vaccine Acquisition Program (JVAP) on 15 December 2014 at Fort Detrick, Maryland, USA.
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Affiliation(s)
- Janice M Rusnak
- Joint Program Executive Office for Chemical, Biological, Radiological and Nuclear Defense (JPEO-CBRND), Joint Project Manager-Medical Countermeasure Systems (JMP-MCS), Joint Vaccine Acquisition Program (JVAP), 1564 Freedman Drive, Fort Detrick, MD 21702, USA.
| | - Pamela J Glass
- Department of Virology, United States Army Medical Research Institute of Infectious Diseases (USAMRIID), 1425 Porter Street, Fort Detrick, MD 21702, USA
| | - Scott C Weaver
- Institute for Human Infections and Immunity, World Reference Center for Emerging Viruses and Arboviruses and Department of Microbiology and Immunology, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555, USA
| | - Carol L Sabourin
- Battelle Biomedical Research Center, 1425 Plain City-Georgesville Road, West Jefferson, OH 43162, USA
| | - Andrew M Glenn
- Joint Program Executive Office for Chemical, Biological, Radiological and Nuclear Defense (JPEO-CBRND), Joint Project Manager-Medical Countermeasure Systems (JMP-MCS), Joint Vaccine Acquisition Program (JVAP), 1564 Freedman Drive, Fort Detrick, MD 21702, USA
| | - William Klimstra
- Center for Vaccine Research, University of Pittsburgh, 3501 Fifth Avenue, Pittsburgh, PA 15261, USA
| | - Christopher S Badorrek
- Joint Program Executive Office for Chemical, Biological, Radiological and Nuclear Defense (JPEO-CBRND), Joint Project Manager-Medical Countermeasure Systems (JMP-MCS), Joint Vaccine Acquisition Program (JVAP), 1564 Freedman Drive, Fort Detrick, MD 21702, USA
| | - Farooq Nasar
- Department of Virology, United States Army Medical Research Institute of Infectious Diseases (USAMRIID), 1425 Porter Street, Fort Detrick, MD 21702, USA
| | - Lucy A Ward
- Joint Program Executive Office for Chemical, Biological, Radiological and Nuclear Defense (JPEO-CBRND), Joint Project Manager-Medical Countermeasure Systems (JMP-MCS), Joint Vaccine Acquisition Program (JVAP), 1564 Freedman Drive, Fort Detrick, MD 21702, USA
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25
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Aziz S. Is there a reduction in morbidity of paediatric pneumonia with zinc as anintervention? J PAK MED ASSOC 2019; 69:764-766. [PMID: 31189278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Siddiqi R, Memon RS, Ahmed H. Introduction of rotavirus vaccine in Pakistan - the need to be vigilant for intestinal intussusception in children - letter to the editor. J PAK MED ASSOC 2019; 69:925-926. [PMID: 31201412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Rabbia Siddiqi
- 4th Year Student, Dow Medical College, Dow University of Health Sciences, Pakistan
| | - Roha Saeed Memon
- 3rd Year Student, Dow Medical College, Dow University of Health Sciences, Pakistan
| | - Hassan Ahmed
- Dow Medical College, Dow University of Health Sciences, Pakistan
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Kesten JM, Flannagan C, Ruane-McAteer E, Merriel SWD, Nadarzynski T, Shapiro G, Rosberger Z, Prue G. Mixed-methods study in England and Northern Ireland to understand young men who have sex with men's knowledge and attitudes towards human papillomavirus vaccination. BMJ Open 2019; 9:e025070. [PMID: 31092645 PMCID: PMC6530382 DOI: 10.1136/bmjopen-2018-025070] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Men who have sex with men (MSM) are at greater risk for human papillomavirus (HPV)-associated cancers. Since 2016, MSM have been offered the HPV vaccination, which is most effective when received prior to sexual debut, at genitourinary medicine clinics in the UK. In September 2019, the national HPV vaccination programme will be extended to boys. This study aimed to understand young MSM's (YMSM) knowledge and attitudes towards HPV vaccination. DESIGN Questionnaires assessed YMSM demographics, sexual behaviour, culture, knowledge and attitudes towards HPV vaccination and stage of vaccine decision-making using the precaution adoption process model. Focus groups explored sexual health information sources, attitudes, barriers and facilitators to vaccination and strategies to support vaccination uptake. Questionnaire