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van Schalkwyk JM. New Zealand's covid-19 policy switch will harm vulnerable people. BMJ 2021; 375:n2738. [PMID: 34764138 DOI: 10.1136/bmj.n2738] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Sharghi M, Heidari Z, Cascio A, Qaderi M, Seyd-Ebrahimi SS, Serra N, Mardaneh J, Kooti W, Firoozbakht M, Boroujerdnia MG, Sergi C. Seroprevalence of Rubella among Women of Reproductive Age in Iran: A Prisma-Based Systematic Review and Meta-Analysis. Ann Clin Lab Sci 2021; 51:852-860. [PMID: 34921039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Rubella is a highly contagious viral disease with a significant teratogenic effect. Various results have been published about the seroprevalence of rubella in Iran. A PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses)-systematic review and meta-analysis were conducted to assess the immunity against rubella in Iranian women. METHODS Eleven English and Persian electronic databases including PubMed, ScienceDirect, Scopus, Web of Science, Google Scholar, Embase, Scientific Information Database, Iran doc, Iran Medex, Magiran, and Medlib were searched using the keywords: Epidemiology, Prevalence, Rubella, Women, Childbearing age, Reproductive age, and Iran. A mathematician (NS) reviewed all steps for accuracy. RESULTS Out of 1,520 articles, 25 well-conducted studies with a total amount of 10,145 women were reviewed. The pooled prevalence rate of anti-rubella IgG was 84% (95% CI: 83%-86%). The highest prevalence rate of IgG was in Zahedan, Rasht, and Arak (each 100%), while the lowest prevalence was in Jahrom (54%). Subgroup analysis showed that from 1989 through 2012, the IgG prevalence rate increased from 78% (95% CI: 73-83%) to 99% (95% CI: 98 100%). CONCLUSIONS Although the vaccination program seems working in Iran, some peripheral regions may be a target to improve health care policies.
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Affiliation(s)
| | - Zahra Heidari
- Department of Biostatistics and Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Antonio Cascio
- Department of Health Promotion and Child Health, Polyclinic University Hospital of Palermo, Palermo, Italy
| | - Mehdi Qaderi
- Student Research Committee, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | | | - Nicola Serra
- Statistic Unit, Department of Public Health, University of Naples 'Federico II', Naples, Italy
| | - Jalal Mardaneh
- Department of Microbiology, School of Medicine, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Wesam Kooti
- Lung Diseases and Allergy Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | | | - Mehri Ghafourian Boroujerdnia
- Department of Immunology, Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Consolato Sergi
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
- Division of Anatomical Pathology, Children's Hospital of Eastern Ontario (CHEO), University of Ottawa, Ontario, Canada
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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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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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Benjamin-Chung J, Arnold BF, Kennedy CJ, Mishra K, Pokpongkiat N, Nguyen A, Jilek W, Holbrook K, Pan E, Kirley PD, Libby T, Hubbard AE, Reingold A, Colford JM. Evaluation of a city-wide school-located influenza vaccination program in Oakland, California, with respect to vaccination coverage, school absences, and laboratory-confirmed influenza: A matched cohort study. PLoS Med 2020; 17:e1003238. [PMID: 32810149 PMCID: PMC7433855 DOI: 10.1371/journal.pmed.1003238] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 07/14/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND It is estimated that vaccinating 50%-70% of school-aged children for influenza can produce population-wide indirect effects. We evaluated a city-wide school-located influenza vaccination (SLIV) intervention that aimed to increase influenza vaccination coverage. The intervention was implemented in ≥95 preschools and elementary schools in northern California from 2014 to 2018. Using a matched cohort design, we estimated intervention impacts on student influenza vaccination coverage, school absenteeism, and community-wide indirect effects on laboratory-confirmed influenza hospitalizations. METHODS AND FINDINGS We used a multivariate matching algorithm to identify a nearby comparison school district with pre-intervention characteristics similar to those of the intervention school district and matched schools in each district. To measure student influenza vaccination, we conducted cross-sectional surveys of student caregivers in 22 school pairs (2017 survey, N = 6,070; 2018 survey, N = 6,507). We estimated the incidence of laboratory-confirmed influenza hospitalization from 2011 to 2018 using surveillance data from school district zip codes. We analyzed student absenteeism data from 2011 to 2018 from each district (N = 42,487,816 student-days). To account for pre-intervention differences between districts, we estimated difference-in-differences (DID) in influenza hospitalization incidence and absenteeism rates using generalized linear and log-linear models with a population offset for incidence outcomes. Prior to the SLIV intervention, the median household income was $51,849 in the intervention site and $61,596 in the comparison site. The population in each site was predominately white (41% in the intervention site, 48% in the comparison site) and/or of Hispanic or Latino ethnicity (26% in the intervention site, 33% in the comparison site). The number of students vaccinated by the SLIV intervention ranged from 7,502 to 