Influenza Vaccination Coverage Among School Employees: Assessing Knowledge, Attitudes, and Behaviors

PubMed Central

de Perio, Marie A.; Wiegand, Douglas M.; Brueck, Scott E.

2015-01-01

BACKGROUND Influenza can spread among students, teachers, and staff in school settings. Vaccination is the most effective method to prevent influenza. We determined 2012–2013 influenza vaccination coverage among school employees, assessed knowledge and attitudes regarding the vaccine, and determined factors associated with vaccine receipt. METHODS We surveyed 412 (49%) of 841 employees at 1 suburban Ohio school district in March 2013. The Web-based survey assessed personal and work characteristics, vaccine receipt, and knowledge and attitudes regarding the vaccine. RESULTS Overall, 238 (58%) respondents reported getting the 2012–2013 influenza vaccine. The most common reason for getting the vaccine was to protect oneself or one’s family (87%). Beliefs that the vaccine was not needed (32%) or that it was not effective (21%) were the most common reasons for not getting it. Factors independently associated with vaccine receipt were having positive attitudes toward the vaccine, feeling external pressure to get it, and feeling personal control over whether to get it. CONCLUSIONS Influenza vaccine coverage among school employees should be improved. Messages encouraging school employees to get the vaccine should address misconceptions about the vaccine. Employers should use methods to maximize employee vaccination as part of a comprehensive influenza prevention program. PMID:25117893

Estimation of measles vaccination coverage using the Lot Quality Assurance Sampling (LQAS) method--Tamilnadu, India, 2002-2003.

PubMed

Sivasankaran, Saravanan; Manickam, P; Ramakrishnan, R; Hutin, Y; Gupte, M D

2006-04-28

As part of the global strategic plan to reduce the number of measles deaths in India, the state of Tamilnadu aims at > or =95% measles vaccination coverage. A study was conducted to measure overall coverage levels for the Poondi Primary Health Center (PPHC), a rural health-care facility in Tiruvallur District, and to determine whether any of the PPHC's six health subcenters had coverage levels <95%. The Lot Quality Assurance Sampling (LQAS) method was used to identify health subcenters in the PPHC area with measles vaccination coverage levels <95% among children aged 12-23 months. Lemeshow and Taber sampling plans were used to determine that the measles vaccination status of 73 children aged 12--23 months had to be assessed in each health subcenter coverage area, with a 5% level of significance and a decision value of two. If more than two children were unvaccinated, the null hypothesis (i.e., that coverage in the health subcenter was low [<95%]) was not rejected. If the number of unvaccinated children was two or fewer, the null hypothesis was rejected, and coverage in the subcenter was considered to be good (i.e., > or =95%). All data were pooled in a stratified sample to estimate overall total coverage in the PPHC area. For two (33.3%) of the six health subcenters, more than two children were unvaccinated (i.e., coverage was <95%). Combining results from all six health subcenters generated a coverage estimate of 97.7% (95% confidence interval = 95.7-98.8) on the basis of 428 (97.7%) of 438 children identified as vaccinated. LQAS techniques proved useful in identifying small health areas with lower vaccination coverage, which helps to target interventions. Monthly review of vaccination coverage by subcenter and village is recommended to identify pockets of unvaccinated children and to maintain uniform high coverage in the PPHC area.

A New Method for Estimating the Coverage of Mass Vaccination Campaigns Against Poliomyelitis From Surveillance Data

PubMed Central

O'Reilly, K. M.; Cori, A.; Durry, E.; Wadood, M. Z.; Bosan, A.; Aylward, R. B.; Grassly, N. C.

2015-01-01

Mass vaccination campaigns with the oral poliovirus vaccine targeting children aged <5 years are a critical component of the global poliomyelitis eradication effort. Monitoring the coverage of these campaigns is essential to allow corrective action, but current approaches are limited by their cross-sectional nature, nonrandom sampling, reporting biases, and accessibility issues. We describe a new Bayesian framework using data augmentation and Markov chain Monte Carlo methods to estimate variation in vaccination coverage from children's vaccination histories investigated during surveillance for acute flaccid paralysis. We tested the method using simulated data with at least 200 cases and were able to detect undervaccinated groups if they exceeded 10% of all children and temporal changes in coverage of ±10% with greater than 90% sensitivity. Application of the method to data from Pakistan for 2010–2011 identified undervaccinated groups within the Balochistan/Federally Administered Tribal Areas and Khyber Pakhtunkhwa regions, as well as temporal changes in coverage. The sizes of these groups are consistent with the multiple challenges faced by the program in these regions as a result of conflict and insecurity. Application of this new method to routinely collected data can be a useful tool for identifying poorly performing areas and assisting in eradication efforts. PMID:26568569

Measuring coverage in MNCH: design, implementation, and interpretation challenges associated with tracking vaccination coverage using household surveys.

PubMed

Cutts, Felicity T; Izurieta, Hector S; Rhoda, Dale A

2013-01-01

Vaccination coverage is an important public health indicator that is measured using administrative reports and/or surveys. The measurement of vaccination coverage in low- and middle-income countries using surveys is susceptible to numerous challenges. These challenges include selection bias and information bias, which cannot be solved by increasing the sample size, and the precision of the coverage estimate, which is determined by the survey sample size and sampling method. Selection bias can result from an inaccurate sampling frame or inappropriate field procedures and, since populations likely to be missed in a vaccination coverage survey are also likely to be missed by vaccination teams, most often inflates coverage estimates. Importantly, the large multi-purpose household surveys that are often used to measure vaccination coverage have invested substantial effort to reduce selection bias. Information bias occurs when a child's vaccination status is misclassified due to mistakes on his or her vaccination record, in data transcription, in the way survey questions are presented, or in the guardian's recall of vaccination for children without a written record. There has been substantial reliance on the guardian's recall in recent surveys, and, worryingly, information bias may become more likely in the future as immunization schedules become more complex and variable. Finally, some surveys assess immunity directly using serological assays. Sero-surveys are important for assessing public health risk, but currently are unable to validate coverage estimates directly. To improve vaccination coverage estimates based on surveys, we recommend that recording tools and practices should be improved and that surveys should incorporate best practices for design, implementation, and analysis.

Estimation of Nationwide Vaccination Coverage and Comparison of Interview and Telephone Survey Methodology for Estimating Vaccination Status

PubMed Central

Park, Boyoung; Lee, Yeon-Kyeng; Cho, Lisa Y.; Go, Un Yeong; Yang, Jae Jeong; Ma, Seung Hyun; Choi, Bo-Youl; Lee, Moo-Sik; Lee, Jin-Seok; Choi, Eun Hwa; Lee, Hoan Jong

2011-01-01

This study compared interview and telephone surveys to select the better method for regularly estimating nationwide vaccination coverage rates in Korea. Interview surveys using multi-stage cluster sampling and telephone surveys using stratified random sampling were conducted. Nationwide coverage rates were estimated in subjects with vaccination cards in the interview survey. The interview survey relative to the telephone survey showed a higher response rate, lower missing rate, higher validity and a less difference in vaccination coverage rates between card owners and non-owners. Primary vaccination coverage rate was greater than 90% except for the fourth dose of DTaP (diphtheria/tetanus/pertussis), the third dose of polio, and the third dose of Japanese B encephalitis (JBE). The DTaP4: Polio3: MMR1 fully vaccination rate was 62.0% and BCG1:HepB3:DTaP4:Polio3:MMR1 was 59.5%. For age-appropriate vaccination, the coverage rate was 50%-80%. We concluded that the interview survey was better than the telephone survey. These results can be applied to countries with incomplete registry and decreasing rates of landline telephone coverage due to increased cell phone usage and countries. Among mandatory vaccines, efforts to increase vaccination rate for the fourth dose of DTaP, the third dose of polio, JBE and regular vaccinations at recommended periods should be conducted in Korea. PMID:21655054

Hitting the Optimal Vaccination Percentage and the Risks of Error: Why to Miss Right.

PubMed

Harvey, Michael J; Prosser, Lisa A; Messonnier, Mark L; Hutton, David W

2016-01-01

To determine the optimal level of vaccination coverage defined as the level that minimizes total costs and explore how economic results change with marginal changes to this level of coverage. A susceptible-infected-recovered-vaccinated model designed to represent theoretical infectious diseases was created to simulate disease spread. Parameter inputs were defined to include ranges that could represent a variety of possible vaccine-preventable conditions. Costs included vaccine costs and disease costs. Health benefits were quantified as monetized quality adjusted life years lost from disease. Primary outcomes were the number of infected people and the total costs of vaccination. Optimization methods were used to determine population vaccination coverage that achieved a minimum cost given disease and vaccine characteristics. Sensitivity analyses explored the effects of changes in reproductive rates, costs and vaccine efficacies on primary outcomes. Further analysis examined the additional cost incurred if the optimal coverage levels were not achieved. Results indicate that the relationship between vaccine and disease cost is the main driver of the optimal vaccination level. Under a wide range of assumptions, vaccination beyond the optimal level is less expensive compared to vaccination below the optimal level. This observation did not hold when the cost of the vaccine cost becomes approximately equal to the cost of disease. These results suggest that vaccination below the optimal level of coverage is more costly than vaccinating beyond the optimal level. This work helps provide information for assessing the impact of changes in vaccination coverage at a societal level.

Health workers' attitudes, perceptions and knowledge of influenza immunization in Lima, Peru: A mixed methods study.

PubMed

Bazán, Magdalena; Villacorta, Erika; Barbagelatta, Gisella; Jimenez, M Michelle; Goya, Cecilia; Bartolini, Rosario M; Penny, Mary E

2017-05-19

Vaccination against seasonal influenza in health workers is recommended but coverage is variable. This study aimed to determine coverage of influenza vaccination among health workers in Lima, Peru in 2010; explore barriers and enabling elements for vaccination; and suggest strategies to improve coverage. Qualitative interviews informed the development of a survey instrument that consisted of open and close-ended questions. Sub-analyses were done by occupational group and results were calculated as percentages for each possible response with confidence intervals of 95%. Coverage of the influenza vaccination was 77.2%. Vaccinated staff were less likely to have permanent contracts (p=0.0150) and vaccination coverage was lower in physicians (p=0.0001). Over 90% cited protection of themselves, families and patients as reasons for vaccination and 48% mentioned peer encouragement. Fear of adverse events (47%) and organizational barriers (>30%) were reasons for non-vaccination. To improve coverage, highest priority was given to strategies providing more information. Key factors in driving health worker vaccination include desire for protection and peer encouragement. Perceptual barriers based on a misunderstanding of the epidemiology of influenza and vaccination could be overcome by targeted education and information. Organizational barriers require attention to how vaccination is implemented within health facilities. Copyright © 2017 Elsevier Ltd. All rights reserved.

Suboptimal MMR2 vaccine coverage in six counties in Norway detected through the national immunisation registry, April 2014 to April 2017

PubMed Central

Hagerup-Jenssen, Maria; Kongsrud, Sigrun; Riise, Øystein Rolandsen

2017-01-01

In 2014, Norway became aware of potential low vaccination coverage for the second dose of measles-mumps-rubella vaccine (MMR2) in six of 19 counties. This was detected by comparing the national coverage (NC) for 16-year-olds extracted from the national immunisation registry SYSVAK with the annual status update for elimination of measles and rubella (ASU) reported to the World Health Organization (WHO). The existing method for calculating NC in 2014 did not show MMR2 coverage. ASU reporting on MMR2 was significantly lower then the NC and below the WHO-recommended 95% coverage. SYSVAK is based on the Norwegian personal identification numbers, which allows monitoring of vaccinations at aggregateded as well as individual level. It is an important tool for active surveillance of the performance of the Norwegian Childhood Immunisation Programme (NCIP). The method for calculating NC was improved in 2015 to reflect MMR2 coverage for 16-year-olds. As a result, Norway has improved its real-time surveillance and monitoring of the actual MMR2 coverage also through SYSVAK (the annual publication of NC). Vaccinators receive feedback for follow-up if 15-year-olds are missing MMR2. In 2017, only three counties had an MMR2 coverage below 90%. PMID:28489000

Crude childhood vaccination coverage in West Africa: Trends and predictors of completeness.

PubMed

Kazungu, Jacob S; Adetifa, Ifedayo M O

2017-02-15

Background : Africa has the lowest childhood vaccination coverage worldwide. If the full benefits of childhood vaccination programmes are to be enjoyed in sub-Saharan Africa, all countries need to improve on vaccine delivery to achieve and sustain high coverage. In this paper, we review trends in vaccination coverage, dropouts between vaccine doses and explored the country-specific predictors of complete vaccination in West Africa.  Methods : We utilized datasets from the Demographic and Health Surveys Program, available for Benin, Burkina Faso, The Gambia, Ghana, Guinea, Cote d'Ivoire, Liberia, Mali, Niger, Nigeria, Senegal, Sierra Leone and Togo, to obtain coverage for Bacillus Calmette-Guerin, polio, measles, and diphtheria, pertussis and tetanus (DPT) vaccines in children aged 12 - 23 months. We also calculated the DPT1-to-DPT3 and DPT1-to-measles dropouts, and proportions of the fully immunised child (FIC). Factors predictive of FIC were explored using Chi-squared tests and multivariable logistic regression.  Results : Overall, there was a trend of increasing vaccination coverage. The proportion of FIC varied significantly by country (range 24.1-81.4%, mean 49%). DPT1-to-DPT3 dropout was high (range 5.1% -33.9%, mean 16.3%). Similarly, DPT1-measles dropout exceeded 10% in all but four countries. Although no single risk factor was consistently associated with FIC across these countries, maternal education, delivery in a health facility, possessing a vaccine card and a recent post delivery visit to a health facility were the key predictors of complete vaccination.  Conclusions : The low numbers of fully immunised children and high dropout between vaccine doses highlights weaknesses and the need to strengthen the healthcare and routine immunization delivery systems in this region. Country-specific correlates of complete vaccination should be explored further to identify interventions required to increase vaccination coverage. Despite the promise of an increasing trend in vaccination coverage in West African countries, more effort is required to attain and maintain global vaccination coverage targets.

Challenges in Estimating Vaccine Coverage in Refugee and Displaced Populations: Results From Household Surveys in Jordan and Lebanon

PubMed Central

Roberton, Timothy; Weiss, William; Doocy, Shannon

2017-01-01

Ensuring the sustained immunization of displaced persons is a key objective in humanitarian emergencies. Typically, humanitarian actors measure coverage of single vaccines following an immunization campaign; few measure routine coverage of all vaccines. We undertook household surveys of Syrian refugees in Jordan and Lebanon, outside of camps, using a mix of random and respondent-driven sampling, to measure coverage of all vaccinations included in the host country’s vaccine schedule. We analyzed the results with a critical eye to data limitations and implications for similar studies. Among households with a child aged 12–23 months, 55.1% of respondents in Jordan and 46.6% in Lebanon were able to produce the child’s EPI card. Only 24.5% of Syrian refugee children in Jordan and 12.5% in Lebanon were fully immunized through routine vaccination services (having received from non-campaign sources: measles, polio 1–3, and DPT 1–3 in Jordan and Lebanon, and BCG in Jordan). Respondents in Jordan (33.5%) and Lebanon (40.1%) reported difficulties obtaining child vaccinations. Our estimated immunization rates were lower than expected and raise serious concerns about gaps in vaccine coverage among Syrian refugees. Although our estimates likely under-represent true coverage, given the additional benefit of campaigns (not captured in our surveys), there is a clear need to increase awareness, accessibility, and uptake of immunization services. Current methods to measure vaccine coverage in refugee and displaced populations have limitations. To better understand health needs in such groups, we need research on: validity of recall methods, links between campaigns and routine immunization programs, and improved sampling of hard-to-reach populations. PMID:28805672

Uptake of oral rotavirus vaccine and timeliness of routine immunization in Brazil’s National Immunization Program

PubMed Central

Flannery, Brendan; Samad, Samia; de Moraes, José Cássio; Tate, Jacqueline E.; Danovaro-Holliday, M. Carolina; de Oliveira, Lúcia Helena; Rainey, Jeanette J.

2015-01-01

Introduction In March, 2006, oral rotavirus vaccine was added to Brazil’s infant immunization schedule with recommended upper age limits for initiating (by age 14 weeks) and completing (by age 24 weeks) the two-dose series to minimize age-specific risk of intussusception following rotavirus vaccination. Several years after introduction, estimated coverage with rotavirus vaccine (83%) was lower compared to coverage for other recommended childhood immunizations (≥94%). Methods We analyzed data from Brazil’s national immunization program on uptake of oral rotavirus vaccine by geographic region and compared administrative coverage estimates for first and second doses of oral rotavirus vaccine (Rota1 and Rota2) with first and second doses of diphtheria-tetanus-pertussis-Haemophilus influenzae type b vaccine (DTP-Hib1 and DTP-Hib2). For 27 Brazilian cities, we compared differences between estimated rotavirus and DTP-Hib coverage in 2010 with delayed receipt of DTP-Hib vaccine among a cohort of children surveyed before rotavirus introduction. Results In 2010, infant vaccination coverage was 99.0% for DTP-Hib1 versus 95.2% for Rota1 (3.8% difference), and 98.4% for DTP-Hib2 versus 83.0% for Rota2 (15.4% difference), with substantial regional variation. Differences between DTP-Hib and rotavirus vaccination coverage in Brazilian cities correlated with delay in DTP-Hib vaccination among children surveyed. Age restrictions for initiating and completing the rotavirus vaccination series likely contributed to lower coverage with rotavirus vaccine in Brazil. Conclusion To maximize benefits of rotavirus vaccination, strategies are needed to improve timeliness of routine immunizations; monitoring rotavirus vaccine uptake and intussusception risk is needed to guide further recommendations for rotavirus vaccination. PMID:23313652

Measuring Coverage in MNCH: Design, Implementation, and Interpretation Challenges Associated with Tracking Vaccination Coverage Using Household Surveys

PubMed Central

Cutts, Felicity T.; Izurieta, Hector S.; Rhoda, Dale A.

2013-01-01

Vaccination coverage is an important public health indicator that is measured using administrative reports and/or surveys. The measurement of vaccination coverage in low- and middle-income countries using surveys is susceptible to numerous challenges. These challenges include selection bias and information bias, which cannot be solved by increasing the sample size, and the precision of the coverage estimate, which is determined by the survey sample size and sampling method. Selection bias can result from an inaccurate sampling frame or inappropriate field procedures and, since populations likely to be missed in a vaccination coverage survey are also likely to be missed by vaccination teams, most often inflates coverage estimates. Importantly, the large multi-purpose household surveys that are often used to measure vaccination coverage have invested substantial effort to reduce selection bias. Information bias occurs when a child's vaccination status is misclassified due to mistakes on his or her vaccination record, in data transcription, in the way survey questions are presented, or in the guardian's recall of vaccination for children without a written record. There has been substantial reliance on the guardian's recall in recent surveys, and, worryingly, information bias may become more likely in the future as immunization schedules become more complex and variable. Finally, some surveys assess immunity directly using serological assays. Sero-surveys are important for assessing public health risk, but currently are unable to validate coverage estimates directly. To improve vaccination coverage estimates based on surveys, we recommend that recording tools and practices should be improved and that surveys should incorporate best practices for design, implementation, and analysis. PMID:23667334

Estimation of child vaccination coverage at state and national levels in India

PubMed Central

Gupta, Satish; Kumar, Rakesh; Haldar, Pradeep; Sethi, Raman; Bahl, Sunil

2016-01-01

Abstract Objective To review the data, for 1999–2013, on state-level child vaccination coverage in India and provide estimates of coverage at state and national levels. Methods We collated data from administrative reports, population-based surveys and other sources and used them to produce annual estimates of vaccination coverage. We investigated bacille Calmette–Guérin vaccine, the first and third doses of vaccine against diphtheria, tetanus and pertussis, the third dose of oral polio vaccine and the first dose of vaccine against measles. We obtained relevant data covering the period 1999–2013 for each of 16 states and territories and the period 2001–2013 for the state of Jharkhand – which was only created in 2000. We aggregated the resultant state-level estimates, using a population-weighted approach, to give national values. Findings For each of the vaccinations we investigated, about half of the 253 estimates of annual coverage at state level that we produced were based on survey results. The rest were based on interpolation between – or extrapolation from – so-called anchor points or, more rarely, on administrative data. Our national estimates indicated that, for each of the vaccines we investigated, coverage gradually increased between 1999 and 2010 but then levelled off. Conclusion The delivery of routine vaccination services to Indian children appears to have improved between 1999 and 2013. There remains considerable scope to improve the recording and reporting of childhood vaccination coverage in India and regular systematic reviews of the coverage data are recommended. PMID:27843162

Coverage of childhood vaccination among children aged 12-23 months, Tamil Nadu, 2015, India

PubMed Central

Murhekar, Manoj V.; Kamaraj, P.; Kanagasabai, K.; Elavarasu, G.; Rajasekar, T. Daniel; Boopathi, K.; Mehendale, Sanjay

2017-01-01

Background & objectives: District-Level Household Survey-4 (DLHS-4) indicated that during 2012-2013, only 56 per cent of children aged 12-23 months in Tamil Nadu were fully vaccinated, which were lesser than those reported in earlier national surveys. We, therefore, conducted cluster surveys to estimate coverage of childhood vaccination in the State, and also to identify the factors associated with low coverage. Methods: Cross-sectional surveys were conducted in 15 strata [municipal corporation non-slum (n=1), municipal corporation slum (n=1), hilly (n=1), rural (n=6) and urban (n=6)]. From each stratum, 30 clusters were selected using probability proportional to the population size linear systematic sampling; seven children aged 12-23 months were selected from each cluster and their mothers/care-takers were interviewed to collect information about vaccination status of the child. A child was considered fully vaccinated if he/she received bacillus Calmette-Guérin (BCG), three doses of pentavalent, three doses of oral polio vaccine and one dose of measles vaccine, and appropriately vaccinated if all vaccine doses were given at right age and with right interval. Further, coverage of fully vaccinated children (FVC) as per vaccination cards or mothers’ recall, validated coverage of FVC (V-FVC) among those having cards, and coverage of appropriately vaccinated children (AVC) were estimated using survey data analysis module with appropriate sampling weights. Results: A total of 3150 children were surveyed, of them 2528 (80.3%) had vaccination card. The weighted coverage of FVC, V-FVC and AVC in the State was 79.9 per cent [95% confidence interval (CI): 78.2-81.5], 78.8 per cent (95% CI: 76.9-80.5) and 69.7 per cent (95% CI: 67.7-71.7), respectively. The coverage of individual vaccine ranged between 84 per cent (measles) and 99.8 per cent (BCG). About 12 per cent V-FVC were not vaccinated as per the vaccination schedule. Interpretation & conclusions: The coverage of FVC in Tamil Nadu was high, with about 80 per cent children completing primary vaccination. Efforts to increase vaccination coverage in the State need to focus on educating vaccinators about the need to adhere to the national vaccination schedule and strengthening supervision to ensure that children are vaccinated appropriately. PMID:28749402

Uptake and timeliness of rotavirus vaccination in Norway: The first year post-introduction.

PubMed

Valcarcel Salamanca, Beatriz; Hagerup-Jenssen, Maria Elisabeth; Flem, Elmira

2016-09-07

To minimise vaccine-associated risk of intussusception following rotavirus vaccination, Norway adopted very strict age limits for initiating and completing the vaccine series at the time rotavirus vaccination was included in the national immunisation programme, October 2014. Although Norway has a high coverage for routine childhood vaccines, these stringent age limits could negatively affect rotavirus coverage. We documented the status and impact of rotavirus vaccination on other infant vaccines during the first year after its introduction. We used individual vaccination data from the national immunisation register to calculate coverage for rotavirus and other vaccines and examine adherence with the recommended schedules. We identified factors associated with completing the full rotavirus series by performing multiple logistic regression analyses. We also evaluated potential changes in uptake and timeliness of other routine vaccines after the introduction of rotavirus vaccine using the Kaplan-Meier method. The national coverage for rotavirus vaccine achieved a year after the introduction was 89% for one dose and 82% for two doses, respectively. Among fully rotavirus-vaccinated children, 98% received both doses within the upper age limit and 90% received both doses according to the recommended schedule. The child's age at the initiation of rotavirus series and being vaccinated with diphtheria, tetanus, pertussis, polio and Haemophilus influenzae type b (DTaP/IPV/Hib) and pneumococcal vaccines were the strongest predictors of completing the full rotavirus series. No major changes in uptake and timeliness of other paediatric vaccines were observed after introduction of rotavirus vaccine. Norway achieved a high national coverage and excellent adherence with the strict age limits for rotavirus vaccine administration during the first year of introduction, indicating robustness of the national immunisation programme. Rotavirus vaccination did not impact coverage or timeliness of other infant vaccines. Copyright © 2016. Published by Elsevier Ltd.

A New Method for Estimating the Coverage of Mass Vaccination Campaigns Against Poliomyelitis From Surveillance Data.

PubMed

O'Reilly, K M; Cori, A; Durry, E; Wadood, M Z; Bosan, A; Aylward, R B; Grassly, N C

2015-12-01

Mass vaccination campaigns with the oral poliovirus vaccine targeting children aged <5 years are a critical component of the global poliomyelitis eradication effort. Monitoring the coverage of these campaigns is essential to allow corrective action, but current approaches are limited by their cross-sectional nature, nonrandom sampling, reporting biases, and accessibility issues. We describe a new Bayesian framework using data augmentation and Markov chain Monte Carlo methods to estimate variation in vaccination coverage from children's vaccination histories investigated during surveillance for acute flaccid paralysis. We tested the method using simulated data with at least 200 cases and were able to detect undervaccinated groups if they exceeded 10% of all children and temporal changes in coverage of ±10% with greater than 90% sensitivity. Application of the method to data from Pakistan for 2010-2011 identified undervaccinated groups within the Balochistan/Federally Administered Tribal Areas and Khyber Pakhtunkhwa regions, as well as temporal changes in coverage. The sizes of these groups are consistent with the multiple challenges faced by the program in these regions as a result of conflict and insecurity. Application of this new method to routinely collected data can be a useful tool for identifying poorly performing areas and assisting in eradication efforts. © The Author 2015. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health.

The varicella vaccination pattern among children under 5 years old in selected areas in China.

PubMed

Yue, Chenyan; Li, Yan; Wang, Yamin; Liu, Yan; Cao, Linsheng; Zhu, Xu; Martin, Kathryn; Wang, Huaqing; An, Zhijie

2017-07-11

Vaccine is the most effective way to protect susceptible children from varicella. Few published literature or reports on varicella vaccination of Chinese children exist. Thus, in order to obtain specific information on varicella vaccination of this population, we conducted this survey. We first used purposive sampling methods to select 6 provinces 10 counties from eastern, middle and western parts of China with high quality of Immunization Information Management System (IIMS), and then randomly select children from population in the IIMS, then we checked vaccination certificate on-site. Based on the varicella vaccination information collected from 481 children's vaccination certificates from all ten selected counties in China, overall coverage of the first dose of varicella vaccine was 73.6%. There is a positive linear correlation between per capita GDP and vaccine coverage at county level (r=0.929, P < 0.01). The cumulative vaccine coverage among children at 1 year, 2 years and ≥3 years old were 67.6%, 71.9% and 73.6% respectively (X2=4.53, P =0.10). The age of vaccination was mainly concentrated in 12-17 months. The coverage rate of the first dose of varicella vaccine in selected areas was lower than that recommended by WHO position paper. The coverage rate was relatively low in areas of low social-economic status. The cumulative coverage had no significant statistical difference among different age group. Most children received varicella vaccine before 3 years old. We suggest introducing the varicella vaccine into routine immunization program, to ensure universal high coverage among children in China. We also suggest that varicella vaccination information should be checked before entering school, in order to control and prevent varicella outbreaks in schools.

Determining the pneumococcal conjugate vaccine coverage required for indirect protection against vaccine-type pneumococcal carriage in low and middle-income countries: a protocol for a prospective observational study.

PubMed

Chan, Jocelyn; Nguyen, Cattram D; Lai, Jana Y R; Dunne, Eileen M; Andrews, Ross; Blyth, Christopher C; Datta, Siddhartha; Fox, Kim; Ford, Rebecca; Hinds, Jason; La Vincente, Sophie; Lehmann, Deborah; Lim, Ruth; Mungun, Tuya; Newton, Paul N; Phetsouvanh, Rattanaphone; Pomat, Willam S; Xeuatvongsa, Anonh; von Mollendorf, Claire; Dance, David A B; Satzke, Catherine; Muholland, Kim; Russell, Fiona M

2018-05-18

Pneumococcal conjugate vaccines (PCVs) prevent disease through both direct protection of vaccinated individuals and indirect protection of unvaccinated individuals by reducing nasopharyngeal (NP) carriage and transmission of vaccine-type (VT) pneumococci. While the indirect effects of PCV vaccination are well described, the PCV coverage required to achieve the indirect effects is unknown. We will investigate the relationship between PCV coverage and VT carriage among undervaccinated children using hospital-based NP pneumococcal carriage surveillance at three sites in Asia and the Pacific. We are recruiting cases, defined as children aged 2-59 months admitted to participating hospitals with acute respiratory infection in Lao People's Democratic Republic, Mongolia and Papua New Guinea. Thirteen-valent PCV status is obtained from written records. NP swabs are collected according to standard methods, screened using lytA qPCR and serotyped by microarray. Village-level vaccination coverage, for the resident communities of the recruited cases, is determined using administrative data or community survey. Our analysis will investigate the relationship between VT carriage among undervaccinated cases (indirect effects) and vaccine coverage using generalised estimating equations. Ethical approval has been obtained from the relevant ethics committees at participating sites. The results are intended for publication in open-access peer-reviewed journals and will demonstrate methods suitable for low- and middle-income countries to monitor vaccine impact and inform vaccine policy makers about the PCV coverage required to achieve indirect protection. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Suboptimal MMR2 vaccine coverage in six counties in Norway detected through the national immunisation registry, April 2014 to April 2017.

PubMed

Hagerup-Jenssen, Maria; Kongsrud, Sigrun; Riise, Øystein Rolandsen

2017-04-27

In 2014, Norway became aware of potential low vaccination coverage for the second dose of measles-mumps-rubella vaccine (MMR2) in six of 19 counties. This was detected by comparing the national coverage (NC) for 16-year-olds extracted from the national immunisation registry SYSVAK with the annual status update for elimination of measles and rubella (ASU) reported to the World Health Organization (WHO). The existing method for calculating NC in 2014 did not show MMR2 coverage. ASU reporting on MMR2 was significantly lower then the NC and below the WHO-recommended 95% coverage. SYSVAK is based on the Norwegian personal identification numbers, which allows monitoring of vaccinations at aggregateded as well as individual level. It is an important tool for active surveillance of the performance of the Norwegian Childhood Immunisation Programme (NCIP). The method for calculating NC was improved in 2015 to reflect MMR2 coverage for 16-year-olds. As a result, Norway has improved its real-time surveillance and monitoring of the actual MMR2 coverage also through SYSVAK (the annual publication of NC). Vaccinators receive feedback for follow-up if 15-year-olds are missing MMR2. In 2017, only three counties had an MMR2 coverage below 90%. This article is copyright of The Authors, 2017.

Mapping information exposure on social media to explain differences in HPV vaccine coverage in the United States.

PubMed

Dunn, Adam G; Surian, Didi; Leask, Julie; Dey, Aditi; Mandl, Kenneth D; Coiera, Enrico

2017-05-25

Together with access, acceptance of vaccines affects human papillomavirus (HPV) vaccine coverage, yet little is known about media's role. Our aim was to determine whether measures of information exposure derived from Twitter could be used to explain differences in coverage in the United States. We conducted an analysis of exposure to information about HPV vaccines on Twitter, derived from 273.8 million exposures to 258,418 tweets posted between 1 October 2013 and 30 October 2015. Tweets were classified by topic using machine learning methods. Proportional exposure to each topic was used to construct multivariable models for predicting state-level HPV vaccine coverage, and compared to multivariable models constructed using socioeconomic factors: poverty, education, and insurance. Outcome measures included correlations between coverage and the individual topics and socioeconomic factors; and differences in the predictive performance of the multivariable models. Topics corresponding to media controversies were most closely correlated with coverage (both positively and negatively); education and insurance were highest among socioeconomic indicators. Measures of information exposure explained 68% of the variance in one dose 2015 HPV vaccine coverage in females (males: 63%). In comparison, models based on socioeconomic factors explained 42% of the variance in females (males: 40%). Measures of information exposure derived from Twitter explained differences in coverage that were not explained by socioeconomic factors. Vaccine coverage was lower in states where safety concerns, misinformation, and conspiracies made up higher proportions of exposures, suggesting that negative representations of vaccines in the media may reflect or influence vaccine acceptance. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Methods used for immunization coverage assessment in Canada, a Canadian Immunization Research Network (CIRN) study.

PubMed

Wilson, Sarah E; Quach, Susan; MacDonald, Shannon E; Naus, Monika; Deeks, Shelley L; Crowcroft, Natasha S; Mahmud, Salaheddin M; Tran, Dat; Kwong, Jeff; Tu, Karen; Gilbert, Nicolas L; Johnson, Caitlin; Desai, Shalini

2017-08-03

Accurate and complete immunization data are necessary to assess vaccine coverage, safety and effectiveness. Across Canada, different methods and data sources are used to assess vaccine coverage, but these have not been systematically described. Our primary objective was to examine and describe the methods used to determine immunization coverage in Canada. The secondary objective was to compare routine infant and childhood coverage estimates derived from the Canadian 2013 Childhood National Immunization Coverage Survey (cNICS) with estimates collected from provinces and territories (P/Ts). We collected information from key informants regarding their provincial, territorial or federal methods for assessing immunization coverage. We also collected P/T coverage estimates for select antigens and birth cohorts to determine absolute differences between these and estimates from cNICS. Twenty-six individuals across 16 public health organizations participated between April and August 2015. Coverage surveys are conducted regularly for toddlers in Quebec and in one health authority in British Columbia. Across P/Ts, different methodologies for measuring coverage are used (e.g., valid doses, grace periods). Most P/Ts, except Ontario, measure up-to-date (UTD) coverage and 4 P/Ts also assess on-time coverage. The degree of concordance between P/T and cNICS coverage estimates varied by jurisdiction, antigen and age group. In addition to differences in the data sources and processes used for coverage assessment, there are also differences between Canadian P/Ts in the methods used for calculating immunization coverage. Comparisons between P/T and cNICS estimates leave remaining questions about the proportion of children fully vaccinated in Canada.

Methods used for immunization coverage assessment in Canada, a Canadian Immunization Research Network (CIRN) study

PubMed Central

Quach, Susan; MacDonald, Shannon E.; Naus, Monika; Deeks, Shelley L.; Crowcroft, Natasha S.; Mahmud, Salaheddin M.; Tran, Dat; Kwong, Jeff; Tu, Karen; Johnson, Caitlin; Desai, Shalini

2017-01-01

ABSTRACT Accurate and complete immunization data are necessary to assess vaccine coverage, safety and effectiveness. Across Canada, different methods and data sources are used to assess vaccine coverage, but these have not been systematically described. Our primary objective was to examine and describe the methods used to determine immunization coverage in Canada. The secondary objective was to compare routine infant and childhood coverage estimates derived from the Canadian 2013 Childhood National Immunization Coverage Survey (cNICS) with estimates collected from provinces and territories (P/Ts). We collected information from key informants regarding their provincial, territorial or federal methods for assessing immunization coverage. We also collected P/T coverage estimates for select antigens and birth cohorts to determine absolute differences between these and estimates from cNICS. Twenty-six individuals across 16 public health organizations participated between April and August 2015. Coverage surveys are conducted regularly for toddlers in Quebec and in one health authority in British Columbia. Across P/Ts, different methodologies for measuring coverage are used (e.g., valid doses, grace periods). Most P/Ts, except Ontario, measure up-to-date (UTD) coverage and 4 P/Ts also assess on-time coverage. The degree of concordance between P/T and cNICS coverage estimates varied by jurisdiction, antigen and age group. In addition to differences in the data sources and processes used for coverage assessment, there are also differences between Canadian P/Ts in the methods used for calculating immunization coverage. Comparisons between P/T and cNICS estimates leave remaining questions about the proportion of children fully vaccinated in Canada. PMID:28708945

Annual changes in rotavirus hospitalization rates before and after rotavirus vaccine implementation in the United States

PubMed Central

Dahl, Rebecca M.; Parashar, Umesh D.; Lopman, Benjamin A.

2018-01-01

Background Hospitalizations for rotavirus and acute gastroenteritis (AGE) have declined in the US with rotavirus vaccination, though biennial peaks in incidence in children aged less than 5 years occur. This pattern may be explained by lower rotavirus vaccination coverage in US children (59% to 73% from 2010–2015), resulting in accumulation of susceptible children over two successive birth cohorts. Methods Retrospective cohort analysis of claims data of commercially insured US children aged <5 years. Age-stratified hospitalization rates for rotavirus and for AGE from the 2002–2015 rotavirus seasons were examined. Median age and rotavirus vaccination coverage for biennial rotavirus seasons during pre-vaccine (2002–2005), early post-vaccine (2008–2011) and late post-vaccine (2012–2015) years. Results Age-stratified hospitalization rates decreased from pre-vaccine to early post-vaccine and then to late post-vaccine years. The clearest biennial pattern in hospitalization rates is the early post-vaccine period, with higher rates in 2009 and 2011 than in 2008 and 2010. The pattern diminishes in the late post-vaccine period. For rotavirus hospitalizations, the median age and the difference in age between biennial seasons was highest during the early post-vaccine period; these differences were not observed for AGE hospitalizations. There was no significant difference in vaccination coverage between biennial seasons. Conclusions These observations provide conflicting evidence that incomplete vaccine coverage drove the biennial pattern in rotavirus hospitalizations that has emerged with rotavirus vaccination in the US. As this pattern is diminishing with higher vaccine coverage in recent years, further increases in vaccine coverage may reach a threshold that eliminates peak seasons in hospitalizations. PMID:29444124

Seasonal influenza vaccine coverage among high-risk populations in Thailand, 2010–2012

PubMed Central

Owusu, Jocelynn T.; Prapasiri, Prabda; Ditsungnoen, Darunee; Leetongin, Grit; Yoocharoen, Pornsak; Rattanayot, Jarowee; Olsen, Sonja J.; Muangchana, Charung

2015-01-01

Background The Advisory Committee on Immunization Practice of Thailand prioritizes seasonal influenza vaccinations for populations who are at highest risk for serious complications (pregnant women, children 6 months–2 years, persons ≥65 years, persons with chronic diseases, obese persons), and health-care personnel and poultry cullers. The Thailand government purchases seasonal influenza vaccine for these groups. We assessed vaccination coverage among high-risk groups in Thailand from 2010 to 2012. Methods National records on persons who received publicly purchased vaccines from 2010 to 2012 were analyzed by high-risk category. Denominator data from multiple sources were compared to calculate coverage. Vaccine coverage was defined as the proportion of individuals in each category who received the vaccine. Vaccine wastage was defined as the proportion of publicly purchased vaccines that were not used. Results From 2010 to 2012, 8.18 million influenza vaccines were publicly purchased (range, 2.37–3.29 million doses/year), and vaccine purchases increased 39% over these years. Vaccine wastage was 9.5%. Approximately 5.7 million (77%) vaccine doses were administered to persons ≥65 years and persons with chronic diseases, 1.4 million (19%) to healthcare personnel/poultry cullers, 82,570 (1.1%) to children 6 months–2 years, 78,885 (1.1%) to obese persons, 26,481 (0.4%) to mentally disabled persons, and 17,787 (0.2%) to pregnant women. Between 2010 and 2012, coverage increased among persons with chronic diseases (8.6% versus 14%; p < 0.01) and persons ≥65 years (12%, versus 20%; p < 0.01); however, coverage decreased for mentally disabled persons (6.1% versus 4.9%; p < 0.01), children 6 months–2 years (2.3% versus 0.9%; p < 0.01), pregnant women (1.1% versus 0.9%; p < 0.01), and obese persons (0.2% versus 0.1%; p < 0.01). Conclusions From 2010 to 2012, the availability of publicly purchased vaccines increased. While coverage remained low for all target groups, coverage was highest among persons ≥65 years and persons with chronic diseases. Annual coverage assessments are necessary to promote higher coverage among high-risk groups in Thailand. PMID:25454853

Defining epitope coverage requirements for T cell-based HIV vaccines: Theoretical considerations and practical applications

PubMed Central

2011-01-01

Background HIV vaccine development must address the genetic diversity and plasticity of the virus that permits the presentation of diverse genetic forms to the immune system and subsequent escape from immune pressure. Assessment of potential HIV strain coverage by candidate T cell-based vaccines (whether natural sequence or computationally optimized products) is now a critical component in interpreting candidate vaccine suitability. Methods We have utilized an N-mer identity algorithm to represent T cell epitopes and explore potential coverage of the global HIV pandemic using natural sequences derived from candidate HIV vaccines. Breadth (the number of T cell epitopes generated) and depth (the variant coverage within a T cell epitope) analyses have been incorporated into the model to explore vaccine coverage requirements in terms of the number of discrete T cell epitopes generated. Results We show that when multiple epitope generation by a vaccine product is considered a far more nuanced appraisal of the potential HIV strain coverage of the vaccine product emerges. By considering epitope breadth and depth several important observations were made: (1) epitope breadth requirements to reach particular levels of vaccine coverage, even for natural sequence-based vaccine products is not necessarily an intractable problem for the immune system; (2) increasing the valency (number of T cell epitope variants present) of vaccine products dramatically decreases the epitope requirements to reach particular coverage levels for any epidemic; (3) considering multiple-hit models (more than one exact epitope match with an incoming HIV strain) places a significantly higher requirement upon epitope breadth in order to reach a given level of coverage, to the point where low valency natural sequence based products would not practically be able to generate sufficient epitopes. Conclusions When HIV vaccine sequences are compared against datasets of potential incoming viruses important metrics such as the minimum epitope count required to reach a desired level of coverage can be easily calculated. We propose that such analyses can be applied early in the planning stages and during the execution phase of a vaccine trial to explore theoretical and empirical suitability of a vaccine product to a particular epidemic setting. PMID:22152192

Coverage with Tetanus, Diphtheria, and Acellular Pertussis Vaccine and Influenza Vaccine Among Pregnant Women - Minnesota, March 2013-December 2014.

PubMed

Barber, Alexandra; Muscoplat, Miriam Halstead; Fedorowicz, Anna

2017-01-20

Pertussis and influenza infections can result in severe disease in infants. The diphtheria, tetanus, acellular pertussis (DTaP) vaccine is recommended for infants beginning at age 2 months, and influenza vaccine is recommended for infants aged ≥6 months. Vaccination of pregnant women induces the production of antibodies that are transferred across the placenta to the fetus and provide passive protection until infants are old enough to receive DTaP and influenza vaccines (1-3). To protect young infants before they are age-eligible for vaccination, the Advisory Committee on Immunization Practices (ACIP) has recommended since 2004 that all women who are or will be pregnant during influenza season receive inactivated influenza vaccine (1), and since 2013 that all pregnant women receive the tetanus, diphtheria, acellular pertussis (Tdap) vaccine (3). Tdap and influenza vaccination coverage was assessed among pregnant women in Minnesota. Vital records data containing maternal demographic characteristics, prenatal care data, and delivery payment methods were matched with vaccination data from the Minnesota Immunization Information Connection (MIIC) to assess vaccination coverage. MIIC stores vaccination records for Minnesota residents. Overall, coverage with Tdap vaccine was 58.2% and with influenza vaccine was 45.9%. Coverage was higher for each vaccine among women who received adequate prenatal care compared with those who received inadequate or intermediate care, based on the initiation of prenatal care and the number of recommended prenatal visits attended. Coverage also varied based on mother's race, country of birth or region, and other demographic characteristics. Further study is needed to better understand the maternal vaccination disparities found in this study and to inform future public health initiatives.

Low coverage of central point vaccination against dog rabies in Bamako, Mali.

PubMed

Muthiani, Yvonne; Traoré, Abdallah; Mauti, Stephanie; Zinsstag, Jakob; Hattendorf, Jan

2015-06-15

Canine rabies remains an important public-health problem in Africa. Dog mass vaccination is the recommended method for rabies control and elimination. We report on the first small-scale mass dog vaccination campaign trial in Bamako, Mali. Our objective was to estimate coverage of the vaccination campaign and to quantify determinants of intervention effectiveness. In September 2013, a central point vaccination campaign--free of cost for dog owners--was carried out in 17 posts on three consecutive days within Bamako's Commune 1. Vaccination coverage and the proportion of ownerless dogs were estimated by combining mark-recapture household and transect surveys using Bayesian modeling. The estimated vaccination coverage was 17.6% (95% Credibility Interval, CI: 14.4-22.1%) which is far below the World Health Organization (WHO) recommended vaccination coverage of 70%. The Bayesian estimate for the owned dog population of Commune 1 was 3459 dogs (95% CI: 2786-4131) and the proportion of ownerless dogs was about 8%. The low coverage observed is primarily attributed to low participation by dog owners. Dog owners reported several reasons for not bringing their dogs to the vaccination posts. The most frequently reported reasons for non-attendance were lack of information (25%) and the inability to handle the dog (16%). For 37% of respondents, no clear reason was given for non-vaccination. Despite low coverage, the vaccination campaign in Bamako was relatively easy to implement, both in terms of logistics and organization. Almost half of the participating dog owners brought their pets on the first day of the campaign. Participatory stakeholder processes involving communities and local authorities are needed to identify effective communication channels and locally adapted vaccination strategies, which could include both central-point and door-to-door vaccination. Copyright © 2015 Elsevier B.V. All rights reserved.

Yellow fever vaccination coverage following massive emergency immunization campaigns in rural Uganda, May 2011: a community cluster survey

PubMed Central

2013-01-01

Background Following an outbreak of yellow fever in northern Uganda in December 2010, Ministry of Health conducted a massive emergency vaccination campaign in January 2011. The reported vaccination coverage in Pader District was 75.9%. Administrative coverage though timely, is affected by incorrect population estimates and over or under reporting of vaccination doses administered. This paper presents the validated yellow fever vaccination coverage following massive emergency immunization campaigns in Pader district. Methods A cross sectional cluster survey was carried out in May 2011 among communities in Pader district and 680 respondents were indentified using the modified World Health Organization (WHO) 40 × 17 cluster survey sampling methodology. Respondents were aged nine months and above. Interviewer administered questionnaires were used to collect data on demographic characteristics, vaccination status and reasons for none vaccination. Vaccination status was assessed using self reports and vaccination card evidence. Our main outcomes were measures of yellow fever vaccination coverage in each age-specific stratum, overall, and disaggregated by age and sex, adjusting for the clustered design and the size of the population in each stratum. Results Of the 680 survey respondents, 654 (96.1%, 95% CI 94.9 – 97.8) reported being vaccinated during the last campaign but only 353 (51.6%, 95% CI 47.2 – 56.1) had valid yellow fever vaccination cards. Of the 280 children below 5 years, 269 (96.1%, 95% CI 93.7 – 98.7) were vaccinated and nearly all males 299 (96.9%, 95% CI 94.3 – 99.5) were vaccinated. The main reasons for none vaccination were; having travelled out of Pader district during the campaign period (40.0%), lack of transport to immunization posts (28.0%) and, sickness at the time of vaccination (16.0%). Conclusions Our results show that actual yellow fever vaccination coverage was high and satisfactory in Pader district since it was above the desired minimum threshold coverage of 80% according to World Health Organization. Massive emergency vaccination done following an outbreak of Yellow fever achieved high population coverage in Pader district. Active surveillance is necessary for early detection of yellow fever cases. PMID:23497254

Timeliness Vaccination of Measles Containing Vaccine and Barriers to Vaccination among Migrant Children in East China

PubMed Central

Hu, Yu; Li, Qian; Luo, Shuying; Lou, Linqiao; Qi, Xiaohua; Xie, Shuyun

2013-01-01

Background The reported coverage rates of first and second doses of measles containing vaccine (MCV) are almost 95% in China, while measles cases are constantly being reported. This study evaluated the vaccine coverage, timeliness, and barriers to immunization of MCV1 and MCV2 in children aged from 8–48 months. Methods We assessed 718 children aged 8–48 months, of which 499 children aged 18–48 months in September 2011. Face to face interviews were administered with children’s mothers to estimate MCV1 and MCV2 coverage rate, its timeliness and barriers to vaccine uptake. Results The coverage rates were 76.9% for MCV1 and 44.7% for MCV2 in average. Only 47.5% of surveyed children received the MCV1 timely, which postpone vaccination by up to one month beyond the stipulated age of 8 months. Even if coverage thus improves with time, postponed vaccination adds to the pool of unprotected children in the population. Being unaware of the necessity for vaccination and its schedule, misunderstanding of side-effect of vaccine, and child being sick during the recommended vaccination period were significant preventive factors for both MCV1 and MCV2 vaccination. Having multiple children, mother’s education level, household income and children with working mothers were significantly associated with delayed or missing MCV1 immunization. Conclusions To avoid future outbreaks, it is crucial to attain high coverage levels by timely vaccination, thus, accurate information should be delivered and a systematic approach should be targeted to high-risk groups. PMID:24013709

Human papillomavirus vaccine delivery strategies that achieved high coverage in low- and middle-income countries

PubMed Central

Barge, Sandhya; Le, Nga Thi; Mugisha, Emmanuel; Penny, Mary E; Gandhi, Sanjay; Janmohamed, Amynah; Kumakech, Edward; Mosqueira, N Rocio; Nguyen, Nghi Quy; Paul, Proma; Tang, Yuxiao; Minh, Tran Hung; Uttekar, Bella Patel; Jumaan, Aisha O

2011-01-01

Abstract Objective To assess human papillomavirus (HPV) vaccination coverage after demonstration projects conducted in India, Peru, Uganda and Viet Nam by PATH and national governments and to explore the reasons for vaccine acceptance or refusal. Methods Vaccines were delivered through schools or health centres or in combination with other health interventions, and either monthly or through campaigns at fixed time points. Using a two-stage cluster sample design, the authors selected households in demonstration project areas and interviewed over 7000 parents or guardians of adolescent girls to assess coverage and acceptability. They defined full vaccination as the receipt of all three vaccine doses and used an open-ended question to explore acceptability. Findings Vaccination coverage in school-based programmes was 82.6% (95% confidence interval, CI: 79.3–85.6) in Peru, 88.9% (95% CI: 84.7–92.4) in 2009 in Uganda and 96.1% (95% CI: 93.0–97.8) in 2009 in Viet Nam. In India, a campaign approach achieved 77.2% (95% CI: 72.4–81.6) to 87.8% (95% CI: 84.3–91.3) coverage, whereas monthly delivery achieved 68.4% (95% CI: 63.4–73.4) to 83.3% (95% CI: 79.3–87.3) coverage. More than two thirds of respondents gave as reasons for accepting the HPV vaccine that: (i) it protects against cervical cancer; (ii) it prevents disease, or (iii) vaccines are good. Refusal was more often driven by programmatic considerations (e.g. school absenteeism) than by opposition to the vaccine. Conclusion High coverage with HPV vaccine among young adolescent girls was achieved through various delivery strategies in the developing countries studied. Reinforcing positive motivators for vaccine acceptance is likely to facilitate uptake. PMID:22084528

High resolution age-structured mapping of childhood vaccination coverage in low and middle income countries.

PubMed

Utazi, C Edson; Thorley, Julia; Alegana, Victor A; Ferrari, Matthew J; Takahashi, Saki; Metcalf, C Jessica E; Lessler, Justin; Tatem, Andrew J

2018-03-14

The expansion of childhood vaccination programs in low and middle income countries has been a substantial public health success story. Indicators of the performance of intervention programmes such as coverage levels and numbers covered are typically measured through national statistics or at the scale of large regions due to survey design, administrative convenience or operational limitations. These mask heterogeneities and 'coldspots' of low coverage that may allow diseases to persist, even if overall coverage is high. Hence, to decrease inequities and accelerate progress towards disease elimination goals, fine-scale variation in coverage should be better characterized. Using measles as an example, cluster-level Demographic and Health Surveys (DHS) data were used to map vaccination coverage at 1 km spatial resolution in Cambodia, Mozambique and Nigeria for varying age-group categories of children under five years, using Bayesian geostatistical techniques built on a suite of publicly available geospatial covariates and implemented via Markov Chain Monte Carlo (MCMC) methods. Measles vaccination coverage was found to be strongly predicted by just 4-5 covariates in geostatistical models, with remoteness consistently selected as a key variable. The output 1 × 1 km maps revealed significant heterogeneities within the three countries that were not captured using province-level summaries. Integration with population data showed that at the time of the surveys, few districts attained the 80% coverage, that is one component of the WHO Global Vaccine Action Plan 2020 targets. The elimination of vaccine-preventable diseases requires a strong evidence base to guide strategies and inform efficient use of limited resources. The approaches outlined here provide a route to moving beyond large area summaries of vaccination coverage that mask epidemiologically-important heterogeneities to detailed maps that capture subnational vulnerabilities. The output datasets are built on open data and methods, and in flexible format that can be aggregated to more operationally-relevant administrative unit levels. Copyright © 2018 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Review on dog rabies vaccination coverage in Africa: a question of dog accessibility or cost recovery?

PubMed

Jibat, Tariku; Hogeveen, Henk; Mourits, Monique C M

2015-02-01

Rabies still poses a significant human health problem throughout most of Africa, where the majority of the human cases results from dog bites. Mass dog vaccination is considered to be the most effective method to prevent rabies in humans. Our objective was to systematically review research articles on dog rabies parenteral vaccination coverage in Africa in relation to dog accessibility and vaccination cost recovery arrangement (i.e.free of charge or owner charged). A systematic literature search was made in the databases of CAB abstracts (EBSCOhost and OvidSP), Scopus, Web of Science, PubMed, Medline (EBSCOhost and OvidSP) and AJOL (African Journal Online) for peer reviewed articles on 1) rabies control, 2) dog rabies vaccination coverage and 3) dog demography in Africa. Identified articles were subsequently screened and selected using predefined selection criteria like year of publication (viz. ≥ 1990), type of study (cross sectional), objective(s) of the study (i.e. vaccination coverage rates, dog demographics and financial arrangements of vaccination costs), language of publication (English) and geographical focus (Africa). The selection process resulted in sixteen peer reviewed articles which were used to review dog demography and dog ownership status, and dog rabies vaccination coverage throughout Africa. The main review findings indicate that 1) the majority (up to 98.1%) of dogs in African countries are owned (and as such accessible), 2) puppies younger than 3 months of age constitute a considerable proportion (up to 30%) of the dog population and 3) male dogs are dominating in numbers (up to 3.6 times the female dog population). Dog rabies parenteral vaccination coverage was compared between "free of charge" and "owner charged" vaccination schemes by the technique of Meta-analysis. Results indicate that the rabies vaccination coverage following a free of charge vaccination scheme (68%) is closer to the World Health Organization recommended coverage rate (70%) than the achieved coverage rate in owner-charged dog rabies vaccination schemes (18%). Most dogs in Africa are owned and accessible for parenteral vaccination against rabies if the campaign is performed "free of charge".

Review on Dog Rabies Vaccination Coverage in Africa: A Question of Dog Accessibility or Cost Recovery?

PubMed Central

Jibat, Tariku; Hogeveen, Henk; Mourits, Monique C. M.