data were analysed using descriptive statistics and focus group data were analysed thematically. SETTING Questionnaires were completed online or on paper. Focus groups were conducted within Lesbian Gay Bisexual Transgender Queer organisational settings and a university student's union in England and Northern Ireland. PARTICIPANTS Seventeen YMSM (M=20.5 years) participated in four focus groups and 51 (M=21.1 years) completed questionnaires. RESULTS Over half of YMSM were aware of HPV (54.9%), yet few (21.6%) had previously discussed vaccination with a healthcare professional (HCP). Thematic analyses found YMSM were willing to receive the HPV vaccine. Vaccination programmes requiring YMSM to request the vaccine, particularly prior to sexual orientation disclosure to family and friends, were viewed as unfeasible. Educational campaigns explaining vaccine benefits were indicated as a way to encourage uptake. CONCLUSIONS This study suggests that to effectively implement HPV vaccination for YMSM, this population requires clearer information and greater discussion with their HCP. In support of the decision made by the Joint Committee on Vaccination and Immunisation, universal vaccination is the most feasible and equitable option. However, the absence of a catch-up programme will leave a significant number of YMSM at risk of HPV infection.
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Affiliation(s)
- Joanna May Kesten
- National Institute for Health Research (NIHR) Health Protection Research Unit (HPRU) in Evaluation of Interventions and NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) West, University of Bristol, Population Health Sciences, Bristol Medical School, Bristol, UK
| | - Carrie Flannagan
- Institute of Nursing and Health Research, School of Nursing, Ulster University, Newtownabbey, UK
| | - Eimear Ruane-McAteer
- School of Nursing and Midwifery, Medical Biology Centre, Queen's University Belfast, Belfast, UK
| | | | - Tom Nadarzynski
- School of Social Sciences, University of Westminster, London, UK
| | - Gilla Shapiro
- Department of Psychology, McGill University, Montreal, Canada
| | - Zeev Rosberger
- Department of Psychology, McGill University, Montreal, Canada
| | - Gillian Prue
- School of Nursing and Midwifery, Medical Biology Centre, Queen's University Belfast, Belfast, UK
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Nair NP, Reddy N S, Giri S, Mohan VR, Parashar U, Tate J, Shah MP, Arora R, Gupte M, Mehendale SM, Kang G. Rotavirus vaccine impact assessment surveillance in India: protocol and methods. BMJ Open 2019; 9:e024840. [PMID: 31028037 PMCID: PMC6502045 DOI: 10.1136/bmjopen-2018-024840] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [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] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Rotavirus infection accounts for 39% of under-five diarrhoeal deaths globally and 22% of these deaths occur in India. Introduction of rotavirus vaccine in a national immunisation programme is considered to be the most effective intervention in preventing severe rotavirus disease. In 2016, India introduced an indigenous rotavirus vaccine (Rotavac) into the Universal Immunisation Programme in a phased manner. This paper describes the protocol for surveillance to monitor the performance of rotavirus vaccine following its introduction into the routine childhood immunisation programme. METHODS An active surveillance system was established to identify acute gastroenteritis cases among children less than 5 years of age. For all children enrolled at sentinel sites, case reporting forms are completed and a copy of vaccination record and a stool specimen obtained. The forms and specimens are sent to the referral laboratory for data entry, analysis, testing and storage. Data from sentinel sites in states that have introduced rotavirus vaccine into their routine immunisation schedule will be used to determine rotavirus vaccine impact and effectiveness. ETHICS AND DISSEMINATION The Institutional Review Board of Christian Medical College, Vellore, and all the site institutional ethics committees approved the project. Results will be disseminated in peer-reviewed journals and with stakeholders of the universal immunisation programme in India.