10,106 (22%-28% of eligible students) each year. During the intervention, influenza vaccination coverage among elementary students was 53%-66% in the comparison district. Coverage was similar between the intervention and comparison districts in influenza seasons 2014-2015 and 2015-2016 and was significantly higher in the intervention site in seasons 2016-2017 (7%; 95% CI 4, 11; p < 0.001) and 2017-2018 (11%; 95% CI 7, 15; p < 0.001). During seasons when vaccination coverage was higher among intervention schools and the vaccine was moderately effective, there was evidence of statistically significant indirect effects: The DID in the incidence of influenza hospitalization per 100,000 in the intervention versus comparison site was -17 (95% CI -30, -4; p = 0.008) in 2016-2017 and -37 (95% CI -54, -19; p < 0.001) in 2017-2018 among non-elementary-school-aged individuals and -73 (95% CI -147, 1; p = 0.054) in 2016-2017 and -160 (95% CI -267, -53; p = 0.004) in 2017-2018 among adults 65 years or older. The DID in illness-related school absences per 100 school days during the influenza season was -0.63 (95% CI -1.14, -0.13; p = 0.014) in 2016-2017 and -0.80 (95% CI -1.28, -0.31; p = 0.001) in 2017-2018. Limitations of this study include the use of an observational design, which may be subject to unmeasured confounding, and caregiver-reported vaccination status, which is subject to poor recall and low response rates. CONCLUSIONS A city-wide SLIV intervention in a large, diverse urban population was associated with a decrease in the incidence of laboratory-confirmed influenza hospitalization in all age groups and a decrease in illness-specific school absence rate among students in 2016-2017 and 2017-2018, seasons when the vaccine was moderately effective, suggesting that the intervention produced indirect effects. Our findings suggest that in populations with moderately high background levels of influenza vaccination coverage, SLIV programs are associated with further increases in coverage and reduced influenza across the community.
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Affiliation(s)
- Jade Benjamin-Chung
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, California, United States of America
| | - Benjamin F. Arnold
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, California, United States of America
- Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California, United States of America
| | - Chris J. Kennedy
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, California, United States of America
| | - Kunal Mishra
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, California, United States of America
| | - Nolan Pokpongkiat
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, California, United States of America
| | - Anna Nguyen
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, California, United States of America
| | - Wendy Jilek
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, California, United States of America
| | - Kate Holbrook
- Division of Communicable Disease Control and Prevention, Alameda County Public Health Department, Oakland, California, United States of America
| | - Erica Pan
- Division of Communicable Disease Control and Prevention, Alameda County Public Health Department, Oakland, California, United States of America
- Department of Pediatrics, Division of Infectious Diseases, University of California, San Francisco, San Francisco, California, United States of America
| | - Pam D. Kirley
- California Emerging Infections Program, Oakland, California, United States of America
| | - Tanya Libby
- California Emerging Infections Program, Oakland, California, United States of America
| | - Alan E. Hubbard
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, California, United States of America
| | - Arthur Reingold
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, California, United States of America
| | - John M. Colford
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, California, United States of America
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Saslow D, Andrews KS, Manassaram-Baptiste D, Smith RA, Fontham ETH. Human papillomavirus vaccination 2020 guideline update: American Cancer Society guideline adaptation. CA Cancer J Clin 2020; 70:274-280. [PMID: 32639044 DOI: 10.3322/caac.21616] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 05/19/2020] [Indexed: 01/12/2023] Open
Abstract
The American Cancer Society (ACS) presents an adaptation of the current Advisory Committee on Immunization Practices recommendations for human papillomavirus (HPV) vaccination. The ACS recommends routine HPV vaccination between ages 9 and 12 years to achieve higher on-time vaccination rates, which will lead to increased numbers of cancers prevented. Health care providers are encouraged to start offering the HPV vaccine series at age 9 or 10 years. Catch-up HPV vaccination is recommended for all persons through age 26 years who are not adequately vaccinated. Providers should inform individuals aged 22 to 26 years who have not been previously vaccinated or who have not completed the series that vaccination at older ages is less effective in lowering cancer risk. Catch-up HPV vaccination is not recommended for adults aged older than 26 years. The ACS does not endorse the 2019 Advisory Committee on Immunization Practices recommendation for shared clinical decision making for some adults aged 27 through 45 years who are not adequately vaccinated because of the low effectiveness and low cancer prevention potential of vaccination in this age group, the burden of decision making on patients and clinicians, and the lack of sufficient guidance on the selection of individuals who might benefit.