2015-01-01

Background Rabies still poses a significant human health problem throughout most of Africa, where the majority of the human cases results from dog bites. Mass dog vaccination is considered to be the most effective method to prevent rabies in humans. Our objective was to systematically review research articles on dog rabies parenteral vaccination coverage in Africa in relation to dog accessibility and vaccination cost recovery arrangement (i.e.free of charge or owner charged). Methodology/Principal Findings A systematic literature search was made in the databases of CAB abstracts (EBSCOhost and OvidSP), Scopus, Web of Science, PubMed, Medline (EBSCOhost and OvidSP) and AJOL (African Journal Online) for peer reviewed articles on 1) rabies control, 2) dog rabies vaccination coverage and 3) dog demography in Africa. Identified articles were subsequently screened and selected using predefined selection criteria like year of publication (viz. ≥ 1990), type of study (cross sectional), objective(s) of the study (i.e. vaccination coverage rates, dog demographics and financial arrangements of vaccination costs), language of publication (English) and geographical focus (Africa). The selection process resulted in sixteen peer reviewed articles which were used to review dog demography and dog ownership status, and dog rabies vaccination coverage throughout Africa. The main review findings indicate that 1) the majority (up to 98.1%) of dogs in African countries are owned (and as such accessible), 2) puppies younger than 3 months of age constitute a considerable proportion (up to 30%) of the dog population and 3) male dogs are dominating in numbers (up to 3.6 times the female dog population). Dog rabies parenteral vaccination coverage was compared between “free of charge” and “owner charged” vaccination schemes by the technique of Meta-analysis. Results indicate that the rabies vaccination coverage following a free of charge vaccination scheme (68%) is closer to the World Health Organization recommended coverage rate (70%) than the achieved coverage rate in owner-charged dog rabies vaccination schemes (18%). Conclusions/Significance Most dogs in Africa are owned and accessible for parenteral vaccination against rabies if the campaign is performed “free of charge”. PMID:25646774

Trends in influenza vaccination coverage rates in South Korea from 2005 to 2014: Effect of public health policies on vaccination behavior.

PubMed

Seo, Jeongmin; Lim, Juwon

2018-05-05

Influenza is a major cause of morbidity and mortality worldwide. Annual vaccination is effective in its prevention and is recommended especially in susceptible populations such as the elderly over 65 years, children younger than 5, pregnant women, and people with chronic diseases. Overall, South Korea has a high vaccination rate owing to its National Immunization Program, although the method and extent of its coverage varies among the target subgroups. The aim of this study is to assess the trend of influenza vaccination coverage between 2005 and 2014 in South Korea to address the influence of sociodemographic and disease factors on vaccination behavior. Also, we aim to compare the vaccination coverage of target subgroups and evaluate the effect of relevant policies to provide suggestions for their improvement. A total of 61,036 respondents from the Korea National Health and Nutrition Examination Surveys III to VI were included. The total influenza vaccination coverage increased from 38.0% in 2005 to 44.1% in 2014. Vaccination coverage was higher among the elderly aged ≥65 years (range, 70.0-79.8%; p-for-trend <0.001) and children under 5 (range, 64.6-78.9%; p-for-trend < 0.001) than among pregnant women (range, 9.4-37.8%; p-for-trend = 0.122) and people with chronic diseases (range, 29.6-42.6%; p-for-trend = 0.068) from 2005 to 2014. High vaccination coverage was associated with female gender, rural residence, low education level, high income, and increasing number of chronic diseases. But the effect of high income on high vaccination coverage was absent in the elderly aged ≥65 years and children under 5. Influenza vaccination rates have steadily increased from 2005 to 2014 in South Korea. Disparities between target groups correspond to their financial coverage under the National Immunization Program, and financial aids remove the influence of high income on higher vaccination rates. Future vaccination policies should focus on pregnant women and people with chronic diseases. Copyright © 2018 Elsevier Ltd. All rights reserved.

2009–2010 Seasonal Influenza Vaccination Coverage Among College Students From 8 Universities in North Carolina

PubMed Central

Poehling, Katherine A.; Blocker, Jill; Ip, Edward H.; Peters, Timothy R.; Wolfson, Mark

2012-01-01

Objective We sought to describe the 2009–2010 seasonal influenza vaccine coverage of college students. Participants 4090 college students from eight North Carolina universities participated in a confidential, web-based survey in October-November 2009. Methods Associations between self-reported 2009–2010 seasonal influenza vaccination and demographic characteristics, campus activities, parental education, and email usage were assessed by bivariate analyses and by a mixed-effects model adjusting for clustering by university. Results Overall, 20% of students (range 14%–30% by university) reported receiving 2009–2010 seasonal influenza vaccine. Being a freshman, attending a private university, having a college-educated parent, and participating in academic clubs/honor societies predicted receipt of influenza vaccine in the mixed-effects model. Conclusions The self-reported 2009–2010 influenza vaccine coverage was one-quarter of the 2020 Healthy People goal (80%) for healthy persons 18–64 years of age. College campuses have the opportunity to enhance influenza vaccine coverage among its diverse student populations. PMID:23157195

Low vaccination coverage of Greek Roma children amid economic crisis: national survey using stratified cluster sampling

PubMed Central

Petraki, Ioanna; Arkoudis, Chrisoula; Terzidis, Agis; Smyrnakis, Emmanouil; Benos, Alexis; Panagiotopoulos, Takis

2017-01-01

Abstract Background: Research on Roma health is fragmentary as major methodological obstacles often exist. Reliable estimates on vaccination coverage of Roma children at a national level and identification of risk factors for low coverage could play an instrumental role in developing evidence-based policies to promote vaccination in this marginalized population group. Methods: We carried out a national vaccination coverage survey of Roma children. Thirty Roma settlements, stratified by geographical region and settlement type, were included; 7–10 children aged 24–77 months were selected from each settlement using systematic sampling. Information on children’s vaccination coverage was collected from multiple sources. In the analysis we applied weights for each stratum, identified through a consensus process. Results: A total of 251 Roma children participated in the study. A vaccination document was presented for the large majority (86%). We found very low vaccination coverage for all vaccines. In 35–39% of children ‘minimum vaccination’ (DTP3 and IPV2 and MMR1) was administered, while 34–38% had received HepB3 and 31–35% Hib3; no child was vaccinated against tuberculosis in the first year of life. Better living conditions and primary care services close to Roma settlements were associated with higher vaccination indices. Conclusions: Our study showed inadequate vaccination coverage of Roma children in Greece, much lower than that of the non-minority child population. This serious public health challenge should be systematically addressed, or, amid continuing economic recession, the gap may widen. Valid national estimates on important characteristics of the Roma population can contribute to planning inclusion policies. PMID:27694159

Coverage of pilot parenteral vaccination campaign against canine rabies in N'Djaména, Chad.

PubMed Central

Kayali, U.; Mindekem, R.; Yémadji, N.; Vounatsou, P.; Kaninga, Y.; Ndoutamia, A. G.; Zinsstag, J.

2003-01-01

Canine rabies, and thus human exposure to rabies, can be controlled through mass vaccination of the animal reservoir if dog owners are willing to cooperate. Inaccessible, ownerless dogs, however, reduce the vaccination coverage achieved in parenteral campaigns. This study aimed to estimate the vaccination coverage in dogs in three study zones of N'Djaména, Chad, after a pilot free parenteral mass vaccination campaign against rabies. We used a capture-mark-recapture approach for population estimates, with a Bayesian, Markov chain, Monte Carlo method to estimate the total number of owned dogs, and the ratio of ownerless to owned dogs to calculate vaccination coverage. When we took into account ownerless dogs, the vaccination coverage in the dog populations was 87% (95% confidence interval (CI), 84-89%) in study zone I, 71% (95% CI, 64-76%) in zone II, and 64% (95% CI, 58-71%) in zone III. The proportions of ownerless dogs to owned dogs were 1.1% (95% CI, 0-3.1%), 7.6% (95% CI, 0.7-16.5%), and 10.6% (95% CI, 1.6-19.1%) in the three study zones, respectively. Vaccination coverage in the three populations of owned dogs was 88% (95% CI, 84-92%) in zone I, 76% (95% CI, 71-81%) in zone II, and 70% (95% CI, 66-76%) in zone III. Participation of dog owners in the free campaign was high, and the number of inaccessible ownerless dogs was low. High levels of vaccination coverage could be achieved with parenteral mass vaccination. Regular parenteral vaccination campaigns to cover all of N'Djaména should be considered as an ethical way of preventing human rabies when post-exposure treatment is of limited availability and high in cost. PMID:14758434

Balancing Evidence and Uncertainty when Considering Rubella Vaccine Introduction

PubMed Central

Lessler, Justin; Metcalf, C. Jessica E.

2013-01-01

Background Despite a safe and effective vaccine, rubella vaccination programs with inadequate coverage can raise the average age of rubella infection; thereby increasing rubella cases among pregnant women and the resulting congenital rubella syndrome (CRS) in their newborns. The vaccination coverage necessary to reduce CRS depends on the birthrate in a country and the reproductive number, R0, a measure of how efficiently a disease transmits. While the birthrate within a country can be known with some accuracy, R0 varies between settings and can be difficult to measure. Here we aim to provide guidance on the safe introduction of rubella vaccine into countries in the face of substantial uncertainty in R0. Methods We estimated the distribution of R0 in African countries based on the age distribution of rubella infection using Bayesian hierarchical models. We developed an age specific model of rubella transmission to predict the level of R0 that would result in an increase in CRS burden for specific birth rates and coverage levels. Combining these results, we summarize the safety of introducing rubella vaccine across demographic and coverage contexts. Findings The median R0 of rubella in the African region is 5.2, with 90% of countries expected to have an R0 between 4.0 and 6.7. Overall, we predict that countries maintaining routine vaccination coverage of 80% or higher are can be confident in seeing a reduction in CRS over a 30 year time horizon. Conclusions Under realistic assumptions about human contact, our results suggest that even in low birth rate settings high vaccine coverage must be maintained to avoid an increase in CRS. These results lend further support to the WHO recommendation that countries reach 80% coverage for measles vaccine before introducing rubella vaccination, and highlight the importance of maintaining high levels of vaccination coverage once the vaccine is introduced. PMID:23861777

State of equity: childhood immunization in the World Health Organization African Region

PubMed Central

Casey, Rebecca Mary; Hampton, Lee McCalla; Anya, Blanche-philomene Melanga; Gacic-Dobo, Marta; Diallo, Mamadou Saliou; Wallace, Aaron Stuart

2017-01-01

Introduction In 2010, the Global Vaccine Action Plan called on all countries to reach and sustain 90% national coverage and 80% coverage in all districts for the third dose of diphtheria-tetanus-pertussis vaccine (DTP3) by 2015 and for all vaccines in national immunization schedules by 2020. The aims of this study are to analyze recent trends in national vaccination coverage in the World Health Organization African Region andto assess how these trends differ by country income category. Methods We compared national vaccination coverage estimates for DTP3 and the first dose of measles-containing vaccine (MCV) obtained from the World Health Organization (WHO)/United Nations Children’s Fund (UNICEF) joint estimates of national immunization coverage for all African Region countries. Using United Nations (UN) population estimates of surviving infants and country income category for the corresponding year, we calculated population-weighted average vaccination coverage by country income category (i.e., low, lower middle, and upper middle-income) for the years 2000, 2005, 2010 and 2015. Results DTP3 coverage in the African Region increased from 52% in 2000 to 76% in 2015,and MCV1 coverage increased from 53% to 74% during the same period, but with considerable differences among countries. Thirty-six African Region countries were low income in 2000 with an average DTP3 coverage of 50% while 26 were low income in 2015 with an average coverage of 80%. Five countries were lower middle-income in 2000 with an average DTP3 coverage of 84% while 12 were lower middle-income in 2015 with an average coverage of 69%. Five countries were upper middle-income in 2000 with an average DTP3 coverage of 73% and eight were upper middle-income in 2015 with an average coverage of 76%. Conclusion Disparities in vaccination coverage by country persist in the African Region, with countries that were lower middle-income having the lowest coverage on average in 2015. Monitoring and addressing these disparities is essential for meeting global immunization targets. PMID:29296140

Intervene before leaving: clustered lot quality assurance sampling to monitor vaccination coverage at health district level before the end of a yellow fever and measles vaccination campaign in Sierra Leone in 2009

PubMed Central

2012-01-01

Background In November 2009, Sierra Leone conducted a preventive yellow fever (YF) vaccination campaign targeting individuals aged nine months and older in six health districts. The campaign was integrated with a measles follow-up campaign throughout the country targeting children aged 9–59 months. For both campaigns, the operational objective was to reach 95% of the target population. During the campaign, we used clustered lot quality assurance sampling (C-LQAS) to identify areas of low coverage to recommend timely mop-up actions. Methods We divided the country in 20 non-overlapping lots. Twelve lots were targeted by both vaccinations, while eight only by measles. In each lot, five clusters of ten eligible individuals were selected for each vaccine. The upper threshold (UT) was set at 90% and the lower threshold (LT) at 75%. A lot was rejected for low vaccination coverage if more than 7 unvaccinated individuals (not presenting vaccination card) were found. After the campaign, we plotted the C-LQAS results against the post-campaign coverage estimations to assess if early interventions were successful enough to increase coverage in the lots that were at the level of rejection before the end of the campaign. Results During the last two days of campaign, based on card-confirmed vaccination status, five lots out of 20 (25.0%) failed for having low measles vaccination coverage and three lots out of 12 (25.0%) for low YF coverage. In one district, estimated post-campaign vaccination coverage for both vaccines was still not significantly above the minimum acceptable level (LT = 75%) even after vaccination mop-up activities. Conclusion C-LQAS during the vaccination campaign was informative to identify areas requiring mop-up activities to reach the coverage target prior to leaving the region. The only district where mop-up activities seemed to be unsuccessful might have had logistical difficulties that should be further investigated and resolved. PMID:22676225

Measles vaccination coverage estimates from surveys, clinic records, and immune markers in oral fluid and blood: a population-based cross-sectional study.

PubMed

Hayford, Kyla T; Shomik, Mohammed S; Al-Emran, Hassan M; Moss, William J; Bishai, David; Levine, Orin S

2013-12-20

Recent outbreaks of measles and polio in low-income countries illustrate that conventional methods for estimating vaccination coverage do not adequately identify susceptible children. Immune markers of protection against vaccine-preventable diseases in oral fluid (OF) or blood may generate more accurate measures of effective vaccination history, but questions remain about whether antibody surveys are feasible and informative tools for monitoring immunization program performance compared to conventional vaccination coverage indicators. This study compares six indicators of measles vaccination status, including immune markers in oral fluid and blood, from children in rural Bangladesh and evaluates the implications of using each indicator to estimate measles vaccination coverage. A cross-sectional population-based study of children ages 12-16 months in Mirzapur, Bangladesh, ascertained measles vaccination (MCV1) history from conventional indicators: maternal report, vaccination card records, 'card+history' and EPI clinic records. Oral fluid from all participants (n=1226) and blood from a subset (n=342) were tested for measles IgG antibodies as indicators of MCV1 history and compared to conventional MCV1 coverage indicators. Maternal report yielded the highest MCV1 coverage estimates (90.8%), followed by EPI records (88.6%), and card+history (84.2%). Seroprotection against measles by OF (57.3%) was significantly lower than other indicators, even after adjusting for incomplete seroconversion and assay performance (71.5%). Among children with blood results, 88.6% were seroprotected, which was significantly higher than coverage by card+history and OF serostatus but consistent with coverage by maternal report and EPI records. Children with vaccination cards or EPI records were more likely to have a history of receiving MCV1 than those without cards or records. Despite similar MCV1 coverage estimates across most indicators, within-child agreement was poor for all indicators. Measles IgG antibodies in OF was not a suitable immune marker for monitoring measles vaccination coverage in this setting. Because agreement between conventional MCV1 indicators was mediocre, immune marker surveillance with blood samples could be used to validate conventional MCV1 indicators and generate adjusted results that can be compared across indicators.

Increasing Coverage of Hepatitis B Vaccination in China

PubMed Central

Wang, Shengnan; Smith, Helen; Peng, Zhuoxin; Xu, Biao; Wang, Weibing

2016-01-01

Abstract This study used a system evaluation method to summarize China's experience on improving the coverage of hepatitis B vaccine, especially the strategies employed to improve the uptake of timely birth dosage. Identifying successful methods and strategies will provide strong evidence for policy makers and health workers in other countries with high hepatitis B prevalence. We conducted a literature review included English or Chinese literature carried out in mainland China, using PubMed, the Cochrane databases, Web of Knowledge, China National Knowledge Infrastructure, Wanfang data, and other relevant databases. Nineteen articles about the effectiveness and impact of interventions on improving the coverage of hepatitis B vaccine were included. Strong or moderate evidence showed that reinforcing health education, training and supervision, providing subsidies for facility birth, strengthening the coordination among health care providers, and using out-of-cold-chain storage for vaccines were all important to improving vaccination coverage. We found evidence that community education was the most commonly used intervention, and out-reach programs such as out-of-cold chain strategy were more effective in increasing the coverage of vaccination in remote areas where the facility birth rate was respectively low. The essential impact factors were found to be strong government commitment and the cooperation of the different government departments. Public interventions relying on basic health care systems combined with outreach care services were critical elements in improving the hepatitis B vaccination rate in China. This success could not have occurred without exceptional national commitment. PMID:27175710

Increasing Coverage of Hepatitis B Vaccination in China: A Systematic Review of Interventions and Implementation Experiences.

PubMed

Wang, Shengnan; Smith, Helen; Peng, Zhuoxin; Xu, Biao; Wang, Weibing

2016-05-01

This study used a system evaluation method to summarize China's experience on improving the coverage of hepatitis B vaccine, especially the strategies employed to improve the uptake of timely birth dosage. Identifying successful methods and strategies will provide strong evidence for policy makers and health workers in other countries with high hepatitis B prevalence.We conducted a literature review included English or Chinese literature carried out in mainland China, using PubMed, the Cochrane databases, Web of Knowledge, China National Knowledge Infrastructure, Wanfang data, and other relevant databases.Nineteen articles about the effectiveness and impact of interventions on improving the coverage of hepatitis B vaccine were included. Strong or moderate evidence showed that reinforcing health education, training and supervision, providing subsidies for facility birth, strengthening the coordination among health care providers, and using out-of-cold-chain storage for vaccines were all important to improving vaccination coverage.We found evidence that community education was the most commonly used intervention, and out-reach programs such as out-of-cold chain strategy were more effective in increasing the coverage of vaccination in remote areas where the facility birth rate was respectively low. The essential impact factors were found to be strong government commitment and the cooperation of the different government departments.Public interventions relying on basic health care systems combined with outreach care services were critical elements in improving the hepatitis B vaccination rate in China. This success could not have occurred without exceptional national commitment.

An Evaluation of Voluntary 2-Dose Varicella Vaccination Coverage in New York City Public Schools

PubMed Central

Rosen, Jennifer B.; Bialek, Stephanie R.; Szeto, Hiram; Zimmerman, Christopher M.

2015-01-01

Objectives. We assessed coverage for 2-dose varicella vaccination, which is not required for school entry, among New York City public school students and examined characteristics associated with receipt of 2 doses. Methods. We measured receipt of either at least 1 or 2 doses of varicella vaccine among students aged 4 years and older in a sample of 336 public schools (n = 223 864 students) during the 2010 to 2011 school year. Data came from merged student vaccination records from 2 administrative data systems. We conducted multivariable regression to assess associations of age, gender, race/ethnicity, and school location with 2-dose prevalence. Results. Coverage with at least 1 varicella dose was 96.2% (95% confidence interval [CI] = 96.2%, 96.3%); coverage with at least 2 doses was 64.8% (95% CI = 64.6%, 64.9%). Increasing student age, non-Hispanic White race/ethnicity, and attendance at school in Staten Island were associated with lower 2-dose coverage. Conclusions. A 2-dose varicella vaccine requirement for school entry would likely improve 2-dose coverage, eliminate coverage disparities, and prevent disease. PMID:25521904

Variation in rotavirus vaccine coverage by sub-counties in Kenya.

PubMed

Wandera, Ernest Apondi; Mohammad, Shah; Ouko, John Odhiambo; Yatitch, James; Taniguchi, Koki; Ichinose, Yoshio

2017-01-01

Rotavirus gastroenteritis is an important cause of childhood morbidity and mortality in Kenya. In July 2014, Kenya introduced the rotavirus vaccine into her national immunization program. Although immunization coverage is crucial in assessing the real-world impact of this vaccine, variability in the vaccine coverage across the country is likely to occur. In view of this, we estimated the extent of coverage for the rotavirus vaccine at two socio-economically different sub-counties using the administrative data. The findings indicate disparities in vaccine coverage and access between the sub-counties and, thus, underscore the need to strengthen immunization systems to facilitate timely, accessible, and equitable vaccine delivery across the country. Both sub-counties recorded high vaccine dropout, suggestive of poor utilization of the vaccine. In this regard, increased social mobilization is needed to encourage vaccine compliance and to enhance tracking of vaccine defaulters. While efforts to improve the accuracy of the administrative coverage estimates are crucial, vaccination coverage surveys will be needed to verify the administrative coverage data and help identify specific factors relating to rotavirus vaccine coverage in the country.

Influenza vaccination coverage rates among adults before and after the 2009 influenza pandemic and the reasons for non-vaccination in Beijing, China: A cross-sectional study

PubMed Central

2013-01-01

Background To optimize the vaccination coverage rates in the general population, the status of coverage rates and the reasons for non-vaccination need to be understood. Therefore, the objective of this study was to assess the changes in influenza vaccination coverage rates in the general population before and after the 2009 influenza pandemic (2008/2009, 2009/2010, and 2010/2011 seasons), and to determine the reasons for non-vaccination. Methods In January 2011 we conducted a multi-stage sampling, retrospective, cross-sectional survey of individuals in Beijing who were ≥ 18 years of age using self-administered, anonymous questionnaires. The questionnaire consisted of three sections: demographics (gender, age, educational level, and residential district name); history of influenza vaccination in the 2008/2009, 2009/2010, and 2010/2011 seasons; and reasons for non-vaccination in all three seasons. The main outcome was the vaccination coverage rate and vaccination frequency. Differences among the subgroups were tested using a Pearson’s chi-square test. Multivariate logistic regression was used to determine possible determinants of influenza vaccination uptake. Results A total of 13002 respondents completed the questionnaires. The vaccination coverage rates were 16.9% in 2008/2009, 21.8% in 2009/2010, and 16.7% in 2010/2011. Compared to 2008/2009 and 2010/2011, the higher rate in 2009/2010 was statistically significant (χ2=138.96, p<0.001), and no significant difference existed between 2008/2009 and 2010/2011 (χ2=1.296, p=0.255). Overall, 9.4% of the respondents received vaccinations in all three seasons, whereas 70% of the respondents did not get a vaccination during the same period. Based on multivariate analysis, older age and higher level of education were independently associated with increased odds of reporting vaccination in 2009/2010 and 2010/2011. Among participants who reported no influenza vaccinations over the previous three seasons, the most commonly reported reason for non-vaccination was ‘I don’t think I am very likely to catch the flu’ (49.3%). Conclusions Within the general population of Beijing the vaccination coverage rates were relatively low and did not change significantly after the influenza pandemic. The perception of not expecting to contract influenza was the predominant barrier to influenza vaccination. Further measures are needed to improve influenza vaccination coverage. PMID:23835253

Use of geographic information systems in rabies vaccination campaigns.

PubMed

Grisi-Filho, José Henrique de Hildebrand e; Amaku, Marcos; Dias, Ricardo Augusto; Montenegro Netto, Hildebrando; Paranhos, Noemia Tucunduva; Mendes, Maria Cristina Novo Campos; Ferreira Neto, José Soares; Ferreira, Fernando

2008-12-01

To develop a method to assist in the design and assessment of animal rabies control campaigns. A methodology was developed based on geographic information systems to estimate the animal (canine and feline) population and density per census tract and per subregion (known as "Subprefeituras") in the city of São Paulo (Southeastern Brazil) in 2002. The number of vaccination units in a given region was estimated to achieve a certain proportion of vaccination coverage. Census database was used for the human population, as well as estimates ratios of dog:inhabitant and cat:inhabitant. Estimated figures were 1,490,500 dogs and 226,954 cats in the city, i.e. an animal population density of 1138.14 owned animals per km(2). In the 2002 campaign, 926,462 were vaccinated, resulting in a vaccination coverage of 54%. The estimated number of vaccination units to be able to reach a 70%-vaccination coverage, by vaccinating 700 animals per unit on average, was 1,729. These estimates are presented as maps of animal density according to census tracts and "Subprefeituras". The methodology used in the study may be applied in a systematic way to the design and evaluation of rabies vaccination campaigns, enabling the identification of areas of critical vaccination coverage.

Coverage and factors associated with influenza vaccination among kindergarten children 2-7 years old in a low-income city of north-western China (2014-2016)

PubMed Central

Yang, Juan; Han, Wei; Lei, Youju; Feng, Huaxiang; Zhu, Xiaoyun; Li, Yanming; Yu, Hongjie; Feng, Luzhao; Shi, Yan

2017-01-01

Influenza vaccination has been shown to be the most effective preventive measure to reduce influenza virus infection and its related morbidity and mortality. Young children aged 6–59 months are recommended as one of the priority groups for seasonal influenza vaccination in China. Our study was conducted to evaluate the level of influenza vaccination coverage during 2014–15 and 2015–16 influenza seasons among kindergarten children aged 2–7 years in Xining, a low-income city of north-western China, and to explore potential factors for noncompliance associated with influenza vaccination. The coverage rate of influenza vaccination was 12.2% (95 CI: 10.6–14.2%) in 2014–15 and 12.8% (95 CI: 11.1–14.7%) in 2015–16. The low coverage rate was found to be primarily associated with the lack of knowledge about influenza vaccine in children’s parents. The most common reason for vaccine declination was the concern about adverse reactions of vaccine. Therefore tailored information should be provided by clinician and public health doctors for targeted groups through effective methods to improve public understanding of vaccination. PMID:28749980

Beyond Rational Decision-Making: Modelling the Influence of Cognitive Biases on the Dynamics of Vaccination Coverage

PubMed Central

Voinson, Marina; Billiard, Sylvain; Alvergne, Alexandra

2015-01-01

Background Theoretical studies predict that it is not possible to eradicate a disease under voluntary vaccination because of the emergence of non-vaccinating “free-riders” when vaccination coverage increases. A central tenet of this approach is that human behaviour follows an economic model of rational choice. Yet, empirical studies reveal that vaccination decisions do not necessarily maximize individual self-interest. Here we investigate the dynamics of vaccination coverage using an approach that dispenses with payoff maximization and assumes that risk perception results from the interaction between epidemiology and cognitive biases. Methods We consider a behaviour-incidence model in which individuals perceive actual epidemiological risks as a function of their opinion of vaccination. As a result of confirmation bias, sceptical individuals (negative opinion) overestimate infection cost while pro-vaccines individuals (positive opinion) overestimate vaccination cost. We considered a feedback between individuals and their environment as individuals could change their opinion, and thus the way they perceive risks, as a function of both the epidemiology and the most common opinion in the population. Results For all parameter values investigated, the infection is never eradicated under voluntary vaccination. For moderately contagious diseases, oscillations in vaccination coverage emerge because individuals process epidemiological information differently depending on their opinion. Conformism does not generate oscillations but slows down the cultural response to epidemiological change. Conclusion Failure to eradicate vaccine preventable disease emerges from the model because of cognitive biases that maintain heterogeneity in how people perceive risks. Thus, assumptions of economic rationality and payoff maximization are not mandatory for predicting commonly observed dynamics of vaccination coverage. This model shows that alternative notions of rationality, such as that of ecological rationality whereby individuals use simple cognitive heuristics, offer promising new avenues for modelling vaccination behaviour. PMID:26599688

Timing and delay in children vaccination; evaluation of expanded program of immunization in outskirt of Iranian cities.

PubMed

Rejali, Mehri; Mohammadbeigi, Abolfazl; Mokhtari, Mohsen; Zahraei, Seyed Mohsen; Eshrati, Babak

2015-01-01

Most studies evaluated the vaccine coverage, but the time of vaccination is important as coverage. This study was conducted to evaluate the Expanded Program of Immunization (EPI) in outskirt of Iranian cities regarding to incidence of delay vaccination among children less than 4 years. This cross sectional descriptive study was conducted among children 24-47 months old, living in the suburbs of five metropolises of Iran. Totally, 3610 eligible children selected with proportioned cluster sampling method and data of vaccination card extracted after interview with child parents. Delayed incidence rate reported and predictive factors assessed by Chi square test and Multivariate logistic regression. Overall, 56.6% to 93.2% vaccines were administered out of time. Delayed vaccination incidence with more than one-week delay varies from 5.5% to 74.9% for polio at birth and MMR2 at 18 month, respectively. Mother's educational level and birth order were the most important predictors of delayed vaccination. Incidence of delayed vaccination was enlarged by increasing birth order and decreased in lower educated mothers. Incidence rate of delayed vaccination is more than expectation. Regarding to high coverage vaccines in Iran, heath officers and health policy makers should attempt for on-time vaccination beside of high immunization coverage especially in slum areas with more concentrated immigrants due to low literature and crowded families.

Highly targeted cholera vaccination campaigns in urban setting are feasible: The experience in Kalemie, Democratic Republic of Congo

PubMed Central

Massing, Louis Albert; Aboubakar, Soumah; Page, Anne-Laure; Cohuet, Sandra; Ngandwe, Adalbert; Mukomena Sompwe, Eric; Ramazani, Romain; Allheimen, Marcela; Levaillant, Philippe; Lechevalier, Pauline; Kashimi, Marie; de la Motte, Axelle; Calmejane, Arielle; Bouhenia, Malika; Dabire, Ernest; Bompangue, Didier; Kebela, Benoit; Porten, Klaudia

2018-01-01

Introduction Oral cholera vaccines are primarily recommended by the World Health Organization for cholera control in endemic countries. However, the number of cholera vaccines currently produced is very limited and examples of OCV use in endemic countries, and especially in urban settings, are scarce. A vaccination campaign was organized by Médecins Sans Frontières and the Ministry of Health in a highly endemic area in the Democratic Republic of Congo. This study aims to describe the vaccine coverage achieved with this highly targeted vaccination campaign and the acceptability among the vaccinated communities. Methods and findings We performed a cross-sectional survey using random spatial sampling. The study population included individuals one year old and above, eligible for vaccination, and residing in the areas targeted for vaccination in the city of Kalemie. Data sources were household interviews with verification by vaccination card. In total 2,488 people were included in the survey. Overall, 81.9% (95%CI: 77.9–85.3) of the target population received at least one dose of vaccine. The vaccine coverage with two doses was 67.2% (95%CI: 61.9–72.0) among the target population. The vaccine coverage was higher during the first round (74.0, 95%CI: 69.3–78.3) than during the second round of vaccination (69.1%, 95%CI: 63.9–74.0). Vaccination coverage was lower in male adults. The main reason for non-vaccination was to be absent during the campaign. No severe adverse events were notified during the interviews. Conclusions Cholera vaccination campaigns using highly targeted strategies are feasible in urban settings. High vaccination coverage can be obtained using door to door vaccination. However, alternative strategies should be considered to reach non-vaccinated populations like male adults and also in order to improve the efficiency of the interventions. PMID:29734337

Estimating the influenza vaccine effectiveness in elderly on a yearly basis using the Spanish influenza surveillance network--pilot case-control studies using different control groups, 2008-2009 season, Spain.

PubMed

Savulescu, Camelia; Valenciano, Marta; de Mateo, Salvador; Larrauri, Amparo

2010-04-01

We conducted a case-control and screening method studies to estimate influenza vaccine effectiveness (IVE) in the age group >or=65 years, based on the Spanish Influenza Sentinel Surveillance System (SISSS). Cases (influenza laboratory-confirmed) were compared to influenza-negative ILI patients (test-negative) and patients without ILI since the beginning of the season (non-ILI). For the screening method, cases' vaccination coverage was compared to the vaccination coverage of the GPs' catchment population. The results suggested a protective effect of the vaccine against laboratory-confirmed influenza in elderly in 2008-2009. The screening method and the test-negative control designs enable estimating IVE using exclusively SISSS data. (c) 2010 Elsevier Ltd. All rights reserved.

Assessing the Potential Cost-Effectiveness of Microneedle Patches in Childhood Measles Vaccination Programs: The Case for Further Research and Development.

PubMed

Adhikari, Bishwa B; Goodson, James L; Chu, Susan Y; Rota, Paul A; Meltzer, Martin I

2016-12-01

Currently available measles vaccines are administered by subcutaneous injections and require reconstitution with a diluent and a cold chain, which is resource intensive and challenging to maintain. To overcome these challenges and potentially increase vaccination coverage, microneedle patches are being developed to deliver the measles vaccine. This study compares the cost-effectiveness of using microneedle patches with traditional vaccine delivery by syringe-and-needle (subcutaneous vaccination) in children's measles vaccination programs. We built a simple spreadsheet model to compute the vaccination costs for using microneedle patch and syringe-and-needle technologies. We assumed that microneedle vaccines will be, compared with current vaccines, more heat stable and require less expensive cool chains when used in the field. We used historical data on the incidence of measles among communities with low measles vaccination rates. The cost of microneedle vaccination was estimated at US$0.95 (range US$0.71-US$1.18) for the first dose, compared with US$1.65 (range US$1.24-US$2.06) for the first dose delivered by subcutaneous vaccination. At 95 % vaccination coverage, microneedle patch vaccination was estimated to cost US$1.66 per measles case averted (range US$1.24-US$2.07) compared with an estimated cost of US$2.64 per case averted (range US$1.98-US$3.30) using subcutaneous vaccination. Use of microneedle patches may reduce costs; however, the cost-effectiveness of patches would depend on the vaccine recipients' acceptability and vaccine effectiveness of the patches relative to the existing conventional vaccine-delivery method. This study emphasizes the need to continue research and development of this vaccine-delivery method that could boost measles elimination efforts through improved access to vaccines and increased vaccination coverage.

The free vaccination policy of influenza in Beijing, China: The vaccine coverage and its associated factors.

PubMed

Lv, Min; Fang, Renfei; Wu, Jiang; Pang, Xinghuo; Deng, Ying; Lei, Trudy; Xie, Zheng

2016-04-19

In order to improve influenza vaccination coverage, the coverage rate and reasons for non-vaccination need to be determined. In 2007, the Beijing Government published a policy providing free influenza vaccinations to elderly people living in Beijing who are older than 60. This study examines the vaccination coverage after the policy was carried out and factors influencing vaccination among the elderly in Beijing. A cross-sectional survey was conducted through the use of questionnaires in 2013. A total of 1673 eligible participants were selected by multistage stratified random sampling in Beijing using anonymous questionnaires in-person. They were surveyed to determine vaccination status and social demographic information. The influenza vaccination coverage was 38.7% among elderly people in Beijing in 2012. The most common reason for not being vaccinated was people thinking they did not need to have a flu shot. After controlling for age, gender, income, self-reported health status, and the acceptance of health promotion, the rate in rural areas was 2.566 (95% confidence interval [CI], 1.801-3.655, P<0.010) times greater than that in urban areas. Different mechanisms of health education and health promotion have different influences on vaccination uptake. Those whom received information through television, community boards, or doctors were more likely to get vaccinated compared to those who did not (Odds Ratio [OR]=1.403, P<0.010; OR=1.812, P<0.010; OR=2.647, P<0.010). The influenza vaccine coverage in Beijing is much lower than that of developed countries with similar policies. The rural-urban disparity in coverage rate (64.1% versus 33.5%), may be explained by differing health provision systems and personal attitudes toward free services due to socioeconomic factors. Methods for increasing vaccination levels include increasing the focus on primary care and health education programs, particularly recommendations from doctors, to the distinct target populations, especially with a focus on expanding these efforts in urban areas. Copyright © 2016 Elsevier Ltd. All rights reserved.

Influenza Vaccination Coverage Rates, Knowledge, Attitudes, and Beliefs in Jordan: A Comprehensive Study.

PubMed

Assaf, Areej M; Hammad, Eman A; Haddadin, Randa N

2016-11-01

Influenza vaccination is the most effective method in preventing influenza and its complications. This study's objectives were to investigate the vaccination coverage and frequency and to assess knowledge, attitudes, and practices toward influenza vaccination in Jordan during the year 2012 and the 5 years preceding it. Additionally, it aimed at identifying the barriers and motivations to receive the vaccine and the factors contributing to its uptake. In May 2012, a self-administered cross-sectional survey was distributed to 3,200 adults conveniently selected across Jordan to explore influenza vaccination status, knowledge, attitudes, and practices toward the influenza vaccine. The survey response rate was 98.3%. The overall coverage rate of seasonal influenza vaccination ranged from 9.9% to 27.5%. Results of the univariate analysis revealed that males, participants older than 45 years, business owners, and university students or graduates were more likely to take the vaccine. Healthcare workers (HCW) showed higher rates than non-HCW and those with concomitant chronic diseases were more committed to receive the vaccine. Knowledge about the influenza vaccine is considered high in the Jordanian population. Fear from side effects was the major barrier, while the fear of the virus spread and outbreak was the major reason to receive the vaccine. The coverage rates were low in Jordan compared to other countries. The need for influenza vaccine campaigns and on-going education in Jordan health schools is crucial to increase the rate and remove misconceptions and negative attitudes toward vaccination.

Issues and considerations in the use of serologic biomarkers for classifying vaccination history in household surveys.

PubMed

MacNeil, Adam; Lee, Chung-Won; Dietz, Vance

2014-09-03

Accurate estimates of vaccination coverage are crucial for assessing routine immunization program performance. Community based household surveys are frequently used to assess coverage within a country. In household surveys to assess routine immunization coverage, a child's vaccination history is classified on the basis of observation of the immunization card, parental recall of receipt of vaccination, or both; each of these methods has been shown to commonly be inaccurate. The use of serologic data as a biomarker of vaccination history is a potential additional approach to improve accuracy in classifying vaccination history. However, potential challenges, including the accuracy of serologic methods in classifying vaccination history, varying vaccine types and dosing schedules, and logistical and financial implications must be considered. We provide historic and scientific context for the potential use of serologic data to assess vaccination history and discuss in detail key areas of importance for consideration in the context of using serologic data for classifying vaccination history in household surveys. Further studies are needed to directly evaluate the performance of serologic data compared with use of immunization cards or parental recall for classification of vaccination history in household surveys, as well assess the impact of age at the time of sample collection on serologic titers, the predictive value of serology to identify a fully vaccinated child for multi-dose vaccines, and the cost impact and logistical issues on outcomes associated with different types of biological samples for serologic testing. Published by Elsevier Ltd.

Expansion of seasonal influenza vaccination in the Americas

PubMed Central

Ropero-Álvarez, Alba María; Kurtis, Hannah J; Danovaro-Holliday, M Carolina; Ruiz-Matus, Cuauhtémoc; Andrus, Jon K

2009-01-01

Background Seasonal influenza is a viral disease whose annual epidemics are estimated to cause three to five million cases of severe illness and 250,000 to 500,000 deaths worldwide. Vaccination is the main strategy for primary prevention. Methods To assess the status of influenza vaccination in the Americas, influenza vaccination data reported to the Pan American Health Organization (PAHO) through 2008 were analyzed. Results Thirty-five countries and territories administered influenza vaccine in their public health sector, compared to 13 countries in 2004. Targeted risk groups varied. Sixteen countries reported coverage among older adults, ranging from 21% to 100%; coverage data were not available for most countries and targeted populations. Some tropical countries used the Northern Hemisphere vaccine formulation and others used the Southern Hemisphere vaccine formulation. In 2008, approximately 166.3 million doses of seasonal influenza vaccine were purchased in the Americas; 30 of 35 countries procured their vaccine through PAHO's Revolving Fund. Conclusion Since 2004 there has been rapid uptake of seasonal influenza vaccine in the Americas. Challenges to fully implement influenza vaccination remain, including difficulties measuring coverage rates, variable vaccine uptake, and limited surveillance and effectiveness data to guide decisions regarding vaccine formulation and timing, especially in tropical countries. PMID:19778430

Comparative assessment of immunization coverage of migrant children between national immunization program vaccines and non-national immunization program vaccines in East China

PubMed Central

Hu, Yu; Luo, Shuying; Tang, Xuewen; Lou, Linqiao; Chen, Yaping; Guo, Jing

2015-01-01

This study aimed to describe the disparities in immunization coverage between National Immunization Program (NIP) vaccines and non-NIP vaccines in Yiwu and to identify potential determinants. A face-to-face interview-based questionnaire survey among 423 migrant children born from 1 June 2010 to 31 May 2013 was conducted. Immunization coverage was estimated according to the vaccines scheduled at different age, the birth cohorts, and socio- demographic characteristics. Single-level logistic regression analysis was applied to identify the determinants of coverage of non-NIP vaccines. We found that NIP vaccines recorded higher immunization coverage compared with non-NIP vaccines (87.9100%– vs 0%-74.8%). Among the non-NIP vaccines, varicella vaccine (VarV) recorded the highest coverage of 85.4%, which was introduced in 1998; while 7-valent pneumococcal conjugate vaccine(PCV7) recorded the lowest coverage of 0% for primary series, which was introduced recently. Lower coverage rate of non-NIP vaccines was significantly associated with more siblings in household, shorter duration of living in the surveyed areas, lower family income, mother with a job, mother with poor awareness of vaccination, and mother with lower education level. We found the immunization coverage rate of non-NIP vaccines was significant lower than that of NIP vaccines. Expansion of NIP to include non-NIP vaccines can provide better protection against the vaccine preventable diseases through increased immunization coverage. PMID:25760670

Comparative assessment of immunization coverage of migrant children between national immunization program vaccines and non-national immunization program vaccines in East China.

PubMed

Hu, Yu; Luo, Shuying; Tang, Xuewen; Lou, Linqiao; Chen, Yaping; Guo, Jing

2015-01-01

This study aimed to describe the disparities in immunization coverage between National Immunization Program (NIP) vaccines and non-NIP vaccines in Yiwu and to identify potential determinants. A face-to-face interview-based questionnaire survey among 423 migrant children born from 1 June 2010 to 31 May 2013 was conducted. Immunization coverage was estimated according to the vaccines scheduled at different age, the birth cohorts, and socio- demographic characteristics. Single-level logistic regression analysis was applied to identify the determinants of coverage of non-NIP vaccines. We found that NIP vaccines recorded higher immunization coverage compared with non-NIP vaccines (87.9100%- vs 0%-74.8%). Among the non-NIP vaccines, varicella vaccine (VarV) recorded the highest coverage of 85.4%, which was introduced in 1998; while 7-valent pneumococcal conjugate vaccine(PCV7) recorded the lowest coverage of 0% for primary series, which was introduced recently. Lower coverage rate of non-NIP vaccines was significantly associated with more siblings in household, shorter duration of living in the surveyed areas, lower family income, mother with a job, mother with poor awareness of vaccination, and mother with lower education level. We found the immunization coverage rate of non-NIP vaccines was significant lower than that of NIP vaccines. Expansion of NIP to include non-NIP vaccines can provide better protection against the vaccine preventable diseases through increased immunization coverage.

Effective case/infection ratio of poliomyelitis in vaccinated populations.

PubMed

Bencskó, G; Ferenci, T

2016-07-01

Recent polio outbreaks in Syria and Ukraine, and isolation of poliovirus from asymptomatic carriers in Israel have raised concerns that polio might endanger Europe. We devised a model to calculate the time needed to detect the first case should the disease be imported into Europe, taking the effect of vaccine coverage - both from inactivated and oral polio vaccines, also considering their differences - on the length of silent transmission into account by deriving an 'effective' case/infection ratio that is applicable for vaccinated populations. Using vaccine coverage data and the newly developed model, the relationship between this ratio and vaccine coverage is derived theoretically and is also numerically determined for European countries. This shows that unnoticed transmission is longer for countries with higher vaccine coverage and a higher proportion of IPV-vaccinated individuals among those vaccinated. Assuming borderline transmission (R = 1·1), the expected time to detect the first case is between 326 days and 512 days in different countries, with the number of infected individuals between 235 and 1439. Imperfect surveillance further increases these numbers, especially the number of infected until detection. While longer silent transmission does not increase the number of clinical diseases, it can make the application of traditional outbreak response methods more complicated, among others.

Sub-national variation in measles vaccine coverage and outbreak risk: a case study from a 2010 outbreak in Malawi.

PubMed

Kundrick, Avery; Huang, Zhuojie; Carran, Spencer; Kagoli, Matthew; Grais, Rebecca Freeman; Hurtado, Northan; Ferrari, Matthew

2018-06-15

Despite progress towards increasing global vaccination coverage, measles continues to be one of the leading, preventable causes of death among children worldwide. Whether and how to target sub-national areas for vaccination campaigns continues to remain a question. We analyzed three metrics for prioritizing target areas: vaccination coverage, susceptible birth cohort, and the effective reproductive ratio (R E ) in the context of the 2010 measles epidemic in Malawi. Using case-based surveillance data from the 2010 measles outbreak in Malawi, we estimated vaccination coverage from the proportion of cases reporting with a history of prior vaccination at the district and health facility catchment scale. Health facility catchments were defined as the set of locations closer to a given health facility than to any other. We combined these estimates with regional birth rates to estimate the size of the annual susceptible birth cohort. We also estimated the effective reproductive ratio, R E , at the health facility polygon scale based on the observed rate of exponential increase of the epidemic. We combined these estimates to identify spatial regions that would be of high priority for supplemental vaccination activities. The estimated vaccination coverage across all districts was 84%, but ranged from 61 to 99%. We found that 8 districts and 354 health facility catchments had estimated vaccination coverage below 80%. Areas that had highest birth cohort size were frequently large urban centers that had high vaccination coverage. The estimated R E ranged between 1 and 2.56. The ranking of districts and health facility catchments as priority areas varied depending on the measure used. Each metric for prioritization may result in discrete target areas for vaccination campaigns; thus, there are tradeoffs to choosing one metric over another. However, in some cases, certain areas may be prioritized by all three metrics. These areas should be treated with particular concern. Furthermore, the spatial scale at which each metric is calculated impacts the resulting prioritization and should also be considered when prioritizing areas for vaccination campaigns. These methods may be used to allocate effort for prophylactic campaigns or to prioritize response for outbreak response vaccination.

The role of religious leaders in promoting acceptance of vaccination within a minority group: a qualitative study

PubMed Central

2013-01-01

Background Although childhood vaccination programs have been very successful, vaccination coverage in minority groups may be considerably lower than in the general population. In order to increase vaccination coverage in such minority groups involvement of faith-based organizations and religious leaders has been advocated. We assessed the role of religious leaders in promoting acceptance or refusal of vaccination within an orthodox Protestant minority group with low vaccination coverage in The Netherlands. Methods Semi-structured interviews were conducted with orthodox Protestant religious leaders from various denominations, who were selected via purposeful sampling. Transcripts of the interviews were thematically analyzed, and emerging concepts were assessed for consistency using the constant comparative method from grounded theory. Results Data saturation was reached after 12 interviews. Three subgroups of religious leaders stood out: those who fully accepted vaccination and did not address the subject, those who had religious objections to vaccination but focused on a deliberate choice, and those who had religious objections to vaccination and preached against vaccination. The various approaches of the religious leaders seemed to be determined by the acceptance of vaccination in their congregation as well as by their personal point of view. All religious leaders emphasized the importance of voluntary vaccination programs and religious exemptions from vaccination requirements. In case of an epidemic of a vaccine preventable disease, they would appreciate a dialogue with the authorities. However, they were not willing to promote vaccination on behalf of authorities. Conclusion Religious leaders’ attitudes towards vaccination vary from full acceptance to clear refusal. According to orthodox Protestant church order, local congregation members appoint their religious leaders themselves. Obviously they choose leaders whose views are compatible with the views of the congregation members. Moreover, the positions of orthodox Protestant religious leaders on vaccination will not change easily, as their objections to vaccination are rooted in religious doctrine and they owe their authority to their interpretation and application of this doctrine. Although the dialogue with religious leaders that is pursued by the Dutch government may be helpful in controlling epidemics by other means than vaccination, it is unlikely to increase vaccination coverage. PMID:23711160

Parental knowledge of paediatric vaccination

PubMed Central

Borràs, Eva; Domínguez, Àngela; Fuentes, Miriam; Batalla, Joan; Cardeñosa, Neus; Plasencia, Antoni

2009-01-01

Background Although routine vaccination is a major tool in the primary prevention of some infectious diseases, there is some reluctance in a proportion of the population. Negative parental perceptions of vaccination are an important barrier to paediatric vaccination. The aim of this study was to investigate parental knowledge of paediatric vaccines and vaccination in Catalonia. Methods A retrospective, cross-sectional study was carried out in children aged < 3 years recruited by random sampling from municipal districts of all health regions of Catalonia. The total sample was 630 children. Parents completed a standard questionnaire for each child, which included vaccination coverage and knowledge about vaccination. The level of knowledge of vaccination was scored according to parental answers. Results An association was observed between greater vaccination coverage of the 4:4:4:3:1 schedule (defined as: 4 DTPa/w doses, 4 Hib doses, 4 OPV doses, 3 MenC doses and 1 MMR dose) and maternal age >30 years (OR: 2.30; 95% CI: 1.20–4.43) and with a knowledge of vaccination score greater than the mean (OR: 0.45; 95% CI: 0.28–0.72). The score increased with maternal educational level and in parents of vaccinated children. A total of 20.47% of parents stated that vaccines could have undesirable consequences for their children. Of these, 23.26% had no specific information and 17.83% stated that vaccines can cause adverse reactions and the same percentage stated that vaccines cause allergies and asthma. Conclusion Higher vaccination coverage is associated with older maternal age and greater knowledge of vaccination. Vaccination coverage could be raised by improving information on vaccines and vaccination. PMID:19473498

Cluster Survey Evaluation of a Measles Vaccination Campaign in Jharkhand, India, 2012

PubMed Central

Scobie, Heather M.; Ray, Arindam; Routray, Satyabrata; Bose, Anindya; Bahl, Sunil; Sosler, Stephen; Wannemuehler, Kathleen; Kumar, Rakesh; Haldar, Pradeep; Anand, Abhijeet

2015-01-01

Introduction India was the last country in the world to implement a two-dose strategy for measles-containing vaccine (MCV) in 2010. As part of measles second-dose introduction, phased measles vaccination campaigns were conducted during 2010–2013, targeting 131 million children 9 months to <10 years of age. We performed a post-campaign coverage survey to estimate measles vaccination coverage in Jharkhand state. Methods A multi-stage cluster survey was conducted 2 months after the phase 2 measles campaign occurred in 19 of 24 districts of Jharkhand during November 2011–March 2012. Vaccination status of children 9 months to <10 years of age was documented based on vaccination card or mother’s recall. Coverage estimates and 95% confidence intervals (95% CI) for 1,018 children were calculated using survey methods. Results In the Jharkhand phase 2 campaign, MCV coverage among children aged 9 months to <10 years was 61.0% (95% CI: 54.4–67.7%). Significant differences in coverage were observed between rural (65.0%; 95% CI: 56.8–73.2%) and urban areas (45.6%; 95% CI: 37.3–53.9%). Campaign awareness among mothers was low (51.5%), and the most commonly reported reason for non-vaccination was being unaware of the campaign (69.4%). At the end of the campaign, 53.7% (95% CI: 46.5–60.9%) of children 12 months to <10 years of age received ≥2 MCV doses, while a large proportion of children remained under-vaccinated (34.0%, 95% CI: 28.0–40.0%) or unvaccinated (12.3%, 95% CI: 9.3–16.2%). Conclusions Implementation of the national measles campaign was a significant achievement towards measles elimination in India. In Jharkhand, campaign performance was below the target coverage of ≥90% set by the Government of India, and challenges in disseminating campaign messages were identified. Efforts towards increasing two-dose MCV coverage are needed to achieve the recently adopted measles elimination goal in India and the South-East Asia region. PMID:26010084

Surveillance of Vaccination Coverage Among Adult Populations - United States, 2014.

PubMed

Williams, Walter W; Lu, Peng-Jun; O'Halloran, Alissa; Kim, David K; Grohskopf, Lisa A; Pilishvili, Tamara; Skoff, Tami H; Nelson, Noele P; Harpaz, Rafael; Markowitz, Lauri E; Rodriguez-Lainz, Alfonso; Bridges, Carolyn B

2016-02-05

Overall, the prevalence of illness attributable to vaccine-preventable diseases is greater among adults than among children. Adults are recommended to receive vaccinations based on their age, underlying medical conditions, lifestyle, prior vaccinations, and other considerations. Updated vaccination recommendations from CDC are published annually in the U.S. Adult Immunization Schedule. Despite longstanding recommendations for use of many vaccines, vaccination coverage among U.S. adults is low. August 2013-June 2014 (for influenza vaccination) and January-December 2014 (for pneumococcal, tetanus and diphtheria [Td] and tetanus and diphtheria with acellular pertussis [Tdap], hepatitis A, hepatitis B, herpes zoster, and human papillomavirus [HPV] vaccination). The National Health Interview Survey (NHIS) is a continuous, cross-sectional national household survey of the noninstitutionalized U.S. civilian population. In-person interviews are conducted throughout the year in a probability sample of households, and NHIS data are compiled and released annually. The survey objective is to monitor the health of the U.S. population and provide estimates of health indicators, health care use and access, and health-related behaviors. Compared with data from the 2013 NHIS, increases in vaccination coverage occurred for Tdap vaccine among adults aged ≥19 years (a 2.9 percentage point increase to 20.1%) and herpes zoster vaccine among adults aged ≥60 years (a 3.6 percentage point increase to 27.9%). Aside from these modest improvements, vaccination coverage among adults in 2014 was similar to estimates from 2013 (for influenza coverage, similar to the 2012-13 season). Influenza vaccination coverage among adults aged ≥19 years was 43.2%. Pneumococcal vaccination coverage among high-risk persons aged 19-64 years was 20.3% and among adults aged ≥65 years was 61.3%. Td vaccination coverage among adults aged ≥19 years was 62.2%. Hepatitis A vaccination coverage among adults aged ≥19 years was 9.0%. Hepatitis B vaccination coverage among adults aged ≥19 years was 24.5%. HPV vaccination coverage among adults aged 19-26 years was 40.2% for females and 8.2% for males. Racial/ethnic differences in coverage persisted for all seven vaccines, with higher coverage generally for whites compared with most other groups. Adults without health insurance were significantly less likely than those with health insurance to report receipt of influenza vaccine (aged ≥19 years), pneumococcal vaccine (aged 19-64 years with high-risk conditions and aged ≥65 years), Td vaccine (aged ≥19 years), Tdap vaccine (aged ≥19 years and 19-64 years), hepatitis A vaccine (aged ≥19 years overall and among travelers), hepatitis B vaccine (aged ≥19 years, 19-49 years, and 19-59 years with diabetes), herpes zoster vaccine (aged ≥60 years and 60-64 years), and HPV vaccine (females aged 19-26 years and males aged 19-26 years). Adults who reported having a usual place for health care generally were more likely to receive recommended vaccinations than those who did not have a usual place for health care, regardless of whether they had health insurance. Vaccination coverage was significantly higher among those reporting one or more physician contacts in the past year compared with those who had not visited a physician in the past year, regardless of whether they had health insurance. Even among adults who had health insurance and ≥10 physician contacts within the past year, 23.8%-88.8% reported not having received vaccinations that were recommended either for all persons or for those with some specific indication. Overall, vaccination coverage among U.S.-born respondents was significantly higher than that of foreign-born respondents with few exceptions (influenza vaccination [adults aged 19-49 years], hepatitis A vaccination [adults aged ≥19 years], hepatitis B vaccination [adults with diabetes aged ≥60 years], and HPV vaccination [males aged 19-26 years]). Overall, increases in adult vaccination coverage are needed. Although modest gains occurred in Tdap vaccination coverage among adults aged ≥19 years and herpes zoster vaccination coverage among adults aged ≥60 years, coverage for other vaccines and risk groups did not improve, and racial/ethnic disparities persisted for routinely recommended adult vaccines. Coverage for all vaccines for adults remained low, and missed opportunities to vaccinate adults continued. Although having health insurance coverage and a usual place for health care are associated with higher vaccination coverage, these factors alone do not assure optimal adult vaccination coverage. Assessing associations with vaccination is important for understanding factors that contribute to low coverage rates and to disparities in vaccination, and for implementing strategies to improve vaccination coverage. Practices that have been demonstrated to improve vaccination coverage should be used. These practices include assessment of patients' vaccination indications by health care providers and routine recommendation and offer of needed vaccines to adults, implementation of reminder-recall systems, use of standing-order programs for vaccination, and assessment of practice-level vaccination rates with feedback to staff members. For vaccination to be improved among those least likely to be up-to-date on recommended adult vaccines, efforts also are needed to identify adults who do not have a regular provider or insurance and who report fewer health care visits.