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Affiliation(s)
- Nayana P Nair
- Department of GI Sciences, Christian Medical College, Vellore, India
| | | | - Sidhartha Giri
- Department of GI Sciences, Christian Medical College, Vellore, India
| | | | - Umesh Parashar
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jacqueline Tate
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Rashmi Arora
- Indian Council of Medical Research, New Delhi, India
- Translational Health Science and Technology Institute, Faridabad, India
| | - Mohan Gupte
- Indian Council of Medical Research, New Delhi, India
| | - Sanjay M Mehendale
- Indian Council of Medical Research, New Delhi, India
- National Institute of Epidemiology, Chennai, India
| | | | - Gagandeep Kang
- Department of GI Sciences, Christian Medical College, Vellore, India
- Translational Health Science and Technology Institute, Faridabad, India
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Abstract
The dengue vaccine, CYD-TDV (Dengvaxia), has been licensed in 20 countries in Latin America and Southeast Asia beginning in 2015. In April 2018, the World Health Organization (WHO) advised that CYD-TDV should only be administered to individuals with a history of previous dengue virus infection. Using literature-based parameters, a mathematical model of dengue transmission and vaccination was developed to determine the optimal vaccination strategy while considering the effect of antibody-dependent enhancement (ADE). We computed the optimal vaccination rates under various vaccination costs and serological profiles. We observe that the optimal dengue vaccination rates for seropositive individuals are highest at the initial phase of a vaccination program, requiring intense effort at the early phase of an epidemic. The model shows that even in the presence of ADE, vaccination could reduce dengue incidence and provide population benefits. Specifically, optimal vaccination rates increase with a higher proportion of monotypic seropositive individuals, resulting in a higher impact of vaccination. Even in the presence of ADE and with limited vaccine efficacy, our work provides a population-level perspective on the potential merits of dengue vaccination.
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Affiliation(s)
- Eunha Shim
- Department of Mathematics, Soongsil University, Sangdo-ro 369, Dongjak-gu, Seoul, 156-743, Republic of Korea
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Traicoff D, Pope A, Bloland P, Lal D, Bahl J, Stewart S, Ryman T, Abbruzzese M, Lee C, Ahrendts J, Shamalla L, Sandhu H. Developing standardized competencies to strengthen immunization systems and workforce. Vaccine 2019; 37:1428-1435. [PMID: 30765172 DOI: 10.1016/j.vaccine.2019.01.047] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 01/11/2019] [Accepted: 01/24/2019] [Indexed: 11/16/2022]
Abstract
Despite global support for immunization as a core component of the human right to health and the maturity of immunization programs in low- and middle-income countries throughout the world, there is no comprehensive description of the standardized competencies needed for immunization programs at the national, multiple sub-national, and community levels. The lack of defined and standardized competencies means countries have few guidelines to help them address immunization workforce planning, program management, and performance monitoring. Potential consequences resulting from the lack of defined competencies include inadequate or inefficient distribution of resources to support the required functions and difficulties in adequately managing the health workforce. In 2015, an international multi-agency working group convened to define standardized competencies that national immunization programs could adapt for their own workforce planning needs. The working group used a stepwise approach to ensure that the competencies would align with immunization programs' objectives. The first step defined the attributes of a successful immunization program. The group then defined the work functions needed to achieve those attributes. Based on the work functions, the working group defined specific competencies. This process resulted in three products: (1) Attributes of an immunization program described within eight technical domains at four levels within a health system: National, Provincial, District/Local, and Community; (2) 229 distinct functions within those eight domains at each of the four levels; and (3) 242 competencies, representing eight technical domains and two foundational domains (Management and Leadership and Vaccine Preventable Diseases and Program). Currently available as a working draft and being tested with immunization projects in several countries, the final document will be published by WHO as normative guidelines. Vertical immunization programs as well as integrated systems can customize the framework to suit their needs. Standardized competencies can support immunization program improvements and help strengthen effective health systems.