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Affiliation(s)
- Debbie Saslow
- Human Papillomavirus and Gynecologic Cancers, American Cancer Society, Atlanta, Georgia
| | - Kimberly S Andrews
- Guideline Development Process, American Cancer Society, Atlanta, Georgia
| | | | - Robert A Smith
- Cancer Screening, American Cancer Society, Atlanta, Georgia
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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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Azzari C, Diez-Domingo J, Eisenstein E, Faust SN, Konstantopoulos A, Marshall GS, Rodrigues F, Schwarz TF, Weil-Olivier C. Experts' opinion for improving global adolescent vaccination rates: a call to action. Eur J Pediatr 2020; 179:547-553. [PMID: 32072304 PMCID: PMC7080665 DOI: 10.1007/s00431-019-03511-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 09/12/2019] [Accepted: 10/21/2019] [Indexed: 01/17/2023]
Abstract
Worldwide, lifestyle and resource disparities among adolescents contribute to unmet health needs, which have crucial present and future public health implications for both adolescents and broader communities. Risk of infection among adolescents is amplified by biological, behavioral, and environmental factors; however, infectious diseases to which adolescents are susceptible are often preventable with vaccines. Beyond these concerns, there is a lack of knowledge regarding adolescent vaccination and disease risk among parents and adolescents, which can contribute to low vaccine uptake. Promising efforts have been made to improve adolescent vaccination by programs with motivational drivers and comprehensive communication with the public. In May 2017, a multidisciplinary group of experts met in Amsterdam, Netherlands, to discuss adolescent vaccine uptake, as part of an educational initiative called the Advancing Adolescent Health Spring Forum. This article presents consensus opinions resulting from the meeting, which pertain to the burden of vaccine-preventable diseases among adolescents, reasons for low vaccine uptake, and common characteristics of successful strategies for improving adolescent vaccination.Conclusion: There is an urgent "call to action," particularly targeting healthcare providers and public health authorities, for the prioritization of adolescent vaccination as a necessary element of preventive healthcare in this age group.What is Known:• Despite increased risk of certain infectious diseases, adolescent vaccination uptake remains low.What is New:• Barriers to adolescent vaccine uptake include lack of information regarding vaccines and disease risk, health system inadequacies, and insufficient healthcare follow-up.• Successful efforts to improve adolescent vaccine uptake need cohesive leadership and involvement of multiple stakeholders, as well as youth-friendly messaging; healthcare providers and policymakers should prioritize adolescent vaccination and implement proven program strategies to improve adolescent health worldwide.
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Affiliation(s)
- Chiara Azzari
- Department of Health Sciences, University of Florence and Meyer Children’s Hospital, viale Pieraccini 24, 50139 Florence, Italy
| | | | - Evelyn Eisenstein
- University of the State of Rio de Janeiro, - UERJ Bloco C - 9º andar, R. São Francisco Xavier, 524 - Maracanã, 20550-900 Rio de Janeiro, Brazil
| | - Saul N. Faust
- National Institute of Health Research Clinical Research Facility, University of Southampton and University Hospital NHS Foundation Trust, Southampton Centre for Biomedical Research, C Level West Wing, Mailpoint 218, Southampton General Hospital, Tremona Road, SO16 6YD, Southampton, UK
| | | | - Gary S. Marshall
- Department of Pediatrics, University of Louisville School of Medicine, 571 S. Floyd St., Suite 321, Louisville, KY 40202 USA
| | - Fernanda Rodrigues
- Hospital Pediátrico – Centro Hospitalar e Universitário de Coimbra, Praceta Prof. Mota Pinto, 3000-075 Coimbra, Portugal
| | - Tino F. Schwarz
- Institute of Laboratory Medicine and Vaccination Centre, Klinikum Wuerzburg Mitte, Standort Juliusspital, Juliuspromenade 19, 97070 Wuerzburg, Germany
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Abstract
INTRODUCTION Vaccine hesitancy, defined as the delay in acceptance or refusal of vaccination despite availability of vaccination services is responsible in part for suboptimal levels of vaccination coverage worldwide. The WHO recommends that countries incorporate plans to measure and address vaccine hesitancy into their immunisation programmes. This requires that governments and health institutions be able to detect concerns about vaccination in the population and monitor changes in vaccination behaviours. To do this effectively, tools to detect and measure vaccine hesitancy are required. The purpose of this scoping review is to give a broad overview of currently available vaccine hesitancy measuring tools and present a summary of their nature, similarities and differences. METHODS AND ANALYSIS The review will be conducted using the framework for scoping review proffered by Arksey and O'Malley. It will comply with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews' guidelines. The broader research question of this review is: what vaccine hesitancy measuring tools are currently available?Search strategies will be developed using controlled vocabulary and selected keywords. PubMed, Web of Science, Scopus and reference lists of relevant publications will be searched. Titles and abstracts will be independently screened by two authors and data from full-text articles meeting the inclusion criteria will be extracted independently by two authors using a pretested data charting form. Discrepancies will be resolved by discussion and consensus. Results will be presented using descriptive statistics such as percentages, tables, charts and flow diagrams as appropriate. Narrative analysis will be used to summarise the findings of the review. ETHICS AND DISSEMINATION Ethics approval is not required for the review. It will be submitted as part of a doctoral thesis, presented at conferences and published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER https://osf.io/x8fjk/.