Vaccination coverage and factors influencing routine vaccination status in 12 high risk health zones in the Province of Kinshasa City, Democratic Republic of Congo (DRC), 2015

PubMed Central

Mwamba, Guillaume Ngoie; Yoloyolo, Norbert; Masembe, Yolande; Nsambu, Muriel Nzazi; Nzuzi, Cathy; Tshekoya, Patrice; Dah, Barthelemy; Kaya, Guylain

2017-01-01

Introduction Vaccination coverage of the first dose of diphtheria-tetanus-pertussis-hepatitis B-Haemophilus influenza type b (pentavalent) vaccine for the City-Province of Kinshasain the years 2012 – 2014 wasbelow the national objective of 92%, with coverage less than 80% reported in 12 of the 35 health zones (HZ). The purpose of this study was to discern potential contributing factors to low vaccination coverage in Kinshasa. Methods We conducted a multi-stage cluster household study of children 6 – 11 months in households residing in their current neighborhood for at least 3 months in the 12 high risk HZ in Kinshasa. Additional information on vaccination status of the children was collected at the health facility. Results Of the 1,513 households with a child 6-11 months old, 81% were eligible and participated. Among the 1224 children surveyed, 96% had received the first dose of pentavalent vaccine; 84% had received the third dose; and 71% had received all recommended vaccines for their age. Longer travel time to get to health facility (p=0.04) and shorter length of residence in the neighborhood (p=0.04) showed significant differences in relation to incomplete vaccination. Forty percent of children received their most recent vaccination in a facility outside of their HZ of residence. Conclusion This survey found vaccination coverage in 12 HZs in Kinshasa was higher than estimates derived from administrative reports. The large percentage of children vaccinated outside of their HZ of residence demonstrates the challenge to use of the Reaching Every District strategy in urban areas. PMID:29296142

Predictors of measles vaccination coverage among children 6-59 months of age in the Democratic Republic of the Congo.

PubMed

Ashbaugh, Hayley R; Hoff, Nicole A; Doshi, Reena H; Alfonso, Vivian H; Gadoth, Adva; Mukadi, Patrick; Okitolonda-Wemakoy, Emile; Muyembe-Tamfum, Jean Jacques; Gerber, Sue K; Cherry, James D; Rimoin, Anne W

2018-01-25

Measles is a significant contributor to child mortality in the Democratic Republic of the Congo (DRC), despite routine immunization programs and supplementary immunization activities (SIA). Further, national immunization coverage levels may hide disparities among certain groups of children, making effective measles control even more challenging. This study describes measles vaccination coverage and reporting methods and identifies predictors of vaccination among children participating in the 2013-2014 DRC Demographic and Health Survey (DHS). We examined vaccination coverage of 6947 children aged 6-59 months. A multivariate logistic regression model was used to identify predictors of vaccination among children reporting vaccination via dated card in order to identify least reached children. We also assessed spatial distribution of vaccination report type by rural versus urban residence. Urban children with educated mothers were more likely to be vaccinated (OR = 4.1, 95% CI: 1.6, 10.7) versus children of mothers with no education, as were children in wealthier rural families (OR = 2.9, 95% CI: 1.9, 4.4). At the provincial level, urban areas more frequently reported vaccination via dated card than rural areas. Results indicate that, while the overall coverage level of 70% is too low, socioeconomic and geographic disparities also exist which could make some children even less likely to be vaccinated. Dated records of measles vaccination must be increased, and groups of children with the greatest need should be targeted. As access to routine vaccination services is limited in DRC, identifying and targeting under-reached children should be a strategic means of increasing country-wide effective measles control. Published by Elsevier Ltd.

Vaccination coverage among callers to a state influenza hotline--Connecticut, 2004-05 influenza season.

PubMed

2005-03-04

In response to the influenza vaccine shortage in the United States, the Connecticut Department of Public Health (DPH) operated a telephone hotline during October 22, 2004-January 15, 2005. The purpose of the hotline was to address questions from the public regarding the availability of influenza vaccine, reduce the number of telephone inquiries to physicians and local health departments (LHDs), and advise callers regarding which groups were most at risk and in need of influenza vaccination. Caller information was collected and shared daily with LHDs, which were encouraged to follow up with callers as their resources allowed. This report summarizes results of a retrospective survey of callers to the DPH influenza vaccine hotline during November 2004. The results indicated that vaccination coverage varied by age group and that persons receiving follow-up calls from LHDs were more likely to receive vaccination. State health departments might consider a hotline as a method for educating the public regarding influenza vaccination and a follow-up system as a means to improve vaccination coverage, especially among those at greatest risk.

The impact of new vaccine introduction on the coverage of existing vaccines: a cross-national, multivariable analysis.

PubMed

Shearer, Jessica C; Walker, Damian G; Risko, Nicholas; Levine, Orin S

2012-12-14

A surge of new and underutilized vaccine introductions into national immunization programmes has called into question the effect of new vaccine introduction on immunization and health systems. In particular, countries deciding whether to introduce a new or underutilized vaccine into their routine immunization programme may query possible effects on the delivery and coverage of existing vaccines. Using coverage of diphtheria-tetanus-pertussis (DTP) vaccine as a proxy for immunization system performance, this study aims to test whether new vaccine introduction into national immunization programs was associated with changes in coverage of three doses of DTP vaccine among infants. DTP3 vaccine coverage was analyzed in 187 countries during 1999-2009 using multivariable cross-national mixed-effect longitudinal models. Controlling for other possible determinants of DTP3 coverage at the national level these models found minimal association between the introduction of Hepatitis-, Haemophilus influenzae type b-, and rotavirus-containing vaccines and DTP3 coverage. Instead, frequent and sometimes large fluctuations in coverage are associated with other development and health systems variables, including the presence of armed conflict, coverage of antenatal care services, infant mortality, the percent of health expenditures that are private and total health expenditures per capita. Introductions of new vaccines did not affect national coverage of DTP3 vaccine in the countries studied. Introductions of other new vaccines and multiple vaccine introductions should be monitored for immunization and health systems impacts. Copyright © 2012 Elsevier Ltd. All rights reserved.

Evaluation of human papilloma virus (HPV) vaccination strategies and vaccination coverage in adolescent girls worldwide.

PubMed

Owsianka, Barbara; Gańczak, Maria

2015-01-01

An analysis of HPV vaccination strategies and vaccination coverage in adolescent girls worldwide for the last eight years with regard to potential improvement of vaccination coverage rates in Poland. Literature search, covering the period 2006-2014, was performed using Medline. Comparative analysis of HPV vaccination strategies and coverage between Poland and other countries worldwide was conducted. In the last eight years, a number of countries introduced HPV vaccination for adolescent girls to their national immunization programmes. Vaccination strategies differ, consequently affecting vaccination coverage, ranging from several percent to more than 90%. Usually, there are also disparities at national level. The highest HPV vaccination coverage rates are observed in countries where vaccines are administered in school settings and funded from the national budget. Poland is one of the eight EU countries where HPV vaccination has not been introduced to mandatory immunization programme and where paid vaccination is only provided in primary health care settings. HPV vaccination coverage in adolescent girls is estimated at 7.5-10%. Disparities in HPV vaccination coverage rates in adolescent girls worldwide may be due to different strategies of vaccination implementation between countries. Having compared to other countries, the low HPV vaccination coverage in Polish adolescent girls may result from the lack of funding at national level and the fact that vaccines are administered in a primary health care setting. A multidimensional approach, involving the engagement of primary health care and school personnel as well as financial assistance of government at national and local level and the implementation of media campaigns, particularly in regions with high incidence of cervical cancer, could result in an increase of HPV vaccination coverage rates in Poland.

The effectiveness of vaccine day and educational interventions on influenza vaccine coverage among health care workers at long-term care facilities.

PubMed

Kimura, Akiko C; Nguyen, Christine N; Higa, Jeffrey I; Hurwitz, Eric L; Vugia, Duc J

2007-04-01

We examined barriers to influenza vaccination among long-term care facility (LTCF) health care workers in Southern California and developed simple, effective interventions to improve influenza vaccine coverage of these workers. In 2002, health care workers at LTCFs were surveyed regarding their knowledge and attitudes about influenza and the influenza vaccine. Results were used to develop 2 interventions, an educational campaign and Vaccine Day (a well-publicized day for free influenza vaccination of all employees at the worksite). Seventy facilities were recruited to participate in an intervention trial and randomly assigned to 4 study groups. The combination of Vaccine Day and an educational campaign was most effective in increasing vaccine coverage (53% coverage; prevalence ratio [PR]=1.45; 95% confidence interval [CI]=1.24, 1.71, compared with 27% coverage in the control group). Vaccine Day alone was also effective (46% coverage; PR= 1.41; 95% CI=1.17, 1.71). The educational campaign alone was not effective in improving coverage levels (34% coverage; PR=1.18; 95% CI=0.93, 1.50). Influenza vaccine coverage of LTCF health care workers can be improved by providing free vaccinations at the worksite with a well-publicized Vaccine Day.

Determinants of Vaccination Coverage and Consequences for Rabies Control in Bali, Indonesia.

PubMed

Arief, Riana A; Hampson, Katie; Jatikusumah, Andri; Widyastuti, Maria D W; Sunandar; Basri, Chaerul; Putra, Anak A G; Willyanto, Iwan; Estoepangestie, Agnes T S; Mardiana, I W; Kesuma, I K G N; Sumantra, I P; Doherty, Paul F; Salman, M D; Gilbert, Jeff; Unger, Fred

2016-01-01

Maintaining high vaccination coverage is key to successful rabies control, but mass dog vaccination can be challenging and population turnover erodes coverage. Declines in rabies incidence following successive island-wide vaccination campaigns in Bali suggest that prospects for controlling and ultimately eliminating rabies are good. Rabies, however, has continued to circulate at low levels. In the push to eliminate rabies from Bali, high coverage needs to be maintained across all areas of the island. We carried out door-to-door (DTD) questionnaire surveys ( n  = 10,352 dog-owning households) and photographic mark-recapture surveys (536 line transects, 2,597 observations of free-roaming dogs) in 2011-2012 to estimate dog population sizes and assess rabies vaccination coverage and dog demographic characteristics in Bali, Indonesia. The median number of dogs per subvillage unit ( banjar ) was 43 (range 0-307) for owned dogs estimated from the DTD survey and 17 (range 0-83) for unconfined dogs (including both owned and unowned) from transects. Vaccination coverage of owned dogs was significantly higher in adults (91.4%) compared to juveniles (<1 year, 43.9%), likely due to insufficient targeting of pups and from puppies born subsequent to vaccination campaigns. Juveniles had a 10-70 times greater risk of not being vaccinated in urban, suburban, and rural areas [combined odds ratios (ORs): 9.9-71.1, 95% CI: 8.6-96.0]. Free-roaming owned dogs were also 2-3 times more likely to be not vaccinated compared to those confined (combined Ors: 1.9-3.6, 95% CI: 1.4-5.4), with more dogs being confined in urban (71.2%) than in suburban (16.1%) and rural areas (8.0%). Vaccination coverage estimates from transects were also much lower (30.9%) than household surveys (83.6%), possibly due to loss of collars used to identify the vaccination status of free-roaming dogs, but these unconfined dogs may also include dogs that were unowned or more difficult to vaccinate. Overall, coverage levels were high in the owned dog population, but for future campaigns in Bali to have the highest chance of eliminating rabies, concerted effort should be made to vaccinate free-roaming dogs particularly in suburban and rural areas, with advertising to ensure that owners vaccinate pups. Long-lasting, cheap, and quick methods are needed to mark vaccinated animals and reassure communities of the reach of vaccination campaigns.

Determinants of Vaccination Coverage and Consequences for Rabies Control in Bali, Indonesia

PubMed Central

Arief, Riana A.; Hampson, Katie; Jatikusumah, Andri; Widyastuti, Maria D. W.; Sunandar; Basri, Chaerul; Putra, Anak A. G.; Willyanto, Iwan; Estoepangestie, Agnes T. S.; Mardiana, I. W.; Kesuma, I. K. G. N.; Sumantra, I. P.; Doherty, Paul F.; Salman, M. D.; Gilbert, Jeff; Unger, Fred

2017-01-01

Maintaining high vaccination coverage is key to successful rabies control, but mass dog vaccination can be challenging and population turnover erodes coverage. Declines in rabies incidence following successive island-wide vaccination campaigns in Bali suggest that prospects for controlling and ultimately eliminating rabies are good. Rabies, however, has continued to circulate at low levels. In the push to eliminate rabies from Bali, high coverage needs to be maintained across all areas of the island. We carried out door-to-door (DTD) questionnaire surveys (n = 10,352 dog-owning households) and photographic mark–recapture surveys (536 line transects, 2,597 observations of free-roaming dogs) in 2011–2012 to estimate dog population sizes and assess rabies vaccination coverage and dog demographic characteristics in Bali, Indonesia. The median number of dogs per subvillage unit (banjar) was 43 (range 0–307) for owned dogs estimated from the DTD survey and 17 (range 0–83) for unconfined dogs (including both owned and unowned) from transects. Vaccination coverage of owned dogs was significantly higher in adults (91.4%) compared to juveniles (<1 year, 43.9%), likely due to insufficient targeting of pups and from puppies born subsequent to vaccination campaigns. Juveniles had a 10–70 times greater risk of not being vaccinated in urban, suburban, and rural areas [combined odds ratios (ORs): 9.9–71.1, 95% CI: 8.6–96.0]. Free-roaming owned dogs were also 2–3 times more likely to be not vaccinated compared to those confined (combined Ors: 1.9–3.6, 95% CI: 1.4–5.4), with more dogs being confined in urban (71.2%) than in suburban (16.1%) and rural areas (8.0%). Vaccination coverage estimates from transects were also much lower (30.9%) than household surveys (83.6%), possibly due to loss of collars used to identify the vaccination status of free-roaming dogs, but these unconfined dogs may also include dogs that were unowned or more difficult to vaccinate. Overall, coverage levels were high in the owned dog population, but for future campaigns in Bali to have the highest chance of eliminating rabies, concerted effort should be made to vaccinate free-roaming dogs particularly in suburban and rural areas, with advertising to ensure that owners vaccinate pups. Long-lasting, cheap, and quick methods are needed to mark vaccinated animals and reassure communities of the reach of vaccination campaigns. PMID:28119919

Reasons for low influenza vaccination coverage – a cross-sectional survey in Poland

PubMed Central

Kardas, Przemyslaw; Zasowska, Anna; Dec, Joanna; Stachurska, Magdalena

2011-01-01

Aim To assess the reasons for low influenza vaccination coverage in Poland, including knowledge of influenza and attitudes toward influenza vaccination. Methods This was a cross-sectional, anonymous, self-administered survey in primary care patients in Lodzkie voivodship (central Poland). The study participants were adults who visited their primary care physicians for various reasons from January 1 to April 30, 2007. Results Six hundred and forty participants completed the survey. In 12 months before the study, 20.8% participants had received influenza vaccination. The most common reasons listed by those who had not been vaccinated were good health (27.6%), lack of trust in vaccination effectiveness (16.8%), and the cost of vaccination (9.7%). The most common source of information about influenza vaccination were primary care physicians (46.6%). Despite reasonably good knowledge of influenza, as many as approximately 20% of participants could not point out any differences between influenza and other viral respiratory tract infections. Conclusions The main reasons for low influenza vaccination coverage in Poland were patients’ misconceptions and the cost of vaccination. Therefore, free-of-charge vaccination and more effective informational campaigns are needed, with special focus on high-risk groups. PMID:21495194

Vaccination coverage among children in kindergarten - United States, 2013-14 school year.

PubMed

Seither, Ranee; Masalovich, Svetlana; Knighton, Cynthia L; Mellerson, Jenelle; Singleton, James A; Greby, Stacie M

2014-10-17

State and local vaccination requirements for school entry are implemented to maintain high vaccination coverage and protect schoolchildren from vaccine-preventable diseases. Each year, to assess state and national vaccination coverage and exemption levels among kindergartners, CDC analyzes school vaccination data collected by federally funded state, local, and territorial immunization programs. This report describes vaccination coverage in 49 states and the District of Columbia (DC) and vaccination exemption rates in 46 states and DC for children enrolled in kindergarten during the 2013-14 school year. Median vaccination coverage was 94.7% for 2 doses of measles, mumps, and rubella (MMR) vaccine; 95.0% for varying local requirements for diphtheria, tetanus toxoid, and acellular pertussis (DTaP) vaccine; and 93.3% for 2 doses of varicella vaccine among those states with a 2-dose requirement. The median total exemption rate was 1.8%. High exemption levels and suboptimal vaccination coverage leave children vulnerable to vaccine-preventable diseases. Although vaccination coverage among kindergartners for the majority of reporting states was at or near the 95% national Healthy People 2020 targets for 4 doses of DTaP, 2 doses of MMR, and 2 doses of varicella vaccine, low vaccination coverage and high exemption levels can cluster within communities. Immunization programs might have access to school vaccination coverage and exemption rates at a local level for counties, school districts, or schools that can identify areas where children are more vulnerable to vaccine-preventable diseases. Health promotion efforts in these local areas can be used to help parents understand the risks for vaccine-preventable diseases and the protection that vaccinations provide to their children.

2009-2010 Seasonal Influenza Vaccination Coverage among College Students from 8 Universities in North Carolina

ERIC Educational Resources Information Center

Poehling, Katherine A.; Blocker, Jill; Ip, Edward H.; Peters, Timothy R.; Wolfson, Mark

2012-01-01

Objective: The authors sought to describe the 2009-2010 seasonal influenza vaccine coverage of college students. Participants: A total of 4,090 college students from 8 North Carolina universities participated in a confidential, Web-based survey in October-November 2009. Methods: Associations between self-reported 2009-2010 seasonal influenza…

Overview of Global, Regional, and National Routine Vaccination Coverage Trends and Growth Patterns From 1980 to 2009: Implications for Vaccine-Preventable Disease Eradication and Elimination Initiatives

PubMed Central

Wallace, Aaron S.; Ryman, Tove K.; Dietz, Vance

2015-01-01

Background Review of the historical growth in annual vaccination coverage across countries and regions can better inform decision makers’ development of future goals and strategies to improve routine vaccination services. Methods Using the World Health Organization (WHO) and the United Nations Children's Fund estimates of annual national third dose of diphtheria-tetanus-pertussis–containing vaccine (DTP3) and third dose of polio vaccine (POL3) coverage for 1980–2009, we calculated the mean absolute annual rate of change in national DTP3 coverage among all countries (globally) and among countries within each WHO region, as well as the number of years taken by each region to reach specific regional coverage levels. Last, we assessed differences in mean absolute annual rate of change in DTP3 coverage, stratified by baseline level of DTP3 coverage. Results During the 1980s, global DTP3 coverage increased a mean of 5.3 percentage points/year. Annual rate of change decreased to 0.5 percentage points/year in the 1990s and then increased to 0.9 percentage points/year during the 2000s. Mean annual rate of change in coverage across all countries was highest (9.2 percentage points) when national coverage levels were 26%–30% and lowest (−0.9 percentage points) when national coverage levels were 96%–100%. Regional differences existed as both WHO South-East Asia Region and WHO African Region countries experienced mean negative DTP3 coverage growth at lower coverage levels (81%–85%) than other regions. The regions that have achieved 95% DTP3 coverage (Americas, Western Pacific, and European) took 25–29 years to reach that level from a level of 50% DTP3 coverage. POL3 coverage change trends were similar to described DTP3 coverage change trends. Conclusions Mean national coverage growth patterns across all regions are nonlinear as coverage levels increase. Saturation points of mean 0 percentage-point growth in annual coverage varies by region and require further investigation. The achievement of >90% routine coverage is observed to take decades, which has implications for disease eradication and elimination initiatives. PMID:25316875

An assessment of mumps vaccine effectiveness by dose during an outbreak in Canada

PubMed Central

Deeks, Shelley L.; Lim, Gillian H.; Simpson, Mary Anne; Gagné, Louise; Gubbay, Jonathan; Kristjanson, Erik; Fung, Cecilia; Crowcroft, Natasha S.

2011-01-01

Background This investigation was done to assess vaccine effectiveness of one and two doses of the measles, mumps and rubella (MMR) vaccine during an outbreak of mumps in Ontario. The level of coverage required to reach herd immunity and interrupt community transmission of mumps was also estimated. Methods Information on confirmed cases of mumps was retrieved from Ontario’s integrated Public Health Information System. Cases that occurred between Sept. 1, 2009, and June 10, 2010, were included. Selected health units supplied coverage data from the Ontario Immunization Record Information System. Vaccine effectiveness by dose was calculated using the screening method. The basic reproductive number (R0) represents the average number of new infections per case in a fully susceptile population, and R0 values of between 4 and 10 were considered for varying levels of vaccine effectiveness. Results A total of 134 confirmed cases of mumps were identified. Information on receipt of MMR vaccine was available for 114 (85.1%) cases, of whom 63 (55.3%) reported having received only one dose of vaccine; 32 (28.1%) reported having received two doses. Vaccine effectiveness of one dose of the MMR vaccine ranged from 49.2% to 81.6%, whereas vaccine effectiveness of two doses ranged from 66.3% to 88.0%. If we assume vaccine effectiveness of 85% for two doses of the vaccine, vaccine coverage of 88.2% and 98.0% would be needed to interrupt community transmission of mumps if the corresponding reproductive values were four and six. Interpretation Our estimates of vaccine effectiveness of one and two doses of mumps-containing vaccine were consistent with the estimates that have been reported in other outbreaks. Outbreaks occurring in Ontario and elsewhere serve as a warning against complacency over vaccination programs. PMID:21576295

Estimating vaccination coverage in the absence of immunisation registers--the German experience.

PubMed

Siedler, A; Rieck, T; Reuss, A; Walter, D; Poggensee, G; Poethko-Muller, C; Reiter, S

2012-04-26

Immunisation registers are regarded as an appropriate solution to measure vaccination coverage on a population level. In Germany, a decentralised healthcare system and data protection regulations constrain such an approach. Moreover, shared responsibilities in the process of immunisation and multiple providers form the framework for public health interventions on vaccination issues. On the national level, those interventions consist mainly of conceptualising immunisation strategies, establishing vaccination programmes, and issuing recommendations. This paper provides an overview on sources and methods for collecting appropriate coverage data at national level and their public health relevance in Germany. Methods of data collection and available information on immunisations are described for three approaches: school entrance health examination, population surveys and insurance refund claim data. School entrance health examinations allow regional comparisons and estimation of trends for a specific cohort of children and for all recommended childhood vaccinations. Surveys deliver population based data on completeness and timeliness of selected vaccinations in populations defined by age or socio-demographic parameters and on knowledge and attitudes towards vaccination. Insurance refund claim data inform continuously on immunisation status (e.g. of children aged two years) or on vaccination incidence promptly after new or modified recommendations. In a complex healthcare system, the German National Public Health Institute (Robert Koch Institute, RKI) successfully compiles coverage data from different sources, which complement and validate one another. With the German approach of combining different data sources in the absence of immunisation registers, it is possible to gain solid and reliable data on the acceptance of vaccination programmes and target groups for immunisation. This approach might be of value for other countries with decentralised healthcare systems.

Vaccination coverage among foreign-born and U.S.-born adolescents in the United States: Successes and gaps - National Immunization Survey-Teen, 2012-2014.

PubMed

Healy, Jessica; Rodriguez-Lainz, Alfonso; Elam-Evans, Laurie D; Hill, Holly A; Reagan-Steiner, Sarah; Yankey, David

2018-03-20

An overall increase has been reported in vaccination rates among adolescents during the past decade. Studies of vaccination coverage have shown disparities when comparing foreign-born and U.S.-born populations among children and adults; however, limited information is available concerning potential disparities in adolescents. The National Immunization Survey-Teen is a random-digit-dialed telephone survey of caregivers of adolescents aged 13-17 years, followed by a mail survey to vaccination providers that is used to estimate vaccination coverage among the U.S. population of adolescents. Using the National Immunization Survey-Teen data, we assessed vaccination coverage during 2012-2014 among adolescents for routinely recommended vaccines for this age group (≥1 dose tetanus and diphtheria toxoids and acellular pertussis [Tdap] vaccine, ≥1 dose quadrivalent meningococcal conjugate [MenACWY] vaccine, ≥3 doses human papillomavirus [HPV] vaccine) and for routine childhood vaccination catch-up doses (≥2 doses measles, mumps, and rubella [MMR] vaccine, ≥2 doses varicella vaccine, and ≥3 doses hepatitis B [HepB] vaccine). Vaccination coverage prevalence and vaccination prevalence ratios were estimated. Of the 58,090 respondents included, 3.3% were foreign-born adolescents. Significant differences were observed between foreign-born and U.S.-born adolescents for insurance status, income-to-poverty ratio, education, interview language, and household size. Foreign-born adolescents had significantly lower unadjusted vaccination coverage for HepB (89% vs. 93%), and higher coverage for the recommended ≥3 doses of HPV vaccine among males, compared with U.S.-born adolescents (22% vs. 14%). Adjustment for demographic and socioeconomic factors accounted for the disparity in HPV but not HepB vaccination coverage. We report comparable unadjusted vaccination coverage among foreign-born and U.S.-born adolescents for Tdap, MenACWY, MMR, ≥2 varicella. Although coverage was high for HepB vaccine, it was significantly lower among foreign-born adolescents, compared with U.S.-born adolescents. HPV and ≥2-dose varicella vaccination coverage were low among both groups. Published by Elsevier Ltd.

Vaccination coverage and immunization timeliness among children aged 12-23 months in Senegal: a Kaplan-Meier and Cox regression analysis approach

PubMed Central

Mbengue, Mouhamed Abdou Salam; Mboup, Aminata; Ly, Indou Deme; Faye, Adama; Camara, Fatou Bintou Niang; Thiam, Moussa; Ndiaye, Birahim Pierre; Dieye, Tandakha Ndiaye; Mboup, Souleymane

2017-01-01

Introduction Expanded programme on immunizations in resource-limited settings currently measure vaccination coverage defined as the proportion of children aged 12-23 months that have completed their vaccination. However, this indicator does not address the important question of when the scheduled vaccines were administered. We assessed the determinants of timely immunization to help the national EPI program manage vaccine-preventable diseases and impact positively on child survival in Senegal. Methods Vaccination data were obtained from the Demographic and Health Survey (DHS) carried out across the 14 regions in the country. Children were aged between 12-23 months. The assessment of vaccination coverage was done with the health card and/or by the mother’s recall of the vaccination act. For each vaccine, an assessment of delay in age-appropriate vaccination was done following WHO recommendations. Additionally, Kaplan-Meier survival function was used to estimate the proportion vaccinated by age and cox-proportional hazards models were used to examine risk factors for delays. Results A total of 2444 living children between 12–23 months of age were included in the analysis. The country vaccination was below the WHO recommended coverage level and, there was a gap in timeliness of children immunization. While BCG vaccine uptake was over 95%, coverage decreased with increasing number of Pentavalent vaccine doses (Penta 1: 95.6%, Penta 2: 93.5%: Penta 3: 89.2%). Median delay for BCG was 1.7 weeks. For polio at birth, the median delay was 5 days; all other vaccine doses had median delays of 2-4 weeks. For Penta 1 and Penta 3, 23.5% and 15.7% were given late respectively. A quarter of measles vaccines were not administered or were scheduled after the recommended age. Vaccinations that were not administered within the recommended age ranges were associated with mothers’ poor education level, multiple siblings, low socio-economic status and living in rural areas. Conclusion A significant delay in receipt of infant vaccines is found in Senegal while vaccine coverage is suboptimal. The national expanded program on immunization should consider measuring age at immunization or using seroepidemiological data to better monitor its impact. PMID:29296143

Vaccination Coverage Disparities Between Foreign-Born and U.S.-Born Children Aged 19-35 Months, United States, 2010-2012.

PubMed

Varan, Aiden K; Rodriguez-Lainz, Alfonso; Hill, Holly A; Elam-Evans, Laurie D; Yankey, David; Li, Qian

2017-08-01

Healthy People 2020 targets high vaccination coverage among children. Although reductions in coverage disparities by race/ethnicity have been described, data by nativity are limited. The National Immunization Survey is a random-digit-dialed telephone survey that estimates vaccination coverage among U.S. children aged 19-35 months. We assessed coverage among 52,441 children from pooled 2010-2012 data for individual vaccines and the combined 4:3:1:3*:3:1:4 series (which includes ≥4 doses of diphtheria, tetanus, and acellular pertussis vaccine/diphtheria and tetanus toxoids vaccine/diphtheria, tetanus toxoids, and pertussis vaccine, ≥3 doses of poliovirus vaccine, ≥1 dose of measles-containing vaccine, ≥3 or ≥4 doses of Haemophilus influenzae type b vaccine (depending on product type of vaccine; denoted as 3* in the series name), ≥3 doses of hepatitis B vaccine, ≥1 dose of varicella vaccine, and ≥4 doses of pneumococcal conjugate vaccine). Coverage estimates controlling for sociodemographic factors and multivariable logistic regression modeling for 4:3:1:3*:3:1:4 series completion are presented. Significantly lower coverage among foreign-born children was detected for DTaP, hepatitis A, hepatitis B, Hib, pneumococcal conjugate, and rotavirus vaccines, and for the combined series. Series completion disparities persisted after control for demographic, access-to-care, poverty, and language effects. Substantial and potentially widening disparities in vaccination coverage exist among foreign-born children. Improved immunization strategies targeting this population and continued vaccination coverage monitoring by nativity are needed.

Routine immunization in Pakistan: comparison of multiple data sources and identification of factors associated with vaccination

PubMed Central

Imran, Hafsa; Raja, Dania; Grassly, Nicholas C; Wadood, M Zubair; Safdar, Rana M; O’Reilly, Kathleen M

2018-01-01

Abstract Background Within Pakistan, estimates of vaccination coverage with the pentavalent vaccine, oral polio vaccine (OPV) and measles vaccine (MV) in 2011 were reported to be 74%, 75% and 53%, respectively. These national estimates may mask regional variation. The reasons for this variation have not been explored. Methods Data from the Multiple Indicator Cluster Surveys (MICS) for Balochistan and Punjab (2010–2011) are analysed to examine factors associated with receiving three or more doses of the pentavalent vaccine and one or more MVs using regression modelling. Pentavalent and OPV estimates from the MICS were compared to vaccine dose histories from surveillance for acute flaccid paralysis (AFP; poliomyelitis) to ascertain agreement. Results Adjusted coverage of children 12–23 months of age were estimated to be 16.0%, 75.5% and 34.2% in Balochistan and 58.0%, 87.7% and 72.6% in Punjab for the pentavalent vaccine, OPV and MV, respectively. Maternal education, healthcare utilization and wealth were associated with receiving the pentavalent vaccine and the MV. There was a strong correlation of district estimates of vaccination coverage between AFP and MICS data, but AFP estimates of pentavalent coverage in Punjab were biased toward higher values. Conclusions National estimates mask variation and estimates from individual surveys should be considered alongside other estimates. The development of strategies targeted towards poorly educated parents within low-wealth quintiles that may not typically access healthcare could improve vaccination rates. PMID:29432552

Vaccination coverage among children in kindergarten - United States, 2012-13 school year.

PubMed

2013-08-02

State and local school vaccination requirements are implemented to maintain high vaccination coverage and minimize the risk from vaccine preventable diseases. To assess school vaccination coverage and exemptions, CDC annually analyzes school vaccination coverage data from federally funded immunization programs. These awardees include 50 states and the District of Columbia (DC), five cities, and eight U.S.-affiliated jurisdictions. This report summarizes vaccination coverage from 48 states and DC and exemption rates from 49 states and DC for children entering kindergarten for the 2012-13 school year. Forty-eight states and DC reported vaccination coverage, with medians of 94.5% for 2 doses of measles, mumps, and rubella (MMR) vaccine; 95.1% for local requirements for diphtheria, tetanus toxoid, and acellular pertussis (DTaP) vaccination; and 93.8% for 2 doses of varicella vaccine among awardees with a 2-dose requirement. Forty-nine states and DC reported exemption rates, with the median total of 1.8%. Although school entry coverage for most awardees was at or near national Healthy People 2020 targets of maintaining 95% vaccination coverage levels for 2 doses of MMR vaccine, 4 doses of DTaP† vaccine, and 2 doses of varicella vaccine, low vaccination and high exemption levels can cluster within communities, increasing the risk for disease. Reports to CDC are aggregated at the state level; however, local reporting of school vaccination coverage might be accessible by awardees. These local-level data can be used to create evidence-based health communication strategies to help parents understand the risks for vaccine-preventable diseases and the benefits of vaccinations to the health of their children and other kindergarteners.

Socioeconomic inequalities and vaccination coverage: results of an immunisation coverage survey in 27 Brazilian capitals, 2007–2008

PubMed Central

Sampaio de Almeida Ribeiro, Manoel Carlos; de Moraes, José Cássio; Flannery, Brendan

2012-01-01

Background Since 1988, Brazil's Unified Health System has sought to provide universal and equal access to immunisations. Inequalities in immunisation may be examined by contrasting vaccination coverage among children in the highest versus the lowest socioeconomic strata. The authors examined coverage with routine infant immunisations from a survey of Brazilian children according to socioeconomic stratum of residence census tract. Methods The authors conducted a household cluster survey in census tracts systematically selected from five socioeconomic strata, according to average household income and head of household education, in 26 Brazilian capitals and the federal district. The authors calculated coverage with recommended vaccinations among children until 18 months of age, according to socioeconomic quintile of residence census tract, and examined factors associated with incomplete vaccination. Results Among 17 295 children with immunisation cards, 14 538 (82.6%) had received all recommended vaccinations by 18 months of age. Among children residing in census tracts in the highest socioeconomic stratum, 77.2% were completely immunised by 18 months of age versus 81.2%–86.2% of children residing in the four census tract quintiles with lower socioeconomic indicators (p<0.01). Census tracts in the highest socioeconomic quintile had significantly lower coverage for bacille Calmette-Guérin, oral polio and hepatitis B vaccines than those with lower socioeconomic indicators. In multivariable analysis, higher birth order and residing in the highest socioeconomic quintile were associated with incomplete vaccination. After adjusting for interaction between socioeconomic strata of residence census tract and household wealth index, only birth order remained significant. Conclusions Evidence from Brazilian capitals shows success in achieving high immunisation coverage among poorer children. Strategies are needed to reach children in wealthier areas. PMID:22268129

Knowledge, Attitudes and Perceptions About Routine Childhood Vaccinations Among Jewish Ultra-Orthodox Mothers Residing in Communities with Low Vaccination Coverage in the Jerusalem District.

PubMed

Stein Zamir, Chen; Israeli, Avi

2017-05-01

Background and aims Childhood vaccinations are an important component of primary prevention. Maternal and Child Health (MCH) clinics in Israel provide routine vaccinations without charge. Several vaccine-preventable-diseases outbreaks (measles, mumps) emerged in Jerusalem in the past decade. We aimed to study attitudes and knowledge on vaccinations among mothers, in communities with low immunization coverage. Methods A qualitative study including focus groups and semi-structured interviews. Results Low immunization coverage was defined below the district's mean (age 2 years, 2013) for measles-mumps-rubella-varicella 1st dose (MMR1\\MMRV1) and diphtheria-tetanus-pertussis 4th dose (DTaP4), 96 and 89%, respectively. Five communities were included, all were Jewish ultra-orthodox. The mothers' (n = 87) median age was 30 years and median number of children 4. Most mothers (94%) rated vaccinations as the main activity in the MCH clinics with overall positive attitudes. Knowledge about vaccines and vaccination schedule was inadequate. Of vaccines scheduled at ages 0-2 years (n = 13), the mean number mentioned was 3.9 ± 2.8 (median 4, range 0-9). Vaccines mentioned more often were outbreak-related (measles, mumps, polio) and HBV (given to newborns). Concerns about vaccines were obvious, trust issues and religious beliefs were not. Vaccination delay was very common and timeliness was considered insignificant. Practical difficulties in adhering to the recommended schedule prevailed. The vaccinations visits were associated with pain and stress. Overall, there was a sense of self-responsibility accompanied by inability to influence others. Conclusion Investigating maternal knowledge and attitudes on childhood vaccinations provides insights that may assist in planning tailored intervention programs aimed to increase both vaccination coverage and timeliness.

Impact of the addition of new vaccines in the early childhood schedule on vaccine coverage by 24 months of age from 2006 to 2016 in Quebec, Canada.

PubMed

Kiely, Marilou; Boulianne, Nicole; Talbot, Denis; Ouakki, Manale; Guay, Maryse; Landry, Monique; Zafack, Joseline; Sauvageau, Chantal; De Serres, Gaston

2018-07-05

Between 2004 and 2016, in the province of Quebec (Canada), 4 new antigens were added in the early childhood vaccine schedule from birth to 18 months, increasing the number of injections or doses needed from 7 to 12. These additions may have decreased the proportion of children who had received all recommended vaccines. To assess the impact of the introduction of new vaccines to the childhood schedule on the 24-month vaccine coverage from 2006 to 2016 and identify factors associated with incomplete vaccination status by 24 months of age. We used the data from six cross-sectional vaccine coverage surveys conducted every two years which included a total of 3515 children aged 2 years old and randomly selected from the Quebec public health insurance database. Factors associated with an incomplete vaccine status by 24 months were identified with multivariable logistic regression. Despite the addition of 4 new vaccine antigens since 2004, the vaccine coverage remained high from 2006 (82.4%) through 2016 (88.3%) for vaccines present in the schedule since 2006. In 2016, vaccine coverage was 78.2% for all vaccines included in the schedule. The vaccine coverage of new vaccines increases rapidly within 2 years of their introduction. For both new and older vaccines, incomplete vaccine status by 24 months of age is associated with a delay of 30 days or more in receiving the vaccines scheduled at 2 and 12 months of age. Increasing to 12 the number of doses in the recommended schedule has slightly reduced the vaccine coverage by 24 months of age and the vaccine coverage of vaccines already in the schedule remained stable over the years. Future additions to the vaccine schedule may not be similarly accepted by the population and this will require continuing the monitoring of vaccine coverage. Copyright © 2018 Elsevier Ltd. All rights reserved.

HPV Vaccination Coverage of Male Adolescents in the United States

PubMed Central

Lu, Peng-jun; Yankey, David; Jeyarajah, Jenny; O’Halloran, Alissa; Elam-Evans, Laurie D.; Smith, Philip J.; Stokley, Shannon; Singleton, James A.; Dunne, Eileen F.

2018-01-01

Background In 2011, the Advisory Committee for Immunization Practices (ACIP) recommended routine use HPV vaccine for male adolescents. Methods We used the 2013 National Immunization Survey-Teen (NIS-Teen) data to assess HPV vaccine uptake (≥1 dose) and series completion (≥3 doses). Multivariable logistic regression analysis and a predictive marginal model were conducted to identify independent predictors of vaccination among adolescent males aged 13–17 years. Results HPV vaccination coverage with ≥1 dose was 34.6% while series completion (≥3 doses) was 13.9%. Coverage was significantly higher among non-Hispanic blacks and Hispanics compared with non-Hispanic white males. Multivariable logistic regression showed that characteristics independently associated with a higher likelihood of HPV vaccination (≥1 dose) included: being non-Hispanic black race or Hispanic ethnicity, having mothers who were widowed, divorced, or separated, having 1–3 physician contacts in the past 12 months, a well-child visit at age 11–12 years, having one or two vaccination providers, living in urban or suburban areas, and receiving vaccinations from more than one type of facility (p<0.05). Having mothers with some college or college education, having a higher family income to poverty ratio, living in South or Midwest, and receiving vaccinations from all STD/school/teen clinics or other facilities were independently associated with a lower likelihood of HPV vaccination (p<0.05). Conclusions Following recommendations for routine HPV vaccination among male adolescents, uptake in 2013 was low in males. Increased efforts are needed to improve vaccination coverage, especially for those who are least likely to be vaccinated. PMID:26504124

Influenza Vaccination Coverage and Its Associated Factors among North Korean Defectors Living in the Republic of Korea.

PubMed

Song, In Gyu; Lee, Haewon; Yi, Jinseon; Kim, Min Sun; Park, Sang Min

2015-09-01

This study aimed to examine influenza vaccination coverage of North Korean defectors (NKD) in the Republic of Korea (Korea) and explore the factors affected the vaccination coverage. Total 378 NKD were analyzed. Four Korean control subjects were randomly matched by age and gender from the Korea National Health and Nutrition Examination Survey V (n = 1,500). The adjusted vaccination coverage revealed no statistical difference between the defectors group and indigenous group (29.1% vs. 29.5%, P = 0.915). In the aged under 50 group, the vaccination coverage of NKD was higher than that of Korean natives (37.8% vs. 25.8%, P = 0.016). However in the aged 50 yr and over group, the vaccination coverage of North Korean defectors was lower than that of the natives (28.0% vs. 37.6%, P = 0.189). Even the gap was wider in the aged 65 yr and over group (36.4% vs. 77.8%, P = 0.007). Gender and medical check-up experience within 2 yr showed association with the vaccination coverage of NKD. Influenza vaccination coverage of aged defectors' group (aged 50 yr and over) was lower than indigenous people though overall vaccination coverage was similar. Further efforts to increase influenza vaccination coverage of this group are needed.

Association of Health Insurance Status and Vaccination Coverage among Adolescents 13-17 Years of Age.

PubMed

Lu, Peng-Jun; Yankey, David; Jeyarajah, Jenny; O'Halloran, Alissa; Fredua, Benjamin; Elam-Evans, Laurie D; Reagan-Steiner, Sarah

2018-04-01

To assess selected vaccination coverage among adolescents by health insurance status and other access-to-care characteristics. The 2015 National Immunization Survey-Teen data were used to assess vaccination coverage disparities among adolescents by health insurance status and other access-to-care variables. Multivariable logistic regression analysis and a predictive marginal modeling were conducted to evaluate associations between health insurance status and vaccination coverage. Overall, vaccination coverage was significantly lower among uninsured compared with insured adolescents for all vaccines assessed for except ≥3 doses of human papillomavirus vaccine (HPV) among male adolescents. Among adolescents 13-17 years of age, vaccination of uninsured compared with insured adolescents, respectively, for tetanus toxoid, reduced content diphtheria toxoid, and acellular pertussis vaccine was 77.4% vs 86.8%; for ≥1 dose of meningococcal conjugate vaccine was 72.9% vs 81.7%; for ≥1 dose of HPV was 38.8% vs 50.2% among male and 42.9% vs 63.8% among female adolescents; for 3 doses of HPV was 24.9% vs 42.8% among female adolescents. In addition, vaccination coverage differed by the following: type of insurance among insured adolescents, having a well-child visit at 11-12 years of age, and number of healthcare provider contacts in the past year. Uninsured were less likely than insured adolescents to be vaccinated for HPV (female: ≥1 dose and 3 doses; and male: ≥1 doses) after adjusting for confounding variables. Overall, vaccination coverage was lower among uninsured adolescents. HPV vaccination coverage was lower than tetanus toxoid, reduced content diphtheria toxoid, and acellular pertussis vaccine Tdap and meningococcal conjugate vaccine in both insured and uninsured adolescents. Wider implementation of effective evidence-based strategies is needed to help improve vaccination coverage among adolescents, particularly for those who are uninsured. Limitation of current federally funded vaccination programs or access to healthcare would be expected to erode vaccine coverage of adolescents. Published by Elsevier Inc.

Impact of school-entry and education mandates by states on HPV vaccination coverage: Analysis of the 2009–2013 National Immunization Survey-Teen

PubMed Central

Perkins, Rebecca B.; Lin, Mengyun; Wallington, Sherrie F.; Hanchate, Amresh D.

2016-01-01

ABSTRACT Objective: To determine the effectiveness of existing school entry and education mandates on HPV vaccination coverage, we compared coverage among girls residing in states and jurisdictions with and without education and school-entry mandates. Virginia and the District of Columbia enacted school entry mandates, though both laws included liberal opt-out provisions. Ten additional states had mandates requiring distribution of education to parents or provision of education within school curricula. Methods: Using data from the National Immunization Survey-Teen from 2009–2013, we estimated multilevel logistic regression models to compare coverage with HPV vaccines for girls ages 13–17 residing in states and jurisdictions with and without school entry and education mandates, adjusting for demographic factors, healthcare access, and provider recommendation. Results: Girls residing in states and jurisdictions with HPV vaccine school entry mandates (DC and VA) and education mandates (LA, MI, CO, IN, IA, IL, NJ, NC, TX, and WA) did not have higher HPV vaccine series initiation or completion than those living in states without mandates for any year (2009–2013). Similar results were seen when comparing girls ages 13–14 to those ages 15–17, and after adjustment for known covariates of vaccination. Conclusions: States and jurisdictions with school-entry and education mandates do not currently have higher HPV vaccination coverage than states without such legislation. Liberal opt-out language in existing school entry mandates may weaken their impact. Policy-makers contemplating legislation to improve vaccination coverage should be aware of the limitations of existing mandates. PMID:27152418

Childhood vaccination coverage rates among military dependents in the United States.

PubMed

Dunn, Angela C; Black, Carla L; Arnold, John; Brodine, Stephanie; Waalen, Jill; Binkin, Nancy

2015-05-01

The Military Health System provides universal coverage of all recommended childhood vaccinations. Few studies have examined the effect that being insured by the Military Health System has on childhood vaccination coverage. The purpose of this study was to compare the coverage of the universally recommended vaccines among military dependents versus other insured and uninsured children using a nationwide sample of children. The National Immunization Survey is a multistage, random-digit dialing survey designed to measure vaccination coverage estimates of US children aged 19 to 35 months old. Data from 2007 through 2012 were combined to permit comparison of vaccination coverage among military dependent and all other children. Among military dependents, 28.0% of children aged 19 to 35 months were not up to date on the 4:3:1:3:3:1 vaccination series excluding Haemophilus influenzae type b vaccine compared with 21.1% of all other children (odds ratio: 1.4; 95% confidence interval: 1.2-1.6). After controlling for sociodemographic characteristics, compared with all other US children, military dependent children were more likely to be incompletely vaccinated (odds ratio: 1.3; 95% confidence interval: 1.1-1.5). Lower vaccination coverage rates among US military dependent children might be due to this population being highly mobile. However, the lack of a military-wide childhood immunization registry and incomplete documentation of vaccinations could contribute to the lower vaccination coverage rates seen in this study. These results suggest the need for further investigation to evaluate vaccination coverage of children with complete ascertainment of vaccination history, and if lower immunization rates are verified, assessment of reasons for lower vaccination coverage rates among military dependent children. Copyright © 2015 by the American Academy of Pediatrics.

A systematic review and meta-analysis of the effects of educating parents on the benefits and schedules of childhood vaccinations in low and middle-income countries.

PubMed

Lukusa, Lungeni Auguy; Ndze, Valantine Ngum; Mbeye, Nyanyiwe Masingi; Wiysonge, Charles Shey

2018-03-26

Public health benefits of childhood vaccinations risk being derailed by low vaccination coverage in low and middle-income countries. One reason for the low coverage is poor parental knowledge of the importance of completing vaccination schedules. We therefore assessed the effects on childhood vaccination coverage, of educating parents and other persons assuming the parental role. We prospectively registered the systematic review, published the protocol, and used standard Cochrane methods to collect and synthesise the evidence. We found six eligible randomised trials with 4248 participants. Three trials assessed health-facility based education of mothers on the importance of completing vaccination schedules; immediately after birth and three months later (one study) or during the first vaccination visit (two studies). The other trials assessed community-based education, including information campaigns on the importance of vaccines using audiotaped presentations and leaflet distributions (one study); structured group discussions on benefits and costs of childhood vaccination and local action plans for improving vaccine uptake (one study); and home-based information sessions using graphic cards showing benefits and costs of childhood vaccinations and location of vaccination centres (one study). Combining the data shows that these interventions lead to substantial improvements in childhood vaccination coverage (relative increase 36%, 95% confidence interval 14% to 62%). There was no difference between the effects of community-based and facility-based education. Therefore, education in communities and health facilities on the importance of childhood vaccinations should be integrated into all vaccination programmes in low and middle-income countries; accompanied by robust monitoring of impacts and use of data for action.

School Entry Requirements and Coverage of Nontargeted Adolescent Vaccines.

PubMed

Moss, Jennifer L; Reiter, Paul L; Truong, Young K; Rimer, Barbara K; Brewer, Noel T

2016-12-01

Low human papillomavirus (HPV) vaccination coverage is an urgent public health problem requiring action. To identify policy remedies to suboptimal HPV vaccination, we assessed the relationship between states' school entry requirements and adolescent vaccination. We gathered data on states' school entry requirements for adolescent vaccination (tetanus, diphtheria, and pertussis [Tdap] booster; meningococcal; and HPV) from 2007 to 2012 from Immunization Action Coalition. The National Immunization Survey-Teen provided medical record-verified vaccination data for 99 921 adolescents. We calculated coverage (among 13- to 17-year-olds) for individual vaccinations and concomitant vaccination. HPV vaccination outcomes were among female adolescents. Analyses used weighted longitudinal multivariable models. States with requirements for Tdap booster and meningococcal vaccination had 22 and 24 percentage point increases in coverage for these vaccines, respectively, compared with other states (both P < .05). States with HPV vaccination requirements had <1 percentage point increase in coverage for this vaccine (P < .05). Tdap booster and meningococcal vaccination requirements, respectively, were associated with 8 and 4 percentage point spillover increases for HPV vaccination coverage (both P < .05) and with increases for concomitant vaccination (all P < .05). Ensuring all states have meningococcal vaccination requirements could improve the nation's HPV vaccination coverage, given that many states already require Tdap booster but not meningococcal vaccination for school entry. Vaccination programs and clinicians should capitalize on changes in adolescent vaccination, including concomitant vaccination, that may arise after states adopt vaccination requirements. Additional studies are needed on the effects of HPV vaccination requirements and opt-out provisions. Copyright © 2016 by the American Academy of Pediatrics.

Influenza during pregnancy: Incidence, vaccination coverage and attitudes toward vaccination in the French web-based cohort G-GrippeNet.

PubMed

Loubet, Paul; Guerrisi, Caroline; Turbelin, Clément; Blondel, Béatrice; Launay, Odile; Bardou, Marc; Goffinet, François; Colizza, Vittoria; Hanslik, Thomas; Kernéis, Solen

2016-04-29

Pregnancy is a risk factor for severe influenza. However, data on influenza incidence during pregnancy are scarce. Likewise, no data are available on influenza vaccine coverage in France since national recommendation in 2012. We aimed to assess these points using a novel nationwide web-based surveillance system, G-GrippeNet. During the 2014/2015 influenza season, pregnant women living in metropolitan France were enrolled through a web platform (https://www.grippenet.fr/). Throughout the season, participants were asked to report, on a weekly basis, if they had experienced symptoms of influenza-like-illness (ILI). ILI episodes reported were used to calculate incidence density rates based on period of participation from each participant. Vaccination coverage was estimated after weighing on age and education level from national data on pregnant women. Factors associated with higher vaccination coverage were obtained through a logistic regression with Odds Ratio (OR) corrected with the Zhang and Yu method. A total of 153 women were enrolled. ILI incidence density rate was 1.8 per 100 person-week (95% CI, 1.5-2.1). This rate was higher in women older than 40 years (RR = 3.0, 95% CI [1.1-8.3], p = 0.03) and during first/second trimesters compared to third trimester (RR = 4.0, 95% CI [1.4-12.0], p = 0.01). Crude vaccination coverage was 39% (95% CI, 31-47) and weighted vaccination coverage was estimated at 26% (95% CI, 20-34). Health care provider recommendation for vaccination (corrected OR = 7.8; 95% CI [3.0-17.1]) and non-smoking status (cOR = 2.1; 95% CI [1.2-6.9]) were associated with higher vaccine uptake. This original web based longitudinal surveillance study design proved feasible in pregnant women population. First results are of interest and underline that public health policies should emphasize the vaccination promotion through health care providers. Copyright © 2016 Elsevier Ltd. All rights reserved.

Inferring rubella outbreak risk from seroprevalence data in Belgium.

PubMed

Abrams, Steven; Kourkouni, Eleni; Sabbe, Martine; Beutels, Philippe; Hens, Niel

2016-12-07

Rubella is usually a mild disease for which infections often pass by unnoticed. In approximately 50% of the cases, there are no or only few clinical symptoms. However, rubella contracted during early pregnancy could lead to spontaneous abortion, to central nervous system defects, or to one of a range of other serious and debilitating conditions in a newborn such as the congenital rubella syndrome. Before the introduction of mass vaccination, rubella was a common childhood infection occurring all over the world. However, since the introduction of rubella antigen-containing vaccines, the incidence of rubella has declined dramatically in high-income countries. Recent large-scale mumps outbreaks, one of the components in the combined measles-mumps-rubella vaccine, occurring in countries throughout Europe with high vaccination coverage, provide evidence of pathogen-specific waning of vaccine-induced immunity and primary vaccine failure. In addition, recent measles outbreaks affecting populations with suboptimal vaccination coverages stress the importance of maintaining high vaccination coverages. In this paper, we focus on the assessment of rubella outbreak risk using a previously developed method to identify geographic regions of high outbreak potential. The methodology relies on 2006 rubella seroprevalence data and vaccination coverage data from Belgium and information on primary and secondary vaccine failure obtained from extensive literature reviews. We estimated the rubella outbreak risk in Belgium to be low, however maintaining high levels of immunisation and surveillance are of utmost importance to avoid future outbreaks. Copyright © 2016 Elsevier Ltd. All rights reserved.

Influenza Vaccination Coverage among Adults in Korea: 2008–2009 to 2011–2012 Seasons

PubMed Central

Yang, Hye Jung; Cho, Sung-il

2014-01-01

The aim of this study was to examine seasonal and pandemic influenza vaccination coverage in adults from the 2008–2009 season to the 2011–2012 season, including pandemic and post-pandemic seasons in Korea. We collected data of self-reported vaccine use from the Korean Community Health Survey. We also collected information on socioeconomic status and health behaviors in subpopulations. We tested for linear trends among the data to investigate vaccine coverage before and after the pandemic; and multiple logistic regression analyses were performed to identify predictors of obtaining the influenza vaccination. The results revealed a steady increase in vaccination coverage in every subgroup during four consecutive seasons. The highest rate of vaccine coverage (43.6%) occurred two years after the pandemic. Factors associated with vaccine receipt were: older age; lower education level; lower income; and health behaviors such as regular walking and receiving a health check-up. Smoking and drinking alcohol were inversely associated with vaccination. Having a chronic health condition was also a strong predictor of vaccine receipt. Though vaccination coverage rates were high in high-risk groups; disparities in coverage rates were substantial; particularly in young adults. Interventions are needed to minimize the coverage gaps among subgroups and to improve overall vaccination rates. PMID:25429683

Influenza vaccination coverage among adults in Korea: 2008-2009 to 2011-2012 seasons.

PubMed

Yang, Hye Jung; Cho, Sung-Il

2014-11-25

The aim of this study was to examine seasonal and pandemic influenza vaccination coverage in adults from the 2008-2009 season to the 2011-2012 season, including pandemic and post-pandemic seasons in Korea. We collected data of self-reported vaccine use from the Korean Community Health Survey. We also collected information on socioeconomic status and health behaviors in subpopulations. We tested for linear trends among the data to investigate vaccine coverage before and after the pandemic; and multiple logistic regression analyses were performed to identify predictors of obtaining the influenza vaccination. The results revealed a steady increase in vaccination coverage in every subgroup during four consecutive seasons. The highest rate of vaccine coverage (43.6%) occurred two years after the pandemic. Factors associated with vaccine receipt were: older age; lower education level; lower income; and health behaviors such as regular walking and receiving a health check-up. Smoking and drinking alcohol were inversely associated with vaccination. Having a chronic health condition was also a strong predictor of vaccine receipt. Though vaccination coverage rates were high in high-risk groups; disparities in coverage rates were substantial; particularly in young adults. Interventions are needed to minimize the coverage gaps among subgroups and to improve overall vaccination rates.