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Affiliation(s)
- Denise Traicoff
- Centers for Disease Control and Prevention, 1600 Clifton Rd, MS A-04, Atlanta, GA 30333, USA.
| | - Alice Pope
- Centers for Disease Control and Prevention, 1600 Clifton Rd, MS A-04, Atlanta, GA 30333, USA.
| | - Peter Bloland
- Centers for Disease Control and Prevention, 1600 Clifton Rd, MS A-04, Atlanta, GA 30333, USA.
| | - Dharmesh Lal
- Public Health Foundation of India, Plot No. 47, Sector 44, Institutional Area, Gurugram 122002, India
| | - Jhilmil Bahl
- World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland.
| | - Steven Stewart
- Centers for Disease Control and Prevention, 1600 Clifton Rd, MS A-04, Atlanta, GA 30333, USA
| | - Tove Ryman
- Bill & Melinda Gates Foundation, 500 5th Ave, Seattle, WA 98109, USA.
| | - Molly Abbruzzese
- Bill & Melinda Gates Foundation, 500 5th Ave, Seattle, WA 98109, USA.
| | - Carla Lee
- Centers for Disease Control and Prevention, 1600 Clifton Rd, MS A-04, Atlanta, GA 30333, USA.
| | - Johannes Ahrendts
- Gavi, The Vaccine Alliance, Global Health Campus, Chemin du Pommier 40, 1218 Grand-Saconnex, Geneva, Switzerland.
| | - Lorraine Shamalla
- UNICEF, Programme Division/Polio, 3 United Nation Plaza, 8th Floor, New York, NY 10017, USA.
| | - Hardeep Sandhu
- Centers for Disease Control and Prevention, 1600 Clifton Rd, MS A-04, Atlanta, GA 30333, USA.
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Jackson ML, Diallo AO, Médah I, Bicaba BW, Yaméogo I, Koussoubé D, Ouédraogo R, Sangaré L, Mbaeyi SA. Initial validation of a simulation model for estimating the impact of serogroup A Neisseria meningitidis vaccination in the African meningitis belt. PLoS One 2018; 13:e0206117. [PMID: 30359419 PMCID: PMC6201925 DOI: 10.1371/journal.pone.0206117] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 10/08/2018] [Indexed: 12/23/2022] Open
Abstract
We previously developed a mathematical simulation of serogroup A Neisseria meningitidis (NmA) transmission in Burkina Faso, with the goal of forecasting the relative benefit of different vaccination programs. Here, we revisit key structural assumptions of the model by comparing how accurately the different assumptions reproduce observed NmA trends following vaccine introduction. A priori, we updated several of the model's parameters based on recently published studies. We simulated NmA disease under different assumptions about duration of vaccine-induced protection (including the possibility that vaccine-induced protection may last longer than natural immunity). We compared simulated and observed case counts from 2011-2017. We then used the best-fit model to forecast the impact of different vaccination strategies. Our updated model, with the assumption that vaccine-induced immunity lasts longer than immunity following NmA colonization, was able to reproduce observed trends in NmA disease. The updated model predicts that, following a mass campaign among persons 1-29 years of age, either routine immunization of 9 month-old children or periodic mini-campaigns among children 1-4 years of age will lead to sustained control of epidemic NmA in Burkina Faso. This validated model can help public health officials set policies for meningococcal vaccination in Africa.
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Affiliation(s)
- Michael L. Jackson
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Washington, United States of America
| | - Alpha Oumar Diallo
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Isaie Médah
- Direction de la Lutte Contre la Maladie, Ministère de la Santé, Ouagadougou, Burkina Faso
| | - Brice Wilfried Bicaba
- Direction de la Lutte Contre la Maladie, Ministère de la Santé, Ouagadougou, Burkina Faso
| | - Issaka Yaméogo
- Direction de la Lutte Contre la Maladie, Ministère de la Santé, Ouagadougou, Burkina Faso
| | - Daouda Koussoubé
- Direction de la Lutte Contre la Maladie, Ministère de la Santé, Ouagadougou, Burkina Faso
| | - Rasmata Ouédraogo
- Direction de la Lutte Contre la Maladie, Ministère de la Santé, Ouagadougou, Burkina Faso
| | - Lassané Sangaré
- Direction de la Lutte Contre la Maladie, Ministère de la Santé, Ouagadougou, Burkina Faso
| | - Sarah A. Mbaeyi
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Kacem M, Dhouib W, Bennasrallah C, Zemni I, Abroug H, Ben Fredj M, Sriha Belguith A. Expanded program of immunization in the Maghreb. Case study of Tunisia.Systematic review of the literature. Tunis Med 2018; 96:696-705. [PMID: 30746663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Vaccination is the most cost-effective intervention for primary prevention. The Maghreb countries had joined the The Expanded Programme on Immunization (EPI). Tunisia had also introduced the vaccine against hepatitis B and Haemophilus influenzae type B (Hib). OBJECTIVE To describ, through a systematic review, the specific documentation on the EPI in Tunisia. METHOD Target publications were collected using Medline database and Google Scholar from published articles from January 01 1998 to December 12 2017. The synthesis of the data was done according to four axes: "input", "process", "output" and "outcome". RESULTS 17 articles were analyzed, with an average of 4 publications every 5 years. The author's specialty was community and preventive medicine in 56% of cases. Six articles focused on the "input" vaccination program, five related to the immunization process and the other five articles examined output and outcomes. CONCLUSION Tunisian publications concerning vaccination were rare, their efficiency and impact on the change of national vaccination strategy was crucial. Research coordination between Maghreb countries is highly recommended to meet the growing information needs.