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Affiliation(s)
- Elizabeth O Oduwole
- Division of Health Systems and Public Health, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, Western Cape, South Africa
- Cochrane South Africa, South African Medical Research Council, Cape Town, Western Cape, South Africa
| | - Elizabeth D Pienaar
- Cochrane South Africa, South African Medical Research Council, Cape Town, Western Cape, South Africa
| | - Hassan Mahomed
- Division of Health Systems and Public Health, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, Western Cape, South Africa
- Metro Health Services, Western Cape Government: Health, Cape Town, Western Cape Province, South Africa
| | - Charles Shey Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town, Western Cape, South Africa
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, Western Cape Province, South Africa
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, Western Cape, South Africa
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Cuong HQ, Nguyen HX, Van Hau P, Ha NLK, Lan PT, Mounts A, Nguyen TMN. Gap in measles vaccination coverage among children aged 9 months to 10 years in Ho Chi Minh City, Viet Nam, 2014. Western Pac Surveill Response J 2019; 10:39-45. [PMID: 32133210 PMCID: PMC7043096 DOI: 10.5365/wpsar.2017.8.2.001] [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] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION When Viet Nam launched the Expanded Programme on Immunization in 1981, it covered six vaccines, including measles. Subsequently, Viet Nam experienced a marked reduction in measles infections. A nationwide measles epidemic occurred in April 2014 and an investigation found that 86% of affected children aged 9 months to 10 years were not fully vaccinated; therefore, understanding the reasons for not vaccinating could improve vaccination coverage. METHOD We performed a cross-sectional study to determine vaccination coverage and reasons for non-vaccination among children aged 9 months to 10 years in six districts in Ho Chi Minh City with the highest number of measles cases in 2014. Measles vaccination status of the youngest child in each household was determined and reasons for non-vaccination were investigated. A χ2 test and multiple logistic regression were used to identify independent predictors of full vaccination. RESULTS In total, 207 children were enrolled during the study period in 2014. Full measles vaccination coverage was 55% in these households, and 73% of parents were aware of the importance of measles vaccination to protect their children. We found that the father's education level (under high school versus high school and above) and the site where the survey was conducted were significantly associated with vaccination status. CONCLUSION The vaccination coverage was lower than the coverage reported by district preventive medicine centres of the seven study wards. Lack of the second vaccination was a key obstacle to eliminating the vaccination gap. A catch-up mass vaccination campaign or health promotion of measles vaccination directed towards parents should be considered to improve vaccination coverage.
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Affiliation(s)
- Hoang Quoc Cuong
- Pasteur Institute, Ho Chi Minh City, Viet Nam
- Field Epidemiology Training Program, Ho Chi Minh City, Viet Nam
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Nowlan M, Willing E, Turner N. Influences and policies that affect immunisation coverage-a summary review of literature. N Z Med J 2019; 132:79-88. [PMID: 31465331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Effective national immunisation programmes require a high proportion of the population to be immunised. Although New Zealand has made significant progress towards immunisation goals over the last two decades, immunisation coverage remains inadequate to prevent intermittent outbreaks of disease, and immunisation inequities persist between geographic, ethnic and socioeconomic groups. Here we summarise a recent literature review that was conducted to identify and examine key factors that influence immunisation coverage, timeliness of vaccinations and the core drivers that affect vaccine uptake. We conclude that well designed systems, taking a holistic approach with multiple components, gain broader community acceptance and trust; early and continual engagement with well-informed healthcare professionals builds trust and improves uptake; the family's experience during vaccination events is important; community-led vaccine advocacy is required to target specific populations to help to promote and improve access to immunisation. Coercive approaches can be marginally effective, but risk disproportionately penalising those already experiencing mistrust and hardship.