Prevention of HPV-Related Cancers in Norway: Cost-Effectiveness of Expanding the HPV Vaccination Program to Include Pre-Adolescent Boys

PubMed Central

Burger, Emily A.; Sy, Stephen; Nygård, Mari; Kristiansen, Ivar S.; Kim, Jane J.

2014-01-01

Background Increasingly, countries have introduced female vaccination against human papillomavirus (HPV), causally linked to several cancers and genital warts, but few have recommended vaccination of boys. Declining vaccine prices and strong evidence of vaccine impact on reducing HPV-related conditions in both women and men prompt countries to reevaluate whether HPV vaccination of boys is warranted. Methods A previously-published dynamic model of HPV transmission was empirically calibrated to Norway. Reductions in the incidence of HPV, including both direct and indirect benefits, were applied to a natural history model of cervical cancer, and to incidence-based models for other non-cervical HPV-related diseases. We calculated the health outcomes and costs of the different HPV-related conditions under a gender-neutral vaccination program compared to a female-only program. Results Vaccine price had a decisive impact on results. For example, assuming 71% coverage, high vaccine efficacy and a reasonable vaccine tender price of $75 per dose, we found vaccinating both girls and boys fell below a commonly cited cost-effectiveness threshold in Norway ($83,000/quality-adjusted life year (QALY) gained) when including vaccine benefit for all HPV-related diseases. However, at the current market price, including boys would not be considered ‘good value for money.’ For settings with a lower cost-effectiveness threshold ($30,000/QALY), it would not be considered cost-effective to expand the current program to include boys, unless the vaccine price was less than $36/dose. Increasing vaccination coverage to 90% among girls was more effective and less costly than the benefits achieved by vaccinating both genders with 71% coverage. Conclusions At the anticipated tender price, expanding the HPV vaccination program to boys may be cost-effective and may warrant a change in the current female-only vaccination policy in Norway. However, increasing coverage in girls is uniformly more effective and cost-effective than expanding vaccination coverage to boys and should be considered a priority. PMID:24651645

Influenza vaccination coverage and effectiveness in young children in Thailand, 2011–2013

PubMed Central

Kittikraisak, Wanitchaya; Suntarattiwong, Piyarat; Levy, Jens; Fernandez, Stefan; Dawood, Fatimah S; Olsen, Sonja J; Chotpitayasunondh, Tawee

2015-01-01

Background Since 2009, Thailand has recommended influenza vaccine for children aged 6 months through 2 years, but no estimates of influenza vaccine coverage or effectiveness are available for this target group. Methods During August 2011–May 2013, high-risk and healthy children aged ≤36 months were enrolled in a 2-year prospective cohort study. Parents were contacted weekly about acute respiratory illness (ARI) in their child. Ill children had combined nasal and throat swabs tested for influenza viruses by real-time reverse transcription–polymerase chain reaction. Influenza vaccination status was verified with vaccination cards. The Cox proportional hazards approach was used to estimate hazard ratios. Vaccine effectiveness (VE) was estimated as 100% x (1-hazard ratio). Results During 2011–2013, 968 children were enrolled (median age, 10·3 months); 948 (97·9%) had a vaccination record and were included. Of these, 394 (41·6%) had ≥1 medical conditions. Vaccination coverage for the 2011–2012 and 2012–2013 seasons was 29·3% (93/317) and 30·0% (197/656), respectively. In 2011–2012, there were 213 ARI episodes, of which 10 (4·6%) were influenza positive (2·3 per 1000 vaccinated and 3·8 per 1000 unvaccinated child-weeks). The VE was 55% (95% confidence interval [CI], −72, 88). In 2012–2013, there were 846 ARIs, of which 52 (6·2%) were influenza positive (1·8 per 1000 vaccinated and 4·5 per 1000 unvaccinated child-weeks). The VE was 64% (CI, 13%, 85%). Conclusion Influenza vaccination coverage among young children in Thailand was low, although vaccination was moderately effective. Continued efforts are needed to increase influenza vaccination coverage and evaluate VE among young children in Thailand. PMID:25557920

Transport networks and inequities in vaccination: remoteness shapes measles vaccine coverage and prospects for elimination across Africa.

PubMed

Metcalf, C J E; Tatem, A; Bjornstad, O N; Lessler, J; O'Reilly, K; Takahashi, S; Cutts, F; Grenfell, B T

2015-05-01

Measles vaccination is estimated to have averted 13·8 million deaths between 2000 and 2012. Persisting heterogeneity in coverage is a major contributor to continued measles mortality, and a barrier to measles elimination and introduction of rubella-containing vaccine. Our objective is to identify determinants of inequities in coverage, and how vaccine delivery must change to achieve elimination goals, which is a focus of the WHO Decade of Vaccines. We combined estimates of travel time to the nearest urban centre (⩾50 000 people) with vaccination data from Demographic Health Surveys to assess how remoteness affects coverage in 26 African countries. Building on a statistical mapping of coverage against age and geographical isolation, we quantified how modifying the rate and age range of vaccine delivery affects national coverage. Our scenario analysis considers increasing the rate of delivery of routine vaccination, increasing the target age range of routine vaccination, and enhanced delivery to remote areas. Geographical isolation plays a key role in defining vaccine inequity, with greater inequity in countries with lower measles vaccine coverage. Eliminating geographical inequities alone will not achieve thresholds for herd immunity, indicating that changes in delivery rate or age range of routine vaccination will be required. Measles vaccine coverage remains far below targets for herd immunity in many countries on the African continent and is likely to be inadequate for achieving rubella elimination. The impact of strategies such as increasing the upper age range eligible for routine vaccination should be considered.

National, State, and Selected Local Area Vaccination Coverage Among Children Aged 19-35 Months - United States, 2014.

PubMed

Hill, Holly A; Elam-Evans, Laurie D; Yankey, David; Singleton, James A; Kolasa, Maureen

2015-08-28

The reduction in morbidity and mortality associated with vaccine-preventable diseases in the United States has been described as one of the 10 greatest public health achievements of the first decade of the 21st century. A recent analysis concluded that routine childhood vaccination will prevent 322 million cases of disease and about 732,000 early deaths among children born during 1994-2013, for a net societal cost savings of $1.38 trillion. The National Immunization Survey (NIS) has monitored vaccination coverage among U.S. children aged 19-35 months since 1994. This report presents national, regional, state, and selected local area vaccination coverage estimates for children born from January 2011 through May 2013, based on data from the 2014 NIS. For most vaccinations, there was no significant change in coverage between 2013 and 2014. The exception was hepatitis A vaccine (HepA), for which increases were observed in coverage with both ≥1 and ≥2 doses. As in previous years, <1% of children received no vaccinations. National coverage estimates indicate that the Healthy People 2020 target* of 90% was met for ≥3 doses of poliovirus vaccine (93.3%), ≥1 dose of measles, mumps, and rubella vaccine (MMR) (91.5%), ≥3 doses of hepatitis B vaccine (HepB) (91.6%), and ≥1 dose of varicella vaccine (91.0%). Coverage was below target for ≥4 doses of diphtheria, tetanus, and acellular pertussis vaccine (DTaP), the full series of Haemophilus influenzae type b (Hib) vaccine, hepatitis B (HepB) birth dose,† ≥4 doses pneumococcal conjugate vaccine (PCV), ≥2 doses of HepA, the full series of rotavirus vaccine, and the combined vaccine series.§ Examination of coverage by child's race/ethnicity revealed lower estimated coverage among non-Hispanic black children compared with non-Hispanic white children for several vaccinations, including DTaP, the full series of Hib, PCV, rotavirus vaccine, and the combined series. Children from households classified as below the federal poverty level had lower estimated coverage for almost all of the vaccinations assessed, compared with children living at or above the poverty level. Significant variation in coverage by state¶ was observed for several vaccinations, including HepB birth dose, HepA, and rotavirus. High vaccination coverage must be maintained across geographic and sociodemographic groups if progress in reducing the impact of vaccine-preventable diseases is to be sustained.

Evaluation of a vaccine passport to improve vaccine coverage in people living with HIV.

PubMed

Chadwick, D R; Corbett, K; Mann, S; Teruzzi, B; Horner, S

2018-01-01

An increased risk of vaccine-preventable infections (VPIs) is seen in people living with HIV (PLWH), and current vaccine coverage and immunity is variable. Vaccine passports have the potential to improve vaccine coverage. The objective was to assess how successful a vaccine passport was in improving vaccine coverage in PLWH. Baseline immunity to VPIs was established in PLWH attending a single HIV clinic and vaccinations required were determined based on the BHIVA Vaccination Guidelines (2015). The passport was completed and the PLWH informed about additional vaccines they should obtain from primary care. After 6-9 months the passport was reviewed including confirmation if vaccines were given. PLWH satisfaction with the system was evaluated by a survey. Seventy-three PLWH provided sufficient data for analysis. At baseline significant proportions of PLWH were not immune/unvaccinated to the main VPIs, especially human papillomavirus, pneumococcus and measles. After the passport was applied immunity improved significantly (56% overall, p < 0.01) for most VPIs; however, full coverage was not achieved. The system was popular with PLWH. The passport was successful in increasing vaccination coverage although full or near-full coverage was not achieved. A more successful service would probably be achieved by commissioning English HIV clinics to provide all vaccines.

Vaccine exemptions and the kindergarten vaccination coverage gap.

PubMed

Smith, Philip J; Shaw, Jana; Seither, Ranee; Lopez, Adriana; Hill, Holly A; Underwood, Mike; Knighton, Cynthia; Zhao, Zhen; Ravanam, Megha Shah; Greby, Stacie; Orenstein, Walter A

2017-09-25

Vaccination requirements for kindergarten entry vary by state, but all states require 2 doses of measles containing vaccine (MCV) at kindergarten entry. To assess (i) national MCV vaccination coverage for children who had attended kindergarten; (ii) the extent to which undervaccination after kindergarten entry is attributable to parents' requests for an exemption; (iii) the extent to which undervaccinated children had missed opportunities to be administered missing vaccine doses among children whose parent did not request an exemption; and (iv) the vaccination coverage gap between the "highest achievable" MCV coverage and actual MCV coverage among children who had attended kindergarten. A national survey of 1465 parents of 5-7year-old children was conducted during October 2013 through March 2014. Vaccination coverage estimates are based provider-reported vaccination histories. Children have a "missed opportunity" for MCV if they were not up-to-date and if there were dates on which other vaccines were administered but not MCV. The "highest achievable" MCV vaccination coverage rate is 100% minus the sum of the percentages of (i) undervaccinated children with parents who requested an exemption; and (ii) undervaccinated children with parents who did not request an exemption and whose vaccination statuses were assessed during a kindergarten grace period or period when they were provisionally enrolled in kindergarten. Among all children undervaccinated for MCV, 2.7% were attributable to having a parent who requested an exemption. Among children who were undervaccinated for MCV and whose parent did not request an exemption, 41.6% had a missed opportunity for MCV. The highest achievable MCV coverage was 98.6%, actual MCV coverage was 90.9%, and the kindergarten vaccination gap was 7.7%. Vaccination coverage may be increased by schools fully implementing state kindergarten vaccination laws, and by providers assessing children's vaccination status at every clinic visit, and administering missed vaccine doses. Published by Elsevier Ltd.

Do selective immunisation against tuberculosis and hepatitis B reach the targeted populations? A nationwide register-based study evaluating the recommendations in the Norwegian Childhood Immunisation Programme.

PubMed

Feiring, Berit; Laake, Ida; Molden, Tor; Håberg, Siri E; Nøkleby, Hanne; Seterelv, Siri Schøyen; Magnus, Per; Trogstad, Lill

2016-04-12

Selective immunisation is an alternative to universal vaccination if children at increased risk of disease can be identified. Within the Norwegian Childhood Immunisation Programme, BCG vaccine against tuberculosis and vaccine against hepatitis B virus (HBV) are offered only to children with parents from countries with high burden of the respective disease. We wanted to study whether this selective immunisation policy reaches the targeted groups. The study population was identified through the Norwegian Central Population Registry and consisted of all children born in Norway 2007-2010 and residing in Norway until their second birthday, in total 240,484 children. Information on vaccinations from the Norwegian Immunisation Registry, and on parental country of birth from Statistics Norway, was linked to the population registry by personal identifiers. The coverage of BCG and HBV vaccine was compared with the coverage of vaccines in the universal programme. Among the study population, 16.1% and 15.9% belonged to the target groups for BCG and HBV vaccine, respectively. Among children in the BCG target group the BCG vaccine coverage was lower than the coverage of pertussis and measles vaccine (83.6% vs. 98.6% and 92.3%, respectively). Likewise, the HBV vaccine coverage was lower than the coverage of pertussis and measles vaccine in the HBV target group (90.0% vs. 98.6% and 92.3%, respectively). The coverage of the targeted vaccines was highest among children with parents from South Asia and Sub-Saharan Africa. The coverage of vaccines in the universal programme was similar in targeted and non-targeted groups. Children targeted by selective vaccination had lower coverage of the target vaccines than of vaccines in the universal programme, indicating that selective vaccination is challenging. Improved routines for identifying eligible children and delivering the target vaccines are needed. Universal vaccination of all children with these vaccines could be considered. Copyright © 2016 Elsevier Ltd. All rights reserved.

Evaluating Childhood Vaccination Coverage of NIP Vaccines: Coverage Survey versus Zhejiang Provincial Immunization Information System.

PubMed

Hu, Yu; Chen, Yaping

2017-07-11

Vaccination coverage in Zhejiang province, east China, is evaluated through repeated coverage surveys. The Zhejiang provincial immunization information system (ZJIIS) was established in 2004 with links to all immunization clinics. ZJIIS has become an alternative to quickly assess the vaccination coverage. To assess the current completeness and accuracy on the vaccination coverage derived from ZJIIS, we compared the estimates from ZJIIS with the estimates from the most recent provincial coverage survey in 2014, which combined interview data with verified data from ZJIIS. Of the enrolled 2772 children in the 2014 provincial survey, the proportions of children with vaccination cards and registered in ZJIIS were 94.0% and 87.4%, respectively. Coverage estimates from ZJIIS were systematically higher than the corresponding estimates obtained through the survey, with a mean difference of 4.5%. Of the vaccination doses registered in ZJIIS, 16.7% differed from the date recorded in the corresponding vaccination cards. Under-registration in ZJIIS significantly influenced the coverage estimates derived from ZJIIS. Therefore, periodic coverage surveys currently provide more complete and reliable results than the estimates based on ZJIIS alone. However, further improvement of completeness and accuracy of ZJIIS will likely allow more reliable and timely estimates in future.

Knowledge and Awareness of HPV Vaccine and Acceptability to Vaccinate in Sub-Saharan Africa: A Systematic Review

PubMed Central

Perlman, Stacey; Wamai, Richard G.; Bain, Paul A.; Welty, Thomas; Welty, Edith; Ogembo, Javier Gordon

2014-01-01

Objectives We assessed the knowledge and awareness of cervical cancer, HPV and HPV vaccine, and willingness and acceptability to vaccinate in sub-Saharan African (SSA) countries. We further identified countries that fulfill the two GAVI Alliance eligibility criteria to support nationwide HPV vaccination. Methods We conducted a systematic review of peer-reviewed studies on the knowledge and awareness of cervical cancer, HPV and HPV vaccine, and willingness and acceptability to vaccinate. Trends in Diphtheria-tetanus-pertussis (DTP3) vaccine coverage in SSA countries from 1990–2011 were extracted from the World Health Organization database. Findings The review revealed high levels of willingness and acceptability of HPV vaccine but low levels of knowledge and awareness of cervical cancer, HPV or HPV vaccine. We identified only six countries to have met the two GAVI Alliance requirements for supporting introduction of HPV vaccine: 1) the ability to deliver multi-dose vaccines for no less than 50% of the target vaccination cohort in an average size district, and 2) achieving over 70% coverage of DTP3 vaccine nationally. From 2008 through 2011 all SSA countries, with the exception of Mauritania and Nigeria, have reached or maintained DTP3 coverage at 70% or above. Conclusion There is an urgent need for more education to inform the public about HPV, HPV vaccine, and cervical cancer, particularly to key demographics, (adolescents, parents and healthcare professionals), to leverage high levels of willingness and acceptability of HPV vaccine towards successful implementation of HPV vaccination programs. There is unpreparedness in most SSA countries to roll out national HPV vaccination as per the GAVI Alliance eligibility criteria for supporting introduction of the vaccine. In countries that have met 70% DTP3 coverage, pilot programs need to be rolled out to identify the best practice and strategies for delivering HPV vaccines to adolescents and also to qualify for GAVI Alliance support. PMID:24618636

Switch from oral to inactivated poliovirus vaccine in Yogyakarta Province, Indonesia: summary of coverage, immunity, and environmental surveillance.

PubMed

Wahjuhono, Gendro; Revolusiana; Widhiastuti, Dyah; Sundoro, Julitasari; Mardani, Tri; Ratih, Woro Umi; Sutomo, Retno; Safitri, Ida; Sampurno, Ondri Dwi; Rana, Bardan; Roivainen, Merja; Kahn, Anna-Lea; Mach, Ondrej; Pallansch, Mark A; Sutter, Roland W

2014-11-01

Inactivated poliovirus vaccine (IPV) is rarely used in tropical developing countries. To generate additional scientific information, especially on the possible emergence of vaccine-derived polioviruses (VDPVs) in an IPV-only environment, we initiated an IPV introduction project in Yogyakarta, an Indonesian province. In this report, we present the coverage, immunity, and VDPV surveillance results. In Yogyakarta, we established environmental surveillance starting in 2004; and conducted routine immunization coverage and seroprevalence surveys before and after a September 2007 switch from oral poliovirus vaccine (OPV) to IPV, using standard coverage and serosurvey methods. Rates and types of polioviruses found in sewage samples were analyzed, and all poliovirus isolates after the switch were sequenced. Vaccination coverage (>95%) and immunity (approximately 100%) did not change substantially before and after the IPV switch. No VDPVs were detected. Before the switch, 58% of environmental samples contained Sabin poliovirus; starting 6 weeks after the switch, Sabin polioviruses were rarely isolated, and if they were, genetic sequencing suggested recent introductions. This project demonstrated that under almost ideal conditions (good hygiene, maintenance of universally high IPV coverage, and corresponding high immunity against polioviruses), no emergence and circulation of VDPV could be detected in a tropical developing country setting. © The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

Vaccine coverage estimation using a computerized vaccination registry with potential underreporting and a seroprevalence study.

PubMed

Breva, Lina Pérez; Domingo, Javier Díez; Martínez Beneito, Miguel Ángel; Barberà, Joan Puig

2015-04-27

To develop a method to estimate vaccination coverage using both a computerized vaccine registry with an unknown underreporting rate and a seroprevalence study. A real example of a meningococcal C conjugate vaccine (MCCV) coverage estimation is studied to illustrate the proposed methodology. We reviewed the Vaccine Information System of Valencia (Sistema de Información Vacunal, SIV) for the MCCV status of 1430 subjects aged 3-29 years as part of a seroprevalence study. When MCCV was not registered in SIV, subjects were classified into three groups (MCCV non-registered, no vaccination records and missing information) depending on the registry of other vaccines. A Bayesian model was developed to ascertain the percentage of MCCV-vaccinated subjects based on the meningococcal C seroprotection levels from the seroprevalence study. The seroprotection levels in subjects with no MCCV registered in SIV (358) were similar to those in subjects with MCCV registered (1072). This indicated a large proportion of vaccinated subjects with no MCCV registered. The estimated vaccine coverage was over 80% in all age groups, except >22 years, where it was 67.6% (95% CI: [54.0-80.4]), which corresponded to those aged over 13 years at the time of the catch-up campaign. An underreporting rate of 23.5-73.4%, depending on the age group, was estimated in those vaccinated in the 2002 catch-up campaign. The Bayesian model allowed for a more realistic estimation of MCCV uptake. In this example, we quantified the underreporting of a vaccine registry, especially occurring during a catch-up campaign that occurred at the establishment of the registry. Copyright © 2015. Published by Elsevier Ltd.

A mass vaccination campaign targeting adults and children to prevent typhoid fever in Hechi; Expanding the use of Vi polysaccharide vaccine in Southeast China: A cluster-randomized trial

PubMed Central

Yang, Jin; Acosta, Camilo J; Si, Guo-ai; Zeng, Jun; Li, Cui-yun; Liang, Da-bin; Ochiai, R Leon; Page, Anne-Laure; Danovaro-Holliday, M Carolina; Zhang, Jie; Zhou, Bao-de; Liao, He-zhuang; Wang, Ming-liu; Tan, Dong-mei; Tang, Zhen-zhu; Gong, Jian; Park, Jin-Kyung; Ali, Mohammad; Ivanoff, Bernard; Liang, Gui-chen; Yang, Hong-hui; Pang, Tikki; Xu, Zhi-yi; Donner, Allan; Galindo, Claudia M; Dong, Bai-qing; Clemens, John D

2005-01-01

Background One of the goals of this study was to learn the coverage, safety and logistics of a mass vaccination campaign against typhoid fever in children and adults using locally produced typhoid Vi polysaccharide (PS) and group A meningococcal PS vaccines in southern China. Methods The vaccination campaign targeted 118,588 persons in Hechi, Guangxi Province, aged between 5 to 60 years, in 2003. The study area was divided into 107 geographic clusters, which were randomly allocated to receive one of the single-dose parenteral vaccines. All aspects regarding vaccination logistics, feasibility and safety were documented and systematically recorded. Results of the logistics, feasibility and safety are reported. Results The campaign lasted 5 weeks and the overall vaccination coverage was 78%. On average, the 30 vaccine teams gave immunizations on 23 days. Vaccine rates were higher in those aged ≤ 15 years (90%) than in adolescents and young adults (70%). Planned mop-up activities increased the coverage by 17%. The overall vaccine wastage was 11%. The cold chain was maintained and documented. 66 individuals reported of adverse events out of all vaccinees, where fever (21%), malaise (19%) and local redness (19%) were the major symptoms; no life-threatening event occurred. Three needle-sharp events were reported. Conclusion The mass immunization proved feasible and safe, and vaccine coverage was high. Emphasis should be placed on: injection safety measures, community involvement and incorporation of mop-up strategies into any vaccination campaign. School-based and all-age Vi mass immunizations programs are potentially important public health strategies for prevention of typhoid fever in high-risk populations in southern China. PMID:15904514

Vaccinating Girls and Boys with Different Human Papillomavirus Vaccines: Can It Optimise Population-Level Effectiveness?

PubMed Central

Drolet, Mélanie; Boily, Marie-Claude; Van de Velde, Nicolas; Franco, Eduardo L.; Brisson, Marc

2013-01-01

Background Decision-makers may consider vaccinating girls and boys with different HPV vaccines to benefit from their respective strengths; the quadrivalent (HPV4) prevents anogenital warts (AGW) whilst the bivalent (HPV2) may confer greater cross-protection. We compared, to a girls-only vaccination program with HPV4, the impact of vaccinating: 1) both genders with HPV4, and 2) boys with HPV4 and girls with HPV2. Methods We used an individual-based transmission-dynamic model of heterosexual HPV infection and diseases. Our base-case scenario assumed lifelong efficacy of 100% against vaccine types, and 46,29,8,18,6% and 77,43,79,8,0% efficacy against HPV-31,-33,-45,-52,-58 for HPV4 and HPV2, respectively. Results Assuming 70% vaccination coverage and lifelong cross-protection, vaccinating boys has little additional benefit on AGW prevention, irrespective of the vaccine used for girls. Furthermore, using HPV4 for boys and HPV2 for girls produces greater incremental reductions in SCC incidence than using HPV4 for both genders (12 vs 7 percentage points). At 50% vaccination coverage, vaccinating boys produces incremental reductions in AGW of 17 percentage points if both genders are vaccinated with HPV4, but increases female incidence by 16 percentage points if girls are switched to HPV2 (heterosexual male incidence is incrementally reduced by 24 percentage points in both scenarios). Higher incremental reductions in SCC incidence are predicted when vaccinating boys with HPV4 and girls with HPV2 versus vaccinating both genders with HPV4 (16 vs 12 percentage points). Results are sensitive to vaccination coverage and the relative duration of protection of the vaccines. Conclusion Vaccinating girls with HPV2 and boys with HPV4 can optimize SCC prevention if HPV2 has higher/longer cross-protection, but can increase AGW incidence if vaccination coverage is low among boys. PMID:23840589

Determinants of vaccination coverage in rural Nigeria

PubMed Central

Odusanya, Olumuyiwa O; Alufohai, Ewan F; Meurice, Francois P; Ahonkhai, Vincent I

2008-01-01

Background Childhood immunization is a cost effective public health strategy. Expanded Programme on Immunisation (EPI) services have been provided in a rural Nigerian community (Sabongidda-Ora, Edo State) at no cost to the community since 1998 through a privately financed vaccination project (private public partnership). The objective of this survey was to assess vaccination coverage and its determinants in this rural community in Nigeria Methods A cross-sectional survey was conducted in September 2006, which included the use of interviewer-administered questionnaire to assess knowledge of mothers of children aged 12–23 months and vaccination coverage. Survey participants were selected following the World Health Organization's (WHO) immunization coverage cluster survey design. Vaccination coverage was assessed by vaccination card and maternal history. A child was said to be fully immunized if he or she had received all of the following vaccines: a dose of Bacille Calmette Guerin (BCG), three doses of oral polio (OPV), three doses of diphtheria, pertussis and tetanus (DPT), three doses of hepatitis B (HB) and one dose of measles by the time he or she was enrolled in the survey, i.e. between the ages of 12–23 months. Knowledge of the mothers was graded as satisfactory if mothers had at least a score of 3 out of a maximum of 5 points. Logistic regression was performed to identify determinants of full immunization status. Results Three hundred and thirty-nine mothers and 339 children (each mother had one eligible child) were included in the survey. Most of the mothers (99.1%) had very positive attitudes to immunization and > 55% were generally knowledgeable about symptoms of vaccine preventable diseases except for difficulty in breathing (as symptom of diphtheria). Two hundred and ninety-five mothers (87.0%) had a satisfactory level of knowledge. Vaccination coverage against all the seven childhood vaccine preventable diseases was 61.9% although it was significantly higher (p = 0.002) amongst those who had a vaccination card (131/188, 69.7%) than in those assessed by maternal history (79/151, 52.3%). Multiple logistic regression showed that mothers' knowledge of immunization (p = 0.006) and vaccination at a privately funded health facility (p < 0.001) were significantly correlated with the rate of full immunization. Conclusion Eight years after initiation of this privately financed vaccination project (private-public partnership), vaccination coverage in this rural community is at a level that provides high protection (81%) against DPT/OPV. Completeness of vaccination was significantly correlated with knowledge of mothers on immunization and adequate attention should be given to this if high coverage levels are to be sustained. PMID:18986544

Process Evaluation of an Intervention to Increase Provision of Adolescent Vaccines at School Health Centers

ERIC Educational Resources Information Center

Golden, Shelley D.; Moracco, Kathryn E.; Feld, Ashley L.; Turner, Kea L.; DeFrank, Jessica T.; Brewer, Noel T.

2014-01-01

Background: Vaccination programs in school health centers (SHCs) may improve adolescent vaccine coverage. We conducted a process evaluation of an intervention to increase SHC-located vaccination to better understand the feasibility and challenges of such interventions. Method: Four SHCs participated in an intervention to increase provision of…

Evaluation of a poliomyelitis immunization campaign in Madras city.

PubMed

Balraj, V; John, T J

1986-01-01

An annual pulse immunization campaign with oral polio vaccine (OPV) was evaluated to determine vaccine coverage, relative success of publicity methods and reasons for lack of response. The campaign was directed at 3-36 month olds in Madras city, India, in January-March 1985. The evaluation method was the "30-cluster" sample survey technique, designed by WHO, where surveys were done in 30 districts of the city on 10 children in each age group. The survey was conducted in April 1985 by 5 trained and supervised interviewers. This campaign increased the vaccine coverage to 94%, 88% and 72% for first, second and third doses of OPV. Coverage was higher in older children. Percent coverage decreased slightly over 1-3 doses, and from there rapidly up to 6-7 doses. The campaign accounted for 27% of all the OPV the study children had received. 47% of parents heard about the vaccination through word of mouth, either from health workers, volunteers or "balwadi ayahs," women day-care workers. 17% learned through television or radio. 3% cited mobile loudspeakers, handbills, posters or slides in cinemas. Many parents did not avail themselves of the vaccine because they believed that 3 doses are sufficient. Actually the WHO recommends 4 doses; the Indian Academy of Pediatrics recommends 5 doses; while criteria from research on Indian children would suggest that 5-7 doses are required to raise strong immunity.

Vaccination coverage for measles, mumps and rubella in anthroposophical schools in Gelderland, The Netherlands.

PubMed

Klomp, Judith H E; van Lier, Alies; Ruijs, Wilhelmina L M

2015-06-01

Social clustering of unvaccinated children in anthroposophical schools occurs, as inferred from various measles outbreaks that can be traced to these schools. However, accurate vaccination coverage data of anthroposophical schools are not widely available. In 2012, we performed a survey to estimate the vaccination coverage in three different grades of 11 anthroposophical schools in Gelderland, The Netherlands. We also gauged the opinion on childhood vaccination of the parents and compared these with the results of a national survey. In 2014, we were also able to obtain the registered total vaccination coverage per school from the national vaccination register to compare this with our survey data. The self-reported MMR vaccination coverage (2012) in the three grades of the schools in our study was 83% (range 45-100% per school). The registered total vaccination coverage (2014) was 78% (range 59-88% per school). The 95% confidence intervals of the two different vaccination coverages overlap for all schools. The parents in this study were less convinced about the beneficial effect of vaccinations and more worried about the possible side effects of vaccination compared with parents in general. Despite high overall vaccination coverage, the WHO goal to eliminate measles and rubella will not easily be achieved when social clustering of unvaccinated children in anthroposophical schools remains. © The Author 2014. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

Increased immunization coverage addresses the equity gap in Nepal

PubMed Central

Nelin, Viktoria; Raaijmakers, Hendrikus; Kim, Hyung Joon; Singh, Chahana; Målqvist, Mats

2017-01-01

Abstract Objective To compare immunization coverage and equity distribution of coverage between 2001 and 2014 in Nepal. Methods We used data from the Demographic and Health Surveys carried out in 2001, 2006 and 2011 together with data from the 2014 Multiple Indicator Cluster Survey. We calculated the proportion, in mean percentage, of children who had received bacille Calmette–Guérin (BCG) vaccine, three doses of polio vaccine, three doses of diphtheria–pertussis–tetanus (DPT) vaccine and measles vaccine. To measure inequities between wealth quintiles, we calculated the slope index of inequality (SII) and relative index of inequality (RII) for all surveys. Findings From 2001 to 2014, the proportion of children who received all vaccines at the age of 12 months increased from 68.8% (95% confidence interval, CI: 67.5–70.1) to 82.4% (95% CI: 80.7–84.0). While coverage of BCG, DPT and measles immunization statistically increased during the study period, the proportion of children who received the third dose of polio vaccine decreased from 93.3% (95% CI: 92.7–93.9) to 88.1% (95% CI: 86.8–89.3). The poorest wealth quintile showed the greatest improvement in immunization coverage, from 58% to 77.9%, while the wealthiest quintile only improved from 84.8% to 86.0%. The SII for children who received all vaccines improved from 0.070 (95% CI: 0.061–0.078) to 0.026 (95% CI: 0.013–0.039) and RII improved from 1.13 to 1.03. Conclusion The improvement in immunization coverage between 2001 and 2014 in Nepal can mainly be attributed to the interventions targeting the disadvantaged populations. PMID:28479621

Journey to vaccination: a protocol for a multinational qualitative study

PubMed Central

Wheelock, Ana; Miraldo, Marisa; Parand, Anam; Vincent, Charles; Sevdalis, Nick

2014-01-01

Introduction In the past two decades, childhood vaccination coverage has increased dramatically, averting an estimated 2–3 million deaths per year. Adult vaccination coverage, however, remains inconsistently recorded and substandard. Although structural barriers are known to limit coverage, social and psychological factors can also affect vaccine uptake. Previous qualitative studies have explored beliefs, attitudes and preferences associated with seasonal influenza (flu) vaccination uptake, yet little research has investigated how participants’ context and experiences influence their vaccination decision-making process over time. This paper aims to provide a detailed account of a mixed methods approach designed to understand the wider constellation of social and psychological factors likely to influence adult vaccination decisions, as well as the context in which these decisions take place, in the USA, the UK, France, India, China and Brazil. Methods and analysis We employ a combination of qualitative interviewing approaches to reach a comprehensive understanding of the factors influencing vaccination decisions, specifically seasonal flu and tetanus. To elicit these factors, we developed the journey to vaccination, a new qualitative approach anchored on the heuristics and biases tradition and the customer journey mapping approach. A purposive sampling strategy is used to select participants who represent a range of key sociodemographic characteristics. Thematic analysis will be used to analyse the data. Typical journeys to vaccination will be proposed. Ethics and dissemination Vaccination uptake is significantly influenced by social and psychological factors, some of which are under-reported and poorly understood. This research will provide a deeper understanding of the barriers and drivers to adult vaccination. Our findings will be published in relevant peer-reviewed journals and presented at academic conferences. They will also be presented as practical recommendations at policy and industry meetings and healthcare professionals’ forums. This research was approved by relevant local ethics committees. PMID:24486678

The current situation of voluntary vaccination and the factors influencing its coverage among children in Takatsuki, Japan: focus on Hib and pneumococcal vaccines.

PubMed

Tsuda, Yuko; Watanabe, Misuzu; Tanimoto, Yoshimi; Hayashida, Itsushi; Kusabiraki, Toshiyuki; Komiyama, Maki; Kono, Koichi

2015-03-01

This study aimed to understand the current scenario of voluntary vaccination and the factors influencing its coverage among 18-month-old children of Takatsuki City, Japan. Based on 1167 parents responses, we found that voluntary vaccination coverage rates were low when compared with routine vaccination rates. The children who were not the first born of the family and who had young and poorly educated parents were less likely to receive voluntary vaccination. Japanese government-supported vaccines, such as Haemophilus influenzae type b and pneumococcal vaccine, had a higher coverage than the vaccines for which parents had to bear the entire vaccination cost. Furthermore, it was found that mass communication media and family pediatricians were effective means to disseminate voluntary vaccination-related information. We envisage that an active participation of medical professionals, easy access to vaccinations, and mass awareness programs will increase voluntary vaccination coverage in Takatsuki. © 2013 APJPH.

Two Birds With One Stone: Estimating Population Vaccination Coverage From a Test-negative Vaccine Effectiveness Case-control Study.

PubMed

Doll, Margaret K; Morrison, Kathryn T; Buckeridge, David L; Quach, Caroline

2016-10-15

Vaccination program evaluation includes assessment of vaccine uptake and direct vaccine effectiveness (VE). Often examined separately, we propose a design to estimate rotavirus vaccination coverage using controls from a rotavirus VE test-negative case-control study and to examine coverage following implementation of the Quebec, Canada, rotavirus vaccination program. We present our assumptions for using these data as a proxy for coverage in the general population, explore effects of diagnostic accuracy on coverage estimates via simulations, and validate estimates with an external source. We found 79.0% (95% confidence interval, 74.3%, 83.0%) ≥2-dose rotavirus coverage among participants eligible for publicly funded vaccination. No differences were detected between study and external coverage estimates. Simulations revealed minimal bias in estimates with high diagnostic sensitivity and specificity. We conclude that controls from a VE case-control study may be a valuable resource of coverage information when reasonable assumptions can be made for estimate generalizability; high rotavirus coverage demonstrates success of the Quebec program. © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

The cost-effectiveness of male HPV vaccination in the United States.

PubMed

Chesson, Harrell W; Ekwueme, Donatus U; Saraiya, Mona; Dunne, Eileen F; Markowitz, Lauri E

2011-10-26

The objective of this study was to estimate the cost-effectiveness of adding human papillomavirus (HPV) vaccination of 12-year-old males to a female-only vaccination program for ages 12-26 years in the United States. We used a simplified model of HPV transmission to estimate the reduction in the health and economic burden of HPV-associated diseases in males and females as a result of HPV vaccination. Estimates of the incidence, cost-per-case, and quality-of-life impact of HPV-associated health outcomes were based on the literature. The HPV-associated outcomes included were: cervical intraepithelial neoplasia (CIN); genital warts; juvenile-onset recurrent respiratory papillomatosis (RRP); and cervical, vaginal, vulvar, anal, oropharyngeal, and penile cancers. The cost-effectiveness of male vaccination depended on vaccine coverage of females. When including all HPV-associated outcomes in the analysis, the incremental cost per quality-adjusted life year (QALY) gained by adding male vaccination to a female-only vaccination program was $23,600 in the lower female coverage scenario (20% coverage at age 12 years) and $184,300 in the higher female coverage scenario (75% coverage at age 12 years). The cost-effectiveness of male vaccination appeared less favorable when compared to a strategy of increased female vaccination coverage. For example, we found that increasing coverage of 12-year-old girls would be more cost-effective than adding male vaccination even if the increased female vaccination strategy incurred program costs of $350 per additional girl vaccinated. HPV vaccination of 12-year-old males might potentially be cost-effective, particularly if female HPV vaccination coverage is low and if all potential health benefits of HPV vaccination are included in the analysis. However, increasing female coverage could be a more efficient strategy than male vaccination for reducing the overall health burden of HPV in the population. Published by Elsevier Ltd.

Whom and where are we not vaccinating? Coverage after the introduction of a new conjugate vaccine against group A meningococcus in Niger in 2010.

PubMed

Kim, Sung Hye; Pezzoli, Lorenzo; Yacouba, Harouna; Coulibaly, Tiekoura; Djingarey, Mamoudou H; Perea, William A; Wierzba, Thomas F

2012-01-01

MenAfriVac is a new conjugate vaccine against Neisseria meningitidis serogroup A developed for the African "meningitis belt". In Niger, the first two phases of the MenAfriVac introduction campaign were conducted targeting 3,135,942 individuals aged 1 to 29 years in the regions of Tillabéri, Niamey, and Dosso, in September and December 2010. We evaluated the campaign and determined which sub-populations or areas had low levels of vaccination coverage in the regions of Tillabéri and Niamey. After Phase I, conducted in the Filingué district, we estimated coverage using a 30×15 cluster-sampling survey and nested lot quality assurance (LQA) analysis in the clustered samples to identify which subpopulations (defined by age 1-14/15-29 and sex) had unacceptable vaccination coverage (<70%). After Phase II, we used Clustered Lot Quality Assurance Sampling (CLQAS) to assess if any of eight districts in Niamey and Tillabéri had unacceptable vaccination coverage (<75%) and estimated overall coverage. Estimated vaccination coverage was 77.4% (95%CI: 84.6-70.2) as documented by vaccination cards and 85.5% (95% CI: 79.7-91.2) considering verbal history of vaccination for Phase I; 81.5% (95%CI: 86.1-77.0) by card and 93.4% (95% CI: 91.0-95.9) by verbal history for Phase II. Based on vaccination cards, in Filingué, we identified both the male and female adult (age 15-29) subpopulations as not reaching 70% coverage; and we identified three (one in Tillabéri and two in Niamey) out of eight districts as not reaching 75% coverage confirmed by card. Combined use of LQA and cluster sampling was useful to estimate vaccination coverage and to identify pockets with unacceptable levels of coverage (adult population and three districts). Although overall vaccination coverage was satisfactory, we recommend continuing vaccination in the areas or sub-populations with low coverage and reinforcing the social mobilization of the adult population.

Impact of Coverage-Dependent Marginal Costs on Optimal HPV Vaccination Strategies

PubMed Central

Ryser, Marc D.; McGoff, Kevin; Herzog, David P.; Sivakoff, David J.; Myers, Evan R.

2015-01-01

The effectiveness of vaccinating males against the human papillomavirus (HPV) remains a controversial subject. Many existing studies conclude that increasing female coverage is more effective than diverting resources into male vaccination. Recently, several empirical studies on HPV immunization have been published, providing evidence of the fact that marginal vaccination costs increase with coverage. In this study, we use a stochastic agent-based modeling framework to revisit the male vaccination debate in light of these new findings. Within this framework, we assess the impact of coverage-dependent marginal costs of vaccine distribution on optimal immunization strategies against HPV. Focusing on the two scenarios of ongoing and new vaccination programs, we analyze different resource allocation policies and their effects on overall disease burden. Our results suggest that if the costs associated with vaccinating males are relatively close to those associated with vaccinating females, then coverage-dependent, increasing marginal costs may favor vaccination strategies that entail immunization of both genders. In particular, this study emphasizes the necessity for further empirical research on the nature of coverage-dependent vaccination costs. PMID:25979280

Surveillance of Vaccination Coverage among Adult Populations - United States, 2015.

PubMed

Williams, Walter W; Lu, Peng-Jun; O'Halloran, Alissa; Kim, David K; Grohskopf, Lisa A; Pilishvili, Tamara; Skoff, Tami H; Nelson, Noele P; Harpaz, Rafael; Markowitz, Lauri E; Rodriguez-Lainz, Alfonso; Fiebelkorn, Amy Parker

2017-05-05

Overall, the prevalence of illness attributable to vaccine-preventable diseases is greater among adults than among children. Adults are recommended to receive vaccinations based on their age, underlying medical conditions, lifestyle, prior vaccinations, and other considerations. Updated vaccination recommendations from CDC are published annually in the U.S. Adult Immunization Schedule. Despite longstanding recommendations for use of many vaccines, vaccination coverage among U.S. adults is low. August 2014-June 2015 (for influenza vaccination) and January-December 2015 (for pneumococcal, tetanus and diphtheria [Td] and tetanus and diphtheria with acellular pertussis [Tdap], hepatitis A, hepatitis B, herpes zoster, and human papillomavirus [HPV] vaccination). The National Health Interview Survey (NHIS) is a continuous, cross-sectional national household survey of the noninstitutionalized U.S. civilian population. In-person interviews are conducted throughout the year in a probability sample of households, and NHIS data are compiled and released annually. The survey objective is to monitor the health of the U.S. population and provide estimates of health indicators, health care use and access, and health-related behaviors. Compared with data from the 2014 NHIS, increases in vaccination coverage occurred for influenza vaccine among adults aged ≥19 years (a 1.6 percentage point increase compared with the 2013-14 season to 44.8%), pneumococcal vaccine among adults aged 19-64 years at increased risk for pneumococcal disease (a 2.8 percentage point increase to 23.0%), Tdap vaccine among adults aged ≥19 years and adults aged 19-64 years (a 3.1 percentage point and 3.3 percentage point increase to 23.1% and to 24.7%, respectively), herpes zoster vaccine among adults aged ≥60 years and adults aged ≥65 years (a 2.7 percentage point and 3.2 percentage point increase to 30.6% and to 34.2%, respectively), and hepatitis B vaccine among health care personnel (HCP) aged ≥19 years (a 4.1 percentage point increase to 64.7%). Herpes zoster vaccination coverage in 2015 met the Healthy People 2020 target of 30%. Aside from these modest improvements, vaccination coverage among adults in 2015 was similar to estimates from 2014. Racial/ethnic differences in coverage persisted for all seven vaccines, with higher coverage generally for whites compared with most other groups. Adults without health insurance reported receipt of influenza vaccine (all age groups), pneumococcal vaccine (adults aged 19-64 years at increased risk), Td vaccine (adults aged ≥19 years, 19-64 years, and 50-64 years), Tdap vaccine (adults aged ≥19 years and 19-64 years), hepatitis A vaccine (adults aged ≥19 years overall and among travelers), hepatitis B vaccine (adults aged ≥19 years, 19-49 years, and among travelers), herpes zoster vaccine (adults aged ≥60 years), and HPV vaccine (males and females aged 19-26 years) less often than those with health insurance. Adults who reported having a usual place for health care generally reported receipt of recommended vaccinations more often than those who did not have such a place, regardless of whether they had health insurance. Vaccination coverage was higher among adults reporting one or more physician contacts in the past year compared with those who had not visited a physician in the past year, regardless of whether they had health insurance. Even among adults who had health insurance and ≥10 physician contacts within the past year, depending on the vaccine, 18.2%-85.6% reported not having received vaccinations that were recommended either for all persons or for those with specific indications. Overall, vaccination coverage among U.S.-born adults was higher than that among foreign-born adults, with few exceptions (influenza vaccination [adults aged 19-49 years and 50-64 years], hepatitis A vaccination [adults aged ≥19 years], and hepatitis B vaccination [adults aged ≥19 years with diabetes or chronic liver conditions]). Coverage for all vaccines for adults remained low but modest gains occurred in vaccination coverage for influenza (adults aged ≥19 years), pneumococcal (adults aged 19-64 years with increased risk), Tdap (adults aged ≥19 years and adults aged 19-64 years), herpes zoster (adults aged ≥60 years and ≥65 years), and hepatitis B (HCP aged ≥19 years); coverage for other vaccines and groups with vaccination indications did not improve. The 30% Healthy People 2020 target for herpes zoster vaccination was met. Racial/ethnic disparities persisted for routinely recommended adult vaccines. Missed opportunities to vaccinate remained. Although having health insurance coverage and a usual place for health care were associated with higher vaccination coverage, these factors alone were not associated with optimal adult vaccination coverage. HPV vaccination coverage for males and females has increased since CDC recommended vaccination to prevent cancers caused by HPV, but many adolescents and young adults remained unvaccinated. Assessing factors associated with low coverage rates and disparities in vaccination is important for implementing strategies to improve vaccination coverage. Evidence-based practices that have been demonstrated to improve vaccination coverage should be used. These practices include assessment of patients' vaccination indications by health care providers and routine recommendation and offer of needed vaccines to adults, implementation of reminder-recall systems, use of standing-order programs for vaccination, and assessment of practice-level vaccination rates with feedback to staff members. For vaccination coverage to be improved among those who reported lower coverage rates of recommended adult vaccines, efforts also are needed to identify adults who do not have a regular provider or insurance and who report fewer health care visits.

Surveillance of Vaccination Coverage among Adult Populations — United States, 2015

PubMed Central

Lu, Peng-Jun; O’Halloran, Alissa; Kim, David K.; Grohskopf, Lisa A.; Pilishvili, Tamara; Skoff, Tami H.; Nelson, Noele P.; Harpaz, Rafael; Markowitz, Lauri E.; Rodriguez-Lainz, Alfonso; Fiebelkorn, Amy Parker

2017-01-01

Problem/Condition Overall, the prevalence of illness attributable to vaccine-preventable diseases is greater among adults than among children. Adults are recommended to receive vaccinations based on their age, underlying medical conditions, lifestyle, prior vaccinations, and other considerations. Updated vaccination recommendations from CDC are published annually in the U.S. Adult Immunization Schedule. Despite longstanding recommendations for use of many vaccines, vaccination coverage among U.S. adults is low. Period Covered August 2014–June 2015 (for influenza vaccination) and January–December 2015 (for pneumococcal, tetanus and diphtheria [Td] and tetanus and diphtheria with acellular pertussis [Tdap], hepatitis A, hepatitis B, herpes zoster, and human papillomavirus [HPV] vaccination). Description of System The National Health Interview Survey (NHIS) is a continuous, cross-sectional national household survey of the noninstitutionalized U.S. civilian population. In-person interviews are conducted throughout the year in a probability sample of households, and NHIS data are compiled and released annually. The survey objective is to monitor the health of the U.S. population and provide estimates of health indicators, health care use and access, and health-related behaviors. Results Compared with data from the 2014 NHIS, increases in vaccination coverage occurred for influenza vaccine among adults aged ≥19 years (a 1.6 percentage point increase compared with the 2013–14 season to 44.8%), pneumococcal vaccine among adults aged 19–64 years at increased risk for pneumococcal disease (a 2.8 percentage point increase to 23.0%), Tdap vaccine among adults aged ≥19 years and adults aged 19–64 years (a 3.1 percentage point and 3.3 percentage point increase to 23.1% and to 24.7%, respectively), herpes zoster vaccine among adults aged ≥60 years and adults aged ≥65 years (a 2.7 percentage point and 3.2 percentage point increase to 30.6% and to 34.2%, respectively), and hepatitis B vaccine among health care personnel (HCP) aged ≥19 years (a 4.1 percentage point increase to 64.7%). Herpes zoster vaccination coverage in 2015 met the Healthy People 2020 target of 30%. Aside from these modest improvements, vaccination coverage among adults in 2015 was similar to estimates from 2014. Racial/ethnic differences in coverage persisted for all seven vaccines, with higher coverage generally for whites compared with most other groups. Adults without health insurance reported receipt of influenza vaccine (all age groups), pneumococcal vaccine (adults aged 19–64 years at increased risk), Td vaccine (adults aged ≥19 years, 19–64 years, and 50–64 years), Tdap vaccine (adults aged ≥19 years and 19–64 years), hepatitis A vaccine (adults aged ≥19 years overall and among travelers), hepatitis B vaccine (adults aged ≥19 years, 19–49 years, and among travelers), herpes zoster vaccine (adults aged ≥60 years), and HPV vaccine (males and females aged 19–26 years) less often than those with health insurance. Adults who reported having a usual place for health care generally reported receipt of recommended vaccinations more often than those who did not have such a place, regardless of whether they had health insurance. Vaccination coverage was higher among adults reporting one or more physician contacts in the past year compared with those who had not visited a physician in the past year, regardless of whether they had health insurance. Even among adults who had health insurance and ≥10 physician contacts within the past year, depending on the vaccine, 18.2%–85.6% reported not having received vaccinations that were recommended either for all persons or for those with specific indications. Overall, vaccination coverage among U.S.-born adults was higher than that among foreign-born adults, with few exceptions (influenza vaccination [adults aged 19–49 years and 50–64 years], hepatitis A vaccination [adults aged ≥19 years], and hepatitis B vaccination [adults aged ≥19 years with diabetes or chronic liver conditions]). Interpretation Coverage for all vaccines for adults remained low but modest gains occurred in vaccination coverage for influenza (adults aged ≥19 years), pneumococcal (adults aged 19–64 years with increased risk), Tdap (adults aged ≥19 years and adults aged 19–64 years), herpes zoster (adults aged ≥60 years and ≥65 years), and hepatitis B (HCP aged ≥19 years); coverage for other vaccines and groups with vaccination indications did not improve. The 30% Healthy People 2020 target for herpes zoster vaccination was met. Racial/ethnic disparities persisted for routinely recommended adult vaccines. Missed opportunities to vaccinate remained. Although having health insurance coverage and a usual place for health care were associated with higher vaccination coverage, these factors alone were not associated with optimal adult vaccination coverage. HPV vaccination coverage for males and females has increased since CDC recommended vaccination to prevent cancers caused by HPV, but many adolescents and young adults remained unvaccinated. Public Health Actions Assessing factors associated with low coverage rates and disparities in vaccination is important for implementing strategies to improve vaccination coverage. Evidence-based practices that have been demonstrated to improve vaccination coverage should be used. These practices include assessment of patients’ vaccination indications by health care providers and routine recommendation and offer of needed vaccines to adults, implementation of reminder-recall systems, use of standing-order programs for vaccination, and assessment of practice-level vaccination rates with feedback to staff members. For vaccination coverage to be improved among those who reported lower coverage rates of recommended adult vaccines, efforts also are needed to identify adults who do not have a regular provider or insurance and who report fewer health care visits. PMID:28472027

Knowledge of and Attitudes to Influenza Vaccination among Community Pharmacists in Catalonia (Spain). 2013-2014 Season: A Cross Sectional Study.

PubMed

Toledo, Diana; Soldevila, Núria; Guayta-Escolies, Rafel; Lozano, Pau; Rius, Pilar; Gascón, Pilar; Domínguez, Angela

2017-07-11

Annual recommendations on influenza seasonal vaccination include community pharmacists, who have low vaccination coverage. The aim of this study was to investigate the relationship between influenza vaccination in community pharmacists and their knowledge of and attitudes to vaccination. An online cross-sectional survey of community pharmacists in Catalonia, Spain, was conducted between September and November 2014. Sociodemographic, professional and clinical variables, the history of influenza vaccination and knowledge of and attitudes to influenza and seasonal influenza vaccination were collected. The survey response rate was 7.33% (506 out of 6906); responses from 463 community pharmacists were included in the final analyses. Analyses were performed using multivariable logistic regression models and stepwise backward selection method for variable selection. The influenza vaccination coverage in season 2013-2014 was 25.1%. There was an association between vaccination and correct knowledge of the virus responsible for epidemics (adjusted Odds Ratio (aOR) = 1.74; 95% CI 1.03-2.95), recommending vaccination in the postpartum (aOR = 3.63; 95% CI 2.01-6.55) and concern about infecting their clients (aOR = 5.27; 95% CI 1.88-14.76). In conclusion, community pharmacists have a very low influenza vaccination coverage, are not very willing to recommend vaccination to all their customers but they are concerned about infecting their clients.

Evaluating Childhood Vaccination Coverage of NIP Vaccines: Coverage Survey versus Zhejiang Provincial Immunization Information System

PubMed Central

Hu, Yu; Chen, Yaping

2017-01-01

Vaccination coverage in Zhejiang province, east China, is evaluated through repeated coverage surveys. The Zhejiang provincial immunization information system (ZJIIS) was established in 2004 with links to all immunization clinics. ZJIIS has become an alternative to quickly assess the vaccination coverage. To assess the current completeness and accuracy on the vaccination coverage derived from ZJIIS, we compared the estimates from ZJIIS with the estimates from the most recent provincial coverage survey in 2014, which combined interview data with verified data from ZJIIS. Of the enrolled 2772 children in the 2014 provincial survey, the proportions of children with vaccination cards and registered in ZJIIS were 94.0% and 87.4%, respectively. Coverage estimates from ZJIIS were systematically higher than the corresponding estimates obtained through the survey, with a mean difference of 4.5%. Of the vaccination doses registered in ZJIIS, 16.7% differed from the date recorded in the corresponding vaccination cards. Under-registration in ZJIIS significantly influenced the coverage estimates derived from ZJIIS. Therefore, periodic coverage surveys currently provide more complete and reliable results than the estimates based on ZJIIS alone. However, further improvement of completeness and accuracy of ZJIIS will likely allow more reliable and timely estimates in future. PMID:28696387

Association of vaccination coverage with sociodemographic factors in workers of primary health care centers of Cordoba, Argentina.

PubMed

Acevedo, Gabriel; López, Laura; Willington, Ana; Burrone, Soledad; Farias, Alejandra; Sánchez, Julieta

2016-01-01

The activities performed by the health personnel have specific occupational risks making it more susceptible to get infectious diseases. Therefore, all healthcare workers must be properly immunized against vaccinepreventable diseases. Assessing the proportion of healthcare workers from the public subsector who are vaccinated and relating the sociodemographic factors with the proportion of the Meningitis vaccination condition of the workers from the primary care level of the city of Córdoba Methods: An observational analytical cross-sectional study was carried out with a sample of 157 workers of the municipal district of Cordoba. A self-administered survey was conducted and univariate and bivariate analyses were performed. For the evaluation of factors related with the vaccination a Chi-Square Test was implemented. The measures of immunization coverage found were: hepatitis B vaccine 67,5%, anti flu vaccine 66,25%, trabadouble bacterial vaccine 60,51% and triple or double viral vaccine 50,32%. The overall analysis showed higher levels of coverage among those workers with a higher level of education and less seniority. This was also evident among the youngest and the physicians. With important differences depending on the educational level for hepatitis B vaccine, for triple or double viral among the youngest workers and double bacterial for those with less seniority. The health personnel studied on this research has a vaccination status that is lower than that of the internationally recommended vaccination status. Although, this status is similar to the one reported in several countries it shows that the under-coverage of vaccination among these workers is an extended problem which must be prioritized by health authorities; given the implications for the health of workers and the population these workers assist.

HPV Vaccination among Adolescent Females from Appalachia: Implications for Cervical Cancer Disparities

PubMed Central

Reiter, Paul L.; Katz, Mira L.; Paskett, Electra D.