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Kim RH, Day SC, Small DS, Snider CK, Rareshide CAL, Patel MS. Variations in Influenza Vaccination by Clinic Appointment Time and an Active Choice Intervention in the Electronic Health Record to Increase Influenza Vaccination. JAMA Netw Open 2018; 1:e181770. [PMID: 30646151 PMCID: PMC6324515 DOI: 10.1001/jamanetworkopen.2018.1770] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [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: 11/24/2022] Open
Abstract
IMPORTANCE Influenza vaccination rates in the United States are suboptimal near 40%, but little is known about variations in care based on clinic appointment time. OBJECTIVES To compare differences in influenza vaccination rates by clinic appointment time and to evaluate the association of an active choice intervention in the electronic health record with changes in vaccination rates. DESIGN, SETTING, AND PARTICIPANTS Retrospective, quality improvement study of 11 primary care practices at the University of Pennsylvania Health System from September 1, 2014, to March 31, 2017. Participants included adults eligible for influenza vaccination. Data analysis was conducted from October 20, 2017, to March 9, 2018. INTERVENTIONS During the 2016 to 2017 influenza season, 3 primary care practices at the University of Pennsylvania Health System implemented an active choice intervention in the electronic health record that prompted medical assistants to ask patients about influenza vaccination during check-in and template vaccination orders for clinicians to review during the visit. MAIN OUTCOMES AND MEASURES Influenza vaccination rates. RESULTS The sample comprised 96 291 patients with a mean (SD) age of 56.2 (17.0) years; 41 865 (43.5%) were men, 61 813 (64.2%) were white, and 23 802 (24.7%) were black. Among all practices across all 3 years, vaccination rates were approximately 44% from 8 am to 10 am, declined to 41.2% by 11 am and 38.3% at noon, increased to 40.2% at 1 pm, and then declined to 34.3% at 3 pm and 32.0% at 4 pm (P < .001 for adjusted linear trend). For the 3 years, vaccination rates were 46.9%, 47.2%, and 45.6% at control practices and 49.7%, 52.2%, and 59.3% at intervention practices, respectively. In adjusted analyses, compared with control practices over time, the active choice intervention was associated with a significant 9.5-percentage point increase in vaccination rates (95% CI, 4.1-14.3; P < .001). Vaccination rates increased similarly across times of the day. CONCLUSIONS AND RELEVANCE Influenza vaccination rates significantly declined as the clinic day progressed. The active choice intervention was associated with a significant increase in influenza vaccination rates that were similar in magnitude throughout the day.