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Affiliation(s)
- Mary Nowlan
- Research Assistant and Medical Writer, Immunisation Advisory Centre, Department of General Practice and Primary Care, University of Auckland, Auckland
| | - Esther Willing
- Lecturer, Kōhatu, Centre for Hauora Māori, University of Otago, Dunedin
| | - Nikki Turner
- Associate Professor, Director of the Immunisation Advisory Centre, Department of General Practice and Primary Care, University of Auckland, Wellington
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Jaca A, Ndze VN, Wiysonge CS. Assessing the methodological quality of systematic reviews of interventions aimed at improving vaccination coverage using AMSTAR and ROBIS checklists. Hum Vaccin Immunother 2019; 15:2824-2835. [PMID: 31348722 PMCID: PMC6930111 DOI: 10.1080/21645515.2019.1631567] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 05/10/2019] [Accepted: 05/26/2019] [Indexed: 10/26/2022] Open
Abstract
Introduction: Systematic reviews (SRs) are the backbone of evidence-based health care, but no gold standard exists to assess their methodological quality. Although the AMSTAR tool is accepted for analyzing the quality of SRs, the ROBIS instrument was recently developed. This study compared the capacity of both instruments to capture the quality of SRs of interventions for improving vaccination coverage.Methods: We conducted a comprehensive literature search in the Cochrane Library and PubMed. Two reviewers independently screened the search output, assessed study eligibility, and extracted data from eligible SRs; resolving differences through consensus. We conducted Principal Component Analysis (PCA) in Stata 14 to determine similarities and differences between AMSTAR and ROBIS.Results: A total of 2322 records were identified through the search and 75 full-text publications were assessed for eligibility, of which 57 met inclusion criteria. Using AMSTAR, we found 32%, 60% and 9% of SRs to have high, moderate and low quality, respectively. With ROBIS, we judged 74%, 14% and 12% of SRs to have low, unclear and high risk of bias. PCA showed that SRs with low risk of bias in ROBIS clustered together with SRs having high-quality in AMSTAR, and SRs with high risk of bias in ROBIS clustered with low-quality SRs in AMSTAR.Conclusions: Our findings suggest that there is an association between methodological quality and risk of bias in SRs of interventions focused on improving vaccination coverage. Therefore, either AMSTAR or ROBIS checklists can be used to evaluate methodological quality of SRs in vaccinology.
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Affiliation(s)
- Anelisa Jaca
- South African Medical Research Council, Cochrane South Africa, Cape Town, South Africa
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Valantine Ngum Ndze
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Charles Shey Wiysonge
- South African Medical Research Council, Cochrane South Africa, Cape Town, South Africa
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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Truelove SA, Graham M, Moss WJ, Metcalf CJE, Ferrari MJ, Lessler J. Characterizing the impact of spatial clustering of susceptibility for measles elimination. Vaccine 2019; 37:732-741. [PMID: 30579756 PMCID: PMC6348711 DOI: 10.1016/j.vaccine.2018.12.012] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [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] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 12/07/2018] [Accepted: 12/11/2018] [Indexed: 01/16/2023]
Abstract
Measles elimination efforts are primarily focused on achieving and maintaining national vaccination coverage goals, based on estimates of the critical vaccination threshold (Vc): the proportion of the population that must be immune to prevent sustained epidemics. Traditionally, Vc estimates assume evenly mixing populations, an invalid assumption. If susceptible individuals preferentially contact one another, communities may remain vulnerable to epidemics even when vaccination coverage targets are met at the national level. Here we present a simple method to estimate Vc and the effective reproductive number, R, while accounting for spatial clustering of susceptibility. For measles, assuming R0 = 15 and 95% population immunity, adjustment for high clustering of susceptibility increases R from 0.75 to 1.29, Vc from 93% to 96%, and outbreak probability after a single introduction from <1% to 23%. The impact of clustering remains minimal until vaccination coverage nears elimination levels. We illustrate our approach using Demographic and Health Survey data from Tanzania and show how non-vaccination clustering potentially contributed to continued endemic transmission of measles virus during the last two decades. Our approach demonstrates why high national vaccination coverage sometimes fails to achieve measles elimination, and that a shift from national to subnational focus is needed as countries approach elimination.