2012-01-01

Background Appalachia is a geographic region with high cervical cancer incidence and mortality rates, yet little is known about human papillomavirus (HPV) vaccination in this region. We determined HPV vaccine coverage among adolescent females from Appalachia, made comparisons to non-Appalachian females, and examined how coverage differs across subregions within Appalachia. Methods We analyzed 2008–2010 data from the National Immunization Survey-Teen (NIS-Teen) for adolescent females ages 13–17 (n=1,951 Appalachian females and n=25,468 non-Appalachian females). We examined HPV vaccine initiation (receipt of at least one dose), completion (receipt of at least three doses), and follow-through (completion among initiators). Analyses used weighted logistic regression. Results HPV vaccine initiation (Appalachian=40.8% vs. non-Appalachian=43.6%; OR=0.92, 95% CI: 0.79–1.07) and completion (Appalachian=27.7% vs. non-Appalachian=25.3%; OR=1.12, 95% CI: 0.95–1.32) were similar between Appalachian and non-Appalachian females. HPV vaccine follow-through was higher among Appalachian females than non-Appalachian females (67.8% vs. 58.1%; OR=1.36, 95% CI: 1.07–1.72). Vaccination outcomes tended to be higher in the Northern (completion and follow-through) and South Central (follow-through) subregions of Appalachia compared to non-Appalachian U.S. Conversely, vaccination outcomes tended to be lower in the Central (initiation and completion) and Southern (initiation and completion) subregions. Conclusions In general, HPV vaccination in Appalachia is mostly similar to the rest of the U.S. However, vaccination is lagging in regions of Appalachia where cervical cancer incidence and mortality rates are highest. Impact Current cervical cancer disparities could potentially worsen if HPV vaccine coverage is not improved in regions of Appalachia with low HPV vaccine coverage. PMID:23136141

Influenza vaccination coverage among US children from 2004/2005 to 2015/2016.

PubMed

Tian, Changwei; Wang, Hua; Wang, Wenming; Luo, Xiaoming

2018-05-15

Quantify the influenza vaccine coverage is essential to identify emerging concerns and to immunization programs for targeting interventions. Data from National Health Interview Survey were used to estimate receipt of at least one dose of influenza vaccination among children 6 months to 17 years of age. Influenza vaccination coverage increased from 16.70% during 2004/2005 to 49.43% during 2015/2016 (3.18% per year, P < 0.001); however, the coverage increased slightly after 2010/2011. Children at high risk of influenza complications had higher influenza vaccination coverage than non at-risk children. Boys and girls had similar coverage each year. While the coverage increased from 2004/2005 to 2015/2016 for all age groups, the coverage decreased with age each year (-0.64 to -1.58% per age group). There was a higher and rapid increase of coverage in Northeast than Midwest, South and West. American Indian or Alaskan Native and Asian showed higher coverage than other race groups (White, Black/African American, Multiple race). Multivariable analysis showed that high-risk status and region had the greatest associations with levels of vaccine coverage. Although the influenza vaccination coverage among children had increased remarkably since 2004/2005, establishing more effective immunization programs are warranted to achieve the Healthy People 2020 target.

Coverage and timing of children's vaccination: an evaluation of the expanded programme on immunisation in The Gambia.

PubMed

Scott, Susana; Odutola, Aderonke; Mackenzie, Grant; Fulford, Tony; Afolabi, Muhammed O; Lowe Jallow, Yamundow; Jasseh, Momodou; Jeffries, David; Dondeh, Bai Lamin; Howie, Stephen R C; D'Alessandro, Umberto

2014-01-01

To evaluate the coverage and timeliness of the Expanded Programme on Immunisation (EPI) in The Gambia. Vaccination data were obtained between January 2005 and December 2012 from the Farafenni Health and Demographic Surveillance System (FHDSS), the Basse Health and Demographic Surveillance System (BHDSS), the Kiang West Demographic surveillance system (KWDSS), a cluster survey in the more urban Western Health Region (WR) and a cross sectional study in four clinics in the semi-urban Greater Banjul area of WR. Kaplan-Meier survival function was used to estimate the proportion vaccinated by age and to assess timeliness to vaccination. BCG vaccine uptake was over 95% in all regions. Coverage of DPT1 ranged from 93.2% in BHDSS to 99.8% in the WR. Coverage decreased with increasing number of DPT doses; DPT3 coverage ranged from 81.7% in BHDSS to 99.0% in WR. Measles vaccination coverage ranged from 83.3% in BHDSS to 97.0% in WR. DPT4 booster coverage was low and ranged from 43.9% in the WR to 82.8% in KWDSS. Across all regions, delaying on previous vaccinations increased the likelihood of being delayed for the subsequent vaccination. The Gambia health system achieves high vaccine coverage in the first year of life. However, there continues to be a delay to vaccination which may impact on the introduction of new vaccines. Examples of effectively functioning EPI programmes such as The Gambia one may well be important models for other low income countries struggling to achieve high routine vaccination coverage.

Coverage of childhood vaccination among children aged 12-23 months, Tamil Nadu, 2015, India.

PubMed

Murhekar, Manoj V; Kamaraj, P; Kanagasabai, K; Elavarasu, G; Rajasekar, T Daniel; Boopathi, K; Mehendale, Sanjay

2017-03-01

District-Level Household Survey-4 (DLHS-4) indicated that during 2012-2013, only 56 per cent of children aged 12-23 months in Tamil Nadu were fully vaccinated, which were lesser than those reported in earlier national surveys. We, therefore, conducted cluster surveys to estimate coverage of childhood vaccination in the State, and also to identify the factors associated with low coverage. Cross-sectional surveys were conducted in 15 strata [municipal corporation non-slum (n=1), municipal corporation slum (n=1), hilly (n=1), rural (n=6) and urban (n=6)]. From each stratum, 30 clusters were selected using probability proportional to the population size linear systematic sampling; seven children aged 12-23 months were selected from each cluster and their mothers/care-takers were interviewed to collect information about vaccination status of the child. A child was considered fully vaccinated if he/she received bacillus Calmette-Guérin (BCG), three doses of pentavalent, three doses of oral polio vaccine and one dose of measles vaccine, and appropriately vaccinated if all vaccine doses were given at right age and with right interval. Further, coverage of fully vaccinated children (FVC) as per vaccination cards or mothers' recall, validated coverage of FVC (V-FVC) among those having cards, and coverage of appropriately vaccinated children (AVC) were estimated using survey data analysis module with appropriate sampling weights. A total of 3150 children were surveyed, of them 2528 (80.3%) had vaccination card. The weighted coverage of FVC, V-FVC and AVC in the State was 79.9 per cent [95% confidence interval (CI): 78.2-81.5], 78.8 per cent (95% CI: 76.9-80.5) and 69.7 per cent (95% CI: 67.7-71.7), respectively. The coverage of individual vaccine ranged between 84 per cent (measles) and 99.8 per cent (BCG). About 12 per cent V-FVC were not vaccinated as per the vaccination schedule. The coverage of FVC in Tamil Nadu was high, with about 80 per cent children completing primary vaccination. Efforts to increase vaccination coverage in the State need to focus on educating vaccinators about the need to adhere to the national vaccination schedule and strengthening supervision to ensure that children are vaccinated appropriately.

Reduction of racial/ethnic disparities in vaccination coverage, 1995-2011.

PubMed

Walker, Allison T; Smith, Philip J; Kolasa, Maureen

2014-04-18

The Presidential Childhood Immunization Initiative was developed in 1993 to address major gaps in childhood vaccination coverage in the United States. Eliminating the cost of vaccines as a barrier to vaccination was one strategy of the Childhood Immunization Initiative; it led to Congressional legislation that authorized creation of the Vaccines for Children program (VFC) in 1994. CDC analyzed National Immunization Survey data for 1995-2011 to evaluate trends in disparities in vaccination coverage rates between non-Hispanic white children and children of other racial/ethnic groups. VFC has been effective in ireducing disparities in vaccination coverage among U.S. children. CDC's Office of Minority Health and Health Equity selected the intervention analysis and discussion that follows to provide an example of a program that has been effective in reducing childhood vaccination coverage-related disparities in the United States. At its inception in 1994, VFC was implemented in 78 Immunization Action Plan areas that covered the entire United States; within each area, concerted efforts were made to improve childhood vaccination coverage. The findings in this report demonstrate that there have been no racial/ethnic disparities in vaccine coverage for measles-mumps-rubella and poliovirus in the United States since 2005. Disparities in coverage for the diphtheria-tetanus-pertussis/diphtheria-tetanus-acellular pertussis vaccine were absent, declining, or inconsistent during this period, depending on the racial/ethnic group examined. The results in this report highlight the effectiveness of VFC.

Parental Delay or Refusal of Vaccine Doses, Childhood Vaccination Coverage at 24 Months of Age, and the Health Belief Model

PubMed Central

Smith, Philip J.; Humiston, Sharon G.; Marcuse, Edgar K.; Zhao, Zhen; Dorell, Christina G.; Howes, Cynthia; Hibbs, Beth

2011-01-01

Objective We evaluated the association between parents' beliefs about vaccines, their decision to delay or refuse vaccines for their children, and vaccination coverage of children at aged 24 months. Methods We used data from 11,206 parents of children aged 24–35 months at the time of the 2009 National Immunization Survey interview and determined their vaccination status at aged 24 months. Data included parents' reports of delay and/or refusal of vaccine doses, psychosocial factors suggested by the Health Belief Model, and provider-reported up-to-date vaccination status. Results In 2009, approximately 60.2% of parents with children aged 24–35 months neither delayed nor refused vaccines, 25.8% only delayed, 8.2% only refused, and 5.8% both delayed and refused vaccines. Compared with parents who neither delayed nor refused vaccines, parents who delayed and refused vaccines were significantly less likely to believe that vaccines are necessary to protect the health of children (70.1% vs. 96.2%), that their child might get a disease if they aren't vaccinated (71.0% vs. 90.0%), and that vaccines are safe (50.4% vs. 84.9%). Children of parents who delayed and refused also had significantly lower vaccination coverage for nine of the 10 recommended childhood vaccines including diphtheria-tetanus-acellular pertussis (65.3% vs. 85.2%), polio (76.9% vs. 93.8%), and measles-mumps-rubella (68.4% vs. 92.5%). After adjusting for sociodemographic differences, we found that parents who were less likely to agree that vaccines are necessary to protect the health of children, to believe that their child might get a disease if they aren't vaccinated, or to believe that vaccines are safe had significantly lower coverage for all 10 childhood vaccines. Conclusions Parents who delayed and refused vaccine doses were more likely to have vaccine safety concerns and perceive fewer benefits associated with vaccines. Guidelines published by the American Academy of Pediatrics may assist providers in responding to parents who may delay or refuse vaccines. PMID:21812176

Highlights of Historical Events Leading to National Surveillance of Vaccination Coverage in the United States

PubMed Central

Smith, Philip J.; Wood, David; Darden, Paul M.

2011-01-01

The articles published in this special supplement of Public Health Reports provide examples of only some of the current efforts in the United States for evaluating vaccination coverage. So, how did we get here? The history of vaccination and assessment of vaccination coverage in the U.S. has its roots in the pre-Revolutionary War era. In many cases, development of vaccines, and attention devoted to the assessment of vaccination coverage, has grown from the impact of infectious disease on major world events such as wars. The purpose of this commentary is to provide a brief overview of the key historical events in the U.S. that influenced the development of vaccines and the efforts to track vaccination coverage, which laid the foundation for contemporary vaccination assessment efforts. PMID:21815302

Infant immunization coverage in Italy: estimates by simultaneous EPI cluster surveys of regions. ICONA Study Group.

PubMed Central

Salmaso, S.; Rota, M. C.; Ciofi Degli Atti, M. L.; Tozzi, A. E.; Kreidl, P.

1999-01-01

In 1998, a series of regional cluster surveys (the ICONA Study) was conducted simultaneously in 19 out of the 20 regions in Italy to estimate the mandatory immunization coverage of children aged 12-24 months with oral poliovirus (OPV), diphtheria-tetanus (DT) and viral hepatitis B (HBV) vaccines, as well as optional immunization coverage with pertussis, measles and Haemophilus influenzae b (Hib) vaccines. The study children were born in 1996 and selected from birth registries using the Expanded Programme of Immunization (EPI) cluster sampling technique. Interviews with parents were conducted to determine each child's immunization status and the reasons for any missed or delayed vaccinations. The study population comprised 4310 children aged 12-24 months. Coverage for both mandatory and optional vaccinations differed by region. The overall coverage for mandatory vaccines (OPV, DT and HBV) exceeded 94%, but only 79% had been vaccinated in accord with the recommended schedule (i.e. during the first year of life). Immunization coverage for pertussis increased from 40% (1993 survey) to 88%, but measles coverage (56%) remained inadequate for controlling the disease; Hib coverage was 20%. These results confirm that in Italy the coverage of only mandatory immunizations is satisfactory. Pertussis immunization coverage has improved dramatically since the introduction of acellular vaccines. A greater effort to educate parents and physicians is still needed to improve the coverage of optional vaccinations in all regions. PMID:10593033

Infant immunization coverage in Italy: estimates by simultaneous EPI cluster surveys of regions. ICONA Study Group.

PubMed

Salmaso, S; Rota, M C; Ciofi Degli Atti, M L; Tozzi, A E; Kreidl, P

1999-01-01

In 1998, a series of regional cluster surveys (the ICONA Study) was conducted simultaneously in 19 out of the 20 regions in Italy to estimate the mandatory immunization coverage of children aged 12-24 months with oral poliovirus (OPV), diphtheria-tetanus (DT) and viral hepatitis B (HBV) vaccines, as well as optional immunization coverage with pertussis, measles and Haemophilus influenzae b (Hib) vaccines. The study children were born in 1996 and selected from birth registries using the Expanded Programme of Immunization (EPI) cluster sampling technique. Interviews with parents were conducted to determine each child's immunization status and the reasons for any missed or delayed vaccinations. The study population comprised 4310 children aged 12-24 months. Coverage for both mandatory and optional vaccinations differed by region. The overall coverage for mandatory vaccines (OPV, DT and HBV) exceeded 94%, but only 79% had been vaccinated in accord with the recommended schedule (i.e. during the first year of life). Immunization coverage for pertussis increased from 40% (1993 survey) to 88%, but measles coverage (56%) remained inadequate for controlling the disease; Hib coverage was 20%. These results confirm that in Italy the coverage of only mandatory immunizations is satisfactory. Pertussis immunization coverage has improved dramatically since the introduction of acellular vaccines. A greater effort to educate parents and physicians is still needed to improve the coverage of optional vaccinations in all regions.

Socioeconomic inequalities are still a barrier to full child vaccine coverage in the Brazilian Amazon: a cross-sectional study in Assis Brasil, Acre, Brazil.

PubMed

Branco, Fernando Luiz Cunha Castelo; Pereira, Thasciany Moraes; Delfino, Breno Matos; Braña, Athos Muniz; Oliart-Guzmán, Humberto; Mantovani, Saulo Augusto Silva; Martins, Antonio Camargo; Oliveira, Cristieli Sérgio de Menezes; Ramalho, Alanderson Alves; Codeço, Claudia Torres; da Silva-Nunes, Mônica

2014-11-27

Vaccines are very important to reduce morbidity and mortality by preventable infectious diseases, especially during childhood. Optimal coverage is not always achieved, for several reasons. Here we assessed vaccine coverage for the first 12 months of age in children between 12 and 59 months old, residing in the urban area of a small Amazonian city, and factors associated with incomplete vaccination. A census was performed in the urban area of Assis Brasil, in the Brazilian Amazon, in January 2010, with mothers of 282 children aged 12 to 59 months old, using structured interviews and data from vaccination cards. Mixed logistic regression was used to determine factors associated with incomplete vaccination schemes. Only 82.6% of all children had a completed the basic vaccine scheme for the first year of life. Vaccine coverage ranged from 52.7% coverage (oral rotavirus vaccine) to 99.7% coverage (for Bacille Calmette-Guérin). The major deficiencies occurred in doses administered after the first six months of life. Incomplete vaccination was associated with not having enough income to buy a house (aOR = 2.12, 95% CI 1.06-4.21), low maternal schooling (aOR = 2.60, 95% CI 1.28 - 5.29) , and time of residence of the child in the urban area of the city (aOR = 0.73, 95% CI 0.55 - 0.95). This study showed that vaccine coverage in the first twelve months of life in Assis Brasil is similar to other areas in the Amazon and it is below the coverage postulated by the Brazilian Ministry of Health. Low vaccine coverage was associated with socioeconomic inequities that still prevail in the Brazilian Amazon. Short and long-term strategies must be taken to update child vaccines and increase vaccine coverage in the Amazon.

Impact of the introduction of rotavirus vaccine on the timeliness of other scheduled vaccines: the Australian experience.

PubMed

Hull, Brynley P; Menzies, Robert; Macartney, Kristine; McIntyre, Peter B

2013-04-08

Strict age limits for receipt of rotavirus vaccines and simultaneous use of vaccines requiring two (Rotarix(®)) and three (RotaTeq(®)) doses in Australia may impact on coverage and timeliness of other vaccines in the infant schedule. Using data from the Australian Childhood Immunisation Register (ACIR), coverage and timeliness of rotavirus vaccines and changes in timeliness of other infant vaccines following rotavirus vaccine introduction was examined, with particular emphasis on Indigenous infants in whom coverage is less optimal. Final dose rotavirus coverage reached 83% within 21 months of program commencement but remained 7% lower than other vaccines due in infancy. Coverage was 11-17% lower in Indigenous infants. Adherence to the first dose upper age limits for rotavirus vaccine was high with >97% of children vaccinated by the recommended age, but for subsequent rotavirus doses, receipt beyond the upper age limits was more common, especially in Indigenous children. Following rotavirus vaccine introduction, there were improvements in timeliness of receipt of all doses of DTPa-containing and 7-valent pneumococcal conjugate vaccines. High population coverage can be attained with rotavirus vaccines, even with adherence to strict upper age restrictions for vaccine dose administration. Rotavirus vaccine introduction appears to have impacted upon the timeliness of other concomitantly scheduled vaccines. These factors should be considered when rotavirus programs are introduced. Copyright © 2013 Elsevier Ltd. All rights reserved.

A mathematical study of a model for childhood diseases with non-permanent immunity

NASA Astrophysics Data System (ADS)

Moghadas, S. M.; Gumel, A. B.

2003-08-01

Protecting children from diseases that can be prevented by vaccination is a primary goal of health administrators. Since vaccination is considered to be the most effective strategy against childhood diseases, the development of a framework that would predict the optimal vaccine coverage level needed to prevent the spread of these diseases is crucial. This paper provides this framework via qualitative and quantitative analysis of a deterministic mathematical model for the transmission dynamics of a childhood disease in the presence of a preventive vaccine that may wane over time. Using global stability analysis of the model, based on constructing a Lyapunov function, it is shown that the disease can be eradicated from the population if the vaccination coverage level exceeds a certain threshold value. It is also shown that the disease will persist within the population if the coverage level is below this threshold. These results are verified numerically by constructing, and then simulating, a robust semi-explicit second-order finite-difference method.

Impact of the CDC's Section 317 Immunization Grants Program funding on childhood vaccination coverage.

PubMed

Rein, David B; Honeycutt, Amanda A; Rojas-Smith, Lucia; Hersey, James C

2006-09-01

The Centers for Disease Control and Prevention's Section 317 Grants Program is the main source of funding for state and jurisdictional immunization programs, yet no study has evaluated its direct impact on vaccination coverage rates. Therefore, we used a fixed-effects model and data collected from 56 US jurisdictions to estimate the impact of Section 317 financial assistance immunization grants on childhood vaccination coverage rates from 1997 to 2003. Our results showed that increases in Section 317 funding were significantly and meaningfully associated with higher rates of vaccination coverage; a 10 dollars increase in per capita funding corresponded with a 1.6-percentage-point increase in vaccination coverage. Policymakers charged with funding public health programs should consider this study's findings, which indicate that money allocated to vaccine activities translates directly into higher vaccine coverage rates.

Public health impact of Infanrix hexa (DTPa-HBV-IPV/Hib) reimbursement: A study programme in France. Part 1: Evolution of hepatitis B vaccine coverage rates in infants aged less than 27 months, in the general population - the PopCorn study.

PubMed

Gaudelus, J; Vié le Sage, F; Dufour, V; Lert, F; Texier, N; Pouriel, M; Tehard, B; Bréart, G

2016-02-01

Reimbursement of the hexavalent vaccine (Infanrix hexa) comprising the DTPa-IPV-Hib components and the hepatitis B valence in a single vaccine was decided in March 2008 in France. The impact of its reimbursement on the hepatitis B vaccine coverage rate was assessed in a study conducted in the general population prior to and after implementation of the reimbursement policy. The PopCorn study (NCT01782794) was a national, cross-sectional and repeated study, with four assessment periods over 3 years, from 2009 to 2012, to assess the hepatitis B vaccine coverage in 12- to 15- and 24- to 27-month-old children, vaccinated between 2007 and 2011 and selected by the quota sampling method. Face-to-face interviews were conducted at their homes and vaccination status was collected using their child's health record. Parents were also interviewed on their perceptions and acceptance of hepatitis B vaccination. Three indicators were calculated to assess hepatitis B vaccination coverage: proportions of infants with at least one dose before 6 months of age, with at least two doses before 6 months of age and with a complete schedule at 24 months of age. A total of 4903 children were enrolled in the study. An overall significant increase (P-value [P<0.05]) of the three indicators of interest over the four periods of time was observed for both age groups. The proportion of children receiving hepatitis B vaccination before 6 months increased from 21% at baseline (before vaccine reimbursement) to almost 75% at the last assessment period in 2012. More than 60% of 24- to 27-month-old children received a complete schedule in 2012 compared to 33% at baseline. No significant increases in the proportions of parents "favourable" and "moderately in favour" of hepatitis B vaccination were observed across the four evaluation periods (respectively, 17-22% and 48-50%, P=0.09). The rapid increase of hepatitis B vaccination coverage suggests a significant change in hepatitis B vaccination practice related to the hexavalent vaccine's reimbursement. This change was observed in a context of stability regarding parents' perceptions and acceptance of hepatitis B vaccination and of coverage rates for other infant vaccinations. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Low vaccine coverage among children born to HIV infected women in Niamey, Niger

PubMed Central

Tchidjou, Hyppolite Kuekou; Vescio, Maria Fenicia; Sanou Sobze, Martin; Souleyman, Animata; Stefanelli, Paola; Mbabia, Adalbert; Moussa, Ide; Gentile, Bruno; Colizzi, Vittorio; Rezza, Giovanni

2016-01-01

Background: The effect of mother’s HIV-status on child vaccination is an important public health issue in countries with high HIV prevalence. We conducted a study in a primary healthcare center located in Niamey, the capital of Niger, which offers free of charge services to HIV positive and/or underprivileged mothers, with the aim of assessing: 1) vaccination coverage for children 0–36 months old, born to HIV-infected mothers, and 2) the impact of maternal HIV status on child vaccination. Methods: Mothers of children less than 36 months old attending the center were interviewed, to collect information on vaccines administered to their child, and family’s socio-demographic characteristics. Results: Overall, 502 children were investigated. Children of HIV-seropositive mothers were less likely to receive follow up vaccinations for Diphtheria-Tetanus-Pertussis (DTP) than those of HIV-seronegative mothers, with a prevalence ratio (PR) of 2.03 (95%CI: 1.58–2.61). Children born to HIV-seropositive mothers were less likely to miss vaccination for MMR than those born to HIV negative mothers, with a RR of 0.46 (95%CI: 0.30–0.72). Conclusions: Vaccine coverage among children born to HIV infected mothers was rather low. It is important to favor access to vaccination programs in this population. PMID:26237156

Estimation of the herd protection of Haemophilus influenzae type b conjugate vaccine against radiologically confirmed pneumonia in children under 2 years old in Dhaka, Bangladesh.

PubMed

Chen, Wei-Ju; Moulton, Lawrence H; Saha, Samir K; Mahmud, Abdullah Al; Arifeen, Shams El; Baqui, Abdullah H

2014-02-12

Herd protection of Haemophilus influenzae type b (Hib) conjugate vaccine has been associated with excessive decrease of invasive Hib diseases, i.e., pneumonia and meningitis, with increased national or regional Hib vaccine coverage. Only a few studies have examined herd protection at the individual level and even less evidence is available from Asia. We examined Hib vaccine herd protection against radiologically confirmed pneumonia among children less than 2 years old. We incorporated data from a matched case-control study and a vaccine coverage survey in Dhaka, Bangladesh. Pneumonia cases (n=343) were confirmed by radiology. For each case, two controls with conditions other than pneumonia or meningitis were selected from the same hospital. Hib vaccine coverage was calculated as percentages of children who received at least 2 doses of Hib vaccine from a survey in the neighborhood centered on each case and control. Conditional logistic regression was fit to examine the association between vaccine coverage and risk of radiologically confirmed pneumonia. Neighborhood Hib vaccine coverage varied from 0% to 63.5% for cases and from 8.7% to 61.5% for controls, respectively. Cases were less likely to have neighborhood coverage higher than 20% (OR=0.49, 0.52, 0.55, and 0.69 for coverage 20-29%, 30-39%, 40-49%, and ≥50%, respectively) than coverage <20%, compared to controls, although the estimates for coverage 40-49% and ≥50% were not statistically significant. The study indicates that Hib vaccine may provide herd protection, even when the coverage is as low as 20-39%, in a low-income country. Asian countries should consider herd protection in implementing effective vaccine policy with limited resources. Copyright © 2014 Elsevier Ltd. All rights reserved.

Childhood vaccination in informal urban settlements in Nairobi, Kenya: Who gets vaccinated?

PubMed Central

2011-01-01

Background Recent trends in global vaccination coverage have shown increases with most countries reaching 90% DTP3 coverage in 2008, although pockets of undervaccination continue to persist in parts of sub-Saharan Africa particularly in the urban slums. The objectives of this study were to determine the vaccination status of children aged between 12-23 months living in two slums of Nairobi and to identify the risk factors associated with incomplete vaccination. Methods The study was carried out as part of a longitudinal Maternal and Child Health study undertaken in Korogocho and Viwandani slums of Nairobi. These slums host the Nairobi Urban Health and Demographic Surveillance System (NUHDSS) run by the African Population and Health Research Centre (APHRC). All women from the NUHDSS area who gave birth since September 2006 were enrolled in the project and administered a questionnaire which asked about the vaccination history of their children. For the purpose of this study, we used data from 1848 children aged 12-23 months who were expected to have received all the WHO-recommended vaccinations. The vaccination details were collected during the first visit about four months after birth with follow-up visits repeated thereafter at four month intervals. Full vaccination was defined as receiving all the basic childhood vaccinations by the end of 24 months of life, whereas up-to-date (UTD) vaccination referred to receipt of BCG, OPV 1-3, DTP 1-3, and measles vaccinations within the first 12 months of life. All vaccination data were obtained from vaccination cards which were sighted during the household visit as well as by recall from mothers. Multivariate models were used to identify the risk factors associated with incomplete vaccination. Results Measles coverage was substantially lower than that for the other vaccines when determined using only vaccination cards or in addition to maternal recall. Up-to-date (UTD) coverage with all vaccinations at 12 months was 41.3% and 51.8% with and without the birth dose of OPV, respectively. Full vaccination coverage (57.5%) was higher than up-to-date coverage (51.8%) at 12 months overall, and in both slum settlements, using data from cards. Multivariate analysis showed that household assets and expenditure, ethnicity, place of delivery, mother's level of education, age and parity were all predictors of full vaccination among children living in the slums. Conclusions The findings show the extent to which children resident in slums are underserved with vaccination and indicate that service delivery of immunization services in the urban slums needs to be reassessed to ensure that all children are reached. PMID:21205306

NSW Annual Immunisation Coverage Report, 2009.

PubMed

Hull, Brynley; Dey, Aditi; Mahajan, Deepika; Campbell-Lloyd, Sue; Menzies, Robert I; McIntyre, Peter B

2010-01-01

This is the first in a series of annual immunisation coverage reports that document trends in NSW for a range of standard measures derived from Australian Childhood Immunisation Register data, including overall coverage at standard age milestones and for individual vaccines. This report includes data up to and including 2009. Data from the Australian Childhood Immunisation Register, the NSW Health Survey and the NSW School Immunisation Program were used to calculate various measures of population coverage relating to childhood vaccines, adult influenza and pneumococcal vaccines and adolescent vaccination, respectively. Immunise Australia Program targets have been reached for children at 12 and 24 months of age but not for children at 5 years of age. Delayed receipt of vaccines is an issue for vaccines recommended for Aboriginal children. Pneumococcal vaccination in the elderly has been steadily rising, although it has remained lower than the influenza coverage estimates. For adolescents, there is better coverage for the first and second doses of human papillomavirus vaccine and the dose of dTpa than for varicella. This comprehensive analysis provides important baseline data for NSW against which future reports can be compared to monitor progress in improving immunisation coverage. Immunisation at the earliest appropriate age should be a public health goal for countries such as Australia where high levels of vaccine coverage at milestone ages have been achieved.

From non school-based, co-payment to school-based, free Human Papillomavirus vaccination in Flanders (Belgium): a retrospective cohort study describing vaccination coverage, age-specific coverage and socio-economic inequalities.

PubMed

Lefevere, Eva; Theeten, Heidi; Hens, Niel; De Smet, Frank; Top, Geert; Van Damme, Pierre

2015-09-22

School-based, free HPV vaccination for girls in the first year of secondary school was introduced in Flanders (Belgium) in 2010. Before that, non school-based, co-payment vaccination for girls aged 12-18 was in place. We compared vaccination coverage, age-specific coverage and socio-economic inequalities in coverage - 3 important parameters contributing to the effectiveness of the vaccination programs - under both vaccination systems. We used retrospective administrative data from different sources. Our sample consisted of all female members of the National Alliance of Christian Mutualities born in 1995, 1996, 1998 or 1999 (N=66,664). For each vaccination system we described the cumulative proportion HPV vaccination initiation and completion over time. We used life table analysis to calculate age-specific rates of HPV vaccination initiation and completion. Analyses were done separately for higher income and low income groups. Under non school-based, co-payment vaccination the proportions HPV vaccination initiation and completion slowly rose over time. By age 17, the proportion HPV vaccination initiation/completion was 0.75 (95% CI 0.74-076)/0.66 (95% CI 0.65-0.67). The median age at vaccination initiation/completion was 14.4 years (95% CI 14.4-14.5)/15.4 years (95% CI 15.3-15.4). Socio-economic inequalities in coverage widened over time and with age. Under school-based, free vaccination rates of HPV vaccination initiation were substantially higher. By age 14,the proportion HPV vaccination initiation/completion was 0.90 (95% CI 0.90-0.90)/0.87 (95% CI 0.87-0.88). The median age at vaccination initiation/completion was 12.7 years (95% CI 12.7-12.7)/13.3 years (95% CI 13.3-13.3). Socio-economic inequalities in coverage and in age-specific coverage were substantially smaller. Copyright © 2015. Published by Elsevier Ltd.

How complete are immunization registries? The Philadelphia story.

PubMed

Kolasa, Maureen S; Chilkatowsky, Andrew P; Clarke, Kevin R; Lutz, James P

2006-01-01

To assess accuracy and completeness of Philadelphia, Pa, registry data among children served by providers in areas at risk for underimmunization. Philadelphia's Department of Public Health selected a simple random sample of 45 children age 19-35 months (or all children age 19-35 months if there were <45 children in the practice) from each of 30 private practices receiving government-funded vaccine and located in zip codes where children are at risk for underimmunization. Chart and registry data were compared with determine the proportion of children missing from the registry and assess differences in immunization coverage. Of 620 children reviewed, 567 (92%) were in the registry. Significant differences (P < .05) were observed in immunization coverage for 4 diphtheria-tetanus-acellular pertussis vaccinations, 3 polio vaccinations, 1 measles-mumps-rubella vaccination, and 3 Haemophilus influenzae type b vaccinations between the chart (80% coverage) and registry (62% coverage). Providers submitting electronic medical records or directly transferring electronic data to the registry had significantly more children in the registry and higher registry-reported immunization coverage than those whose data were entered from billing records or log forms. All practice types experienced difficulties in transferring complete data to the registry. Although 92% of study children were in the registry, immunization coverage was significantly lower when registry data were compared with chart data. Because electronic medical records and direct electronic data transfer resulted in more complete registry data, these methods should be encouraged in linking providers with immunization registries.

Human papillomavirus vaccination coverage using two-dose or three-dose schedule criteria.

PubMed

Lin, Xia; Rodgers, Loren; Zhu, Liping; Stokley, Shannon; Meites, Elissa; Markowitz, Lauri E

2017-10-13

In October 2016, the Advisory Committee on Immunization Practices (ACIP) updated the human papillomavirus (HPV) vaccination recommendation to include a 2-dose schedule for U.S. adolescents initiating the vaccine series before their 15th birthday. We analyzed records for >4million persons aged 9-17years receiving any HPV vaccine by the end of each quarter during January 1, 2014-September 30, 2016 from six Immunization Information Systems Sentinel Sites, and reclassified HPV vaccination up-to-date coverage according to the updated recommendations. Compared with HPV vaccination up-to-date coverage by the 3-dose schedule only, including criteria for either a 2-dose or 3-dose schedule increased up-to-date coverage in 11-12, 13-14, and 15-17 year-olds by 4.5-8.5 percentage points. The difference between 3-dose up-to-date coverage and 2- or 3-dose up-to-date coverage was greatest in late 2016. These data provide baseline HPV vaccination coverage using current ACIP recommendations. Published by Elsevier Ltd.

Impact of the CDC’s Section 317 Immunization Grants Program Funding on Childhood Vaccination Coverage

PubMed Central

Rein, David B.; Honeycutt, Amanda A.; Rojas-Smith, Lucia; Hersey, James C.

2006-01-01

The Centers for Disease Control and Prevention’s Section 317 Grants Program is the main source of funding for state and jurisdictional immunization programs, yet no study has evaluated its direct impact on vaccination coverage rates. Therefore, we used a fixed-effects model and data collected from 56 US jurisdictions to estimate the impact of Section 317 financial assistance immunization grants on childhood vaccination coverage rates from 1997 to 2003. Our results showed that increases in Section 317 funding were significantly and meaningfully associated with higher rates of vaccination coverage; a $10 increase in per capita funding corresponded with a 1.6-percentage-point increase in vaccination coverage. Policymakers charged with funding public health programs should consider this study’s findings, which indicate that money allocated to vaccine activities translates directly into higher vaccine coverage rates. PMID:16873738

Errors and correlates in parental recall of child immunizations: effects on vaccination coverage estimates.

PubMed

Suarez, L; Simpson, D M; Smith, D R

1997-05-01

We evaluated the accuracy of parental recall of children's immunization histories as compared with provider records and examined how errors in parental recall correlate with sociodemographic characteristics. The validation study was part of a population-based household survey designed to assess immunization levels among Texas children under age 2 years. For 72% (n = 3278), interviewers used vaccination records from the parent to copy dates for the diphtheria and tetanus toxoids and pertussis vaccine (DTP), oral polio vaccine (OPV), and measles, mumps, and rubella (MMR) shots. For parents without shot records (n = 1216), interviewers asked about each vaccine, whether the child had received the shot, how many, and at what age. Of these, 85% (n = 1029) were validated with health provider records. Measured against provider records, only 34% of parents accurately recalled the number of DTP shots a child had. More often (42%) parents underestimated the number of DTP shots than overestimated (24%). Agreement between parental recall and provider records was high (83%) for the single dose of MMR. Accuracy of parents' recall did not differ by race/ethnicity, education level, or type of health insurance coverage, but decreased as child's age increased. Having a vaccination record at home was associated with a higher immunization status. Hispanic, lower educated, and uninsured parents were more likely to have a vaccination record than non-Hispanic, higher educated, and privately insured parents. Validity of parental recall of children's immunization histories depends on the vaccine and the age of the child, which is highly correlated with the number of shots parents must recollect. Results suggest that inclusion of parent recall information from vaccination surveys underestimates DTP:OPV:MMR coverage. This underestimation is consistent across economic and race/ethnic groups. Thus, community surveys based on cards and recall should provide reliable conclusions about which groups need intensive program efforts. For the routine monitoring of vaccination coverage, reasonable estimates can be obtained by combining parent-held record and parent recall data. Caution is required when comparing coverage estimates from different surveys since the source of information and method of derivation will produce widely varying coverage rates.

Oral Cholera Vaccine Coverage, Barriers to Vaccination, and Adverse Events following Vaccination, Haiti, 2013.

PubMed

Tohme, Rania A; François, Jeannot; Wannemuehler, Kathleen; Iyengar, Preetha; Dismer, Amber; Adrien, Paul; Hyde, Terri B; Marston, Barbara J; Date, Kashmira; Mintz, Eric; Katz, Mark A

2015-06-01

In 2013, the first government-led oral cholera vaccination (OCV) campaign in Haiti was implemented in Petite Anse and Cerca Carvajal. To evaluate vaccination coverage, barriers to vaccination, and adverse events following vaccination, we conducted a cluster survey. We enrolled 1,121 persons from Petite Anse and 809 persons from Cerca Carvajal, categorized by 3 age groups (1-4, 5-14, >15 years). Two-dose OCV coverage was 62.5% in Petite Anse and 76.8% in Cerca Carvajal. Two-dose coverage was lowest among persons >15 years of age. In Cerca Carvajal, coverage was significantly lower for male than female respondents (69% vs. 85%; p<0.001). No major adverse events were reported. The main reason for nonvaccination was absence during the campaign. Vaccination coverage after this campaign was acceptable and comparable to that resulting from campaigns implemented by nongovernmental organizations. Future campaigns should be tailored to reach adults who are not available during daytime hours.

Implications of private sector Hib vaccine coverage for the introduction of public sector Hib-containing pentavalent vaccine in India: evidence from retrospective time series data.

PubMed

Sharma, Abhishek; Kaplan, Warren A; Chokshi, Maulik; Hasan Farooqui, Habib; Zodpey, Sanjay P

2015-02-23

Haemophilus influenzae type b (Hib) vaccine has been available in India's private sector market since 1997. It was not until 14 December 2011 that the Government of India initiated the phased public sector introduction of a Hib (and DPT, diphtheria, pertussis, tetanus)-containing pentavalent vaccine. Our objective was to investigate the state-specific coverage and behaviour of Hib vaccine in India when it was available only in the private sector market but not in the public sector. This baseline information can act as a guide to determine how much coverage the public sector rollout of pentavalent vaccine (scheduled April 2015) will need to bear in order to achieve complete coverage. 16 of 29 states in India, 2009-2012. Retrospective descriptive secondary data analysis. (1) Annual sales of Hib vaccines, by volume, from private sector hospitals and retail pharmacies collected by IMS Health and (2) national household surveys. State-specific Hib vaccine coverage (%) and its associations with state-specific socioeconomic status. The overall private sector Hib vaccine coverage among the 2009-2012 birth cohort was low (4%) and varied widely among the studied Indian states (minimum 0.3%; maximum 4.6%). We found that private sector Hib vaccine coverage depends on urban areas with good access to the private sector, parent's purchasing capacity and private paediatricians' prescribing practices. Per capita gross domestic product is a key explanatory variable. The annual Hib vaccine uptake and the 2009-2012 coverage levels were several times higher in the capital/metropolitan cities than the rest of the state, suggesting inequity in access to Hib vaccine delivered by the private sector. If India has to achieve high and equitable Hib vaccine coverage levels, nationwide public sector introduction of the pentavalent vaccine is needed. However, the role of private sector in universal Hib vaccine coverage is undefined as yet but it should not be neglected as a useful complement to public sector services. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Implications of private sector Hib vaccine coverage for the introduction of public sector Hib-containing pentavalent vaccine in India: evidence from retrospective time series data

PubMed Central

Sharma, Abhishek; Kaplan, Warren A; Chokshi, Maulik; Hasan Farooqui, Habib; Zodpey, Sanjay P

2015-01-01

Objective Haemophilus influenzae type b (Hib) vaccine has been available in India's private sector market since 1997. It was not until 14 December 2011 that the Government of India initiated the phased public sector introduction of a Hib (and DPT, diphtheria, pertussis, tetanus)-containing pentavalent vaccine. Our objective was to investigate the state-specific coverage and behaviour of Hib vaccine in India when it was available only in the private sector market but not in the public sector. This baseline information can act as a guide to determine how much coverage the public sector rollout of pentavalent vaccine (scheduled April 2015) will need to bear in order to achieve complete coverage. Setting 16 of 29 states in India, 2009–2012. Design Retrospective descriptive secondary data analysis. Data (1) Annual sales of Hib vaccines, by volume, from private sector hospitals and retail pharmacies collected by IMS Health and (2) national household surveys. Outcome measures State-specific Hib vaccine coverage (%) and its associations with state-specific socioeconomic status. Results The overall private sector Hib vaccine coverage among the 2009–2012 birth cohort was low (4%) and varied widely among the studied Indian states (minimum 0.3%; maximum 4.6%). We found that private sector Hib vaccine coverage depends on urban areas with good access to the private sector, parent's purchasing capacity and private paediatricians’ prescribing practices. Per capita gross domestic product is a key explanatory variable. The annual Hib vaccine uptake and the 2009–2012 coverage levels were several times higher in the capital/metropolitan cities than the rest of the state, suggesting inequity in access to Hib vaccine delivered by the private sector. Conclusions If India has to achieve high and equitable Hib vaccine coverage levels, nationwide public sector introduction of the pentavalent vaccine is needed. However, the role of private sector in universal Hib vaccine coverage is undefined as yet but it should not be neglected as a useful complement to public sector services. PMID:25712822

[Real-time monitoring of anti-influenza vaccination in the 65 and over population in France based on vaccine sales].

PubMed

Pivette, M; Auvigne, V; Guérin, P; Mueller, J E

2017-04-01

The aim of this study was to describe a tool based on vaccine sales to estimate vaccination coverage against seasonal influenza in near real-time in the French population aged 65 and over. Vaccine sales data available on sale-day +1 came from a stratified sample of 3004 pharmacies in metropolitan France. Vaccination coverage rates were estimated between 2009 and 2014 and compared with those obtained based on vaccination refund data from the general health insurance scheme. The seasonal vaccination coverage estimates were highly correlated with those obtained from refund data. They were also slightly higher, which can be explained by the inclusion of non-reimbursed vaccines and the consideration of all individuals aged 65 and over. We have developed an online tool that provides estimates of daily vaccination coverage during each vaccination campaign. The developed tool provides a reliable and near real-time estimation of vaccination coverage among people aged 65 and over. It can be used to evaluate and adjust public health messages. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

The role of religious leaders in promoting acceptance of vaccination within a minority group: a qualitative study.

PubMed

Ruijs, Wilhelmina L M; Hautvast, Jeannine L A; Kerrar, Said; van der Velden, Koos; Hulscher, Marlies E J L

2013-05-28

Although childhood vaccination programs have been very successful, vaccination coverage in minority groups may be considerably lower than in the general population. In order to increase vaccination coverage in such minority groups involvement of faith-based organizations and religious leaders has been advocated. We assessed the role of religious leaders in promoting acceptance or refusal of vaccination within an orthodox Protestant minority group with low vaccination coverage in The Netherlands. Semi-structured interviews were conducted with orthodox Protestant religious leaders from various denominations, who were selected via purposeful sampling. Transcripts of the interviews were thematically analyzed, and emerging concepts were assessed for consistency using the constant comparative method from grounded theory. Data saturation was reached after 12 interviews. Three subgroups of religious leaders stood out: those who fully accepted vaccination and did not address the subject, those who had religious objections to vaccination but focused on a deliberate choice, and those who had religious objections to vaccination and preached against vaccination. The various approaches of the religious leaders seemed to be determined by the acceptance of vaccination in their congregation as well as by their personal point of view. All religious leaders emphasized the importance of voluntary vaccination programs and religious exemptions from vaccination requirements. In case of an epidemic of a vaccine preventable disease, they would appreciate a dialogue with the authorities. However, they were not willing to promote vaccination on behalf of authorities. Religious leaders' attitudes towards vaccination vary from full acceptance to clear refusal. According to orthodox Protestant church order, local congregation members appoint their religious leaders themselves. Obviously they choose leaders whose views are compatible with the views of the congregation members. Moreover, the positions of orthodox Protestant religious leaders on vaccination will not change easily, as their objections to vaccination are rooted in religious doctrine and they owe their authority to their interpretation and application of this doctrine. Although the dialogue with religious leaders that is pursued by the Dutch government may be helpful in controlling epidemics by other means than vaccination, it is unlikely to increase vaccination coverage.

Prenatal vaccination education intervention improves both the mothers' knowledge and children's vaccination coverage: Evidence from randomized controlled trial from eastern China

PubMed Central

Chen, Yaping; Wang, Ying; Song, Quanwei; Li, Qian

2017-01-01

ABSTRACT Objectives: To verify the effectiveness of prenatal vaccination education intervention on improving mother's vaccination knowledge and child's vaccination status in Zhejiang province, eastern China. Methods: Pregnant women with ≥ 12 gestational weeks were recruited and randomly assigned into the intervention group and the control group. The intervention group were given a vaccination education session while the control group were not. Two round surveys were performed before and 3 months after the intervention. The vaccination status of child was extracted at 12 months of age from immunization information system. The differences of the vaccination knowledge, the coverage, the completeness and the timeliness of vaccination between 2 groups were evaluated. The effectiveness of vaccination education intervention was assessed, under the control of the other demographic variables. Results: Among the 1252 participants, 851 subjects replied to the post-survey. Significant improvements of vaccination knowledge between the pre- and the post- survey in the intervention group were observed (Mean ± S.D:1.8 ± 1.1 vs. 3.7 ± 1.2 for vaccines score and 2.7 ± 1.5 vs. 4.8 ± 1.0 for vaccine policy score, respectively). The coverage of fully vaccination was significantly higher in the intervention group (90.0% vs. 82.9%, P<0.01). The timeliness of fully vaccination was significantly higher in the intervention group (51.9% vs. 33.0%, P<0.01). In the intervention group, pregnant women were more likely to be with high score of knowledge (OR = 5.2, 95%CI: 2.6–8.8), and children were more likely to complete the full series of vaccination (OR = 3.4, 95%CI: 2.1–4.8), and children were more likely to complete the full series of vaccination in a timely manner (OR = 2.3, 95%CI: 1.6–3.5). Conclusions: Vaccination education in the pregnant women can effectively improve the knowledge regarding immunization and increase the coverage, the completeness and the timeliness of childhood vaccination. Strong partnership needs to be established between the obstetricians and the vaccination staff to improve the performance of NIP. PMID:28319453

Measles vaccine coverage and factors related to uncompleted vaccination among 18-month-old and 36-month-old children in Kyoto, Japan.

PubMed

Matsumura, Takayo; Nakayama, Takeo; Okamoto, Shigeru; Ito, Hideko

2005-06-04

Due to low vaccine coverage, Japan has not only experienced outbreaks of measles but has also been exporting it overseas. This study aims to survey measles vaccine coverage and the factors uncompleted vaccination among community-living children. Subjects were the parents whose children had undergone either an 18-month or a 36-month checkup publicly provided by Kyoto City during November 2001 to January 2002. An anonymous self-administered questionnaire survey was conducted. The coverage was 73.2% among the 18-month-old children (n = 2707) and 88.9% among the 36-month-old children (n = 2340), respectively. The following characteristics of mothers were related to uncompleted measles vaccination: aged below 30, working, concerned about the adverse events of the vaccine, and had insufficient knowledge. Similarly, the following characteristics among children were related to uncompleted measles vaccination: not the first-born child, interacting with other children in group settings. The coverage was the lowest among the children whose mothers were concerned about the adverse events of the vaccine without proper knowledge of measles and its vaccination. To increase vaccine coverage among children, parents' awareness about measles and vaccination against it should be promoted, especially for working mothers. Efforts to enhance access to vaccination services and to communicate with parents about changing vaccination schedules are necessary.

Policy perspectives on post pandemic influenza vaccination in Ghana and Malawi.

PubMed

Sambala, Evanson Z; Manderson, Lenore

2017-02-28

In the late 1990s, in the context of renewed concerns of an influenza pandemic, countries such as Ghana and Malawi established plans for the deployment of vaccines and vaccination strategies. A new pandemic was declared in mid-June 2009, and by April 2011, Ghana and Malawi vaccinated 10% of the population. We examine the public health policy perspectives on vaccination as a means to prevent the spread of infection under post pandemic conditions. In-depth interviews were conducted with 46 policymakers (Ghana, n = 24; Malawi, n = 22), identified through snowballing sampling. Interviews were supplemented by field notes and the analysis of policy documents. The use of vaccination to interrupt the pandemic influenza was affected by delays in the procurement, delivery and administration of vaccines, suboptimal vaccination coverage, refusals to be vaccinated, and the politics behind vaccination strategies. More generally, rolling-out of vaccination after the transmission of the influenza virus had abated was influenced by policymakers' own financial incentives, and government and foreign policy conditionality on vaccination. This led to confusion about targeting and coverage, with many policymakers justifying that the vaccination of 10% of the population would establish herd immunity and so reduce future risk. Ghana succeeded in vaccinating 2.3 million of the select groups (100% coverage), while Malawi, despite recourse to force, succeeded only in vaccinating 1.15 million (74% coverage of select groups). For most policymakers, vaccination coverage was perceived as successful, despite that vaccination delays and coverage would not have prevented infection when influenza was at its peak. While the vaccination strategy was problematic and implemented too late to reduce the effects of the 2009 epidemic, policy makers supported the overall goal of pandemic influenza vaccination to interrupt infection. In this context, there was strong support for governments engaging in contracts with pharmaceutical companies to ensure the timely supply of vaccines, and developing well-defined guidelines to address vaccination delays, refusals and coverage.

Human papillomavirus (HPV) vaccine coverage achievements in low and middle-income countries 2007-2016.

PubMed

Gallagher, Katherine E; Howard, Natasha; Kabakama, Severin; Mounier-Jack, Sandra; Burchett, Helen E D; LaMontagne, D Scott; Watson-Jones, Deborah

2017-12-01

Since 2007, HPV vaccine has been available to low and middle income countries (LAMIC) for small-scale 'demonstration projects', or national programmes. We analysed coverage achieved in HPV vaccine demonstration projects and national programmes that had completed at least 6 months of implementation between January 2007-2016. A mapping exercise identified 45 LAMICs with HPV vaccine delivery experience. Estimates of coverage and factors influencing coverage were obtained from 56 key informant interviews, a systematic published literature search of 5 databases that identified 61 relevant full texts and 188 solicited unpublished documents, including coverage surveys. Coverage achievements were analysed descriptively against country or project/programme characteristics. Heterogeneity in data, funder requirements, and project/programme design precluded multivariate analysis. Estimates of uptake, schedule completion rates and/or final dose coverage were available from 41 of 45 LAMICs included in the study. Only 17 estimates from 13 countries were from coverage surveys, most were administrative data. Final dose coverage estimates were all over 50% with most between 70% and 90%, and showed no trend over time. The majority of delivery strategies included schools as a vaccination venue. In countries with school enrolment rates below 90%, inclusion of strategies to reach out-of-school girls contributed to obtaining high coverage compared to school-only strategies. There was no correlation between final dose coverage and estimated recurrent financial costs of delivery from cost analyses. Coverage achieved during joint delivery of HPV vaccine combined with another intervention was variable with little/no evaluation of the correlates of success. This is the most comprehensive descriptive analysis of HPV vaccine coverage in LAMICs to date. It is possible to deliver HPV vaccine with excellent coverage in LAMICs. Further good quality data are needed from health facility based delivery strategies and national programmes to aid policymakers to effectively and sustainably scale-up HPV vaccination. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

Pertussis vaccination coverage among French parents of infants after 10years of cocoon strategy.

PubMed

Cohen, R; Gaudelus, J; Denis, F; Stahl, J-P; Chevaillier, O; Pujol, P; Martinot, A

2016-06-01

The cocoon strategy against pertussis has been recommended in France since 2004 to indirectly protect young infants who are not yet vaccinated. We aimed to measure vaccination coverage among French parents of infants. A representative sample of 300 mothers and 200 fathers of infants aged <12 months completed a self-administered online questionnaire. They all provided their own vaccination records. Overall, 87% of mothers believed vaccination against pertussis to be important; 83% reported being immunized against pertussis but their vaccination records showed that a third of them was wrong (34%). On the basis of our sample, the 2009-2014 vaccination coverage against pertussis among mothers increased from 22 to 61% (P<0.005); over the same period of time, vaccination coverage against diphtheria, tetanus, and polio remained stable (80%). Vaccination coverage against pertussis among fathers increased from 21 to 42% between 2010 and 2013 (P=0.009). In 2013, one couple out of four (26%) was adequately immunized against pertussis. The cocoon strategy was implemented 10years ago in France but vaccination coverage remains suboptimal among parents of young infants. Healthcare professionals must recommend vaccination against pertussis to young adults and check that their vaccination status is up to date. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Annual immunisation coverage report, 2010.

PubMed

Hull, Brynley; Dey, Aditi; Menzies, Rob; McIntyre, Peter

2013-03-31

This, the fourth annual immunisation coverage report, documents trends during 2010 for a range of standard measures derived from Australian Childhood Immunisation Register (ACIR) data. These include coverage at standard age milestones and for individual vaccines included on the National Immunisation Program (NIP). For the first time, coverage from other sources for adolescents and the elderly are included. The proportion of children 'fully vaccinated' at 12, 24 and 60 months of age was 91.6%, 92.1% and 89.1% respectively. For vaccines available on the NIP but not currently assessed for 'fully immunised' status or for eligibility for incentive payments (rotavirus and pneumococcal at 12 months and meningococcal C and varicella at 24 months) coverage varied. Although pneumococcal vaccine had similar coverage at 12 months to other vaccines, coverage was lower for rotavirus at 12 months (84.7%) and varicella at 24 months (83.0%). Overall coverage at 24 months of age exceeded that at 12 months of age nationally and for most jurisdictions, but as receipt of varicella vaccine at 18 months is excluded from calculations, this represents delayed immunisation, with some contribution from immunisation incentives. The 'fully immunised' coverage estimates for immunisations due by 60 months increased substantially in 2009, reaching almost 90% in 2010, probably related to completed immunisation by 60 months of age being introduced in 2009 as a requirement for GP incentive payments. As previously documented, vaccines recommended for Indigenous children only (hepatitis A and pneumococcal polysaccharide vaccine) had suboptimal coverage at around 57%. Delayed receipt of vaccines by Indigenous children at the 60-month milestone age improved from 56% to 62% but the disparity in on-time vaccination between Indigenous and non-Indigenous children at earlier age milestones did not improve. Coverage data for human papillomavirus (HPV)from the national HPV register are consistent with high coverage in the school-based program (73%) but were lower for the catch-up program for women outside school (30-38%). Coverage estimates for vaccines on the NIP from 65 years of age were comparable with other developed countries.

Determinants of geographic inequalities in HPV vaccination in the most populated region of France.

PubMed

Héquet, Delphine; Rouzier, Roman

2017-01-01

In France, there are recommendations and reimbursements for human papillomavirus (HPV) vaccination but no HPV vaccination programs. Therefore, vaccination is largely determined by parents' initiative, which can lead to inequalities. The objective of this study was to determine the factors associated with poorer vaccination coverage rates in the most populated region of France. The data of this study were obtained from the National Health Insurance between 2011 and 2013. Correlations between vaccination initiation rate (at least 1 dose reimbursed) and socio-demographic/cultural factors were assessed using Pearson's product-moment correlation coefficient. Multivariate analyses were performed using logistic regression. In total, 121,636 girls received at least one HPV vaccine dose. The vaccination rate for girls born from 1996 to 1999 was 18.7%. Disparities in vaccination coverage rates were observed between the 8 departments of the region, ranging from 12.9% to 22.6%. At the department level, unemployment, proportion of immigrants and foreigners, and coverage by CMU health insurance ("Couverture Maladie Universelle", a health insurance plan for those who are not otherwise covered through business or employment and who have a low income) were significantly inversely correlated with vaccination rates, whereas urban residence, medical density, income and use of medical services were not related to coverage. In the multivariate model, only the percentage of foreigners remained independently associated with lower vaccination coverage. At the individual level, the use of medical services was a strong driver of HPV vaccination initiation. We observed geographic disparities in HPV vaccination initiation coverage. Even if no clear factor was identified as a vaccination determinant, we observed a failure of vaccination only based on parents' initiative. Therefore, an organized policy on HPV vaccination, such as school-based programs, can help improve coverage rates.