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Affiliation(s)
- Rebecca H. Kim
- Penn Medicine Nudge Unit, University of Pennsylvania, Philadelphia
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Susan C. Day
- Penn Medicine Nudge Unit, University of Pennsylvania, Philadelphia
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Dylan S. Small
- Penn Medicine Nudge Unit, University of Pennsylvania, Philadelphia
- Wharton School, University of Pennsylvania, Philadelphia
| | | | | | - Mitesh S. Patel
- Penn Medicine Nudge Unit, University of Pennsylvania, Philadelphia
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Wharton School, University of Pennsylvania, Philadelphia
- Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
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Menon S, Rossi R, Kariisa M, Callens S. Determining the HPV vaccine schedule for a HIV-infected population in sub Saharan Africa, a commentary. Virol J 2018; 15:129. [PMID: 30115083 PMCID: PMC6097212 DOI: 10.1186/s12985-018-1039-y] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 08/08/2018] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Epidemiological studies have established human papillomavirus (HPV) infection as the central cause of invasive cervical cancer (ICC) and its precursor lesions. HIV is associated with a higher prevalence and persistence of a broader range of high-risk HPV genotypes, which in turn results in a higher risk of cervical disease. Recent WHO HPV vaccination schedule recommendations, along with the roll out of HAART at an earlier CD4 count within the female HIV-infected population, may have programmatic implications for sub Saharan Africa. This communication identifies research areas, which will need to be addressed for determining a HPV vaccine schedule for this population in sub Saharan Africa. A review of WHO latest recommendations and the evidence concerning one-dose HPV vaccine schedules was undertaken. CONCLUSION For females ≥15 years at the time of first dose and immunocompromised and/or HIV-infected, a 3-dose schedule (0, 1-2, 6 months) is recommended for all three vaccines. There is some evidence that there is similar protection against HPV 16 and 18 infection from a single vaccination than from two or three doses, however there is no cross protection conferred to other genotypes. There is a need for periodic prevalence studies to determine the vaccination coverage of bivalent, quadrivalent and nonavalent vaccine targeted oncogenic HPV genotypes in women with CIN 3 or ICC at national level. In light of the increasing number of sub Saharan HIV-infected girls initiating HAART at a CD4 count above 350 mm3, there are a number of clinical, virological and public health research gaps to address before a tailored vaccine schedule can be established for this population.
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Affiliation(s)
- Sonia Menon
- International Centre for Reproductive Health (ICRH), Department of Obstetrics and Gynaecology, Ghent University, De Pintelaan 185 P3, 9000, Ghent, Belgium.
- International Committee of Red Cross, Geneva, Switzerland.
| | - Rodolfo Rossi
- International Committee of Red Cross, Geneva, Switzerland
| | | | - Steven Callens
- International Centre for Reproductive Health (ICRH), Department of Obstetrics and Gynaecology, Ghent University, De Pintelaan 185 P3, 9000, Ghent, Belgium
- Department of Internal Medicine & Infectious diseases, University Hospital, Ghent, Belgium
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Sagy I, Feder-Bubis P, Novack V, Peleg-Sagy T, Greenberg D. Lessons learned from the 2009-2010 H1N1 outbreak for the management of the 2013 silent polio outbreak. BMC Infect Dis 2018; 18:241. [PMID: 29843639 PMCID: PMC5975376 DOI: 10.1186/s12879-018-3155-0] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 05/21/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The Israeli Ministry of Health (MoH) encountered two substantial outbreaks during the past decade: the H1N1 swine flu outbreak during 2009-2010 and the silent polio outbreak during 2013. Although both outbreaks share several similar characteristics, the functioning of the Israeli MoH was different for each case. The aim of this study was to identify factors that contributed to the change in the MoH response to the polio outbreak in light of the previous 2009-2010 H1N1 outbreak. METHODS We conducted a qualitative research using semi-structured interviews with 18 Israeli policymakers from the MoH, relevant specialists and politicians. Each interview was transcribed and a thematic analysis was conducted independently by two researchers. RESULTS Three main themes were found in the interview analysis, which reflect major differences in the MoH management policy during the polio outbreak. 1) clinical and epidemiological differences between the two disease courses, 2) differences in the functioning of the MoH during the outbreaks, 3) differences in the risk communication strategies used to reach out to the local health community and the general public. Most interviewees felt that the experience of the 2009-2010 H1N1 outbreak which was perceived as unsuccessful, fueled the MoH engagement and proactiveness in the later polio outbreak. CONCLUSION These findings highlight the importance of learning processes within health care organizations during outbreaks and may contribute to better performance and higher immunization rates.