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Affiliation(s)
- Shaun A Truelove
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
| | - Matthew Graham
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; The Hospital for Tropical Diseases, Wellcome Trust Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Viet Nam
| | - William J Moss
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - C Jessica E Metcalf
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, NJ, USA; Office of Population Research, Woodrow Wilson School, Princeton University, Princeton, NJ, USA
| | - Matthew J Ferrari
- Center for Infectious Disease Dynamics, Pennsylvania State University, University Park, PA, USA; Department of Biology, The Pennsylvania State University, University Park, PA, USA
| | - Justin Lessler
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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Adetifa IMO, Karia B, Mutuku A, Bwanaali T, Makumi A, Wafula J, Chome M, Mwatsuma P, Bauni E, Hammitt LL, Mataza C, Tabu C, Kamau T, Williams TN, Scott JAG. Coverage and timeliness of vaccination and the validity of routine estimates: Insights from a vaccine registry in Kenya. Vaccine 2018; 36:7965-7974. [PMID: 30416017 PMCID: PMC6288063 DOI: 10.1016/j.vaccine.2018.11.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 10/31/2018] [Accepted: 11/01/2018] [Indexed: 11/02/2022]
Abstract
BACKGROUND The benefits of childhood vaccines are critically dependent on vaccination coverage. We used a vaccine registry (as gold standard) in Kenya to quantify errors in routine coverage methods (surveys and administrative reports), to estimate the magnitude of survivor bias, contrast coverage with timeliness and use both measures to estimate population immunity. METHODS Vaccination records of children in the Kilifi Health and Demographic Surveillance System (KHDSS), Kenya were combined with births, deaths, migration and residence data from 2010 to 17. Using inverse survival curves, we estimated up-to-date and age-appropriate vaccination coverage, calculated mean vaccination coverage in infancy as the area under the inverse survival curves, and estimated the proportion of fully immunised children (FIC). Results were compared with published coverage estimates. Risk factors for vaccination were assessed using Cox regression models. RESULTS We analysed data for 49,090 infants and 48,025 children aged 12-23 months in 6 birth cohorts and 6 cross-sectional surveys respectively, and found 2nd year of life surveys overestimated coverage by 2% compared to birth cohorts. Compared to mean coverage in infants, static coverage at 12 months was exaggerated by 7-8% for third doses of oral polio, pentavalent (Penta3) and pneumococcal conjugate vaccines, and by 24% for the measles vaccine. Surveys and administrative coverage also underestimated the proportion of the fully immunised child by 10-14%. For BCG, Penta3 and measles, timeliness was 23-44% higher in children born in a health facility but 20-37% lower in those who first attended during vaccine stock outs. CONCLUSIONS Standard coverage surveys in 12-23 month old children overestimate protection by ignoring timeliness, and survivor and recall biases. Where delayed vaccination is common, up-to-date coverage will give biased estimates of population immunity. Surveys and administrative methods also underestimate FIC prevalence. Better measurement of coverage and more sophisticated analyses are required to control vaccine preventable diseases.
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Affiliation(s)
- Ifedayo M O Adetifa
- Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, PO Box 230-80108, Kilifi, Kenya; Infectious Diseases Epidemiology, London School of Hygiene and Tropical Medicine, WC1E 7HT London, UK.
| | - Boniface Karia
- Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, PO Box 230-80108, Kilifi, Kenya.
| | - Alex Mutuku
- Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, PO Box 230-80108, Kilifi, Kenya
| | - Tahreni Bwanaali
- Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, PO Box 230-80108, Kilifi, Kenya
| | - Anne Makumi
- Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, PO Box 230-80108, Kilifi, Kenya
| | - Jackline Wafula
- Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, PO Box 230-80108, Kilifi, Kenya.
| | - Martina Chome
- Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, PO Box 230-80108, Kilifi, Kenya.
| | - Pauline Mwatsuma
- Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, PO Box 230-80108, Kilifi, Kenya
| | - Evasius Bauni
- Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, PO Box 230-80108, Kilifi, Kenya
| | - Laura L Hammitt
- Centre for International Health, Johns Hopkins University, Baltimore, MD, United States.
| | - Christine Mataza
- County Department of Health, Kilifi County Hospital, PO Box 491-80108, Kilifi, Kenya.