Health newscasts for increasing influenza vaccination coverage: an inductive reasoning game approach.

PubMed

Breban, Romulus

2011-01-01

Both pandemic and seasonal influenza are receiving more attention from mass media than ever before. Topics such as epidemic severity and vaccination are changing the way in which we perceive the utility of disease prevention. Voluntary influenza vaccination has been recently modeled using inductive reasoning games. It has thus been found that severe epidemics may occur because individuals do not vaccinate and, instead, attempt to benefit from the immunity of their peers. Such epidemics could be prevented by voluntary vaccination if incentives were offered. However, a key assumption has been that individuals make vaccination decisions based on whether there was an epidemic each influenza season; no other epidemiological information is available to them. In this work, we relax this assumption and investigate the consequences of making more informed vaccination decisions while no incentives are offered. We obtain three major results. First, individuals will not cooperate enough to constantly prevent influenza epidemics through voluntary vaccination no matter how much they learned about influenza epidemiology. Second, broadcasting epidemiological information richer than whether an epidemic occurred may stabilize the vaccination coverage and suppress severe influenza epidemics. Third, the stable vaccination coverage follows the trend of the perceived benefit of vaccination. However, increasing the amount of epidemiological information released to the public may either increase or decrease the perceived benefit of vaccination. We discuss three scenarios where individuals know, in addition to whether there was an epidemic, (i) the incidence, (ii) the vaccination coverage and (iii) both the incidence and the vaccination coverage, every influenza season. We show that broadcasting both the incidence and the vaccination coverage could yield either better or worse vaccination coverage than broadcasting each piece of information on its own.

Health Newscasts for Increasing Influenza Vaccination Coverage: An Inductive Reasoning Game Approach

PubMed Central

Breban, Romulus

2011-01-01

Both pandemic and seasonal influenza are receiving more attention from mass media than ever before. Topics such as epidemic severity and vaccination are changing the way in which we perceive the utility of disease prevention. Voluntary influenza vaccination has been recently modeled using inductive reasoning games. It has thus been found that severe epidemics may occur because individuals do not vaccinate and, instead, attempt to benefit from the immunity of their peers. Such epidemics could be prevented by voluntary vaccination if incentives were offered. However, a key assumption has been that individuals make vaccination decisions based on whether there was an epidemic each influenza season; no other epidemiological information is available to them. In this work, we relax this assumption and investigate the consequences of making more informed vaccination decisions while no incentives are offered. We obtain three major results. First, individuals will not cooperate enough to constantly prevent influenza epidemics through voluntary vaccination no matter how much they learned about influenza epidemiology. Second, broadcasting epidemiological information richer than whether an epidemic occurred may stabilize the vaccination coverage and suppress severe influenza epidemics. Third, the stable vaccination coverage follows the trend of the perceived benefit of vaccination. However, increasing the amount of epidemiological information released to the public may either increase or decrease the perceived benefit of vaccination. We discuss three scenarios where individuals know, in addition to whether there was an epidemic, (i) the incidence, (ii) the vaccination coverage and (iii) both the incidence and the vaccination coverage, every influenza season. We show that broadcasting both the incidence and the vaccination coverage could yield either better or worse vaccination coverage than broadcasting each piece of information on its own. PMID:22205944

Compulsory and recommended vaccination in Italy: evaluation of coverage and non-compliance between 1998-2002 in Northern Italy

PubMed Central

Stampi, Serena; Ricci, Rita; Ruffilli, Isa; Zanetti, Franca

2005-01-01

Background Since vaccinations are an effective prevention tool for maintaining the health of society, the monitoring of immunization coverage allows us to identify areas where disease outbreaks are likely to occur, and possibly assist us in predicting future outbreaks. The aim of this study is the investigation of the coverage achieved for compulsory (diphtheria, tetanus, polio, hepatitis B,) and recommended (pertussis, Haemophilus influenzae, measles-mumps-rubella) vaccinations between 1998 and 2002 in the municipality of Bologna and the identification of the subjects not complying with compulsory and recommended vaccinations. Methods The statistics regarding vaccinal coverage were elaborated from the data supplied by the Bologna vaccinal registration system (1998–2000) and the IPV4 program (2001–2002). To calculate the coverage for compulsory vaccinations and cases of non-compliance reference was made to the protocol drawn up by the Emilia Romagna Regional Administration. The reasons for non-compliance were divided into various categories Results In Bologna the levels of immunization for the four compulsory vaccinations are satisfactory: over 95% children completed the vaccinal cycle, receiving the booster for anti-polio foreseen in their 3rd year and for anti-dyphteria, tetanus, pertussis at 6 years. The frequency of subjects with total non-compliance (i.e. those who have not begun any compulsory vaccinations by the age of one year) is generally higher in Bologna than in the region, with a slight increase in 2002 (2.52% and 1.06% in the city and the region respectively). The frequency of the anti-measles vaccination is higher than that of mumps and rubella, which means that the single vaccine, as opposed to the combined MMR (measles-mumps-rubella) was still being used in the period in question. The most common reason for non compliance is objection of parents and is probably due to reduction of certain diseases or anxiety about the possible risks. Conclusion In Bologna the frequency of children aged 12 and 24 months who have achieved compulsory vaccination varied, in 2002, between 95% and 98%. As regards recommended vaccinations the percentage of coverage against Haemophilus influenzae is 93.3%, while the levels for measles, mumps and pertussis range from 84% to approx. 92%. Although these percentages are higher if compared to those obtained by other Italian regions, every effort should be made to strengthen the aspects that lead to a successful vaccinal strategy. PMID:15845144

Vaccination coverage in the US Commonwealth of the Northern Mariana Islands, 2005.

PubMed

Luman, Elizabeth T; Sablan, Mariana; Anaya, Gabriel; Stokley, Shannon; McCauley, Mary Mason; Shaw, Kate M; Salazar, Angela; Balajadia, Ron; Chaine, Jean Paul; Duncan, Richard

2007-01-01

In July 2005, a house-to-house survey was conducted to determine vaccination coverage achieved through routine health services on the three inhabited islands (Saipan, Rota, and Tinian) of the US Commonwealth of the Northern Mariana Islands (CNMI). A population-based cluster survey was conducted on Saipan; clusters and households were selected by systematic random sampling. On the smaller islands of Rota and Tinian, all households were visited. Vaccination histories and demographic information were obtained during household interview for all children aged 19-35 months, children aged 6 years, and adults aged 65 years and older. Vaccination histories for children were supplemented by hospital/clinic records and an electronic vaccination registry. Among 295 children aged 19-35 months, estimated coverage with the primary vaccination series was 80 percent; coverage with individual vaccines was generally higher. Among 193 children aged 6 years, coverage for vaccines required at school-aged was 83 percent. Among 226 adults aged 65 years and older, 52 percent received influenza vaccine during the previous season while 21 percent had ever received pneumococcal vaccine. The CNMI has achieved the US Healthy People 2010 objective of 80 percent coverage for the standard vaccination series among children aged 19-35 months. High coverage levels among 6-year-old children may reflect the benefit of school entry requirements. Influenza and pneumococcal vaccination among older adults remains low. Efforts to ensure that children and older adults throughout the CNMI are equally well-protected should continue. Strategies to address parental awareness of vaccinations that are due should be explored and may be facilitated by upgrading the electronic vaccination registry.

Factors limiting immunization coverage in urban Dili, Timor-Leste

PubMed Central

Amin, Ruhul; De Oliveira, Telma Joana Corte Real; Da Cunha, Mateus; Brown, Tanya Wells; Favin, Michael; Cappelier, Kelli

2013-01-01

ABSTRACT Background: Timor-Leste's immunization coverage is among the poorest in Asia. The 2009/2010 Demographic and Health Survey found that complete vaccination coverage in urban areas, at 47.7%, was lower than in rural areas, at 54.1%. The city of Dili, the capital of Timor-Leste, had even lower coverage (43.4%) than the national urban average. Objective: To better understand the service- and user-related factors that account for low vaccination coverage in urban Dili, despite high literacy rates and relatively good access to immunization services and communication media. Methods: A mixed-methods (mainly qualitative) study, conducted in 5 urban sub-districts of Dili, involved in-depth interviews with18 Ministry of Health staff and 6 community leaders, 83 observations of immunization encounters, 37 exit interviews with infants' caregivers at 11 vaccination sites, and 11 focus group discussions with 70 caregivers of vaccination-eligible children ages 6 to 23 months. Results: The main reasons for low vaccination rates in urban Dili included caregivers' knowledge, attitudes, and perceptions as well as barriers at immunization service sites. Other important factors were access to services and information, particularly in the city periphery, health workers' attitudes and practices, caregivers' fears of side effects, conflicting priorities, large family size, lack of support from husbands and paternal grandmothers, and seasonal migration. Conclusion: Good access to health facilities or health services does not necessarily translate into uptake of immunization services. The reasons are complex and multifaceted but in general relate to the health services' insufficient understanding of and attention to their clients' needs. Almost all families in Dili would be motivated to have their children immunized if services were convenient, reliable, friendly, and informative. PMID:25276554

Prolonging herd immunity to cholera via vaccination: Accounting for human mobility and waning vaccine effects

PubMed Central

Buckee, Caroline O.

2018-01-01

Background Oral cholera vaccination is an approach to preventing outbreaks in at-risk settings and controlling cholera in endemic settings. However, vaccine-derived herd immunity may be short-lived due to interactions between human mobility and imperfect or waning vaccine efficacy. As the supply and utilization of oral cholera vaccines grows, critical questions related to herd immunity are emerging, including: who should be targeted; when should revaccination be performed; and why have cholera outbreaks occurred in recently vaccinated populations? Methods and findings We use mathematical models to simulate routine and mass oral cholera vaccination in populations with varying degrees of migration, transmission intensity, and vaccine coverage. We show that migration and waning vaccine efficacy strongly influence the duration of herd immunity while birth and death rates have relatively minimal impacts. As compared to either periodic mass vaccination or routine vaccination alone, a community could be protected longer by a blended “Mass and Maintain” strategy. We show that vaccination may be best targeted at populations with intermediate degrees of mobility as compared to communities with very high or very low population turnover. Using a case study of an internally displaced person camp in South Sudan which underwent high-coverage mass vaccination in 2014 and 2015, we show that waning vaccine direct effects and high population turnover rendered the camp over 80% susceptible at the time of the cholera outbreak beginning in October 2016. Conclusions Oral cholera vaccines can be powerful tools for quickly protecting a population for a period of time that depends critically on vaccine coverage, vaccine efficacy over time, and the rate of population turnover through human mobility. Due to waning herd immunity, epidemics in vaccinated communities are possible but become less likely through complementary interventions or data-driven revaccination strategies. PMID:29489815

Measles and rubella vaccination coverage in Haiti, 2012: progress towards verifying and challenges to maintaining measles and rubella elimination

PubMed Central

Tohme, Rania A.; François, Jeannot; Wannemuehler, Kathleen; Magloire, Roc; Danovaro-Holliday, M. Carolina; Flannery, Brendan; Cavallaro, Kathleen F.; Fitter, David L.; Purcell, Nora; Dismer, Amber; Tappero, Jordan W.; Vertefeuille, John F.; Hyde, Terri B.

2015-01-01

Objectives We conducted a nationwide survey to assess measles containing vaccine (MCV) coverage among children aged 1–9 years in Haiti and identify factors associated with vaccination before and during the 2012 nationwide supplementary immunisation activities (SIA). Methods Haiti was stratified into five geographic regions (Metropolitan Port-au-Prince, North, Centre, South and West), 40 clusters were randomly selected in each region, and 35 households were selected per cluster. Results Among the 7000 visited households, 75.8% had at least one child aged 1–9 years; of these, 5279 (99.5%) households consented to participate in the survey. Of 9883 children enrolled, 91% received MCV before and/or during the SIA; 31% received MR for the first time during the SIA, and 50.7% received two doses of MCV (one before and one during the 2012 SIA). Among the 1685 unvaccinated children during the SIA, the primary reason of non-vaccination was caregivers not being aware of the SIA (31.0%). Children aged 1–4 years had significantly lower MR SIA coverage than those aged 5–9 years (79.5% vs. 84.8%) (P < 0.0001). A higher proportion of children living in the West (12.3%) and Centre (11.2%) regions had never been vaccinated than in other regions (4.8–9.1%). Awareness, educational level of the mother and region were significantly associated with MR vaccination during and before the SIA (P < 0.001). Conclusions The 2012 SIA successfully increased MR coverage; however, to maintain measles and rubella elimination, coverage needs to be further increased among children aged 1–4 years and in regions with lower coverage. PMID:25041586

The Norwegian immunisation register--SYSVAK.

PubMed

Trogstad, L; Ung, G; Hagerup-Jenssen, M; Cappelen, I; Haugen, I L; Feiring, B

2012-04-19

The Norwegian immunisation register, SYSVAK, is a national electronic immunisation register. It became nationwide in 1995. The major aim was to register all vaccinations in the Childhood Immunisation Programme to ensure that all children are offered adequate vaccination according to schedule in the programme, and to secure high vaccination coverage. Notification to SYSVAK is mandatory, based on personal identification numbers. This allows follow up of individual vaccination schedules and linkage of SYSVAK data to other national health registers for information on outcome diagnoses, such as the surveillance system for communicable diseases. Information from SYSVAK is used to determine vaccine coverage in a timely manner. Coverage can be broken down to regional/local levels and used for active surveillance of vaccination coverage and decisions about interventions. During the 2009 influenza A(H1N1)pdm09 pandemic, an adaptation of SYSVAK enabled daily surveillance of vaccination coverage on national and regional levels. Currently, data from SYSVAK are used, among others, in studies on adverse events related to pandemic vaccination. Future challenges include maximising usage of collected data in surveillance and research, and continued improvement of data quality. Immunisation registers are rich sources for high quality surveillance of vaccination coverage, effectiveness, vaccine failure and adverse events, and gold mines for research.

Seasonal influenza vaccine coverage among high-risk populations in Thailand, 2010-2012.

PubMed

Owusu, Jocelynn T; Prapasiri, Prabda; Ditsungnoen, Darunee; Leetongin, Grit; Yoocharoen, Pornsak; Rattanayot, Jarowee; Olsen, Sonja J; Muangchana, Charung

2015-01-29

The Advisory Committee on Immunization Practice of Thailand prioritizes seasonal influenza vaccinations for populations who are at highest risk for serious complications (pregnant women, children 6 months-2 years, persons ≥65 years, persons with chronic diseases, obese persons), and healthcare personnel and poultry cullers. The Thailand government purchases seasonal influenza vaccine for these groups. We assessed vaccination coverage among high-risk groups in Thailand from 2010 to 2012. National records on persons who received publicly purchased vaccines from 2010 to 2012 were analyzed by high-risk category. Denominator data from multiple sources were compared to calculate coverage. Vaccine coverage was defined as the proportion of individuals in each category who received the vaccine. Vaccine wastage was defined as the proportion of publicly purchased vaccines that were not used. From 2010 to 2012, 8.18 million influenza vaccines were publicly purchased (range, 2.37-3.29 million doses/year), and vaccine purchases increased 39% over these years. Vaccine wastage was 9.5%. Approximately 5.7 million (77%) vaccine doses were administered to persons ≥65 years and persons with chronic diseases, 1.4 million (19%) to healthcare personnel/poultry cullers, 82,570 (1.1%) to children 6 months-2 years, 78,885 (1.1%) to obese persons, 26,481 (0.4%) to mentally disabled persons, and 17,787 (0.2%) to pregnant women. Between 2010 and 2012, coverage increased among persons with chronic diseases (8.6% versus 14%; p<0.01) and persons ≥65 years (12%, versus 20%; p<0.01); however, coverage decreased for mentally disabled persons (6.1% versus 4.9%; p<0.01), children 6 months-2 years (2.3% versus 0.9%; p<0.01), pregnant women (1.1% versus 0.9%; p<0.01), and obese persons (0.2% versus 0.1%; p<0.01). From 2010 to 2012, the availability of publicly purchased vaccines increased. While coverage remained low for all target groups, coverage was highest among persons ≥65 years and persons with chronic diseases. Annual coverage assessments are necessary to promote higher coverage among high-risk groups in Thailand. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

Annual changes in rotavirus hospitalization rates before and after rotavirus vaccine implementation in the United States.

PubMed

Shah, Minesh P; Dahl, Rebecca M; Parashar, Umesh D; Lopman, Benjamin A

2018-01-01

Hospitalizations for rotavirus and acute gastroenteritis (AGE) have declined in the US with rotavirus vaccination, though biennial peaks in incidence in children aged less than 5 years occur. This pattern may be explained by lower rotavirus vaccination coverage in US children (59% to 73% from 2010-2015), resulting in accumulation of susceptible children over two successive birth cohorts. Retrospective cohort analysis of claims data of commercially insured US children aged <5 years. Age-stratified hospitalization rates for rotavirus and for AGE from the 2002-2015 rotavirus seasons were examined. Median age and rotavirus vaccination coverage for biennial rotavirus seasons during pre-vaccine (2002-2005), early post-vaccine (2008-2011) and late post-vaccine (2012-2015) years. Age-stratified hospitalization rates decreased from pre-vaccine to early post-vaccine and then to late post-vaccine years. The clearest biennial pattern in hospitalization rates is the early post-vaccine period, with higher rates in 2009 and 2011 than in 2008 and 2010. The pattern diminishes in the late post-vaccine period. For rotavirus hospitalizations, the median age and the difference in age between biennial seasons was highest during the early post-vaccine period; these differences were not observed for AGE hospitalizations. There was no significant difference in vaccination coverage between biennial seasons. These observations provide conflicting evidence that incomplete vaccine coverage drove the biennial pattern in rotavirus hospitalizations that has emerged with rotavirus vaccination in the US. As this pattern is diminishing with higher vaccine coverage in recent years, further increases in vaccine coverage may reach a threshold that eliminates peak seasons in hospitalizations.

State of equity: childhood immunization in the World Health Organization African Region.

PubMed

Casey, Rebecca Mary; Hampton, Lee McCalla; Anya, Blanche-Philomene Melanga; Gacic-Dobo, Marta; Diallo, Mamadou Saliou; Wallace, Aaron Stuart

2017-01-01

In 2010, the Global Vaccine Action Plan called on all countries to reach and sustain 90% national coverage and 80% coverage in all districts for the third dose of diphtheria-tetanus-pertussis vaccine (DTP3) by 2015 and for all vaccines in national immunization schedules by 2020. The aims of this study are to analyze recent trends in national vaccination coverage in the World Health Organization African Region andto assess how these trends differ by country income category. We compared national vaccination coverage estimates for DTP3 and the first dose of measles-containing vaccine (MCV) obtained from the World Health Organization (WHO)/United Nations Children's Fund (UNICEF) joint estimates of national immunization coverage for all African Region countries. Using United Nations (UN) population estimates of surviving infants and country income category for the corresponding year, we calculated population-weighted average vaccination coverage by country income category (i.e., low, lower middle, and upper middle-income) for the years 2000, 2005, 2010 and 2015. DTP3 coverage in the African Region increased from 52% in 2000 to 76% in 2015,and MCV1 coverage increased from 53% to 74% during the same period, but with considerable differences among countries. Thirty-six African Region countries were low income in 2000 with an average DTP3 coverage of 50% while 26 were low income in 2015 with an average coverage of 80%. Five countries were lower middle-income in 2000 with an average DTP3 coverage of 84% while 12 were lower middle-income in 2015 with an average coverage of 69%. Five countries were upper middle-income in 2000 with an average DTP3 coverage of 73% and eight were upper middle-income in 2015 with an average coverage of 76%. Disparities in vaccination coverage by country persist in the African Region, with countries that were lower middle-income having the lowest coverage on average in 2015. Monitoring and addressing these disparities is essential for meeting global immunization targets.

Epidemiological game-theory dynamics of chickenpox vaccination in the USA and Israel

PubMed Central

Liu, Jingzhou; Kochin, Beth F.; Tekle, Yonas I.; Galvani, Alison P.

2012-01-01

The general consensus from epidemiological game-theory studies is that vaccination coverage driven by self-interest (Nash vaccination) is generally lower than group-optimal coverage (utilitarian vaccination). However, diseases that become more severe with age, such as chickenpox, pose an exception to this general consensus. An individual choice to be vaccinated against chickenpox has the potential to harm those not vaccinated by increasing the average age at infection and thus the severity of infection as well as those already vaccinated by increasing the probability of breakthrough infection. To investigate the effects of these externalities on the relationship between Nash and utilitarian vaccination coverages for chickenpox, we developed a game-theory epidemic model that we apply to the USA and Israel, which has different vaccination programmes, vaccination and treatment costs, as well as vaccination coverage levels. We find that the increase in chickenpox severity with age can reverse the typical relationship between utilitarian and Nash vaccination coverages in both the USA and Israel. Our model suggests that to obtain herd immunity of chickenpox vaccination, subsidies or external regulation should be used if vaccination costs are high. By contrast, for low vaccination costs, improving awareness of the vaccine and the potential cost of chickenpox infection is crucial. PMID:21632611

Epidemiological game-theory dynamics of chickenpox vaccination in the USA and Israel.

PubMed

Liu, Jingzhou; Kochin, Beth F; Tekle, Yonas I; Galvani, Alison P

2012-01-07

The general consensus from epidemiological game-theory studies is that vaccination coverage driven by self-interest (Nash vaccination) is generally lower than group-optimal coverage (utilitarian vaccination). However, diseases that become more severe with age, such as chickenpox, pose an exception to this general consensus. An individual choice to be vaccinated against chickenpox has the potential to harm those not vaccinated by increasing the average age at infection and thus the severity of infection as well as those already vaccinated by increasing the probability of breakthrough infection. To investigate the effects of these externalities on the relationship between Nash and utilitarian vaccination coverages for chickenpox, we developed a game-theory epidemic model that we apply to the USA and Israel, which has different vaccination programmes, vaccination and treatment costs, as well as vaccination coverage levels. We find that the increase in chickenpox severity with age can reverse the typical relationship between utilitarian and Nash vaccination coverages in both the USA and Israel. Our model suggests that to obtain herd immunity of chickenpox vaccination, subsidies or external regulation should be used if vaccination costs are high. By contrast, for low vaccination costs, improving awareness of the vaccine and the potential cost of chickenpox infection is crucial.

Clustered lot quality assurance sampling: a tool to monitor immunization coverage rapidly during a national yellow fever and polio vaccination campaign in Cameroon, May 2009.

PubMed

Pezzoli, L; Tchio, R; Dzossa, A D; Ndjomo, S; Takeu, A; Anya, B; Ticha, J; Ronveaux, O; Lewis, R F

2012-01-01

We used the clustered lot quality assurance sampling (clustered-LQAS) technique to identify districts with low immunization coverage and guide mop-up actions during the last 4 days of a combined oral polio vaccine (OPV) and yellow fever (YF) vaccination campaign conducted in Cameroon in May 2009. We monitored 17 pre-selected districts at risk for low coverage. We designed LQAS plans to reject districts with YF vaccination coverage <90% and with OPV coverage <95%. In each lot the sample size was 50 (five clusters of 10) with decision values of 3 for assessing OPV and 7 for YF coverage. We 'rejected' 10 districts for low YF coverage and 14 for low OPV coverage. Hence we recommended a 2-day extension of the campaign. Clustered-LQAS proved to be useful in guiding the campaign vaccination strategy before the completion of the operations.

Intervene before leaving: clustered lot quality assurance sampling to monitor vaccination coverage at health district level before the end of a yellow fever and measles vaccination campaign in Sierra Leone in 2009.

PubMed

Pezzoli, Lorenzo; Conteh, Ishata; Kamara, Wogba; Gacic-Dobo, Marta; Ronveaux, Olivier; Perea, William A; Lewis, Rosamund F

2012-06-07

In November 2009, Sierra Leone conducted a preventive yellow fever (YF) vaccination campaign targeting individuals aged nine months and older in six health districts. The campaign was integrated with a measles follow-up campaign throughout the country targeting children aged 9-59 months. For both campaigns, the operational objective was to reach 95% of the target population. During the campaign, we used clustered lot quality assurance sampling (C-LQAS) to identify areas of low coverage to recommend timely mop-up actions. We divided the country in 20 non-overlapping lots. Twelve lots were targeted by both vaccinations, while eight only by measles. In each lot, five clusters of ten eligible individuals were selected for each vaccine. The upper threshold (UT) was set at 90% and the lower threshold (LT) at 75%. A lot was rejected for low vaccination coverage if more than 7 unvaccinated individuals (not presenting vaccination card) were found. After the campaign, we plotted the C-LQAS results against the post-campaign coverage estimations to assess if early interventions were successful enough to increase coverage in the lots that were at the level of rejection before the end of the campaign. During the last two days of campaign, based on card-confirmed vaccination status, five lots out of 20 (25.0%) failed for having low measles vaccination coverage and three lots out of 12 (25.0%) for low YF coverage. In one district, estimated post-campaign vaccination coverage for both vaccines was still not significantly above the minimum acceptable level (LT = 75%) even after vaccination mop-up activities. C-LQAS during the vaccination campaign was informative to identify areas requiring mop-up activities to reach the coverage target prior to leaving the region. The only district where mop-up activities seemed to be unsuccessful might have had logistical difficulties that should be further investigated and resolved.

Marked increase in measles vaccination coverage among young adults in Switzerland: a campaign or cohort effect?

PubMed

Altpeter, Ekkehardt; Wymann, Monica N; Richard, Jean-Luc; Mäusezahl-Feuz, Mirjam

2018-06-01

To evaluate the impact of the Swiss measles elimination strategy-including a mass media campaign-on vaccination coverage and awareness among young adults aged 20-29 years. Comparison of the results of two cross-sectional population surveys in 2012 and 2015. Documented vaccination coverage increased from 77 to 88% for two doses of measles vaccine. Major determinants of complete vaccination were survey year, birth cohort, sex and the absence of prior measles disease. If birth cohort and prior history of measles disease are included as factors in a multivariate model, the difference between 2012 and 2015 vanishes. The marked increase in complete measles vaccination coverage is due to a cohort effect, owing to the introduction of the second dose of vaccine in 1996. Most of the vaccinations were administered before the national strategy was implemented and vaccination catch-ups did not increase during the campaign in young adults. Nevertheless, this study provides evidence of an improvement in the awareness of measles and measles vaccination in young adults, which may result in an impact on measles vaccination coverage in the near future.

Yellow Fever in Africa: Estimating the Burden of Disease and Impact of Mass Vaccination from Outbreak and Serological Data

PubMed Central

Garske, Tini; Van Kerkhove, Maria D.; Yactayo, Sergio; Ronveaux, Olivier; Lewis, Rosamund F.; Staples, J. Erin; Perea, William; Ferguson, Neil M.

2014-01-01

Background Yellow fever is a vector-borne disease affecting humans and non-human primates in tropical areas of Africa and South America. While eradication is not feasible due to the wildlife reservoir, large scale vaccination activities in Africa during the 1940s to 1960s reduced yellow fever incidence for several decades. However, after a period of low vaccination coverage, yellow fever has resurged in the continent. Since 2006 there has been substantial funding for large preventive mass vaccination campaigns in the most affected countries in Africa to curb the rising burden of disease and control future outbreaks. Contemporary estimates of the yellow fever disease burden are lacking, and the present study aimed to update the previous estimates on the basis of more recent yellow fever occurrence data and improved estimation methods. Methods and Findings Generalised linear regression models were fitted to a dataset of the locations of yellow fever outbreaks within the last 25 years to estimate the probability of outbreak reports across the endemic zone. Environmental variables and indicators for the surveillance quality in the affected countries were used as covariates. By comparing probabilities of outbreak reports estimated in the regression with the force of infection estimated for a limited set of locations for which serological surveys were available, the detection probability per case and the force of infection were estimated across the endemic zone. The yellow fever burden in Africa was estimated for the year 2013 as 130,000 (95% CI 51,000–380,000) cases with fever and jaundice or haemorrhage including 78,000 (95% CI 19,000–180,000) deaths, taking into account the current level of vaccination coverage. The impact of the recent mass vaccination campaigns was assessed by evaluating the difference between the estimates obtained for the current vaccination coverage and for a hypothetical scenario excluding these vaccination campaigns. Vaccination campaigns were estimated to have reduced the number of cases and deaths by 27% (95% CI 22%–31%) across the region, achieving up to an 82% reduction in countries targeted by these campaigns. A limitation of our study is the high level of uncertainty in our estimates arising from the sparseness of data available from both surveillance and serological surveys. Conclusions With the estimation method presented here, spatial estimates of transmission intensity can be combined with vaccination coverage levels to evaluate the impact of past or proposed vaccination campaigns, thereby helping to allocate resources efficiently for yellow fever control. This method has been used by the Global Alliance for Vaccines and Immunization (GAVI Alliance) to estimate the potential impact of future vaccination campaigns. Please see later in the article for the Editors' Summary PMID:24800812

Barriers and facilitators to influenza vaccination and vaccine coverage in a cohort of health care personnel.

PubMed

Naleway, Allison L; Henkle, Emily M; Ball, Sarah; Bozeman, Sam; Gaglani, Manjusha J; Kennedy, Erin D; Thompson, Mark G

2014-04-01

Annual influenza vaccination is recommended for health care personnel (HCP). We describe influenza vaccination coverage among HCP during the 2010-2011 season and present reported facilitators of and barriers to vaccination. We enrolled HCP 18 to 65 years of age, working full time, with direct patient contact. Participants completed an Internet-based survey at enrollment and the end of influenza season. In addition to self-reported data, we collected information about the 2010-2011 influenza vaccine from electronic employee health and medical records. Vaccination coverage was 77% (1,307/1,701). Factors associated with higher vaccination coverage include older age, being married or partnered, working as a physician or dentist, prior history of influenza vaccination, more years in patient care, and higher job satisfaction. Personal protection was reported as the most important reason for vaccination followed closely by convenience, protection of patients, and protection of family and friends. Concerns about perceived vaccine safety and effectiveness and low perceived susceptibility to influenza were the most commonly reported barriers to vaccination. About half of the unvaccinated HCP said they would have been vaccinated if required by their employer. Influenza vaccination in this cohort was relatively high but still fell short of the recommended target of 90% coverage for HCP. Addressing concerns about vaccine safety and effectiveness are possible areas for future education or intervention to improve coverage among HCP. Copyright © 2014 Association for Professionals in Infection Control and Epidemiology, Inc. All rights reserved.

Timeliness and completeness of measles vaccination among children in rural areas of Guangxi, China: A stratified three-stage cluster survey.

PubMed

Tang, Xianyan; Geater, Alan; McNeil, Edward; Zhou, Hongxia; Deng, Qiuyun; Dong, Aihu

2017-07-01

Large-scale outbreaks of measles occurred in 2013 and 2014 in rural Guangxi, a region in Southwest China with high coverage for measles-containing vaccine (MCV). This study aimed to estimate the timely vaccination coverage, the timely-and-complete vaccination coverage, and the median delay period for MCV among children aged 18-54 months in rural Guangxi. Based on quartiles of measles incidence during 2011-2013, a stratified three-stage cluster survey was conducted from June through August 2015. Using weighted estimation and finite population correction, vaccination coverage and 95% confidence intervals (CIs) were calculated. Weighted Kaplan-Meier analyses were used to estimate the median delay periods for the first (MCV1) and second (MCV2) doses of the vaccine. A total of 1216 children were surveyed. The timely vaccination coverage rate was 58.4% (95% CI, 54.9%-62.0%) for MCV1, and 76.9% (95% CI, 73.6%-80.0%) for MCV2. The timely-and-complete vaccination coverage rate was 47.4% (95% CI, 44.0%-51.0%). The median delay period was 32 (95% CI, 27-38) days for MCV1, and 159 (95% CI, 118-195) days for MCV2. The timeliness and completeness of measles vaccination was low, and the median delay period was long among children in rural Guangxi. Incorporating the timeliness and completeness into official routine vaccination coverage statistics may help appraise the coverage of vaccination in China. Copyright © 2017 The Authors. Production and hosting by Elsevier B.V. All rights reserved.

Inequalities in full immunization coverage: trends in low- and middle-income countries

PubMed Central

Barros, Aluísio JD; Wong, Kerry LM; Johnson, Hope L; Pariyo, George; França, Giovanny VA; Wehrmeister, Fernando C; Victora, Cesar G

2016-01-01

Abstract Objective To investigate disparities in full immunization coverage across and within 86 low- and middle-income countries. Methods In May 2015, using data from the most recent Demographic and Health Surveys and Multiple Indicator Cluster Surveys, we investigated inequalities in full immunization coverage – i.e. one dose of bacille Calmette-Guérin vaccine, one dose of measles vaccine, three doses of vaccine against diphtheria, pertussis and tetanus and three doses of polio vaccine – in 86 low- or middle-income countries. We then investigated temporal trends in the level and inequality of such coverage in eight of the countries. Findings In each of the World Health Organization’s regions, it appeared that about 56–69% of eligible children in the low- and middle-income countries had received full immunization. However, within each region, the mean recorded level of such coverage varied greatly. In the African Region, for example, it varied from 11.4% in Chad to 90.3% in Rwanda. We detected pro-rich inequality in such coverage in 45 of the 83 countries for which the relevant data were available and pro-urban inequality in 35 of the 86 study countries. Among the countries in which we investigated coverage trends, Madagascar and Mozambique appeared to have made the greatest progress in improving levels of full immunization coverage over the last two decades, particularly among the poorest quintiles of their populations. Conclusion Most low- and middle-income countries are affected by pro-rich and pro-urban inequalities in full immunization coverage that are not apparent when only national mean values of such coverage are reported. PMID:27821882

The impact of varicella vaccination on varicella-related hospitalization rates: global data review

PubMed Central

Hirose, Maki; Gilio, Alfredo Elias; Ferronato, Angela Esposito; Ragazzi, Selma Lopes Betta

2016-01-01

Abstract Objective: To describe the impact of varicella vaccination on varicella-related hospitalization rates in countries that implemented universal vaccination against the disease. Data source: We identified countries that implemented universal vaccination against varicella at the http://apps.who.int/immunization_monitoring/globalsummary/schedules site of the World Health Organization and selected articles in Pubmed describing the changes (pre/post-vaccination) in the varicella-related hospitalization rates in these countries, using the Keywords "varicella", "vaccination/vaccine" and "children" (or) "hospitalization". Publications in English published between January 1995 and May 2015 were included. Data synthesis: 24 countries with universal vaccination against varicella and 28 articles describing the impact of the vaccine on varicella-associated hospitalizations rates in seven countries were identified. The US had 81.4%–99.2% reduction in hospitalization rates in children younger than four years, 6–14 years after the onset of universal vaccination (1995), with vaccination coverage of 90%; Uruguay: 94% decrease (children aged 1–4 years) in six years, vaccination coverage of 90%; Canada: 93% decrease (age 1–4 years) in 10 years, coverage of 93%; Germany: 62.4% decrease (age 1–4 years) in 8 years, coverage of 78.2%; Australia: 76.8% decrease (age 1–4 years) in 5 years, coverage of 90%; Spain: 83.5% decrease (age <5 years) in four years, coverage of 77.2% and Italy 69.7%–73.8% decrease (general population), coverage of 60%–95%. Conclusions: The publications showed variations in the percentage of decrease in varicella-related hospitalization rates after universal vaccination in the assessed countries; the results probably depend on the time since the implementation of universal vaccination, differences in the studied age group, hospital admission criteria, vaccination coverage and strategy, which does not allow direct comparison between data. PMID:26965075

The impact of varicella vaccination on varicella-related hospitalization rates: global data review.

PubMed

Hirose, Maki; Gilio, Alfredo Elias; Ferronato, Angela Esposito; Ragazzi, Selma Lopes Betta

2016-09-01

to describe the impact of varicella vaccination on varicella-related hospitalization rates in countries that implemented universal vaccination against the disease. we identified countries that implemented universal vaccination against varicella at the http://apps.who.int/immunization_monitoring/globalsummary/schedules site of the World Health Organization and selected articles in Pubmed describing the changes (pre/post-vaccination) in the varicella-related hospitalization rates in these countries, using the Keywords "varicella", "vaccination/vaccine" and "children" (or) "hospitalization". Publications in English published between January 1995 and May 2015 were included. 24 countries with universal vaccination against varicella and 28 articles describing the impact of the vaccine on varicella-associated hospitalizations rates in seven countries were identified. The US had 81.4% -99.2% reduction in hospitalization rates in children younger than four years after 6-14 years after the onset of universal vaccination (1995), with vaccination coverage of 90%; Uruguay: 94% decrease (children aged 1-4 years) in six years, vaccination coverage of 90%; Canada: 93% decrease (age 1-4 years) in 10 years, coverage of 93%; Germany: 62.4% decrease (age 1-4 years) in 8 years, coverage of 78.2%; Australia: 76.8% decrease (age 1-4 years) in 5 years, coverage of 90%; Spain: 83.5% decrease (age <5 years) in four years, coverage of 77.2% and Italy 69.7% -73.8% decrease (general population), coverage of 60%-95%. The publications showed variations in the percentage of decrease in varicella-related hospitalization rates after universal vaccination in the assessed countries; the results probably depend on the time since the implementation of universal vaccination, differences in the studied age group, hospital admission criteria, vaccination coverage and strategy, which does not allow direct comparison between data. Copyright © 2016 Sociedade de Pediatria de São Paulo. Publicado por Elsevier Editora Ltda. All rights reserved.

Children on the move and vaccination coverage in a low-income, urban Latino population.

PubMed

Findley, S E; Irigoyen, M; Schulman, A

1999-11-01

The purpose of this study was to determine the impact of childhood moves and foreign birth on vaccination coverage among Latino children in New York City. Vaccination coverage was assessed in a survey of 314 children younger than 5 years at 2 immunization clinics. Forty-seven percent of the study children had moved abroad. After adjustment for health insurance, regular source of care, and country of birth, child moves had no independent effect on vaccination coverage. Foreign-born children had diphtheria-pertussis-tetanus, oral polio vaccine, and measles-mumps-rubella vaccination coverage rates similar to those of US-born children, but they were underimmunized in regard to Haemophilus influenzae type b and hepatitis B. Foreign birth, but not childhood moves, is a barrier to vaccinations among low-income, urban Latino children.

A cross-sectional vaccination coverage study in preschool children attending nurseries-kindergartens: Implications on economic crisis effect

PubMed Central

Menegas, Damianos; Katsioulis, Antonis; Theodoridou, Maria; Kremastinou, Jenny; Hadjichristodoulou, Christos

2017-01-01

ABSTRACT Vaccination coverage studies are important in determining a population's vaccination status and strategically adjusting national immunization programs. This study assessed full and timely vaccination coverage of preschool children aged 2–3 y attending nurseries-kindergartens (N-K) nationwide at the socioeconomic crisis onset. Geographically stratified cluster sampling was implemented considering prefectures as strata and N-K as clusters. The N-K were selected by simple random sampling from the sampling frame while their number was proportional to the stratum size. In total, 185 N-K (response rate 93.9%) and 2539 children (response rate 81.5%) participated. Coverage with traditional vaccines for diphtheria-tetanus-pertussis, polio and measles-mumps-rubella was very high (>95%), followed by Haemophilus influenzae type b and varicella vaccines. Despite very high final coverage, delayed vaccination was observed for hepatitis B (48.3% completed by 12 months). Significant delay was observed for the booster dose of pneumococcal conjugate vaccines (PCV) and meningococcal C conjugate vaccines (MCC). Of the total population studied, 82.3% received 3 PCV doses by 12 months, while 62.3% received the fourth dose by 24 months and 76.2% by 30 months. However, 89.6% received at least one MCC dose over 12 months. Timely vaccinated for hepatitis A with 2 doses by 24 months were 6.1%. Coverage was significantly low for Rotavirus (<20%) and influenza (23.1% one dose). High vaccination coverage is maintained for most vaccines at the beginning of the crisis in Greece. Coverage and timeliness show an increasing trend compared to previous studies. Sustained efforts are needed to support the preventive medicine system as socioeconomic instability continues. PMID:27669156

Survey of distribution of seasonal influenza vaccine doses in 201 countries (2004-2015): The 2003 World Health Assembly resolution on seasonal influenza vaccination coverage and the 2009 influenza pandemic have had very little impact on improving influenza control and pandemic preparedness.

PubMed

Palache, A; Abelin, A; Hollingsworth, R; Cracknell, W; Jacobs, C; Tsai, T; Barbosa, P

2017-08-24

There is no global monitoring system for influenza vaccination coverage, making it difficult to assess progress towards the 2003 World Health Assembly (WHA) vaccination coverage target. In 2008, the IFPMA Influenza Vaccine Supply International Task Force (IVS) developed a survey method to assess the global distribution of influenza vaccine doses as a proxy for vaccination coverage rates. The latest dose distribution data for 2014 and 2015 was used to update previous analyses. Data were confidentially collected and aggregated by the IFPMA Secretariat, and combined with previous IFPMA IVS survey data (2004-2013). Data were available from 201 countries over the 2004-2015 period. A "hurdle" rate was defined as the number of doses required to reach 15.9% of the population in 2008. Overall, the number of distributed doses progressively increased between 2004 and 2011, driven by a 150% increase in AMRO, then plateaued. One percent fewer doses were distributed in 2015 than in 2011. Twenty-three countries were above the hurdle rate in 2015, compared to 15 in 2004, but distribution was highly uneven in and across all WHO regions. Three WHO regions (AMRO, EURO and WPRO) accounted for about 95% of doses distributed. But in EURO and WPRO, distribution rates in 2015 were only marginally higher than in 2004, and in EURO there was an overall downward trend in dose distribution. The vast majority of countries cannot meet the 2003WHA coverage targets and are inadequately prepared for a global influenza pandemic. With only 5% of influenza vaccine doses being distributed to 50% of the world's population, there is urgency to redress the gross inequities in disease prevention and in pandemic preparedness. The 2003WHA resolution must be reviewed and revised and a call issued for the renewed commitment of Member States to influenza vaccination coverage targets. Copyright © 2017. Published by Elsevier Ltd.

NSW annual immunisation coverage report, 2011.

PubMed

Hull, Brynley; Dey, Aditi; Campbell-Lloyd, Sue; Menzies, Robert I; McIntyre, Peter B

2012-12-01

This annual report, the third in the series, documents trends in immunisation coverage in NSW for children, adolescents and the elderly, to the end of 2011. Data from the Australian Childhood Immunisation Register, the NSW School Immunisation Program and the NSW Population Health Survey were used to calculate various measures of population coverage. During 2011, greater than 90% coverage was maintained for children at 12 and 24 months of age. For children at 5 years of age the improvement seen in 2010 was sustained, with coverage at or near 90%. For adolescents, there was improved coverage for all doses of human papillomavirus vaccine, both doses of hepatitis B vaccine, varicella vaccine and the dose of diphtheria, tetanus and acellular pertussis given to school attendees in Years 7 and 10. Pneumococcal vaccination coverage in the elderly has been steadily rising, although it has remained lower than the influenza coverage estimates. This report provides trends in immunisation coverage in NSW across the age spectrum. The inclusion of coverage estimates for the pneumococcal conjugate, varicella and meningococcal C vaccines in the official coverage assessments for 'fully immunised' in 2013 is a welcome initiative.

Yellow fever vaccination coverage following massive emergency immunization campaigns in rural Uganda, May 2011: a community cluster survey.

PubMed

Bagonza, James; Rutebemberwa, Elizeus; Mugaga, Malimbo; Tumuhamye, Nathan; Makumbi, Issa

2013-03-07

Following an outbreak of yellow fever in northern Uganda in December 2010, Ministry of Health conducted a massive emergency vaccination campaign in January 2011. The reported vaccination coverage in Pader District was 75.9%. Administrative coverage though timely, is affected by incorrect population estimates and over or under reporting of vaccination doses administered. This paper presents the validated yellow fever vaccination coverage following massive emergency immunization campaigns in Pader district. A cross sectional cluster survey was carried out in May 2011 among communities in Pader district and 680 respondents were indentified using the modified World Health Organization (WHO) 40 × 17 cluster survey sampling methodology. Respondents were aged nine months and above. Interviewer administered questionnaires were used to collect data on demographic characteristics, vaccination status and reasons for none vaccination. Vaccination status was assessed using self reports and vaccination card evidence. Our main outcomes were measures of yellow fever vaccination coverage in each age-specific stratum, overall, and disaggregated by age and sex, adjusting for the clustered design and the size of the population in each stratum. Of the 680 survey respondents, 654 (96.1%, 95% CI 94.9 - 97.8) reported being vaccinated during the last campaign but only 353 (51.6%, 95% CI 47.2 - 56.1) had valid yellow fever vaccination cards. Of the 280 children below 5 years, 269 (96.1%, 95% CI 93.7 - 98.7) were vaccinated and nearly all males 299 (96.9%, 95% CI 94.3 - 99.5) were vaccinated. The main reasons for none vaccination were; having travelled out of Pader district during the campaign period (40.0%), lack of transport to immunization posts (28.0%) and, sickness at the time of vaccination (16.0%). Our results show that actual yellow fever vaccination coverage was high and satisfactory in Pader district since it was above the desired minimum threshold coverage of 80% according to World Health Organization. Massive emergency vaccination done following an outbreak of Yellow fever achieved high population coverage in Pader district. Active surveillance is necessary for early detection of yellow fever cases.

Human Papillomavirus Vaccine Coverage and Prevalence of Missed Opportunities for Vaccination in an Integrated Healthcare System.

PubMed

Irving, Stephanie A; Groom, Holly C; Stokley, Shannon; McNeil, Michael M; Gee, Julianne; Smith, Ning; Naleway, Allison L

2018-03-01

Human papillomavirus (HPV) vaccination has been recommended in the United States for female and male adolescents since 2006 and 2011, respectively. Coverage rates are lower than those for other adolescent vaccines. The objective of this study was to evaluate an assessment and feedback intervention designed to increase HPV vaccination coverage and quantify missed opportunities for HPV vaccine initiation at preventive care visits. We examined changes in HPV vaccination coverage and missed opportunities within the adolescent (11-17 years) population at 9 Oregon-based Kaiser Permanente Northwest outpatient clinics after an assessment and feedback intervention. Quarterly coverage rates were calculated for the adolescent populations at the clinics, according to age group (11-12 and 13-17 years), sex, and department (Pediatrics and Family Medicine). Comparison coverage assessments were calculated at 3 nonintervention (control) clinics. Missed opportunities for HPV vaccine initiation, defined as preventive care visits in which a patient eligible for HPV dose 1 remained unvaccinated, were examined according to sex and age group. An average of 29,021 adolescents were included in coverage assessments. Before the intervention, 1-dose and 3-dose quarterly coverage rates were increasing at intervention as well as at control clinics in both age groups. Postimplementation quarterly trends in 1-dose or 3-dose coverage did not differ significantly between intervention and control clinics for either age group. One-dose coverage rates among adolescents with Pediatrics providers were significantly higher than those with Family Medicine providers (56% vs 41% for 11- to 12-year-old and 82% vs 69% for 13- to 17-year-old girls; 55% vs 40% for 11- to 12-year-old and 78% vs 62% for 13- to 17-year-old boys). No significant differences in HPV vaccine coverage were identified at intervention clinics. However, coverage rates were increasing before the start of the intervention and might have been influenced by ongoing health system best practices. HPV vaccine coverage rates varied significantly according to department, which could allow for targeted improvement opportunities. Copyright © 2017 Academic Pediatric Association. All rights reserved.

Increase in EPI vaccines coverage after implementation of intermittent preventive treatment of malaria in infant with Sulfadoxine -pyrimethamine in the district of Kolokani, Mali: Results from a cluster randomized control trial

PubMed Central

2011-01-01

Background Even though the efficacy of Intermittent Preventive Treatment in infants (IPTi) with Sulfadoxine-Pyrimethamine (SP) against clinical disease and the absence of its interaction with routine vaccines of the Expanded Immunization Programme (EPI) have been established, there are still some concerns regarding the addition of IPTi, which may increase the work burden and disrupt the routine EPI services especially in Africa where the target immunization coverage remains to be met. However IPTi may also increase the adherence of the community to EPI services and improve EPI coverage, once the benefice of strategy is perceived. Methods To assess the impact of IPTi implementation on the coverage of EPI vaccines, 22 health areas of the district of Kolokani were randomized at a 1:1 ratio to either receive IPTi-SP or to serve as a control. The EPI vaccines coverage was assessed using cross-sectional surveys at baseline in November 2006 and after one year of IPTi pilot-implementation in December 2007. Results At baseline, the proportion of children of 9-23 months who were completely vaccinated (defined as children who received BGG, 3 doses of DTP/Polio, measles and yellow fever vaccines) was 36.7% (95% CI 25.3% -48.0%). After one year of implementation of IPTi-SP using routine health services, the proportion of children completely vaccinated rose to 53.8% in the non intervention zone and 69.5% in the IPTi intervention zone (P <0.001). The proportion of children in the target age groups who received IPTi with each of the 3 vaccinations DTP2, DTP3 and Measles, were 89.2% (95% CI 85.9%-92.0%), 91.0% (95% CI 87.6% -93.7%) and 77.4% (95% CI 70.7%-83.2%) respectively. The corresponding figures in non intervention zone were 2.3% (95% CI 0.9% -4.7%), 2.6% (95% CI 1.0% -5.6%) and 1.7% (95% CI 0.4% - 4.9%). Conclusion This study shows that high coverage of the IPTi can be obtained when the strategy is implemented using routine health services and implementation results in a significant increase in coverage of EPI vaccines in the district of Kolokani, Mali. Trial Registration ClinicalTrials.gov NCT00766662 PMID:21767403

Estimation after classification using lot quality assurance sampling: corrections for curtailed sampling with application to evaluating polio vaccination campaigns.

PubMed

Olives, Casey; Valadez, Joseph J; Pagano, Marcello

2014-03-01

To assess the bias incurred when curtailment of Lot Quality Assurance Sampling (LQAS) is ignored, to present unbiased estimators, to consider the impact of cluster sampling by simulation and to apply our method to published polio immunization data from Nigeria. We present estimators of coverage when using two kinds of curtailed LQAS strategies: semicurtailed and curtailed. We study the proposed estimators with independent and clustered data using three field-tested LQAS designs for assessing polio vaccination coverage, with samples of size 60 and decision rules of 9, 21 and 33, and compare them to biased maximum likelihood estimators. Lastly, we present estimates of polio vaccination coverage from previously published data in 20 local government authorities (LGAs) from five Nigerian states. Simulations illustrate substantial bias if one ignores the curtailed sampling design. Proposed estimators show no bias. Clustering does not affect the bias of these estimators. Across simulations, standard errors show signs of inflation as clustering increases. Neither sampling strategy nor LQAS design influences estimates of polio vaccination coverage in 20 Nigerian LGAs. When coverage is low, semicurtailed LQAS strategies considerably reduces the sample size required to make a decision. Curtailed LQAS designs further reduce the sample size when coverage is high. Results presented dispel the misconception that curtailed LQAS data are unsuitable for estimation. These findings augment the utility of LQAS as a tool for monitoring vaccination efforts by demonstrating that unbiased estimation using curtailed designs is not only possible but these designs also reduce the sample size. © 2014 John Wiley & Sons Ltd.

Sociodemographic predictors of variation in coverage of the national shingles vaccination programme in England, 2014/15.

PubMed

Ward, Charlotte; Byrne, Lisa; White, Joanne M; Amirthalingam, Gayatri; Tiley, Karen; Edelstein, Michael

2017-04-25

In September 2013, England introduced a shingles vaccination programme to reduce incidence and severity of shingles in the elderly. This study aims to assess variation in vaccine coverage with regards to selected sociodemographic factors to inform activities for improving equity of the programme. Eligible 70year-olds were identified from a national vaccine coverage dataset in 2014/15 that includes 95% of GPs in England. NHS England Local Team (LT) and index of multiple deprivation (IMD) scores were assigned to patients based on GP-postcode. Vaccine coverage (%) with 95% confidence intervals (CIs), were calculated overall and by LT, ethnicity and IMD, using binomial regression. Of 502,058 eligible adults, 178,808 (35.6%) had ethnicity recorded. Crude vaccine coverage was 59.5% (95%CI: 59.3-59.7). Coverage was lowest in London (49.6% coverage, 95%CI: 49.0-50.2), and compared to this coverage was significantly higher in all other LTs (+6.3 to +10.4, p<0.001) after adjusting for ethnicity and IMD. Coverage decreased with increasing deprivation and was 8.2% lower in the most deprived (95%CI: 7.3-9.1) compared with the least deprived IMD quintile (64.1% coverage, 95%CI: 63.6-64.6), after adjustment for ethnicity and LT. Compared with White-British (60.7% coverage, 95%CI: 60.5-61.0), other ethnic groups had between 4.0% (Indian) and 21.8% (Mixed: White and Black African) lower coverage. After adjusting for IMD and LT, significantly lower coverage by ethnicity persisted in all groups, except in Mixed: Other, Indian and Bangladeshi compared with White-British. After taking geography and deprivation into account, shingles vaccine coverage varied by ethnicity. White-British, Indian and Bangladeshi groups had highest coverage; Mixed: White and Black African, and Black-other ethnicities had the lowest. Patients' ethnicity and IMD are predictors of coverage which contribute to, but do not wholly account for, geographical variation coverage. Interventions to address service-related, sociodemographic and ethnic inequalities in shingles vaccine coverage are required. Copyright © 2017 Elsevier Ltd. All rights reserved.

Factors predictive of increased influenza and pneumococcal vaccination coverage in long-term care facilities: the CMS-CDC standing orders program Project.

PubMed

Bardenheier, Barbara H; Shefer, Abigail; McKibben, Linda; Roberts, Henry; Rhew, David; Bratzler, Dale

2005-01-01

Between 1999 and 2002, a multistate demonstration project was conducted in long-term care facilities (LTCFs) to encourage implementation of standing orders programs (SOP) as evidence-based vaccine delivery strategies to increase influenza and pneumococcal vaccination coverage in LTCFs. Examine predictors of increase in influenza and pneumococcal vaccination coverage in LTCFs. Intervention study. Self-administered surveys of LTCFs merged with data from OSCAR (On-line Survey Certification and Reporting System) and immunization coverage was abstracted from residents' medical charts in LTCFs. Twenty LTCFs were sampled from 9 intervention and 5 control states in the 2000 to 2001 influenza season for baseline and during the 2001 to 2002 influenza season for postintervention. Each state's quality improvement organization (QIO) promoted the use of standing orders for immunizations as well as other strategies to increase immunization coverage among LTCF residents. Multivariate analysis included Poisson regression to determine independent predictors of at least a 10 percentage-point increase in facility influenza and pneumococcal vaccination coverage. Forty-two (20%) and 59 (28%) of the facilities had at least a 10 percentage-point increase in influenza and pneumococcal immunizations, respectively. In the multivariate analysis, predictors associated with increase in influenza vaccination coverage included adoption of requirement in written immunization protocol to document refusals, less-demanding consent requirements, lower baseline influenza coverage, and small facility size. Factors associated with increase in pneumococcal vaccination coverage included adoption of recording pneumococcal immunizations in a consistent place, affiliation with a multifacility chain, and provision of resource materials. To improve the health of LTCF residents, strategies should be considered that increase immunization coverage, including written protocol for immunizations and documentation of refusals, documenting vaccination status in a consistent place in medical records, and minimal consent requirements for vaccinations.

Correlation between measles vaccine doses: implications for the maintenance of elimination.