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Affiliation(s)
- Iftach Sagy
- Department of Health Systems Management, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be’er-Sheva, Israel
- Clinica Research Center, Soroka University Medical Center, 84101 Beer-Sheva, Israel
| | - Paula Feder-Bubis
- Department of Health Systems Management, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be’er-Sheva, Israel
| | - Victor Novack
- Clinica Research Center, Soroka University Medical Center, 84101 Beer-Sheva, Israel
| | | | - Dan Greenberg
- Department of Health Systems Management, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be’er-Sheva, Israel
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Wilhelm J, Calvo X, Escobar C, Moreno G, Véliz L, Villena R, Potin M. [Statement from the Immunization Committee of the Chilean Infectious Diseases Society in reference to vaccine refusal and mandatory policy on vaccination]. Rev Chilena Infectol 2018; 34:583-586. [PMID: 29488553 DOI: 10.4067/s0716-10182017000600583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Although vaccines have had a tremendous impact in public health they are questioned by certain groups that consider them unnecessary or unsafe and argue in favor of the right to decide to be vaccinated or not. However vaccines must have special considerations because unlike other medical decisions, not vaccinating has consequences not only for the individual but also for other members of the community. Immunizing a high proportion of the population limits the circulation of an infectious agent attaining what is called herd immunity that protects the susceptible members of the group. For this reason many countries consider vaccination mandatory as a responsibility of every citizen. This committee agrees with this view but thinks other strategies should be implemented as well, such as special educational efforts for the public and parents addressing benefits and real risks of vaccinating. Also health care professionals should be trained in vaccines. The notification system for adverse events currently available should be improved and be more accessible. Persons truly affected by adverse events due to vaccination should receive on time responses and be offered psychological and financial support. Finally all stakeholders should make coordinated efforts to work together to deliver messages that answer concerns on vaccines and bring confidence back to the public.
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Abstract
OBJECTIVE To identify opportunities to improve safe and effective immunization delivery in community pharmacies. METHODS Pharmacy managers from chains in Michigan were interviewed about their company's immunizations programs. A survey regarding immunization training, quality assurance measures, pharmacist comfort level immunizing different patient populations, and resources used in practice was distributed to community pharmacists throughout Michigan. RESULTS Most pharmacists (88.8%) confirmed they received American Pharmacists Association immunization training and felt they followed the guidelines outlined in that training course very well. No routine reassessment of immunization technique was reported. In a minority of respondents, some issues were identified: (1) not being up-to-date on cardiopulmonary resuscitation certification as required by state law (7.1%), (2) lack of awareness of location of emergency kit (4.2% for epinephrine, 13.5% for diphenhydramine), and (3) feeling uncomfortable immunizing children (51% for children <7 years). CONCLUSION To address quality control issues identified in the survey, we recommend chain pharmacies incorporate credential checks into annual pharmacy training requirements. Pharmacists may benefit from immunization-related continuing education requirements. State pharmacy organizations may want to take the lead in developing the material to ensure that it is timely and abides by state and federal laws.
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Affiliation(s)
- Brian Bazzell
- 1 University of Michigan College of Pharmacy, Ann Arbor, MI, USA
| | - Sarah Kelling
- 1 University of Michigan College of Pharmacy, Ann Arbor, MI, USA
| | - Heidi Diez
- 1 University of Michigan College of Pharmacy, Ann Arbor, MI, USA
| | - Kristin Klein
- 1 University of Michigan College of Pharmacy, Ann Arbor, MI, USA
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BCG vaccines: WHO position paper – February 2018. Wkly Epidemiol Rec 2018; 93:73-96. [PMID: 29474026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Savoy M. ACIP Releases 2018 Childhood Immunization Recommendations. Am Fam Physician 2018; 97:278. [PMID: 29671520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Margot Savoy
- Christiana Care Health System, Wilmington, DE, USA
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Savoy M. ACIP Releases 2018 Adult Immunization Recommendations. Am Fam Physician 2018; 97:279-280. [PMID: 29671519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Margot Savoy
- Christiana Care Health System, Wilmington, DE, USA