| | - Collins Tabu
- National Vaccines and Immunisations Programme, Ministry of Health, Kenya
| | - Tatu Kamau
- Vector Borne Diseases Control Unit, Ministry of Health, Kenya
| | - Thomas N Williams
- Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, PO Box 230-80108, Kilifi, Kenya; Department of Medicine, Imperial College, St Mary's Hospital, Praed Street, London, United Kingdom; INDEPTH Network, Accra, Ghana.
| | - J Anthony G Scott
- Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, PO Box 230-80108, Kilifi, Kenya; Infectious Diseases Epidemiology, London School of Hygiene and Tropical Medicine, WC1E 7HT London, UK; INDEPTH Network, Accra, Ghana.
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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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Wagenaar BH, Augusto O, Beste J, Toomay SJ, Wickett E, Dunbar N, Bawo L, Wesseh CS. The 2014-2015 Ebola virus disease outbreak and primary healthcare delivery in Liberia: Time-series analyses for 2010-2016. PLoS Med 2018; 15:e1002508. [PMID: 29462138 PMCID: PMC5819774 DOI: 10.1371/journal.pmed.1002508] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 01/16/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The aim of this study is to estimate the immediate and lasting effects of the 2014-2015 Ebola virus disease (EVD) outbreak on public-sector primary healthcare delivery in Liberia using 7 years of comprehensive routine health information system data. METHODS AND FINDINGS We analyzed 10 key primary healthcare indicators before, during, and after the EVD outbreak using 31,836 facility-month service outputs from 1 January 2010 to 31 December 2016 across a census of 379 public-sector health facilities in Liberia (excluding Montserrado County). All indicators had statistically significant decreases during the first 4 months of the EVD outbreak, with all indicators having their lowest raw mean outputs in August 2014. Decreases in outputs comparing the end of the initial EVD period (September 2014) to May 2014 (pre-EVD) ranged in magnitude from a 67.3% decrease in measles vaccinations (95% CI: -77.9%, -56.8%, p < 0.001) and a 61.4% decrease in artemisinin-based combination therapy (ACT) treatments for malaria (95% CI: -69.0%, -53.8%, p < 0.001) to a 35.2% decrease in first antenatal care (ANC) visits (95% CI: -45.8%, -24.7%, p < 0.001) and a 38.5% decrease in medroxyprogesterone acetate doses (95% CI: -47.6%, -29.5%, p < 0.001). Following the nadir of system outputs in August 2014, all indicators showed statistically significant increases from October 2014 to December 2014. All indicators had significant positive trends during the post-EVD period, with every system output exceeding pre-Ebola forecasted trends for 3 consecutive months by November 2016. Health system outputs lost during and after the EVD outbreak were large and sustained for most indicators. Prior to exceeding pre-EVD forecasted trends for 3 months, we estimate statistically significant cumulative losses of -776,110 clinic visits (95% CI: -1,480,896, -101,357, p = 0.030); -24,449 bacille Calmette-Guérin vaccinations (95% CI: -45,947, -2,020, p = 0.032); -9,129 measles vaccinations (95% CI: -12,312, -5,659, p < 0.001); -17,191 postnatal care (PNC) visits within 6 weeks of birth (95% CI: -28,344, -5,775, p = 0.002); and -101,857 ACT malaria treatments (95% CI: -205,839, -2,139, p = 0.044) due to the EVD outbreak. Other outputs showed statistically significant cumulative losses only through December 2014, including losses of -12,941 first pentavalent vaccinations (95% CI: -20,309, -5,527, p = 0.002); -5,122 institutional births (95% CI: -8,767, -1,234, p = 0.003); and -45,024 acute respiratory infections treated (95% CI: -66,185, -24,019, p < 0.001). Compared to pre-EVD forecasted trends, medroxyprogesterone acetate doses and first ANC visits did not show statistically significant net losses. ACT treatment for malaria was the only indicator with an estimated net increase in system outputs through December 2016, showing an excess of +78,583 outputs (95% CI: -309,417, +450,661, p = 0.634) compared to pre-EVD forecasted trends, although this increase was not statistically significant. However, comparing December 2013 to December 2017, ACT malaria cases have increased 49.2% (95% CI: 33.9%, 64.5%, p < 0.001). Compared to pre-EVD forecasted trends, there remains a statistically significant loss of -15,144 PNC visits within 6 weeks (95% CI: -29,453, -787, p = 0.040) through December 2016. CONCLUSIONS The Liberian public-sector primary healthcare system has made strides towards recovery from the 2014-2015 EVD outbreak. All primary healthcare indicators tracked have recovered to pre-EVD levels as of November 2016. Yet, for most indicators, it took more than 1 year to recover to pre-EVD levels. During this time, large losses of essential primary healthcare services occurred compared to what would have been expected had the EVD outbreak not occurred. The disruption of malaria case management during the EVD outbreak may have resulted in increased malaria cases. Large and sustained investments in public-sector primary care health system strengthening are urgently needed for EVD-affected countries.