PubMed

McKee, A; Ferrari, M J; Shea, K

2018-03-01

Measles eradication efforts have been successful at achieving elimination in many countries worldwide. Such countries actively work to maintain this elimination by continuing to improve coverage of two routine doses of measles vaccine following measles elimination. While improving measles vaccine coverage is always beneficial, we show, using a steady-state analysis of a dynamical model, that the correlation between populations receiving the first and second routine dose also has a significant impact on the population immunity achieved by a specified combination of first and second dose coverage. If the second dose is administered to people independently of whether they had the first dose, high second-dose coverage improves the proportion of the population receiving at least one dose, and will have a large effect on population immunity. If the second dose is administered only to people who have had the first dose, high second-dose coverage reduces the rate of primary vaccine failure, but does not reach people who missed the first dose; this will therefore have a relatively small effect on population immunity. When doses are administered dependently, and assuming the first dose has higher coverage, increasing the coverage of the first dose has a larger impact on population immunity than does increasing the coverage of the second. Correlation between vaccine doses has a significant impact on the level of population immunity maintained by current vaccination coverage, potentially outweighing the effects of age structure and, in some cases, recent improvements in vaccine coverage. It is therefore important to understand the correlation between vaccine doses as such correlation may have a large impact on the effectiveness of measles vaccination strategies.

An assessment of mumps vaccine effectiveness by dose during an outbreak in Canada.

PubMed

Deeks, Shelley L; Lim, Gillian H; Simpson, Mary Anne; Gagné, Louise; Gubbay, Jonathan; Kristjanson, Erik; Fung, Cecilia; Crowcroft, Natasha S

2011-06-14

This investigation was done to assess vaccine effectiveness of one and two doses of the measles, mumps and rubella (MMR) vaccine during an outbreak of mumps in Ontario. The level of coverage required to reach herd immunity and interrupt community transmission of mumps was also estimated. Information on confirmed cases of mumps was retrieved from Ontario's integrated Public Health Information System. Cases that occurred between Sept. 1, 2009, and June 10, 2010, were included. Selected health units supplied coverage data from the Ontario Immunization Record Information System. Vaccine effectiveness by dose was calculated using the screening method. The basic reproductive number (R(0)) represents the average number of new infections per case in a fully susceptible population, and R(0) values of between 4 and 10 were considered for varying levels of vaccine effectiveness. A total of 134 confirmed cases of mumps were identified. Information on receipt of MMR vaccine was available for 114 (85.1%) cases, of whom 63 (55.3%) reported having received only one dose of vaccine; 32 (28.1%) reported having received two doses. Vaccine effectiveness of one dose of the MMR vaccine ranged from 49.2% to 81.6%, whereas vaccine effectiveness of two doses ranged from 66.3% to 88.0%. If we assume vaccine effectiveness of 85% for two doses of the vaccine, vaccine coverage of 88.2% and 98.0% would be needed to interrupt community transmission of mumps if the corresponding reproductive values were four and six. Our estimates of vaccine effectiveness of one and two doses of mumps-containing vaccine were consistent with the estimates that have been reported in other outbreaks. Outbreaks occurring in Ontario and elsewhere serve as a warning against complacency over vaccination programs.

Effect of the conditional cash transfer program Oportunidades on vaccination coverage in older Mexican people

PubMed Central

2013-01-01

Background Immunization is one of the most effective ways of preventing illness, disability and death from infectious diseases for older people. However, worldwide immunization rates are still low, particularly for the most vulnerable groups within the elderly population. The objective of this study was to estimate the effect of the Oportunidades -an incentive-based poverty alleviation program- on vaccination coverage for poor and rural older people in Mexico. Methods Cross-sectional study, based on 2007 Oportunidades Evaluation Survey, conducted in low-income households from 741 rural communities (localities with <2,500 inhabitants) of 13 Mexican states. Vaccination coverage was defined according to three individual vaccines: tetanus, influenza and pneumococcal, and for complete vaccination schedule. Propensity score matching and linear probability model were used in order to estimate the Oportunidades effect. Results 12,146 older people were interviewed, and 7% presented cognitive impairment. Among remaining, 4,628 were matched. Low coverage rates were observed for the vaccines analyzed. For Oportunidades and non-Oportunidades populations were 46% and 41% for influenza, 52% and 45% for pneumococcal disease, and 79% and 71% for tetanus, respectively. Oportunidades effect was significant in increasing the proportion of older people vaccinated: for complete schedule 5.5% (CI95% 2.8-8.3), for influenza 6.9% (CI95% 3.8-9.6), for pneumococcal 7.2% (CI95% 4.3-10.2), and for tetanus 6.6% (CI95% 4.1-9.2). Conclusions The results of this study extend the evidence on the effect that conditional transfer programs exert on health indicators. In particular, Oportunidades increased vaccination rates in the population of older people. There is a need to continue raising vaccination rates, however, particularly for the most vulnerable older people. PMID:23835202

Hepatitis A vaccination coverage among adults 18–49 years traveling to a country of high or intermediate endemicity, United States

PubMed Central

Lu, Peng-jun; Byrd, Kathy K.; Murphy, Trudy V.

2018-01-01

Background Since 1996, hepatitis A vaccine (HepA) has been recommended for adults at increased risk for infection including travelers to high or intermediate hepatitis A endemic countries. In 2009, travel outside the United States and Canada was the most common exposure nationally reported for persons with hepatitis A virus (HAV) infection. Objective To assess HepA vaccination coverage among adults 18–49 years traveling to a country of high or intermediate endemicity in the United States. Methods We analyzed data from the 2010 National Health Interview Survey (NHIS), to determine self-reported HepA vaccination coverage (≥1 dose) and series completion (≥2 dose) among persons 18–49 years who traveled, since 1995, to a country of high or intermediate HAV endemicity. Multivariable logistic regression and predictive marginal analyses were conducted to identify factors independently associated with HepA vaccine receipt. Results In 2010, approximately 36.6% of adults 18–49 years reported traveling to high or intermediate hepatitis A endemic countries; among this group unadjusted HepA vaccination coverage was 26.6% compared to 12.7% among non-travelers (P-values < 0.001) and series completion were 16.9% and 7.6%, respectively (P-values < 0.001). On multivariable analysis among all respondents, travel status was an independent predictor of HepA coverage and series completion (both P-values < 0.001). Among travelers, HepA coverage and series completion (≥2 doses) were higher for travelers 18–25 years (prevalence ratios 2.3, 2.8, respectively, P-values < 0.001) and for travelers 26–39 years (prevalence ratios 1.5, 1.5, respectively, P-value < 0.001, P-value = 0.002, respectively) compared to travelers 40–49 years. Other characteristics independently associated with a higher likelihood of HepA receipt among travelers included Asian race/ethnicity, male sex, never having been married, having a high school or higher education, living in the western United States, having greater number of physician contacts or receipt of influenza vaccination in the previous year. HepB vaccination was excluded from the model because of the significant correlation between receipt of HepA vaccination and HepB vaccination could distort the model. Conclusions Although travel to a country of high or intermediate hepatitis A endemicity was associated with higher likelihood of HepA vaccination in 2010 among adults 18–49 years, self-reported HepA vaccination coverage was low among adult travelers to these areas. Healthcare providers should ask their patients’ upcoming travel plans and recommend and offer travel related vaccinations to their patients. PMID:23523408

Implementation of a human papillomavirus vaccination demonstration project in Malawi: successes and challenges.

PubMed

Msyamboza, Kelias Phiri; Mwagomba, Beatrice Matanje; Valle, Moussa; Chiumia, Hastings; Phiri, Twambilire

2017-06-26

Cervical cancer is a major public health problem in Malawi. The age-standardized incidence and mortality rates are estimated to be 75.9 and 49.8 per 100,000 population, respectively. The availability of the human papillomavirus (HPV) vaccine presents an opportunity to reduce the morbidity and mortality associated with cervical cancer. In 2013, the country introduced a school-class-based HPV vaccination pilot project in two districts. The aim of this study was to evaluate HPV vaccine coverage, lessons learnt and challenges identified during the first three years of implementation. This was an evaluation of the HPV vaccination project targeting adolescent girls aged 9-13 years conducted in Malawi from 2013 to 2016. We analysed programme data, supportive supervision reports and minutes of National HPV Task Force meetings to determine HPV vaccine coverage, reasons for partial or no vaccination and challenges. Administrative coverage was validated using a community-based coverage survey. A total of 26,766 in-school adolescent girls were fully vaccinated in the two pilot districts during the first three years of the programme. Of these; 2051 (7.7%) were under the age of 9 years, 884 (3.3%) were over the age of 13 years, and 23,831 (89.0%) were aged 9-13 years (the recommended age group). Of the 765 out-of-school adolescent girls aged 9-13 who were identified during the period, only 403 (52.7%) were fully vaccinated. In Zomba district, the coverage rates of fully vaccinated were 84.7%, 87.6% and 83.3% in year 1, year 2 and year 3 of the project, respectively. The overall coverage for the first three years was 82.7%, and the dropout rate was 7.7%. In Rumphi district, the rates of fully vaccinated coverage were 90.2% and 96.2% in year 1 and year 2, respectively, while the overall coverage was 91.3%, and the dropout rate was 4.9%. Administrative (facility-based) coverage for the first year was validated using a community-based cluster coverage survey. The majority of the coverage results were statistically similar, except for in Rumphi district, where community-based 3-dose coverage was higher than the corresponding administrative-coverage (94.2% vs 90.2%, p < 0.05), and overall (in both districts), facility-based 1-dose coverage was higher than the corresponding community-based (94.6% vs 92.6%, p < 0.05). Transferring out of the district, dropping out of school and refusal were some of the reasons for partial or no uptake of the vaccine. In Malawi, the implementation of a school-class-based HPV vaccination strategy was feasible and produced high (>80%) coverage. However, this strategy may be associated with the vaccination of under- and over-aged adolescent girls who are outside of the vaccine manufacturer's stipulated age group (9-13 years). The health facility-based coverage for out-of-school adolescent girls produced low coverage, with only half of the target population being fully vaccinated. These findings highlight the need to assess the immunogenicity associated with the administration of a two-dose schedule to adolescent girls younger or older than 9-13 years and effectiveness of health facility-based strategy before rolling out the programme.

Vaccination coverage in systemic lupus erythematosus-a cross-sectional analysis of the German long-term study (LuLa cohort).

PubMed

Chehab, Gamal; Richter, Jutta G; Brinks, Ralph; Fischer-Betz, Rebecca; Winkler-Rohlfing, Borgi; Schneider, Matthias

2018-05-10

Vaccinations are an important measure to prevent infections in immunocompromised patients. The knowledge of vaccination coverage and reasons for non-vaccination in patients with SLE is scarce. The aim of this study was to assess coverage rates of selected vaccinations in a representative sample of SLE patients and to identify predictors for non-vaccination. In 2013, information on selected vaccinations (coverage, application and reservations) and on demographics, clinical parameters and health beliefs was assessed by means of a self-reported questionnaire among a representative sample of SLE patients in Germany (LuLa cohort). Five hundred and seventy-nine patients participated. Vaccination status was primarily checked by their general practitioner (57.3%). Of all the patients, 24.9% did not get their vaccination status checked at all, 16.1% had generally been advised against the use of vaccinations by a physician, and 37.5% stated that they had rejected vaccinations themselves. Their main reasons were fears of developing a lupus flare (21.8%) or adverse events (13.5%). A greater belief by patients in the doctor controlling one's health and the general benefit of medication prevented the rejection of vaccines. Vaccination coverage was low for all recorded vaccinations (tetanus 65.8%, influenza 45.2%, pneumococcus 32.2% and meningococcus 6.1%). Older age was predictive of receiving influenza and pneumococcal vaccination. The same applies for CSs >7.5 mg for receiving influenza vaccination. Vaccination coverage in SLE patients is poor and reflects insufficient implementation of national and international recommendations. Rheumatologists need to recognize patients' reservations against vaccinations, to communicate their importance and safety and to give individual recommendations to patients and their health-care providers. German Clinical Trials Register, www.germanctr.de, DRKS00011052.

Validity of vaccination cards and parental recall to estimate vaccination coverage: a systematic review of the literature.

PubMed

Miles, Melody; Ryman, Tove K; Dietz, Vance; Zell, Elizabeth; Luman, Elizabeth T

2013-03-15

Immunization programs frequently rely on household vaccination cards, parental recall, or both to calculate vaccination coverage. This information is used at both the global and national level for planning and allocating performance-based funds. However, the validity of household-derived coverage sources has not yet been widely assessed or discussed. To advance knowledge on the validity of different sources of immunization coverage, we undertook a global review of literature. We assessed concordance, sensitivity, specificity, positive and negative predictive value, and coverage percentage point difference when subtracting household vaccination source from a medical provider source. Median coverage difference per paper ranged from -61 to +1 percentage points between card versus provider sources and -58 to +45 percentage points between recall versus provider source. When card and recall sources were combined, median coverage difference ranged from -40 to +56 percentage points. Overall, concordance, sensitivity, specificity, positive and negative predictive value showed poor agreement, providing evidence that household vaccination information may not be reliable, and should be interpreted with care. While only 5 papers (11%) included in this review were from low-middle income countries, low-middle income countries often rely more heavily on household vaccination information for decision making. Recommended actions include strengthening quality of child-level data and increasing investments to improve vaccination card availability and card marking. There is also an urgent need for additional validation studies of vaccine coverage in low and middle income countries. Copyright © 2013. Published by Elsevier Ltd.

Childhood Vaccine Acceptance and Refusal among Warao Amerindian Caregivers in Venezuela; A Qualitative Approach

PubMed Central

Burghouts, Jochem; Del Nogal, Berenice; Uriepero, Angimar; Hermans, Peter W. M.; de Waard, Jacobus H.; Verhagen, Lilly M.

2017-01-01

Objectives Acceptance of childhood vaccination varies between societies, affecting worldwide vaccination coverage. Low coverage rates are common in indigenous populations where parents often choose not to vaccinate their children. We aimed to gain insight into reasons for vaccine acceptance or rejection among Warao Amerindians in Venezuela. Methods Based on records of vaccine acceptance or refusal, in-depth interviews with 20 vaccine-accepting and 11 vaccine-declining caregivers were performed. Parents’ attitudes were explored using a qualitative approach. Results Although Warao caregivers were generally in favor of vaccination, fear of side effects and the idea that young and sick children are too vulnerable to be vaccinated negatively affected vaccine acceptance. The importance assigned to side effects was related to the perception that these resembled symptoms/diseases of another origin and could thus harm the child. Religious beliefs or traditional healers did not influence the decision-making process. Conclusions Parental vaccine acceptance requires educational programs on the preventive nature of vaccines in relation to local beliefs about health and disease. Attention needs to be directed at population-specific concerns, including explanation on the nature of and therapeutic options for side effects. PMID:28107501

A mixed methods approach to assess animal vaccination programmes: The case of rabies control in Bamako, Mali.

PubMed

Mosimann, Laura; Traoré, Abdallah; Mauti, Stephanie; Léchenne, Monique; Obrist, Brigit; Véron, René; Hattendorf, Jan; Zinsstag, Jakob

2017-01-01

In the framework of the research network on integrated control of zoonoses in Africa (ICONZ) a dog rabies mass vaccination campaign was carried out in two communes of Bamako (Mali) in September 2014. A mixed method approach, combining quantitative and qualitative tools, was developed to evaluate the effectiveness of the intervention towards optimization for future scale-up. Actions to control rabies occur on one level in households when individuals take the decision to vaccinate their dogs. However, control also depends on provision of vaccination services and community participation at the intermediate level of social resilience. Mixed methods seem necessary as the problem-driven transdisciplinary project includes epidemiological components in addition to social dynamics and cultural, political and institutional issues. Adapting earlier effectiveness models for health intervention to rabies control, we propose a mixed method assessment of individual effectiveness parameters like availability, affordability, accessibility, adequacy or acceptability. Triangulation of quantitative methods (household survey, empirical coverage estimation and spatial analysis) with qualitative findings (participant observation, focus group discussions) facilitate a better understanding of the weight of each effectiveness determinant, and the underlying reasons embedded in the local understandings, cultural practices, and social and political realities of the setting. Using this method, a final effectiveness of 33% for commune Five and 28% for commune Six was estimated, with vaccination coverage of 27% and 20%, respectively. Availability was identified as the most sensitive effectiveness parameter, attributed to lack of information about the campaign. We propose a mixed methods approach to optimize intervention design, using an "intervention effectiveness optimization cycle" with the aim of maximizing effectiveness. Empirical vaccination coverage estimation is compared to the effectiveness model with its determinants. In addition, qualitative data provide an explanatory framework for deeper insight, validation and interpretation of results which should improve the intervention design while involving all stakeholders and increasing community participation. This work contributes vital information for the optimization and scale-up of future vaccination campaigns in Bamako, Mali. The proposed mixed method, although incompletely applied in this case study, should be applicable to similar rabies interventions targeting elimination in other settings. Copyright © 2016 Elsevier B.V. All rights reserved.

Immunisation coverage, 2012.

PubMed

Hull, Brynley P; Dey, Aditi; Menzies, Rob I; Brotherton, Julia M; McIntyre, Peter B

2014-09-30

This, the 6th annual immunisation coverage report, documents trends during 2012 for a range of standard measures derived from Australian Childhood Immunisation Register (ACIR) data, and National Human Papillomavirus (HPV) Vaccination Program Register data. These include coverage at standard age milestones and for individual vaccines included on the National Immunisation Program (NIP) and coverage in adolescents and adults. The proportion of Australian children 'fully vaccinated' at 12, 24 and 60 months of age was 91.7%, 92.5% and 91.2%, respectively. For vaccines available on the NIP but not assessed during 2012 for 'fully vaccinated' status or for eligibility for incentive payments (rotavirus and pneumococcal at 12 months and meningococcal C and varicella at 24 months) coverage varied. Although pneumococcal vaccine had similar coverage at 12 months to other vaccines, coverage was lower for rotavirus at 12 months (83.6%) and varicella at 24 months (84.4%). Although 'fully vaccinated' coverage at 12 months of age was lower among Indigenous children than non-Indigenous children in all jurisdictions, the extent of the difference varied, reaching a 15 percentage point differential in South Australia but only a 0.4 percentage point differential in the Northern Territory. Overall, Indigenous coverage at 24 months of age exceeded that at 12 months of age nationally and for all jurisdictions, but as receipt of varicella vaccine at 18 months is excluded from calculations, this represents delayed immunisation, with some contribution from immunisation incentives. The 'fully vaccinated' coverage estimates for vaccinations due by 60 months of age for Indigenous children exceeded 90% at 91% in 2012. Unlike in 2011, at 60 months of age, there was no dramatic variation in coverage between Indigenous and non-Indigenous children for individual jurisdictions. As previously documented, vaccines recommended for Indigenous children only, hepatitis A and pneumococcal vaccine, had suboptimal coverage at 60.1% and 73.1%, respectively, although there was a considerable improvement in coverage from 2011, 57.7% and 68.2% respectively. On-time receipt (before 49 months of age) of vaccines by Indigenous children at the 60-month milestone age improved substantially between 2011 (19%) and 2012 (38%) but the disparity in on-time vaccination between Indigenous and non-Indigenous children worsened at the 60-month age milestone from 2011 (from 1.8 to 5.4 percentage points) and remained the same for the 12 and 24-month age milestones. By late 2012, the percentage of children who received the 1st dose of DTPa vaccine dose at less than 8 weeks of age was greater than 50% in all but 1 jurisdiction and greater than 70% for New South Wales, the Australian Capital Territory and Tasmania. Further, by late 2012, the percentage of children who received the 4th dose of DTPa vaccine dose at less than 4 years of age was greater than 30% in 3 jurisdictions. The percentage of children whose parents officially objected to vaccination in Australia was 1.7% and this figure varied by jurisdiction. However, there is a further 2.1% of children whose parents don't officially object but whose children have no vaccines recorded on the ACIR. Coverage data for the 3rd dose of HPV from the national HPV register in the school catch up program was similar to 2011 at 71% but was substantially lower for the catch up program for females outside school (44%-69%), although this was an improvement from 2011.

Using Dynamic Transmission Modeling to Determine Vaccination Coverage Rate Based on 5-Year Economic Burden of Infectious Disease: An Example of Pneumococcal Vaccine.

PubMed

Wen, Yu-Wen; Wu, Hsin; Chang, Chee-Jen

2015-05-01

Vaccination can reduce the incidence and mortality of an infectious disease and thus increase the years of life and productivity for the entire society. But when determining the vaccination coverage rate, its economic burden is usually not taken into account. This article aimed to use a dynamic transmission modeling (DTM), which is based on a susceptible-infectious-recovered model and is a system of differential equations, to find the optimal vaccination coverage rate based on the economic burden of an infectious disease. Vaccination for pneumococcal diseases was used as an example to demonstrate the main purpose. 23-Valent pneumococcal polysaccharide vaccines (PPV23) and 13-valent pneumococcal conjugate vaccines (PCV13) have shown their cost-effectiveness in elderly and children, respectively. Scenarios analysis of PPV23 to elderly aged 65+ years and of PCV13 to children aged 0 to 4 years was applied to assess the optimal vaccination coverage rate based on the 5-year economic burden. Model parameters were derived from Taiwan's National Health Insurance Research Database, government data, and published literature. Various vaccination coverage rates, the vaccine efficacy, and all epidemiologic parameters were substituted into DTM, and all differential equations were solved in R Statistical Software. If the coverage rate of PPV23 for the elderly and of PCV13 for the children both reach 50%, the economic burden due to pneumococcal disease will be acceptable. This article provided an alternative perspective from the economic burden of diseases to obtain a vaccination coverage rate using the DTM. This will provide valuable information for vaccination policy decision makers. Copyright © 2015 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Influenza vaccination coverage rates among adults before and after the 2009 influenza pandemic and the reasons for non-vaccination in Beijing, China: a cross-sectional study.

PubMed

Wu, Shuangsheng; Yang, Peng; Li, Haiyue; Ma, Chunna; Zhang, Yi; Wang, Quanyi

2013-07-08

To optimize the vaccination coverage rates in the general population, the status of coverage rates and the reasons for non-vaccination need to be understood. Therefore, the objective of this study was to assess the changes in influenza vaccination coverage rates in the general population before and after the 2009 influenza pandemic (2008/2009, 2009/2010, and 2010/2011 seasons), and to determine the reasons for non-vaccination. In January 2011 we conducted a multi-stage sampling, retrospective, cross-sectional survey of individuals in Beijing who were ≥ 18 years of age using self-administered, anonymous questionnaires. The questionnaire consisted of three sections: demographics (gender, age, educational level, and residential district name); history of influenza vaccination in the 2008/2009, 2009/2010, and 2010/2011 seasons; and reasons for non-vaccination in all three seasons. The main outcome was the vaccination coverage rate and vaccination frequency. Differences among the subgroups were tested using a Pearson's chi-square test. Multivariate logistic regression was used to determine possible determinants of influenza vaccination uptake. A total of 13002 respondents completed the questionnaires. The vaccination coverage rates were 16.9% in 2008/2009, 21.8% in 2009/2010, and 16.7% in 2010/2011. Compared to 2008/2009 and 2010/2011, the higher rate in 2009/2010 was statistically significant (χ2=138.96, p<0.001), and no significant difference existed between 2008/2009 and 2010/2011 (χ2=1.296, p=0.255). Overall, 9.4% of the respondents received vaccinations in all three seasons, whereas 70% of the respondents did not get a vaccination during the same period. Based on multivariate analysis, older age and higher level of education were independently associated with increased odds of reporting vaccination in 2009/2010 and 2010/2011. Among participants who reported no influenza vaccinations over the previous three seasons, the most commonly reported reason for non-vaccination was 'I don't think I am very likely to catch the flu' (49.3%). Within the general population of Beijing the vaccination coverage rates were relatively low and did not change significantly after the influenza pandemic. The perception of not expecting to contract influenza was the predominant barrier to influenza vaccination. Further measures are needed to improve influenza vaccination coverage.

Predictors of coverage of the national maternal pertussis and infant rotavirus vaccination programmes in England.

PubMed

Byrne, L; Ward, C; White, J M; Amirthalingam, G; Edelstein, M

2018-01-01

This study assessed variation in coverage of maternal pertussis vaccination, introduced in England in October 2012 in response to a national outbreak, and a new infant rotavirus vaccination programme, implemented in July 2013. Vaccine eligible patients were included from national vaccine coverage datasets and covered April 2014 to March 2015 for pertussis and January 2014 to June 2016 for rotavirus. Vaccine coverage (%) was calculated overall and by NHS England Local Team (LT), ethnicity and Index of Multiple Deprivation (IMD) quintile, and compared using binomial regression. Compared with white-British infants, the largest differences in rotavirus coverage were in 'other', white-Irish and black-Caribbean infants (-13·9%, -12·1% and -10·7%, respectively), after adjusting for IMD and LT. The largest differences in maternal pertussis coverage were in black-other and black-Caribbean women (-16·3% and -15·4%, respectively). Coverage was lowest in London LT for both programmes. Coverage decreased with increasing deprivation and was 14·0% lower in the most deprived quintile compared with the least deprived for the pertussis programme and 4·4% lower for rotavirus. Patients' ethnicity and deprivation were therefore predictors of coverage which contributed to, but did not wholly account for, geographical variation in coverage in England.

Human Papillomavirus Vaccine as an Anti-cancer Vaccine: Collaborative Efforts to Promote HPV Vaccine in the National Comprehensive Cancer Control Program

PubMed Central

Townsend, Julie S.; Steele, C. Brooke; Hayes, Nikki; Bhatt, Achal; Moore, Angela R.

2018-01-01

Background Widespread use of the HPV vaccine has the potential to reduce incidence from HPV-associated cancers. However, vaccine uptake among adolescents remains well below the Healthy People 2020 targets. The Centers for Disease Control and Prevention (CDC)’s National Comprehensive Cancer Control Program awardees (NCCCP) are well positioned to work with immunization programs to increase vaccine uptake. Methods CDC’s chronic disease management information system was queried for objectives and activities associated with HPV vaccine that were reported by NCCCP awardees from 2013 – 2016 as part of program reporting requirements. A content analysis was conducted on the query results to categorize interventions according to strategies outlined in The Guide to Community Preventive Services and the 2014 President’s Cancer Panel report. Results Sixty-two percent of NCCCP awardees had planned or implemented at least one activity since 2013 to address low HPV vaccination coverage in their jurisdictions. Most NCCCP awardees (86%) reported community education activities, while 65% reported activities associated with provider education. Systems-based strategies such as client reminders or provider assessment and feedback were each reported by less than 25% of NCCCP awardees. Conclusion Many NCCCP awardees report planning or implementing activities to address low HPV vaccination coverage, often in conjunction with state immunization programs. NCCCP awardees can play a role in increasing HPV vaccination coverage through their cancer prevention and control expertise and access to partners in the health care community. PMID:28263672

New Wisdom to Defy an Old Enemy: Summary from a scientific symposium at the 4th Influenza Vaccines for the World (IVW) 2012 Congress, 11 October, Valencia, Spain.

PubMed

Poland, Gregory A; Fleming, Douglas M; Treanor, John J; Maraskovsky, Eugene; Luke, Thomas C; Ball, Emma M A; Poland, Caroline M

2013-04-17

Both seasonal and pandemic influenza cause considerable morbidity and mortality globally. In addition, the ongoing threat of new, unpredictable influenza pandemics from emerging variant strains cannot be underestimated. Recently bioCSL (previously known as CSL Biotherapies) sponsored a symposium 'New Wisdom to Defy an Old Enemy' at the 4th Influenza Vaccines for the World Congress in Valencia, Spain. This symposium brought together a renowned faculty of experts to discuss lessons from past experience, novel influenza vaccine developments, and new methods to increase vaccine acceptance and coverage. Specific topics reviewed and discussed included new vaccine development efforts focused on improving efficacy via alternative administration routes, dose modifications, improved adjuvants, and the use of master donor viruses. Improved safety was also discussed, particularly the new finding of an excess of febrile reactions isolated to children who received the 2010 Southern Hemisphere (SH) trivalent inactivated influenza vaccine (TIV). Significant work has been done to both identify the cause and minimize the risk of febrile reactions in children. Other novel prophylactic and therapeutic advances were discussed including immunotherapy. Standard IVIg and hIVIg have been used in ferret studies and human case reports with promising results. New adjuvants, such as ISCOMATRIX™ adjuvant, were noted to provide single-dose, prolonged protection with seasonal vaccine after lethal H5N1 virus challenge in a ferret model of human influenza disease. The data suggest that adjuvanted seasonal influenza vaccines may provide broader protection than unadjuvanted vaccines. The use of an antigen-formulated vaccine to induce broad protection between pandemics that could bridge the gap between pandemic declaration and the production of a homologous vaccine was also discussed. Finally, despite the availability of effective vaccines, most current efforts to increase influenza vaccine coverage rates to higher levels (i.e., above 70-80%) have been ineffective in highly developed countries where the vaccine is used, hindered by the public's skepticism towards vaccines in general. New educational and social media methods to increase vaccine acceptance and coverage were discussed. While the first priority should be the development of improved influenza vaccines, a particular focus on the aging global population is critical. It is also important to draw lessons from other academic disciplines that can help to inform vaccine education programs, policy, and communication. By tailoring communications and patient education using an understanding of cognitive bias and the model of preferred cognitive styles, the likelihood of effecting desirable health decisions can be maximized, leading to improved vaccine coverage and control of influenza and other vaccine-preventable diseases. Copyright © 2013 Elsevier Ltd. All rights reserved.

Financial Issues and Adult Immunization: Medicare Coverage and the Affordable Care Act

PubMed Central

Hurley, Laura P.; Lindley, Megan C.; Allison, Mandy A.; Crane, Lori A.; Brtnikova, Michaela; Beaty, Brenda L.; Snow, Megan; Bridges, Carolyn B.; Kempe, Allison

2017-01-01

Background Financial barriers to adult vaccination are poorly understood. Our objectives were to assess among general internists (GIM) and family physicians (FP) shortly after Affordable Care Act (ACA) implementation: 1) proportion of adult patients deferring or refusing vaccines because of cost and frequency of physicians not recommending vaccines for financial reasons; 2) satisfaction with reimbursement for vaccine purchase and administration by payer type; 3) knowledge of Medicare coverage of vaccines; and 4) awareness of vaccine-specific provisions of the ACA. Methods We administered an Internet and mail survey from June to October 2013 to national networks of 438 GIMs and 401 FPs. Results Response rates were 72% (317/438) for GIM and 59% (236/401) for FP. Among physicians who routinely recommended vaccines, up to 24% of GIM and 30% of FP reported adult patients defer or refuse certain vaccines for financial reasons most of the time. Physicians reported not recommending vaccines because they thought the patient’s insurance would not cover it (35%) or the patient could be vaccinated more affordably elsewhere (38%). Among physicians who saw patients with this insurance, dissatisfaction (‘very dissatisfied’) was highest for payments received from Medicaid (16 % vaccine purchase, 14 % vaccine administration) and Medicare Part B (11 % vaccine purchase, 11 % vaccine administration). Depending on the vaccine, 36–71% reported not knowing how Medicare covered the vaccine. Thirty-seven percent were ‘not at all aware’ and 19% were ‘a little aware’ of vaccine-specific provisions of the ACA. Conclusions Patients are refusing and physicians are not recommending adult vaccinations for financial reasons. Increased knowledge of private and public insurance coverage for adult vaccinations might position physicians to be more likely to recommend vaccines and better enable them to refer patients to other vaccine providers when a particular vaccine or vaccines are not offered in the practice. PMID:28024954

Determinants of apparent rural-urban differentials in measles vaccination uptake in Indonesia.

PubMed

Fernandez, Renae C; Awofeso, Niyi; Rammohan, Anu

2011-01-01

Regional differences in vaccination uptake are common in both developed and developing countries, and are often linked to the availability of healthcare services and socioeconomic factors. In 2007, 0.9 million eligible Indonesian children missed measles vaccination, and 19 456 cases of measles were documented among Indonesian children. The authors investigated rural-urban differentials in measles vaccination coverage among young Indonesian children, and sought to identify key factors influencing the probability of a child receiving the first dose of measles vaccination in Indonesia. Data used in the analyses were sourced from the nationally representative Indonesia Demographic and Health Survey 2007. The influence of location of residence, household wealth, maternal and paternal education, total children ever born and use of skilled birth attendants on measles vaccination coverage was investigated using bivariate analysis and chi-square tests. The independent effects of these variables were established using binomial logistic regression analysis. Indonesia's 2007 first-dose measles national vaccination coverage was, at 72.8%, lower than the 2008 global first-dose measles vaccination average coverage of 82%. Bivariate analysis revealed that the first-dose measles vaccination coverage in rural areas of Indonesia was 68.5%, compared with 80.1% in urban regions (p < 0.001). The apparent significance of rural residence in impairing vaccination coverage was marginal after controlling for the sex of the child, maternal age, maternal and paternal education, wealth, and access to skilled health workers. Apart from sustainable initiatives to increase measles vaccination coverage globally, it is important to close the rural-urban gap in Indonesia's measles vaccination uptake. Addressing critical determinants of inferior measles vaccination coverage in Indonesia's rural regions will facilitate major improvements in Indonesia's child health trends. This article suggests initiatives for addressing three of such determinants in Indonesia's rural areas: poverty, parental education and access to skilled health workers.

Influenza Vaccination Coverage Rate according to the Pulmonary Function of Korean Adults Aged 40 Years and Over: Analysis of the Fifth Korean National Health and Nutrition Examination Survey

PubMed Central

2016-01-01

Influenza vaccination is an effective strategy to reduce morbidity and mortality, particularly for those who have decreased lung functions. This study was to identify the factors that affect vaccination coverage according to the results of pulmonary function tests depending on the age. In this cross-sectional study, data were obtained from 3,224 adults over the age of 40 who participated in the fifth National Health and Nutrition Examination Survey and underwent pulmonary function testing in 2012. To identify the factors that affect vaccination rate, logistic regression analysis was conducted after dividing the subjects into two groups based on the age of 65. Influenza vaccination coverage of the entire subjects was 45.2%, and 76.8% for those aged 65 and over. The group with abnormal pulmonary function had a higher vaccination rate than the normal group, but any pulmonary dysfunction or history of COPD did not affect the vaccination coverage in the multivariate analysis. The subjects who were 40-64 years-old had higher vaccination coverage when they were less educated or with restricted activity level, received health screenings, and had chronic diseases. Those aged 65 and over had significantly higher vaccination coverage only when they received regular health screenings. Any pulmonary dysfunction or having COPD showed no significant correlation with the vaccination coverage in the Korean adult population. PMID:27134491

Global yellow fever vaccination coverage from 1970 to 2016: an adjusted retrospective analysis.

PubMed

Shearer, Freya M; Moyes, Catherine L; Pigott, David M; Brady, Oliver J; Marinho, Fatima; Deshpande, Aniruddha; Longbottom, Joshua; Browne, Annie J; Kraemer, Moritz U G; O'Reilly, Kathleen M; Hombach, Joachim; Yactayo, Sergio; de Araújo, Valdelaine E M; da Nóbrega, Aglaêr A; Mosser, Jonathan F; Stanaway, Jeffrey D; Lim, Stephen S; Hay, Simon I; Golding, Nick; Reiner, Robert C

2017-11-01

Substantial outbreaks of yellow fever in Angola and Brazil in the past 2 years, combined with global shortages in vaccine stockpiles, highlight a pressing need to assess present control strategies. The aims of this study were to estimate global yellow fever vaccination coverage from 1970 through to 2016 at high spatial resolution and to calculate the number of individuals still requiring vaccination to reach population coverage thresholds for outbreak prevention. For this adjusted retrospective analysis, we compiled data from a range of sources (eg, WHO reports and health-service-provider registeries) reporting on yellow fever vaccination activities between May 1, 1939, and Oct 29, 2016. To account for uncertainty in how vaccine campaigns were targeted, we calculated three population coverage values to encompass alternative scenarios. We combined these data with demographic information and tracked vaccination coverage through time to estimate the proportion of the population who had ever received a yellow fever vaccine for each second level administrative division across countries at risk of yellow fever virus transmission from 1970 to 2016. Overall, substantial increases in vaccine coverage have occurred since 1970, but notable gaps still exist in contemporary coverage within yellow fever risk zones. We estimate that between 393·7 million and 472·9 million people still require vaccination in areas at risk of yellow fever virus transmission to achieve the 80% population coverage threshold recommended by WHO; this represents between 43% and 52% of the population within yellow fever risk zones, compared with between 66% and 76% of the population who would have required vaccination in 1970. Our results highlight important gaps in yellow fever vaccination coverage, can contribute to improved quantification of outbreak risk, and help to guide planning of future vaccination efforts and emergency stockpiling. The Rhodes Trust, Bill & Melinda Gates Foundation, the Wellcome Trust, the National Library of Medicine of the National Institutes of Health, the European Union's Horizon 2020 research and innovation programme. Copyright © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.

A brief review of vaccination coverage in immunization registries.

PubMed

Goldstein, Neal D; Maiese, Brett A

2011-01-01

Immunization registries are effective electronic tools for assessing vaccination coverage, but are only as good as the information reported to them. This review summarizes studies through August 2010 on vaccination coverage in registries and identifies key characteristics of successful registries. Based on the current state of registries, paper-based charts combined with electronic registry reporting provide the most cohesive picture of coverage. To ultimately supplant paper charts, registries must exhibit increased coverage and participation.

Impact of vaccination on the incidence of measles in Mozambique in the period 2000 to 2011.

PubMed

Muloliwa, Artur Manuel; Camacho, Luiz Antonio Bastos; Verani, José Fernando Souza; Simões, Taynãna César; Dgedge, Martinho do Carmo

2013-02-01

The aim of this study was to contribute to the better planning of measles elimination actions in Mozambique, by considering the impact of vaccination actions over the period 2000 to 2011. Descriptive and ecological studies and case records made available by the Ministry of Health were used to analyze measles vaccination coverage. Statistical analysis was performed using time series and spatial analysis. Vaccine coverage rates ranged from 82% to 99%. Coverage rates in Maputo city were under 70% and in Niassa province they were over 100%. Coverage showed a clustered pattern in the districts. The measles incidence rate was 1.58 per 100,000 inhabitants (0.00-40.08 per 100,000 inhabitants); districts bordering neighboring countries presented high incidence rates. Although measles morbidity and mortality has decreased in Mozambique, vaccine coverage has been insufficient to interrupt measles transmission. Enhanced surveillance, including investigation of cases and outbreaks, and improvements in measles vaccination are recommended in order to achieve a homogenous coverage rate of ≥ 95% for both routine and mass vaccination campaigns.

Human papillomavirus vaccine delivery strategies that achieved high coverage in low- and middle-income countries.

PubMed

LaMontagne, D Scott; Barge, Sandhya; Le, Nga Thi; Mugisha, Emmanuel; Penny, Mary E; Gandhi, Sanjay; Janmohamed, Amynah; Kumakech, Edward; Mosqueira, N Rocio; Nguyen, Nghi Quy; Paul, Proma; Tang, Yuxiao; Minh, Tran Hung; Uttekar, Bella Patel; Jumaan, Aisha O

2011-11-01

To assess human papillomavirus (HPV) vaccination coverage after demonstration projects conducted in India, Peru, Uganda and Viet Nam by PATH and national governments and to explore the reasons for vaccine acceptance or refusal. Vaccines were delivered through schools or health centres or in combination with other health interventions, and either monthly or through campaigns at fixed time points. Using a two-stage cluster sample design, the authors selected households in demonstration project areas and interviewed over 7000 parents or guardians of adolescent girls to assess coverage and acceptability. They defined full vaccination as the receipt of all three vaccine doses and used an open-ended question to explore acceptability. Vaccination coverage in school-based programmes was 82.6% (95% confidence interval, CI: 79.3-85.6) in Peru, 88.9% (95% CI: 84.7-92.4) in 2009 in Uganda and 96.1% (95% CI: 93.0-97.8) in 2009 in Viet Nam. In India, a campaign approach achieved 77.2% (95% CI: 72.4-81.6) to 87.8% (95% CI: 84.3-91.3) coverage, whereas monthly delivery achieved 68.4% (95% CI: 63.4-73.4) to 83.3% (95% CI: 79.3-87.3) coverage. More than two thirds of respondents gave as reasons for accepting the HPV vaccine that: (i) it protects against cervical cancer; (ii) it prevents disease, or (iii) vaccines are good. Refusal was more often driven by programmatic considerations (e.g. school absenteeism) than by opposition to the vaccine. High coverage with HPV vaccine among young adolescent girls was achieved through various delivery strategies in the developing countries studied. Reinforcing positive motivators for vaccine acceptance is likely to facilitate uptake.

Low vaccination coverage of Greek Roma children amid economic crisis: national survey using stratified cluster sampling.

PubMed

Papamichail, Dimitris; Petraki, Ioanna; Arkoudis, Chrisoula; Terzidis, Agis; Smyrnakis, Emmanouil; Benos, Alexis; Panagiotopoulos, Takis

2017-04-01

Research on Roma health is fragmentary as major methodological obstacles often exist. Reliable estimates on vaccination coverage of Roma children at a national level and identification of risk factors for low coverage could play an instrumental role in developing evidence-based policies to promote vaccination in this marginalized population group. We carried out a national vaccination coverage survey of Roma children. Thirty Roma settlements, stratified by geographical region and settlement type, were included; 7-10 children aged 24-77 months were selected from each settlement using systematic sampling. Information on children's vaccination coverage was collected from multiple sources. In the analysis we applied weights for each stratum, identified through a consensus process. A total of 251 Roma children participated in the study. A vaccination document was presented for the large majority (86%). We found very low vaccination coverage for all vaccines. In 35-39% of children 'minimum vaccination' (DTP3 and IPV2 and MMR1) was administered, while 34-38% had received HepB3 and 31-35% Hib3; no child was vaccinated against tuberculosis in the first year of life. Better living conditions and primary care services close to Roma settlements were associated with higher vaccination indices. Our study showed inadequate vaccination coverage of Roma children in Greece, much lower than that of the non-minority child population. This serious public health challenge should be systematically addressed, or, amid continuing economic recession, the gap may widen. Valid national estimates on important characteristics of the Roma population can contribute to planning inclusion policies. © The Author 2016. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

The impact of personal experiences with infection and vaccination on behaviour-incidence dynamics of seasonal influenza.

PubMed

Wells, C R; Bauch, C T

2012-08-01

Personal experiences with past infection events, or perceived vaccine failures and complications, are known to drive vaccine uptake. We coupled a model of individual vaccinating decisions, influenced by these drivers, with a contact network model of influenza transmission dynamics. The impact of non-influenzal influenza-like illness (niILI) on decision-making was also incorporated: it was possible for individuals to mistake niILI for true influenza. Our objectives were to (1) evaluate the impact of personal experiences on vaccine coverage; (2) understand the impact of niILI on behaviour-incidence dynamics; (3) determine which factors influence vaccine coverage stability; and (4) determine whether vaccination strategies can become correlated on the network in the absence of social influence. We found that certain aspects of personal experience can significantly impact behaviour-incidence dynamics. For instance, longer term memory for past events had a strong stabilising effect on vaccine coverage dynamics, although it could either increase or decrease average vaccine coverage depending on whether memory of past infections or past vaccine failures dominated. When vaccine immunity wanes slowly, vaccine coverage is low and stable, and infection incidence is also very low, unless the effects of niILI are ignored. Strategy correlations can occur in the absence of imitation, on account of the neighbour-neighbour transmission of infection and history-dependent decision making. Finally, niILI weakens the behaviour-incidence coupling and therefore tends to stabilise dynamics, as well as breaking up strategy correlations. Behavioural feedbacks, and the quality of self-diagnosis of niILI, may need to be considered in future programs adopting "universal" flu vaccines conferring long-term immunity. Public health interventions that focus on reminding individuals about their previous influenza infections, as well as communicating facts about vaccine efficacy and the difference between influenza and niILI, may be an effective way to increase vaccine coverage and prevent unexpected drops in coverage. Copyright © 2012 Elsevier B.V. All rights reserved.

[Strategies to improve influenza vaccination coverage in Primary Health Care].

PubMed

Antón, F; Richart, M J; Serrano, S; Martínez, A M; Pruteanu, D F

2016-04-01

Vaccination coverage reached in adults is insufficient, and there is a real need for new strategies. To compare strategies for improving influenza vaccination coverage in persons older than 64 years. New strategies were introduced in our health care centre during 2013-2014 influenza vaccination campaign, which included vaccinating patients in homes for the aged as well as in the health care centre. A comparison was made on vaccination coverage over the last 4 years in 3 practices of our health care centre: P1, the general physician vaccinated patients older than 64 that came to the practice; P2, the general physician systematically insisted in vaccination in elderly patients, strongly advising to book appointments, and P3, the general physician did not insist. These practices looked after P1: 278; P2: 320; P3: 294 patients older than 64 years. Overall/P1/P2/P3 coverages in 2010: 51.2/51.4/55/46.9% (P=NS), in 2011: 52.4/52.9/53.8/50.3% (P=NS), in 2012: 51.9/52.5/55.3/47.6% (P=NS), and in 2013: 63.5/79.1/59.7/52.7 (P=.000, P1 versus P2 and P3; P=NS between P2 and P3). Comparing the coverages in 2012-2013 within each practice P1 (P=.000); P2 (P=.045); P3 (P=.018). In P2 and P3 all vaccinations were given by the nurses as previously scheduled. In P3, 55% of the vaccinations were given by the nurses, 24.1% by the GP, 9.7% rejected vaccination, and the remainder did not come to the practice during the vaccination period (October 2013-February 2014). The strategy of vaccinating in the homes for the aged improved the vaccination coverage by 5% in each practice. The strategy of "I've got you here, I jab you here" in P1 improved the vaccination coverage by 22%. Copyright © 2014 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

Adult vaccination coverage levels among users of complementary/alternative medicine - results from the 2002 National Health Interview Survey (NHIS).

PubMed

Stokley, Shannon; Cullen, Karen A; Kennedy, Allison; Bardenheier, Barbara H

2008-02-22

While many Complementary/Alternative Medicine (CAM) practitioners do not object to immunization, some discourage or even actively oppose vaccination among their patients. However, previous studies in this area have focused on childhood immunizations, and it is unknown whether and to what extent CAM practitioners may influence the vaccination behavior of their adult patients. The purpose of this study was to describe vaccination coverage levels of adults aged > or = 18 years according to their CAM use status and determine if there is an association between CAM use and adult vaccination coverage. Data from the 2002 National Health Interview Survey, limited to 30,617 adults that provided at least one valid answer to the CAM supplement, were analyzed. Receipt of influenza vaccine during the past 12 months, pneumococcal vaccine (ever), and > or = 1 dose of hepatitis B vaccine was self-reported. Coverage levels for each vaccine by CAM use status were determined for adults who were considered high priority for vaccination because of the presence of a high risk condition and for non-priority adults. Multivariable analyses were conducted to evaluate the association between CAM users and vaccination status, adjusting for demographic and healthcare utilization characteristics. Overall, 36% were recent CAM users. Among priority adults, adjusted vaccination coverage levels were significantly different between recent and non-CAM users for influenza (44% vs 38%; p-value < 0.001) and pneumococcal (40% vs 33%; p-value < 0.001) vaccines but were not significantly different for hepatitis B (60% vs 56%; p-value = 0.36). Among non-priority adults, recent CAM users had significantly higher unadjusted and adjusted vaccination coverage levels compared to non-CAM users for all three vaccines (p-values < 0.001). Vaccination coverage levels among recent CAM users were found to be higher than non-CAM users. Because CAM use has been increasing over time in the U.S., it is important to continue monitoring CAM use and its possible influence on receipt of immunizations among adults. Since adult vaccination coverage levels remain below Healthy People 2010 goals, it may be beneficial to work with CAM practitioners to promote adult vaccines as preventive services in keeping with their commitment to maintaining good health.

Vaccine coverage and adherence to EPI schedules in eight resource poor settings in the MAL-ED cohort study.

PubMed

Hoest, Christel; Seidman, Jessica C; Lee, Gwenyth; Platts-Mills, James A; Ali, Asad; Olortegui, Maribel Paredes; Bessong, Pascal; Chandyo, Ram; Babji, Sudhir; Mohan, Venkata Raghava; Mondal, Dinesh; Mahfuz, Mustafa; Mduma, Estomih R; Nyathi, Emanuel; Abreu, Claudia; Miller, Mark A; Pan, William; Mason, Carl J; Knobler, Stacey L

2017-01-11

Launched in 1974, the Expanded Program on Immunization (EPI) is estimated to prevent two-three million deaths annually from polio, diphtheria, tuberculosis, pertussis, measles, and tetanus. Additional lives could be saved through better understanding what influences adherence to the EPI schedule in specific settings. The Etiology, Risk Factors and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development (MAL-ED) study followed cohorts in eight sites in South Asia, Africa, and South America and monitored vaccine receipt over the first two years of life for the children enrolled in the study. Vaccination histories were obtained monthly from vaccination cards, local clinic records and/or caregiver reports. Vaccination histories were compared against the prescribed EPI schedules for each country, and coverage rates were examined in relation to the timing of vaccination. The influence of socioeconomic factors on vaccine timing and coverage was also considered. Coverage rates for EPI vaccines varied between sites and by type of vaccine; overall, coverage was highest in the Nepal and Bangladesh sites and lowest in the Tanzania and Brazil sites. Bacillus Calmette-Guérin coverage was high across all sites, 87-100%, whereas measles vaccination rates ranged widely, 73-100%. Significant delays between the scheduled administration age and actual vaccination date were present in all sites, especially for measles vaccine where less than 40% were administered on schedule. A range of socioeconomic factors were significantly associated with vaccination status in study children but these results were largely site-specific. Our findings highlight the need to improve measles vaccination rates and reduce delayed vaccination to achieve EPI targets related to the establishment of herd immunity and reduction in disease transmission. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Seasonal influenza immunisation in Europe. Overview of recommendations and vaccination coverage for three seasons: pre-pandemic (2008/09), pandemic (2009/10) and post-pandemic (2010/11).

PubMed

Mereckiene, J; Cotter, S; Nicoll, A; Lopalco, P; Noori, T; Weber, Jt; D'Ancona, F; Levy-Bruhl, D; Dematte, L; Giambi, C; Valentiner-Branth, P; Stankiewicz, I; Appelgren, E; O Flanagan, D

2014-04-24

Since 2008, annual surveys of influenza vaccination policies, practices and coverage have been undertaken in 29 European Union (EU)/ European Economic Area (EEA) countries. After 2009, this monitored the impact of European Council recommendation to increase vaccination coverage to 75% among risk groups. This paper summarises the results of three seasonal influenza seasons: 2008/09, 2009/10 and 2010/11. In 2008/09, 27/29 countries completed the survey; in 2009/10 and 2010/11, 28/29 completed it. All or almost all countries recommended vaccination of older people (defined as those aged ≥50, ≥55, ≥59, ≥60 or ≥65 years), and people aged ≥6 months with clinical risk and healthcare workers. A total of 23 countries provided vaccination coverage data for older people, but only 7 and 10 had data for the clinical risk groups and healthcare workers, respectively. The number of countries recommending vaccination for some or all pregnant women increased from 10 in 2008/09 to 22 in 2010/11. Only three countries could report coverage among pregnant women. Seasonal influenza vaccination coverage during and after the pandemic season in older people and clinical groups remained unchanged in countries with higher coverage. However, small decreases were seen in most countries during this period. The results of the surveys indicate that most EU/EEA countries recommend influenza vaccination for the main target groups; however, only a few countries have achieved the target of 75% coverage among risk groups. Coverage among healthcare workers remained low.

Balancing evidence and uncertainty when considering rubella vaccine introduction.

PubMed

Lessler, Justin; Metcalf, C Jessica E

2013-01-01

Despite a safe and effective vaccine, rubella vaccination programs with inadequate coverage can raise the average age of rubella infection; thereby increasing rubella cases among pregnant women and the resulting congenital rubella syndrome (CRS) in their newborns. The vaccination coverage necessary to reduce CRS depends on the birthrate in a country and the reproductive number, R0, a measure of how efficiently a disease transmits. While the birthrate within a country can be known with some accuracy, R0 varies between settings and can be difficult to measure. Here we aim to provide guidance on the safe introduction of rubella vaccine into countries in the face of substantial uncertainty in R0. We estimated the distribution of R0 in African countries based on the age distribution of rubella infection using Bayesian hierarchical models. We developed an age specific model of rubella transmission to predict the level of R0 that would result in an increase in CRS burden for specific birth rates and coverage levels. Combining these results, we summarize the safety of introducing rubella vaccine across demographic and coverage contexts. The median R0 of rubella in the African region is 5.2, with 90% of countries expected to have an R0 between 4.0 and 6.7. Overall, we predict that countries maintaining routine vaccination coverage of 80% or higher are can be confident in seeing a reduction in CRS over a 30 year time horizon. Under realistic assumptions about human contact, our results suggest that even in low birth rate settings high vaccine coverage must be maintained to avoid an increase in CRS. These results lend further support to the WHO recommendation that countries reach 80% coverage for measles vaccine before introducing rubella vaccination, and highlight the importance of maintaining high levels of vaccination coverage once the vaccine is introduced.

NSW annual immunisation coverage report, 2010.

PubMed

Hull, Brynley; Dey, Aditi; Campbell-Lloyd, Sue; Menzies, Robert I; McIntyre, Peter B

2011-11-01

This annual report, the second in the series, documents trends in immunisation coverage in NSW for children, adolescents and the elderly, to the end of 2010. Data from the Australian Childhood Immunisation Register, the NSW School Immunisation Program and the NSW Population Health Survey were used to calculate various measures of population coverage, coverage for Aboriginal children and vaccination timeliness for all children. Over 90% coverage has been reached for children at 12 and 24 months of age. For children at 5 years of age there was an improvement during 2010 in timeliness for vaccines due at 4 years and coverage almost reached 90%. Delayed receipt of vaccines is still an issue for Aboriginal children. For adolescents, there is good coverage for the first and second doses of human papillomavirus vaccine and the dose of diphtheria, tetanus and acellular pertussis. The pneumococcal vaccination rate in the elderly has been steadily rising, although it has remained lower than the influenza coverage estimates. Completion of the recommended immunisation schedule at the earliest appropriate age should be the next public health goal at both the state and local health district level. Official coverage assessments for 'fully immunised' should include the 7-valent pneumococcal conjugate and meningococcal C vaccines, and wider dissemination should be considered.

Timeliness vaccination of measles containing vaccine and barriers to vaccination among migrant children in East China.

PubMed

Hu, Yu; Li, Qian; Luo, Shuying; Lou, Linqiao; Qi, Xiaohua; Xie, Shuyun

2013-01-01

The reported coverage rates of first and second doses of measles containing vaccine (MCV) are almost 95% in China, while measles cases are constantly being reported. This study evaluated the vaccine coverage, timeliness, and barriers to immunization of MCV1 and MCV2 in children aged from 8-48 months. We assessed 718 children aged 8-48 months, of which 499 children aged 18-48 months in September 2011. Face to face interviews were administered with children's mothers to estimate MCV1 and MCV2 coverage rate, its timeliness and barriers to vaccine uptake. The coverage rates were 76.9% for MCV1 and 44.7% for MCV2 in average. Only 47.5% of surveyed children received the MCV1 timely, which postpone vaccination by up to one month beyond the stipulated age of 8 months. Even if coverage thus improves with time, postponed vaccination adds to the pool of unprotected children in the population. Being unaware of the necessity for vaccination and its schedule, misunderstanding of side-effect of vaccine, and child being sick during the recommended vaccination period were significant preventive factors for both MCV1 and MCV2 vaccination. Having multiple children, mother's education level, household income and children with working mothers were significantly associated with delayed or missing MCV1 immunization. To avoid future outbreaks, it is crucial to attain high coverage levels by timely vaccination, thus, accurate information should be delivered and a systematic approach should be targeted to high-risk groups.

[Influenza vaccination of hospital healthcare staff from the perspective of the employer: a positive balance].