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Immunization and Vaccine-related Implementation Research Advisory Committee (IVIR-AC): summary of conclusions and recommendations, 20–22 September 2017. Wkly Epidemiol Rec 2018; 93:1-7. [PMID: 29303231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Country Immunization Information System Assessments (IISAs), in Kenya (2015) and Ghana (2016). Wkly Epidemiol Rec 2017; 92:694-700. [PMID: 29130680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Wallace AS, Bohara R, Stewart S, Subedi G, Anand A, Burnett E, Giri J, Shrestha J, Gurau S, Dixit S, Rajbhandari R, Schluter WW. Impact of an Intervention to Use a Measles, Rubella, and Polio Mass Vaccination Campaign to Strengthen Routine Immunization Services in Nepal. J Infect Dis 2017; 216:S280-S286. [PMID: 28838201 PMCID: PMC5771484 DOI: 10.1093/infdis/jix164] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background The potential to strengthen routine immunization (RI) services through supplementary immunization activities (SIAs) is an important benefit of global measles and rubella elimination and polio eradication strategies. However, little evidence exists on how best to use SIAs to strengthen RI. As part the 2012 Nepal measles-rubella and polio SIA, we developed an intervention package designed to improve RI processes and evaluated its effect on specific RI process measures. Methods The intervention package was incorporated into existing SIA activities and materials to improve healthcare providers' RI knowledge and practices throughout Nepal. In 1 region (Central Region) we surveyed the same 100 randomly selected health facilities before and after the SIA and evaluated the following RI process measures: vaccine safety, RI planning, RI service delivery, vaccine supply chain, and RI data recording practices. Data collection included observations of vaccination sessions, interviews with the primary healthcare provider who administered vaccines at each facility, and administrative record reviews. Pair-matched analytical methods were used to determine whether statistically significant changes in the selected RI process measures occurred over time. Results After the SIA, significant positive changes were measured in healthcare provider knowledge of adverse events following immunization (11% increase), availability of RI microplans (+17%) and maps (+12%), and awareness of how long a reconstituted measles vial can be used before it must be discarded (+14%). For the SIA, 42% of providers created an SIA high-risk villages list, and >50% incorporated this information into RI outreach session site planning. Significant negative changes occurred in correct knowledge of measles vaccination contraindications (-11%), correct definition for a measles outbreak (-21%), and how to treat a child with a severe adverse event following immunization (-10%). Twenty percent of providers reported cancelling ≥1 RI sessions during the SIA. Many RI process measures were at high proportions (>90%) before the SIA and remained high afterward, including proper vaccine administration techniques, proper vaccine waste management, and availability of vaccine carriers and vaccine registers. Conclusions Focusing on activities that are easily linked between SIAs and RI services, such as using SIA high-risk village list to strengthen RI microplanning and examining ways to minimize the impact of an SIA on RI session scheduling, should be prioritized when implementing SIAs.
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Affiliation(s)
- Aaron S Wallace
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Steven Stewart
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Abhijeet Anand
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Eleanor Burnett
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | - Sameer Dixit
- Center for Molecular Development Network, Kathamandu, Nepal
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Hepatitis B vaccines: WHO position paper – July 2017. Wkly Epidemiol Rec 2017; 92:369-92. [PMID: 28685564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Evaluation of the 2010 National Vaccine Plan Mid-course Review: Recommendations From the National Vaccine Advisory Committee: Approved by the National Vaccine Advisory Committee on February 7, 2017. Public Health Rep 2017; 132:411-30. [PMID: 28644068 DOI: 10.1177/0033354917714233] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Fagrell B, Bergstrand G. [Tick-borne encephalitis vaccination in Sweden is not self-evident]. Lakartidningen 2017; 114:EMSH. [PMID: 28485761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Berlin J. Taking Another Shot. Tex Med 2017; 113:24-30. [PMID: 28323316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
At a time when conscientious exemptions for vaccination are on the rise, Texas physicians are supporting lawmakers who plan to push for the release of school campus-level exemption data.
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Savoy M. ACIP Releases 2017 Adult Immunization Recommendations. Am Fam Physician 2017; 95:262-263. [PMID: 28290626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Margot Savoy
- Christiana Care Health System, Wilmington, DE, USA
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Savoy M. ACIP Releases 2017 Childhood Immunization Recommendations. Am Fam Physician 2017; 95:260-261. [PMID: 28290627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Margot Savoy
- Christiana Care Health System, Wilmington, DE, USA
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