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Affiliation(s)
- Bradley H. Wagenaar
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Partners in Health, Monrovia, Liberia
- Health Alliance International, Seattle, Washington, United States of America
- * E-mail:
| | - Orvalho Augusto
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Health Alliance International, Seattle, Washington, United States of America
- Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Jason Beste
- Partners in Health, Monrovia, Liberia
- Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
| | | | | | | | - Luke Bawo
- Ministry of Health, Monrovia, Liberia
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Poscia A, Ferro S, Tribuzi L, Spadea A. [Audit as a tool to improve the efficiency of the immunization services: the experience of a Local Health Authority in Rome]. Ig Sanita Pubbl 2017; 73:507-521. [PMID: 29433136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION The Italian Ministry of Health has launched an alert about the reduction in vaccine coverage (VC), which decreased below 95% since 2014 for many paediatric vaccines, oppositely from the National Prevention Plan 2014-18 and the National Immunization Plan 2017-2019. Even though the growing vaccine hesitancy attracts the attention of the media in the last few years, the organization of an easily accessible and efficient supply network remains a crucial imperative for ensuring satisfactory and uniform vaccine coverage. Taking into consideration some critical issues identified within the vaccination centres of the Local Health Authority (ASL) RM/A, the local health management decided to improve the VC in deep collaboration with all the health professionals. The amelioration process includes the following actions: verifying the current situation, analysing the main concerns, evaluating the possible solution, and activating those already deemed feasible. This paper aims to describe in details the methodology used in the audit and to present the results and actions undertaken following this amelioration process. METHODS In the ASL RM/A, which counts 550.000 inhabitants, all the 5 vaccination centres started from 2014 to carry out at least one 30-hour audit each year in order to improve VC. The audits are structured according to the four steps defined by the Ministry of Health to address systematically the critical points identified, by implementing the improvement actions proposed by the audit team to the health management. The audits, accredited under the ECM for the medical and nursing personnel, started in February 2014 and the last edition of the program was completed in December 2016. RESULTS During 20 meetings the audit "Centri Vaccinali" involved 11 professionals from 5 vaccine centres, who acknowledged being highly satisfied with the audit, which has been recognized as a valuable tool for improving their work. Following the activities performed in the VC improvement programme, throughout the 3-years period an in-depth review of the most relevant procedures implemented daily by the involved experts was conducted. Moreover, the share of goals and deadlines among the various professionals has leaded to a positive and fruitful collaboration of all experts working in the vaccination centres. This was achieved without creating an additional burden deriving from the improvement process activities. The analysis conducted after two years from the start of the programme has shown not just a significant improvement in vaccine coverage, but also an important increase in the number of vaccine sessions and in the total number of administered vaccines. CONCLUSIONS Throughout the described process of improvement, the collaboration among health care professionals was significantly improved and immunization strategies were identified and shared among the centres. The audit demonstrated to be an effective methodology for facilitating the accessibility and usage of vaccination centres by the citizen/user as well as by the healthcare providers. It showed a quick and significant improvement that, by promoting accountability and transparency, will ensure greater efficacy and safety of vaccine services.
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Affiliation(s)
- Andrea Poscia
- Istituto di Sanità Pubblica - Sezione di Igiene, Università Cattolica del Sacro Cuore di Roma, Italia
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Estimation of the epidemiological impact of sub-optimal vaccination coverage in France. Bull Acad Natl Med 2016; 200:219-31. [PMID: 29898318] [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: 06/08/2023]
Abstract
Vaccination coverage is insuficient for many vaccines in France. We estimated from available epidemiological data, the number of cases, deaths or hospitalizations that occur- red while they could have been avoided by achieving the expected coverage levels. Non prevented mortality is especially important for influenza. However, fulminant hepatitis B and deaths due to pertussis or bacterial invasive diseases also occur each year in subjects which should have been protected by vaccination. The measles epidemic that occurred in France between 2008 and 2012 and caused a large number of severe forms, also reflects the negative consequences of insufficient levels of immunization coverage.
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