PubMed

Hak, Eelko; Knol, Lisanne M; Wilschut, Jan C; Postma, Maarten J

2010-01-01

To assess the annual productivity loss among hospital healthcare workers attributable to influenza and to estimate the costs and economic benefits of a vaccination programme from the perspective of the the employer. Cost-benefit analysis. The percentage of work loss due to influenza was determined using monthly age and gender specific figures for productivity loss among healthcare workers of the University Medical Center Groningen (UMCG), the Netherlands over the period January 2006-June 2008. Influenza periods were determined on the basis of national surveillance data. The average increase in productivity loss in these periods was estimated by comparison with the periods outside influenza seasons. The direct costs of productivity loss from the perspective of the employer were estimated using the friction cost method. In the sensitivity analyses various modelling parameters were varied, such as the vaccination coverage. In the UMCG, with approximately 9,400 employees, the estimated annual costs associated with productivity loss due to influenza before the introduction of the yearly influenza vaccination program were € 675,242 or on average, € 72 per employee. The economic benefits of the current vaccination program with a vaccination coverage of 24% with a vaccine effectiveness of 71% were estimated at € 89,858 or € 10 per employee. The nett economic benefits of a vaccination program with a target vaccination coverage of 70% with a vaccine effectiveness of 71% were estimated at € 244,325 or € 26 per employee. This modelling study performed from the perspective of the employer showed that an annual influenza vaccination programme for hospital personnel can save costs.

Forecasted trends in vaccination coverage and correlations with socioeconomic factors: a global time-series analysis over 30 years.

PubMed

de Figueiredo, Alexandre; Johnston, Iain G; Smith, David M D; Agarwal, Sumeet; Larson, Heidi J; Jones, Nick S

2016-10-01

Incomplete immunisation coverage causes preventable illness and death in both developing and developed countries. Identification of factors that might modulate coverage could inform effective immunisation programmes and policies. We constructed a performance indicator that could quantitatively approximate measures of the susceptibility of immunisation programmes to coverage losses, with an aim to identify correlations between trends in vaccine coverage and socioeconomic factors. We undertook a data-driven time-series analysis to examine trends in coverage of diphtheria, tetanus, and pertussis (DTP) vaccination across 190 countries over the past 30 years. We grouped countries into six world regions according to WHO classifications. We used Gaussian process regression to forecast future coverage rates and provide a vaccine performance index: a summary measure of the strength of immunisation coverage in a country. Overall vaccine coverage increased in all six world regions between 1980 and 2010, with variation in volatility and trends. Our vaccine performance index identified that 53 countries had more than a 50% chance of missing the Global Vaccine Action Plan (GVAP) target of 90% worldwide coverage with three doses of DTP (DTP3) by 2015. These countries were mostly in sub-Saharan Africa and south Asia, but Austria and Ukraine also featured. Factors associated with DTP3 immunisation coverage varied by world region: personal income (Spearman's ρ=0·66, p=0·0011) and government health spending (0·66, p<0·0001) were informative of immunisation coverage in the Eastern Mediterranean between 1980 and 2010, whereas primary school completion was informative of coverage in Africa (0·56, p<0·0001) over the same period. The proportion of births attended by skilled health staff correlated significantly with immunisation coverage across many world regions. Our vaccine performance index highlighted countries at risk of failing to achieve the GVAP target of 90% coverage by 2015, and could aid policy makers' assessments of the strength and resilience of immunisation programmes. Weakening correlations with socioeconomic factors show a need to tackle vaccine confidence, whereas strengthening correlations point to clear factors to address. UK Engineering and Physical Sciences Research Council. Copyright © 2016 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY license. Published by Elsevier Ltd.. All rights reserved.

Infectious Disease Risk and Vaccination in Northern Syria after 5 Years of Civil War: The MSF Experience

PubMed Central

de Lima Pereira, Alan; Southgate, Rosamund; Ahmed, Hikmet; O’Connor, Penelope; Cramond, Vanessa; Lenglet, Annick

2018-01-01

Introduction: In 2015, following an influx of population into Kobanê in northern Syria, Médecins Sans Frontières (MSF) in collaboration with the Kobanê Health Administration (KHA) initiated primary healthcare activities. A vaccination coverage survey and vaccine-preventable disease (VPD) risk analysis were undertaken to clarify the VPD risk and vaccination needs. This was followed by a measles Supplementary Immunization Activity (SIA). We describe the methods and results used for this prioritisation activity around vaccination in Kobanê in 2015. Methods: We implemented a pre-SIA survey in 135 randomly-selected households in Kobanê using a vaccination history questionnaire for all children <5 years. We conducted a VPD Risk Analysis using MSF ‘Preventive Vaccination in Humanitarian Emergencies’ guidance to prioritize antigens with the highest public health threat for mass vaccination activities. A Measles SIA was then implemented and followed by vaccine coverage survey in 282 randomly-selected households targeting children <5 years. Results: The pre-SIA survey showed that 168/212 children (79.3%; 95%CI=72.7-84.6%) had received one vaccine or more in their lifetime. Forty-three children (20.3%; 95%CI: 15.1-26.6%) had received all vaccines due by their age; only one was <12 months old and this child had received all vaccinations outside of Syria. The VPD Risk Analysis prioritised measles, Haemophilus Influenza type B (Hib) and Pneumococcus vaccinations. In the measles SIA, 3410 children aged 6-59 months were vaccinated. The use of multiple small vaccination sites to reduce risks associated with crowds in this active conflict setting was noted as a lesson learnt. The post-SIA survey estimated 82% (95%CI: 76.9-85.9%; n=229/280) measles vaccination coverage in children 6-59 months. Discussion: As a result of the conflict in Syria, the progressive collapse of the health care system in Kobanê has resulted in low vaccine coverage rates, particularly in younger age groups. The repeated displacements of the population, attacks on health institutions and exodus of healthcare workers, challenge the resumption of routine immunization in this conflict setting and limit the use of SIAs to ensure sustainable immunity to VPDs. We have shown that the risk for several VPDs in Kobanê remains high. Conclusion: We call on all health actors and the international community to work towards re-establishment of routine immunisation activities as a priority to ensure that children who have had no access to vaccination in the last five years are adequately protected for VPDs as soon as possible. PMID:29511602

Surveillance of influenza vaccination coverage--United States, 2007-08 through 2011-12 influenza seasons.

PubMed

Lu, Peng-jun; Santibanez, Tammy A; Williams, Walter W; Zhang, Jun; Ding, Helen; Bryan, Leah; O'Halloran, Alissa; Greby, Stacie M; Bridges, Carolyn B; Graitcer, Samuel B; Kennedy, Erin D; Lindley, Megan C; Ahluwalia, Indu B; LaVail, Katherine; Pabst, Laura J; Harris, LaTreace; Vogt, Tara; Town, Machell; Singleton, James A

2013-10-25

Substantial improvement in annual influenza vaccination of recommended groups is needed to reduce the health effects of influenza and reach Healthy People 2020 targets. No single data source provides season-specific estimates of influenza vaccination coverage and related information on place of influenza vaccination and concerns related to influenza and influenza vaccination. 2007-08 through 2011-12 influenza seasons. CDC uses multiple data sources to obtain estimates of vaccination coverage and related data that can guide program and policy decisions to improve coverage. These data sources include the National Health Interview Survey (NHIS), the Behavioral Risk Factor Surveillance System (BRFSS), the National Flu Survey (NFS), the National Immunization Survey (NIS), the Immunization Information Systems (IIS) eight sentinel sites, Internet panel surveys of health-care personnel and pregnant women, and the Pregnancy Risk Assessment and Monitoring System (PRAMS). National influenza vaccination coverage among children aged 6 months-17 years increased from 31.1% during 2007-08 to 56.7% during the 2011-12 influenza season as measured by NHIS. Vaccination coverage among children aged 6 months-17 years varied by state as measured by NIS. Changes from season to season differed as measured by NIS and NHIS. According to IIS sentinel site data, full vaccination (having either one or two seasonal influenza vaccinations, as recommended by the Advisory Committee on Immunization Practices for each influenza season, based on the child's influenza vaccination history) with up to two recommended doses for the 2011-12 season was 27.1% among children aged 6 months-8 years and was 44.3% for the youngest children (aged 6-23 months). Influenza vaccination coverage among adults aged ≥18 years increased from 33.0% during 2007-08 to 38.3% during the 2011-12 influenza season as measured by NHIS. Vaccination coverage by age group for the 2011-12 season as measured by BRFSS was <5 percentage points different from NHIS estimates, whereas NFS estimates were 6-8 percentage points higher than BRFSS estimates. Vaccination coverage among persons aged ≥18 years varied by state as measured by BRFSS. For adults aged ≥18 years, a doctor's office was the most common place for receipt of influenza vaccination (38.4%, BRFSS; 32.5%, NFS) followed by a pharmacy (20.1%, BRFSS; 19.7%, NFS). Overall, 66.9% of health-care personnel (HCP) reported having been vaccinated during the 2011-12 season, as measured by an Internet panel survey of HCP, compared with 62.4%, as estimated through NHIS. Vaccination coverage among pregnant women was 47.0%, as measured by an Internet panel survey of women pregnant during the influenza season, and 43.0%, as measured by BRFSS during the 2011-12 influenza season. Overall, as measured by NFS, 86.8% of adults aged ≥18 years rated the influenza vaccine as very or somewhat effective, and 46.5% of adults aged ≥18 years believed their risk for getting sick with influenza if unvaccinated was high or somewhat high. During the 2011-12 season, influenza vaccination coverage varied by state, age group, and selected populations (e.g., HCP and pregnant women), with coverage estimates well below the Healthy People 2020 goal of 70% for children aged 6 months-17 years, 70% for adults aged ≥18 years, and 90% for HCP. Continued efforts are needed to encourage health-care providers to offer influenza vaccination and to promote public health education efforts among various populations to improve vaccination coverage. Ongoing surveillance to obtain coverage estimates and information regarding other issues related to influenza vaccination (e.g., knowledge, attitudes, and beliefs) is needed to guide program and policy improvements to reduce morbidity and mortality associated with influenza by increasing vaccination rates. Ongoing comparisons of telephone and Internet panel surveys with in-person surveys such as NHIS are needed for appropriate interpretation of data and resulting public health actions. Examination of results from all data sources is necessary to fully assess the various components of influenza vaccination coverage among different populations in the United States.

Yellow Fever in Africa: estimating the burden of disease and impact of mass vaccination from outbreak and serological data.

PubMed

Garske, Tini; Van Kerkhove, Maria D; Yactayo, Sergio; Ronveaux, Olivier; Lewis, Rosamund F; Staples, J Erin; Perea, William; Ferguson, Neil M

2014-05-01

Yellow fever is a vector-borne disease affecting humans and non-human primates in tropical areas of Africa and South America. While eradication is not feasible due to the wildlife reservoir, large scale vaccination activities in Africa during the 1940s to 1960s reduced yellow fever incidence for several decades. However, after a period of low vaccination coverage, yellow fever has resurged in the continent. Since 2006 there has been substantial funding for large preventive mass vaccination campaigns in the most affected countries in Africa to curb the rising burden of disease and control future outbreaks. Contemporary estimates of the yellow fever disease burden are lacking, and the present study aimed to update the previous estimates on the basis of more recent yellow fever occurrence data and improved estimation methods. Generalised linear regression models were fitted to a dataset of the locations of yellow fever outbreaks within the last 25 years to estimate the probability of outbreak reports across the endemic zone. Environmental variables and indicators for the surveillance quality in the affected countries were used as covariates. By comparing probabilities of outbreak reports estimated in the regression with the force of infection estimated for a limited set of locations for which serological surveys were available, the detection probability per case and the force of infection were estimated across the endemic zone. The yellow fever burden in Africa was estimated for the year 2013 as 130,000 (95% CI 51,000-380,000) cases with fever and jaundice or haemorrhage including 78,000 (95% CI 19,000-180,000) deaths, taking into account the current level of vaccination coverage. The impact of the recent mass vaccination campaigns was assessed by evaluating the difference between the estimates obtained for the current vaccination coverage and for a hypothetical scenario excluding these vaccination campaigns. Vaccination campaigns were estimated to have reduced the number of cases and deaths by 27% (95% CI 22%-31%) across the region, achieving up to an 82% reduction in countries targeted by these campaigns. A limitation of our study is the high level of uncertainty in our estimates arising from the sparseness of data available from both surveillance and serological surveys. With the estimation method presented here, spatial estimates of transmission intensity can be combined with vaccination coverage levels to evaluate the impact of past or proposed vaccination campaigns, thereby helping to allocate resources efficiently for yellow fever control. This method has been used by the Global Alliance for Vaccines and Immunization (GAVI Alliance) to estimate the potential impact of future vaccination campaigns.

Evolutionary game theory and social learning can determine how vaccine scares unfold.

PubMed

Bauch, Chris T; Bhattacharyya, Samit

2012-01-01

Immunization programs have often been impeded by vaccine scares, as evidenced by the measles-mumps-rubella (MMR) autism vaccine scare in Britain. A "free rider" effect may be partly responsible: vaccine-generated herd immunity can reduce disease incidence to such low levels that real or imagined vaccine risks appear large in comparison, causing individuals to cease vaccinating. This implies a feedback loop between disease prevalence and strategic individual vaccinating behavior. Here, we analyze a model based on evolutionary game theory that captures this feedback in the context of vaccine scares, and that also includes social learning. Vaccine risk perception evolves over time according to an exogenously imposed curve. We test the model against vaccine coverage data and disease incidence data from two vaccine scares in England & Wales: the whole cell pertussis vaccine scare and the MMR vaccine scare. The model fits vaccine coverage data from both vaccine scares relatively well. Moreover, the model can explain the vaccine coverage data more parsimoniously than most competing models without social learning and/or feedback (hence, adding social learning and feedback to a vaccine scare model improves model fit with little or no parsimony penalty). Under some circumstances, the model can predict future vaccine coverage and disease incidence--up to 10 years in advance in the case of pertussis--including specific qualitative features of the dynamics, such as future incidence peaks and undulations in vaccine coverage due to the population's response to changing disease incidence. Vaccine scares could become more common as eradication goals are approached for more vaccine-preventable diseases. Such models could help us predict how vaccine scares might unfold and assist mitigation efforts.

How is communication of vaccines in traditional media: a systematic review.

PubMed

Catalan-Matamoros, Daniel; Peñafiel-Saiz, Carmen

2018-06-01

Taking into account that a key determinant in public approval of vaccinations is how the media constructs and frames messages about vaccination programmes, our aim is to review communication studies exploring media coverage of vaccines within traditional media venues. Using a registered protocol (PROSPERO: 42017072849), a systematic review was conducted that searched in three international electronic databases (PubMed, Scopus, and the International Bibliography of Social Science) for articles published between 2007 and 2017 following content-analysis methods. The characteristics and outcomes were systematically identified and described. The search yielded 24 eligible studies that were further analysed in the review. Media coverage of vaccines has been largely studied during the last decade. Findings revealed that 62% ( n = 15) of studies analysed the human papillomavirus vaccine, 87% ( n = 21) examined newspapers, and 62% ( n = 15) examined North American media. In relation to media content analyses, 75% found negative messages on vaccines and 83% identified a lack of accurate information. This systematic review suggests an agenda for further research. There is a significant need to analyse other types of traditional media beyond newspapers. Future studies should focus on other geographical areas such as low-income countries and on analysing visual materials and digital media. We found that negative messages and inaccurate information are common in media coverage on vaccines; therefore, further research focusing on these topics is needed. Officials in public health organizations should develop a close collaboration with the media to improve public communication on vaccines.

Diphtheria in Lao PDR: Insufficient Coverage or Ineffective Vaccine?

PubMed Central

Nouanthong, Phonethipsavanh; Souvannaso, Chanthasone; Vilivong, Keooudomphone; Muller, Claude P.; Goossens, Sylvie; Quet, Fabrice; Buisson, Yves

2015-01-01

Background During late 2012 and early 2013 several outbreaks of diphthe-ria were notified in the North of the Lao People’s Democratic Republic. The aim of this study was to determine whether the re-emergence of this vaccine-preventable disease was due to insufficient vaccination coverage or reduction of vaccine effectiveness within the affected regions. Methods A serosurvey was conducted in the Huaphan Province on a cluster sampling of 132 children aged 12–59 months. Serum samples, socio-demographic data, nutri-tional status and vaccination history were collected when available. Anti-diphtheria and anti-tetanus IgG antibody levels were measured by ELISA. Results Overall, 63.6% of participants had detectable diphtheria antibodies and 71.2% tetanus antibodies. Factors independently associated with non-vaccination against diphtheria were the distance from the health centre (OR: 6.35 [95% CI: 1.4–28.8], p = 0.01), the Lao Theung ethnicity (OR: 12.2 [95% CI:1,74–85, 4], p = 0.01) and the lack of advice on vac-cination given at birth (OR: 9.8 [95% CI: 1.5–63.8], (p = 0.01) while the level of maternal edu-cation was a protective factor (OR: 0.08 [95% CI: 0.008–0.81], p = 0.03). Most respondents claimed financial difficulties as the main reason for non-vaccination. Out of 55 children whose vaccination certificates stated that they were given all 3 doses of diphtheria-containing vaccine, 83.6% had diphtheria antibodies and 92.7% had tetanus antibodies. Furthermore, despite a high prevalence of stunted and underweight children (53% and 25.8%, respectively), the low levels of anti-diphtheria antibodies were not correlated to the nutritional status. Conclusions Our data highlight a significant deficit in both the vaccination coverage and diphtheria vaccine effectiveness within the Huaphan Province. Technical defi-ciencies in the methods of storage and distribution of vaccines as well as unreliability of vac-cination cards are discussed. Several hypotheses are advanced to explain such a decline in immunity against diphtheria and recommendations are provided to prevent future outbreaks. PMID:25909365

The value of male human papillomavirus vaccination in preventing cervical cancer and genital warts in a low-resource setting.

PubMed

Sharma, M; Sy, S; Kim, J J

2016-05-01

To estimate health benefits and incremental cost-effectiveness of human papillomavirus (HPV) vaccination of pre-adolescent boys and girls compared with girls alone for preventing cervical cancer and genital warts. Model-based economic evaluation. Southern Vietnam. Males and females aged ≥9 years. We simulated dynamic HPV transmission to estimate cervical cancer and genital warts cases. Models were calibrated to epidemiological data from south Vietnam. Incremental cost-effectiveness ratios (ICERs): cost per quality-adjusted life-year (QALY). Vaccinating girls alone was associated with reductions in lifetime cervical cancer risk ranging from 20 to 56.9% as coverage varied from 25 to 90%. Adding boys to the vaccination programme yielded marginal incremental benefits (≤3.6% higher absolute cervical cancer risk reduction), compared with vaccinating girls alone at all coverages. At ≤25 international dollars (I$) per vaccinated adolescent (I$5 per dose), HPV vaccination of boys was below the threshold of Vietnam's per-capita GDP (I$2800), with ICERs ranging from I$734 per QALY at 25% coverage to I$2064 per QALY for 90% coverage. Including health benefits from averting genital warts yielded more favourable ICERs, and vaccination of boys at I$10/dose became cost-effective at or below 75% coverage. Using a lower cost-effectiveness threshold of 50% of Vietnam's GDP (I$1400), vaccinating boys was no longer attractive at costs above I$5 per dose regardless of coverage. Vaccination of boys may be cost-effective at low vaccine costs, but provides little benefit over vaccinating girls only. Focusing on achieving high vaccine coverage of girls may be more efficient for southern Vietnam and similar low-resource settings. Limited cervical cancer reduction from including boys in HPV vaccination of girls in low-resource settings. © 2015 Royal College of Obstetricians and Gynaecologists.

Measuring populations to improve vaccination coverage

NASA Astrophysics Data System (ADS)

Bharti, Nita; Djibo, Ali; Tatem, Andrew J.; Grenfell, Bryan T.; Ferrari, Matthew J.

2016-10-01

In low-income settings, vaccination campaigns supplement routine immunization but often fail to achieve coverage goals due to uncertainty about target population size and distribution. Accurate, updated estimates of target populations are rare but critical; short-term fluctuations can greatly impact population size and susceptibility. We use satellite imagery to quantify population fluctuations and the coverage achieved by a measles outbreak response vaccination campaign in urban Niger and compare campaign estimates to measurements from a post-campaign survey. Vaccine coverage was overestimated because the campaign underestimated resident numbers and seasonal migration further increased the target population. We combine satellite-derived measurements of fluctuations in population distribution with high-resolution measles case reports to develop a dynamic model that illustrates the potential improvement in vaccination campaign coverage if planners account for predictable population fluctuations. Satellite imagery can improve retrospective estimates of vaccination campaign impact and future campaign planning by synchronizing interventions with predictable population fluxes.

Measuring populations to improve vaccination coverage

PubMed Central

Bharti, Nita; Djibo, Ali; Tatem, Andrew J.; Grenfell, Bryan T.; Ferrari, Matthew J.

2016-01-01

In low-income settings, vaccination campaigns supplement routine immunization but often fail to achieve coverage goals due to uncertainty about target population size and distribution. Accurate, updated estimates of target populations are rare but critical; short-term fluctuations can greatly impact population size and susceptibility. We use satellite imagery to quantify population fluctuations and the coverage achieved by a measles outbreak response vaccination campaign in urban Niger and compare campaign estimates to measurements from a post-campaign survey. Vaccine coverage was overestimated because the campaign underestimated resident numbers and seasonal migration further increased the target population. We combine satellite-derived measurements of fluctuations in population distribution with high-resolution measles case reports to develop a dynamic model that illustrates the potential improvement in vaccination campaign coverage if planners account for predictable population fluctuations. Satellite imagery can improve retrospective estimates of vaccination campaign impact and future campaign planning by synchronizing interventions with predictable population fluxes. PMID:27703191

Coverage and predictors of vaccination against 2012/13 seasonal influenza in Madrid, Spain

PubMed Central

Jiménez-García, Rodrigo; Esteban-Vasallo, María D; Rodríguez-Rieiro, Cristina; Hernandez-Barrera, Valentín; Domínguez-Berjón, MA Felicitas; Carrasco Garrido, Pilar; Lopez de Andres, Ana; Cameno Heras, Moises; Iniesta Fornies, Domingo; Astray-Mochales, Jenaro

2014-01-01

We aim to determine 2012–13 seasonal influenza vaccination coverage. Data were analyzed by age group and by coexistence of concomitant chronic conditions. Factors associated with vaccine uptake were identified. We also analyze a possible trend in vaccine uptake in post pandemic seasons. We used computerized immunization registries and clinical records of the entire population of the Autonomous Community of Madrid, Spain (6 284 128 persons) as data source. A total of 871 631 individuals were vaccinated (13.87%). Coverage for people aged ≥ 65 years was 56.57%. Global coverage in people with a chronic condition was 15.7% in children and 18.69% in adults aged 15–59 years. The variables significantly associated with a higher likelihood of being vaccinated in the 2012–13 campaign for the age groups studied were higher age, being Spanish-born, higher number of doses of seasonal vaccine received in previous campaigns, uptake of pandemic vaccination, and having a chronic condition. We conclude that vaccination coverage in persons aged <60 years with chronic conditions is less than acceptable. The very low coverage among children with chronic conditions calls for urgent interventions. Among those aged ≥60 years, uptake is higher but still far from optimal and seems to be descending in post-pandemic campaigns. For those aged ≥65 years the mean percentage of decrease from the 2009/10 to the actual campaign has been 12%. Computerized clinical and immunization registers are useful tools for providing rapid and detailed information about influenza vaccination coverage in the population. PMID:24280728

Coverage and predictors of vaccination against 2012/13 seasonal influenza in Madrid, Spain: analysis of population-based computerized immunization registries and clinical records.

PubMed

Jiménez-García, Rodrigo; Esteban-Vasallo, María D; Rodríguez-Rieiro, Cristina; Hernandez-Barrera, Valentín; Domínguez-Berjón, M A Felicitas; Carrasco Garrido, Pilar; Lopez de Andres, Ana; Cameno Heras, Moises; Iniesta Fornies, Domingo; Astray-Mochales, Jenaro

2014-01-01

We aim to determine 2012-13 seasonal influenza vaccination coverage. Data were analyzed by age group and by coexistence of concomitant chronic conditions. Factors associated with vaccine uptake were identified. We also analyze a possible trend in vaccine uptake in post pandemic seasons. We used computerized immunization registries and clinical records of the entire population of the Autonomous Community of Madrid, Spain (6,284,128 persons) as data source. A total of 871,631 individuals were vaccinated (13.87%). Coverage for people aged ≥ 65 years was 56.57%. Global coverage in people with a chronic condition was 15.7% in children and 18.69% in adults aged 15-59 years. The variables significantly associated with a higher likelihood of being vaccinated in the 2012-13 campaign for the age groups studied were higher age, being Spanish-born, higher number of doses of seasonal vaccine received in previous campaigns, uptake of pandemic vaccination, and having a chronic condition. We conclude that vaccination coverage in persons aged<60 years with chronic conditions is less than acceptable. The very low coverage among children with chronic conditions calls for urgent interventions. Among those aged ≥60 years, uptake is higher but still far from optimal and seems to be descending in post-pandemic campaigns. For those aged ≥65 years the mean percentage of decrease from the 2009/10 to the actual campaign has been 12%. Computerized clinical and immunization registers are useful tools for providing rapid and detailed information about influenza vaccination coverage in the population.

[Anti-pneumococcal vaccine coverage for hospitalized risk patients: Assessment and suggestions for improvements].

PubMed

Richard, C; Le Garlantezec, P; Lamand, V; Rasamijao, V; Rapp, C

2016-05-01

Streptococcus pneumoniae can cause invasive infections. Incidence and severity are linked to patients' risk factors. Due to the resistance to leading antibiotics, the anti-pneumococcal vaccination has become a major public health issue. The purpose of this survey was to evaluate the anti-pneumococcal vaccine coverage in a population of adults with risk factors. This was a prospective study that included patients with at least one recommendation for pneumococcal vaccination as indicated by the Weekly Epidemiological Bulletin (BEH), to which three further US recommendations were added (diabetes, obesity and age>65years). One hundred and thirty-four patients with an average age of 70 years were included. The physician could only confirm 68 % of the patients' vaccination status. Vaccination coverage as recommended by the BEH board was 30 % (n=54). All HIV patients were vaccinated (n=2) and the vaccination coverage was 75 % (n=8) for patients treated for autoimmune diseases and only 10 % (n=20) for patients treated with chemotherapy. Patients with no vaccination didn't know the existence of the vaccine or didn't know that vaccination was recommended to them. This study has highlighted a deficit in pneumococcal vaccination coverage and a high level of ignorance of the existence of recommended vaccination. In addition to awareness campaign for patients and caregiver training, the expansion of the vaccine e-book utilization could improve the vaccination status. Copyright © 2015 Académie Nationale de Pharmacie. Published by Elsevier Masson SAS. All rights reserved.

Effect of a preventive vaccine on the dynamics of HIV transmission

NASA Astrophysics Data System (ADS)

Gumel, A. B.; Moghadas, S. M.; Mickens, R. E.

2004-12-01

A deterministic mathematical model for the transmission dynamics of HIV infection in the presence of a preventive vaccine is considered. Although the equilibria of the model could not be expressed in closed form, their existence and threshold conditions for their stability are theoretically investigated. It is shown that the disease-free equilibrium is locally-asymptotically stable if the basic reproductive number R<1 (thus, HIV disease can be eradicated from the community) and unstable if R>1 (leading to the persistence of HIV within the community). A robust, positivity-preserving, non-standard finite-difference method is constructed and used to solve the model equations. In addition to showing that the anti-HIV vaccine coverage level and the vaccine-induced protection are critically important in reducing the threshold quantity R, our study predicts the minimum threshold values of vaccine coverage and efficacy levels needed to eradicate HIV from the community.

A reflection on invasive pneumococcal disease and pneumococcal conjugate vaccination coverage in children in Southern Europe (2009-2016).

PubMed

Moreira, Marta; Castro, Olga; Palmieri, Melissa; Efklidou, Sofia; Castagna, Stefano; Hoet, Bernard

2017-06-03

Higher-valent pneumococcal conjugate vaccines (PCVs) were licensed from 2009 in Europe; similar worldwide clinical effectiveness was observed for PCVs in routine use. Despite a proven medical need, PCV vaccination in Southern Europe remained suboptimal until 2015/16. We searched PubMed for manuscripts published between 2009 and mid-2016. Included manuscripts had to contain data about invasive pneumococcal disease (IPD) incidence, or vaccination coverage with higher-valent PCVs. This review represents the first analysis of vaccination coverage and impact of higher-valent PCVs on overall IPD in Southern European countries (Portugal, Spain, Italy, Greece, Cyprus). Vaccination coverage in the Portuguese private market peaked around 2008 at 75% (children ≤ 2 years) but declined to 63% in 2012. In Madrid, coverage was 95% (2007-2012) but dropped to 67% (2013/14; children ≤ 2 years) after funding termination in May 2012. PCVs were recently introduced in the national immunisation program (NIP) of Portugal (2015) and Spain (2015/16). In Italy, coverage for the complete PCV schedule (children ≤ 2 years) was 88% in 2013, although highly variable between regions (45-99%). In Greece, in 2013, 82.3% had received 3 PCV doses by 12 months, while 62.3% received the fourth dose by 24 months. Overall IPD (net benefit: effect on vaccine types, vaccine-related types, and non-vaccine types) has decreased; in Greece, pneumococcal meningitis incidence remained stable. Continued IPD surveillance or national registers using ICD-10 codes of clinically suspected IPD are necessary, with timely publicly available reports and adequate national vaccination registers to assess trends in vaccination coverage, allowing evaluation of PCVs in NIPs.

Human papillomavirus vaccination coverage in Luxembourg - Implications of lowering and restricting target age groups.

PubMed

Latsuzbaia, Ardashel; Arbyn, Marc; Weyers, Steven; Mossong, Joël

2018-04-25

In Luxembourg, a national Human Papillomavirus (HPV) vaccination programme was introduced in 2008, targeting 12-17 year old girls offering a choice of bivalent or quadrivalent vaccine free of charge. In 2015, the programme was changed offering the bivalent vaccine only to 11-13 year old girls. The aim of this study was to evaluate the HPV vaccination coverage, to assess the impact of age target changes and compare vaccination coverage to other European countries. Anonymous HPV vaccination records consisting of individual vaccine doses obtained free of charge in pharmacies between 2008 and 2016 were extracted from the Luxembourgish Social Security database. Additional aggregate tables by nationality and municipality were analysed. Of the target cohort of 39,610 girls born between 1991 and 2003 residing in Luxembourg, 24,550 (62.0%) subjects obtained at least one dose, 22,082 (55.7%) obtained at least two doses, and 17,197 (43.4%) obtained three doses of HPV vaccine. The mean age at first dose was 13.7 years during 2008-14 and 12.7 years in 2016 after the age target change. Coverage varied significantly by nationality (p < 0.0001): Portuguese (80%), former Yugoslavs (74%), Luxembourgish (54%), Belgian (52%), German (47%), French (39%) and other nationalities (51%). Coverage varied also by geographical region, with lower rates (<50%) noted in some Northern and Central areas of Luxembourg (range: 38% to 78%). Overall HPV vaccination coverage in Luxembourg is moderate and varied by nationality and region. The policy changes in 2015 did not have a substantial impact except lowering age at initiating vaccination. Options to improve coverage deserve further investigation. Copyright © 2018 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Country-level predictors of vaccination coverage and inequalities in Gavi-supported countries.

PubMed

Arsenault, Catherine; Johri, Mira; Nandi, Arijit; Mendoza Rodríguez, José M; Hansen, Peter M; Harper, Sam

2017-04-25

Important inequalities in childhood vaccination coverage persist between countries and population groups. Understanding why some countries achieve higher and more equitable levels of coverage is crucial to redress these inequalities. In this study, we explored the country-level determinants of (1) coverage of the third dose of diphtheria-tetanus-pertussis- (DTP3) containing vaccine and (2) within-country inequalities in DTP3 coverage in 45 countries supported by Gavi, the Vaccine Alliance. We used data from the most recent Demographic and Health Surveys (DHS) conducted between 2005 and 2014. We measured national DTP3 coverage and the slope index of inequality in DTP3 coverage with respect to household wealth, maternal education, and multidimensional poverty. We collated data on country health systems, health financing, governance and geographic and sociocultural contexts from published sources. We used meta-regressions to assess the relationship between these country-level factors and variations in DTP3 coverage and inequalities. To validate our findings, we repeated these analyses for coverage with measles-containing vaccine (MCV). We found considerable heterogeneity in DTP3 coverage and in the magnitude of inequalities across countries. Results for MCV were consistent with those from DTP3. Political stability, gender equality and smaller land surface were important predictors of higher and more equitable levels of DTP3 coverage. Inequalities in DTP3 coverage were also lower in countries receiving more external resources for health, with lower rates of out-of-pocket spending and with higher national coverage. Greater government spending on heath and lower linguistic fractionalization were also consistent with better vaccination outcomes. Improving vaccination coverage and reducing inequalities requires that policies and programs address critical social determinants of health including geographic and social exclusion, gender inequality and the availability of financial protection for health. Further research should investigate the mechanisms contributing to these associations. Copyright © 2017 Elsevier Ltd. All rights reserved.

Innovations in adult influenza vaccination in China, 2014-2015: Leveraging a chronic disease management system in a community-based intervention.

PubMed

Yi, Bo; Zhou, Suizan; Song, Ying; Chen, Enfu; Lao, Xuyin; Cai, Jian; Greene, Carolyn M; Feng, Luzhao; Zheng, Jiandong; Yu, Hongjie; Dong, Hongjun

2018-04-03

To evaluate a community-based intervention that leveraged the non-communicable disease management system to increase seasonal influenza vaccination coverage among older adults in Ningbo, China. From October 2014 - March 2015, we piloted the following on one street in Ningbo, China: educating community healthcare workers (C-HCWs) about influenza and vaccination; requiring C-HCWs to recommend influenza vaccination to older adults during routine chronic disease follow-up; and opening 14 additional temporary vaccination clinics. We selected a non-intervention street for comparison pre- and post-intervention vaccine coverage. In April 2016, we interviewed a random sample of unvaccinated older adults on the intervention street to ask why they remained unvaccinated. Pre-intervention influenza vaccine coverage among adults aged 60 years and older on both streets was 0.3%. Post-intervention, coverage among adults 60 years and older was 19% (1338/7013) on the intervention street and 0.4% (20/5500) on the non-intervention street (p<0.01). Among vaccinated older adults, 98% reported their main reason for vaccination was receiving a C-HCW's recommendation, 90% were vaccinated at temporary vaccination clinics, and 53% paid for vaccine (10 USD) out-of-pocket. Reasons for not getting vaccinated among 150 unvaccinated adults (response rate = 75%) included: good health (39%); not trusting C-HCWs' recommendations (24%); not knowing where to get vaccinated (17%); and not wanting to pay (9%). Recommending influenza vaccination within a non-communicable disease management system, combined with adding vaccination sites, increased vaccine coverage among older adults in Ningbo, China.

Vaccination coverage and out-of-sequence vaccinations in rural Guinea-Bissau: an observational cohort study

PubMed Central

Hornshøj, Linda; Benn, Christine Stabell; Fernandes, Manuel; Rodrigues, Amabelia; Aaby, Peter; Fisker, Ane Bærent

2012-01-01

Objective The WHO aims for 90% coverage of the Expanded Program on Immunization (EPI), which in Guinea-Bissau included BCG vaccine at birth, three doses of diphtheria−tetanus−pertussis vaccine (DTP) and oral polio vaccine (OPV) at 6, 10 and 14 weeks and measles vaccine (MV) at 9 months when this study was conducted. The WHO assesses coverage by 12 months of age. The sequence of vaccines may have an effect on child mortality, but is not considered in official statistics or assessments of programme performance. We assessed vaccination coverage and frequency of out-of-sequence vaccinations by 12 and 24 months of age. Design Observational cohort study. Setting and participants The Bandim Health Project's (BHP) rural Health and Demographic Surveillance site covers 258 randomly selected villages in all regions of Guinea-Bissau. Villages are visited biannually and vaccination cards inspected to ascertain vaccination status. Between 2003 and 2009 vaccination status by 12 months of age was assessed for 5806 children aged 12–23 months; vaccination status by 24 months of age was assessed for 3792 children aged 24–35 months. Outcome measures Coverage of EPI vaccinations and frequency of out-of-sequence vaccinations. Results Half of 12-month-old children and 65% of 24-month-old children had completed all EPI vaccinations. Many children received vaccines out of sequence: by 12 months of age 54% of BCG-vaccinated children had received DTP with or before BCG and 28% of measles-vaccinated children had received DTP with or after MV. By 24 months of age the proportion of out-of-sequence vaccinations was 58% and 35%, respectively, for BCG and MV. Conclusions In rural Guinea-Bissau vaccination coverage by 12 months of age was low, but continued to increase beyond 12 months of age. More than half of all children received vaccinations out of sequence. This highlights the need to improve vaccination services. PMID:23166127

Beyond new vaccine introduction: the uptake of pneumococcal conjugate vaccine in the African Region.

PubMed

Olayinka, Folake; Ewald, Leah; Steinglass, Robert

2017-01-01

The number of vaccines available to low-income countries has increased dramatically over the last decade. Overall infant immunization coverage in the WHO African region has stagnated in the past few years while countries' ability to maintain high immunization coverage rates following introduction of new vaccines has been uneven. This case study examines post-introduction coverage among African countries that introduced PCV between 2008 and 2013 and the factors affecting Pneumococcal Conjugate Vaccine (PCV) introduction. Nearly one-third of countries did not achieve 80% infant PCV3 coverage by two years post-introduction and 58% of countries experienced a decline in coverage between post introduction years two and four. Major factors affecting coverage rates included introduction without adequate preparation, insufficient supply chain capacity and management, poor communication between organizations and with the public, and data collection systems that were insufficient to meet information needs. Deliberately addressing these issues as well as longstanding weaknesses during new vaccine introduction can strengthen the immunization and broader health system. Further study is required to identify and address factors that affect maintenance of high coverage following introduction of new vaccines in the African region. Immunization with PCV is one of the most important interventions protecting against pneumonia, the second leading cause of death for children under five globally.

Correlates of human papillomavirus vaccine coverage: a state-level analysis.

PubMed

Moss, Jennifer L; Reiter, Paul L; Brewer, Noel T

2015-02-01

We tested the hypothesis that states with higher rates of cancers associated with human papillomavirus (HPV) would have lower HPV vaccine coverage. We gathered state-level data on HPV-related cancer rates and HPV vaccine initiation coverage for girls and boys, separately, and HPV vaccine follow-through (i.e., receipt of 3 doses among those initiating the series) for girls only. In addition, we gathered state-level data on demographic composition and contact with the health care system. We calculated Pearson correlations for these ecological relationships. Human papillomavirus vaccine initiation among girls was lower in states with higher levels of cervical cancer incidence and mortality (r = -0.29 and -0.46, respectively). In addition, vaccine follow-through among girls was lower in states with higher levels of cervical cancer mortality (r = -0.30). Other cancer rates were associated with HPV vaccine initiation and follow-through among girls, but not among boys. Human papillomavirus vaccine initiation among girls was lower in states with higher proportions of non-Hispanic black residents and lower proportions of higher-income residents. Human papillomavirus vaccine follow-through was higher in states with greater levels of adolescents' contact with the health care system. Human papillomavirus vaccine coverage for girls was lower in states with higher HPV-related cancer rates. Public health efforts should concentrate on geographic areas with higher cancer rates. Strengthening adolescent preventive health care use may be particularly important to increase vaccine follow-through. Cost-effectiveness analyses may overestimate the benefits of current vaccination coverage and underestimate the benefits of increasing coverage.

Essential health care among Mexican indigenous people in a universal coverage context.

PubMed

Servan-Mori, Edson; Pelcastre-Villafuerte, Blanca; Heredia-Pi, Ileana; Montoya-Rodríguez, Arain

2014-01-01

To analyze the influence of indigenous condition on essential health care among Mexican children, older people and women in reproductive age. The influence of indigenous condition on the probability of receiving medical care due to acute respiratory infection (ARI) and acute diarrheal disease (ADD), vaccination coverage; and antenatal care (ANC) was analyzed using the 2012 National Health Survey and non-experimental matching methods. Indigenous condition does not influence per-se vaccination coverage (in < 1 year), probability of attention of ARI's and ADD's as well as, timely, frequent, and quality ANC. Being indigenous and older adult increases 9% the probability of receiving a fulfilled vaccination schedule. Unfavorable structural conditions in which Mexican indigenous live constitutes the persistent mechanisms of their health vulnerability. Public policy should consider this level of intervention, in a way that intensive and focalized health strategies contribute to improve their health condition and life.

Effects of the introduction of new vaccines in Guinea-Bissau on vaccine coverage, vaccine timeliness, and child survival: an observational study.

PubMed

Fisker, Ane B; Hornshøj, Linda; Rodrigues, Amabelia; Balde, Ibraima; Fernandes, Manuel; Benn, Christine S; Aaby, Peter

2014-08-01

In 2008, the GAVI Alliance funded the introduction of new vaccines (including pentavalent diphtheria-tetanus-pertussis [DTP] plus hepatitis B and Haemophilus influenzae type b antigens) in Guinea-Bissau. The introduction was accompanied by increased vaccination outreach services and a more restrictive wastage policy, including only vaccinating children younger than 12 months. We assessed coverage of all vaccines in the Expanded Program on Immunizations before and after the new vaccines' introduction, and the implications on child survival. This observational cohort study used data from the Bandim Health Project, which has monitored vaccination status and mortality in randomly selected village clusters in Guinea-Bissau since 1990. We assessed the change in vaccination coverage using cohort data from children born in 2007 and 2009; analysed the proportion of children who received measles vaccine after 12 months of age using data from 1999-2006; and compared child mortality after age 12 months in children who had received measles vaccine and those who had not using data from 1999 to 2006. The proportion of children who were fully vaccinated by 12 months of age was 53% (468 of 878) in the 2007 cohort and 53% (467 of 879) in the 2009 cohort (relative risk [RR] 1·00, 95% CI 0·89-1·11). Coverage of DTP-3 and pentavalent-3 increased from 73% (644 of 878) in 2007 to 81% (712 of 879) in 2009 (RR 1·10, 95% CI 1·04 -1·17); by contrast, the coverage of measles vaccination declined from 71% (620 of 878) to 66% (577 of 879; RR 0·93, 0·85-1·01). The effect of the changes was significantly different for DTP-3 coverage compared with measles vaccine coverage (p=0·002). After 12 months of age, the adjusted mortality rate ratio was 0·71 (95% CI 0·56-0·90) for children who had received measles vaccine compared with those who had not (0·59 [0·43-0·80] for girls and 0·87 [0·62-1·23] for boys). The introduction of the new vaccination programme in 2008 was associated with increased coverage of DTP, but decreased coverage of measles vaccine. In 1999-2006, child mortality was higher in children who had not received measles vaccine than in those who had. DANIDA, European Research Council, the Danish Independent Research Council, European Union FP7 via OPTIMUNISE, and Danish National Research Foundation. Copyright © 2014 Fisker et al. Open Access article distributed under the terms of CC BY. Published by .. All rights reserved.

Pneumococcal Transmission and Disease In Silico: A Microsimulation Model of the Indirect Effects of Vaccination

PubMed Central

Nurhonen, Markku; Cheng, Allen C.; Auranen, Kari

2013-01-01

Background The degree and time frame of indirect effects of vaccination (serotype replacement and herd immunity) are key determinants in assessing the net effectiveness of vaccination with pneumococcal conjugate vaccines (PCV) in control of pneumococcal disease. Using modelling, we aimed to quantify these effects and their dependence on coverage of vaccination and the vaccine's efficacy against susceptibility to pneumococcal carriage. Methods and Findings We constructed an individual-based simulation model that explores the effects of large-scale PCV programmes and applied it in a developed country setting (Finland). A population structure with transmission of carriage taking place within relevant mixing groups (families, day care groups, schools and neighbourhoods) was considered in order to properly assess the dependency of herd immunity on coverage of vaccination and vaccine efficacy against carriage. Issues regarding potential serotype replacement were addressed by employing a novel competition structure between multiple pneumococcal serotypes. Model parameters were calibrated from pre-vaccination data about the age-specific carriage prevalence and serotype distribution. The model predicts that elimination of vaccine-type carriage and disease among those vaccinated and, due to a substantial herd effect, also among the general population takes place within 5–10 years since the onset of a PCV programme with high (90%) coverage of vaccination and moderate (50%) vaccine efficacy against acquisition of carriage. A near-complete replacement of vaccine-type carriage by non-vaccine-type carriage occurs within the same time frame. Conclusions The changed patterns in pneumococcal carriage after PCV vaccination predicted by the model are unequivocal. The overall effect on disease incidence depends crucially on the magnitude of age- and serotype-specific case-to-carrier ratios of the remaining serotypes relative to those of the vaccine types. Thus the availability of reliable data on the incidence of both pneumococcal carriage and disease is essential in assessing the net effectiveness of PCV vaccination in a given epidemiological setting. PMID:23457504

Vaccine coverage and determinants of incomplete vaccination in children aged 12-23 months in Dschang, West Region, Cameroon: a cross-sectional survey during a polio outbreak.

PubMed

Russo, Gianluca; Miglietta, Alessandro; Pezzotti, Patrizio; Biguioh, Rodrigue Mabvouna; Bouting Mayaka, Georges; Sobze, Martin Sanou; Stefanelli, Paola; Vullo, Vincenzo; Rezza, Giovanni

2015-07-10

Inadequate immunization coverage with increased risk of vaccine preventable diseases outbreaks remains a problem in Africa. Moreover, different factors contribute to incomplete vaccination status. This study was performed in Dschang (West Region, Cameroon), during the polio outbreak occurred in October 2013, in order to estimate the immunization coverage among children aged 12-23 months, to identify determinants for incomplete vaccination status and to assess the risk of poliovirus spread in the study population. A cross-sectional household survey was conducted in November-December 2013, using the WHO two-stage sampling design. An interviewer-administered questionnaire was used to obtain information from consenting parents of children aged 12-23 months. Vaccination coverage was assessed by vaccination card and parents' recall. Chi-square test and multilevel logistic regression model were used to identify the determinants of incomplete immunization status. Statistical significance was set at p < 0.05. Overall, 3248 households were visited and 502 children were enrolled. Complete immunization coverage was 85.9% and 84.5%, according to card plus parents' recall and card only, respectively. All children had received at least one routine vaccination, the OPV-3 (Oral Polio Vaccine) coverage was >90%, and 73.4% children completed the recommended vaccinations before 1-year of age. In the final multilevel logistic regression model, factors significantly associated with incomplete immunization status were: retention of immunization card (AOR: 7.89; 95% CI: 1.08-57.37), lower mothers' utilization of antenatal care (ANC) services (AOR:1.25; 95% CI: 1.07-63.75), being the ≥ 3(rd) born child in the family (AOR: 425.4; 95% CI: 9.6-18,808), younger mothers' age (AOR: 49.55; 95% CI: 1.59-1544), parents' negative attitude towards immunization (AOR: 20.2; 95% CI: 1.46-278.9), and poorer parents' exposure to information on vaccination (AOR: 28.07; 95 % CI: 2.26-348.1). Longer distance from the vaccination centers was marginally significant (p = 0.05). Vaccination coverage was high; however, 1 out of 7 children was partially vaccinated, and 1 out of 4 did not complete timely the recommended vaccinations. In order to improve the immunization coverage, it is necessary to strengthen ANC services, and to improve parents' information and attitude towards immunization, targeting younger parents and families living far away from vaccination centers, using appropriate communication strategies. Finally, the estimated OPV-3 coverage is reassuring in relation to the ongoing polio outbreak.

Assessment of eight HPV vaccination programs implemented in lowest income countries

PubMed Central

2012-01-01

Background Cervix cancer, preventable, continues to be the third most common cancer in women worldwide, especially in lowest income countries. Prophylactic HPV vaccination should help to reduce the morbidity and mortality associated with cervical cancer. The purpose of the study was to describe the results of and key concerns in eight HPV vaccination programs conducted in seven lowest income countries through the Gardasil Access Program (GAP). Methods The GAP provides free HPV vaccine to organizations and institutions in lowest income countries. The HPV vaccination programs were entirely developed, implemented and managed by local institutions. Institutions submitted application forms with institution characteristics, target population, communication delivery strategies. After completion of the vaccination campaign (3 doses), institutions provided a final project report with data on doses administered and vaccination models. Two indicators were calculated, the program vaccination coverage and adherence. Qualitative data were also collected in the following areas: government and community involvement; communication, and sensitization; training and logistics resources, and challenges. Results A total of eight programs were implemented in seven countries. The eight programs initially targeted a total of 87,580 girls, of which 76,983 received the full 3-dose vaccine course, with mean program vaccination coverage of 87.8%; the mean adherence between the first and third doses of vaccine was 90.9%. Three programs used school-based delivery models, 2 used health facility-based models, and 3 used mixed models that included schools and health facilities. Models that included school-based vaccination were most effective at reaching girls aged 9-13 years. Mixed models comprising school and health facility-based vaccination had better overall performance compared with models using just one of the methods. Increased rates of program coverage and adherence were positively correlated with the number of vaccination sites. Qualitative key insights from the school models showed a high level of coordination and logistics to facilitate vaccination administration, a lower risk of girls being lost to follow-up and vaccinations conducted within the academic year limit the number of girls lost to follow-up. Conclusion Mixed models that incorporate both schools and health facilities appear to be the most effective at delivering HPV vaccine. This study provides lessons for development of public health programs and policies as countries go forward in national decision-making for HPV vaccination. PMID:22621342

Association between mothers’ screening uptake and daughters’ HPV vaccination: a quasi-experimental study on the effect of an active invitation campaign

PubMed Central

Baldacchini, Flavia; Campari, Cinzia; Perilli, Cinzia; Pascucci, Maria Grazia; Finarelli, Alba Carola; Moscara, Luigi; Rossi, Paolo Giorgi

2017-01-01

Objectives In Emilia-Romagna, the Human Papillomavirus (HPV) vaccination campaign started in 2008 offering free vaccines for 1996 and 1997 cohorts. Systematic active invitation was implemented for the 1997 cohort. Our study aimed at measuring the impact of the active invitation campaign on HPV vaccine coverage and on coverage inequalities in 11-year-old girls. Second, we evaluated the effect of the HPV vaccination campaign on participation in cervical cancer screening by mothers of target girls. Methods We collected information on vaccination status for girls residing in Reggio Emilia in 2008 and mothers’ screening history, before and after the 2008 vaccination campaign. Log-binomial regression models were performed to estimate Relative Risk (RR) and 95% confidence intervals (CIs) of being vaccinated as regarded citizenship, siblings, mothers’ education, marital status and screening history, stratified by birth cohort. We also calculated RR of receiving a Pap test after the vaccination campaign as regarded education, daughter’s cohort and mothers’ decision to have their daughter vaccinated. Interaction between education and cohort in mothers overdue for Pap testing was calculated. Results Vaccination coverage was 46.3% for the uninvited cohort (1046/2260) and 77.9% for the invited cohort (1798/2307). In the uninvited cohort, daughters’ vaccination showed association with mothers’ education (8 to 11 years of education vs. graduated mothers, RR 1.61 95% CI 1.14–2.28), citizenship (foreigners vs. Italians, RR 0.45 95% CI 0.37–0.56) and screening history (regular vs. non-participant; RR 1.72 95% CI 1.26–2.36). In the invited cohort, only a slight association with screening history persisted (regular vs. non-participant; RR 1.20 95% CI 1.04–1.40). Highly educated under-screened mothers of the invited cohort showed a higher probability of receiving a Pap test after the vaccination campaign period (RR 1.27 95% CI 1.04–1.56) compared with those not invited, Conclusion Active invitation could increase overall HPV immunisation coverage and reduce socio-demographic inequalities and the association with mothers’ screening participation. PMID:28951407

Human papillomavirus vaccination coverage among females and males, National Health and Nutrition Examination Survey, United States, 2007-2016.

PubMed

Lewis, Rayleen M; Markowitz, Lauri E

2018-05-03

Human papillomavirus (HPV) vaccination has been routinely recommended at age 11-12 years in the United States for females since 2006 and males since 2011. Coverage can be estimated using self/parent-reported HPV vaccination collected in the National Health and Nutrition Examination Survey (NHANES) for a wider age range than other national surveys. We assessed vaccination coverage in 2015-2016, temporal trends by age, and the validity of self/parent-reported vaccination status. Participants aged 9-59 years completed an interview collecting demographic and vaccination information. Weighted coverage was estimated for two-year NHANES cycles by age group for 2007-2008 to 2015-2016 for females (N = 14318) and 2011-2012 to 2015-2016 for males (N = 7847). Temporal trends in coverage were assessed from 2007-2008 to 2011-2012 for females and from 2011-2012 to 2015-2016 for both sexes. Sensitivity and specificity of self/parent-reported vaccination were assessed using provider-verified vaccination records from a pilot study in 14-29 year-olds. In 2015-2016, ≥1 dose coverage among females was highest in 14-19 (54.7%) and 20-24 (56.0%) year-olds and lower in successively older age groups. Among males, ≥1 dose coverage was highest in 14-19 year-olds (39.5%) and lower at older ages. Coverage was similar in 9-13 year-old females and males. Between 2007-2008 and 2011-2012, there were increases among females younger than 30 years. Between 2011-2012 and 2015-2016, there were increases among female age groups including 20-39 year-olds; male coverage increased among ages 9-13, 14-19, and 20-24 years. Self/parent-reported receipt of ≥1 dose had a sensitivity and specificity of 87.0% and 83.3%. Performance was lower for 3 doses. While overall HPV vaccination coverage remains low, it is higher in females than males, except in 9-13 year-olds. There have been increases in coverage among many age groups, but coverage has stalled in younger females. Adequate validity was demonstrated for self/parent-reported vaccination of ≥1 dose, but not 3 doses, in a pilot study. Copyright © 2018 Elsevier Ltd. All rights reserved.

Uniqueness of Nash equilibrium in vaccination games.

PubMed

Bai, Fan

2016-12-01

One crucial condition for the uniqueness of Nash equilibrium set in vaccination games is that the attack ratio monotonically decreases as the vaccine coverage level increasing. We consider several deterministic vaccination models in homogeneous mixing population and in heterogeneous mixing population. Based on the final size relations obtained from the deterministic epidemic models, we prove that the attack ratios can be expressed in terms of the vaccine coverage levels, and also prove that the attack ratios are decreasing functions of vaccine coverage levels. Some thresholds are presented, which depend on the vaccine efficacy. It is proved that for vaccination games in homogeneous mixing population, there is a unique Nash equilibrium for each game.

Journey to vaccination: a protocol for a multinational qualitative study.

PubMed

Wheelock, Ana; Miraldo, Marisa; Parand, Anam; Vincent, Charles; Sevdalis, Nick

2014-01-31

In the past two decades, childhood vaccination coverage has increased dramatically, averting an estimated 2-3 million deaths per year. Adult vaccination coverage, however, remains inconsistently recorded and substandard. Although structural barriers are known to limit coverage, social and psychological factors can also affect vaccine uptake. Previous qualitative studies have explored beliefs, attitudes and preferences associated with seasonal influenza (flu) vaccination uptake, yet little research has investigated how participants' context and experiences influence their vaccination decision-making process over time. This paper aims to provide a detailed account of a mixed methods approach designed to understand the wider constellation of social and psychological factors likely to influence adult vaccination decisions, as well as the context in which these decisions take place, in the USA, the UK, France, India, China and Brazil. We employ a combination of qualitative interviewing approaches to reach a comprehensive understanding of the factors influencing vaccination decisions, specifically seasonal flu and tetanus. To elicit these factors, we developed the journey to vaccination, a new qualitative approach anchored on the heuristics and biases tradition and the customer journey mapping approach. A purposive sampling strategy is used to select participants who represent a range of key sociodemographic characteristics. Thematic analysis will be used to analyse the data. Typical journeys to vaccination will be proposed. Vaccination uptake is significantly influenced by social and psychological factors, some of which are under-reported and poorly understood. This research will provide a deeper understanding of the barriers and drivers to adult vaccination. Our findings will be published in relevant peer-reviewed journals and presented at academic conferences. They will also be presented as practical recommendations at policy and industry meetings and healthcare professionals' forums. This research was approved by relevant local ethics committees.

Human papillomavirus (HPV) vaccination coverage in young Australian women is higher than previously estimated: independent estimates from a nationally representative mobile phone survey.

PubMed

Brotherton, Julia M L; Liu, Bette; Donovan, Basil; Kaldor, John M; Saville, Marion

2014-01-23

Accurate estimates of coverage are essential for estimating the population effectiveness of human papillomavirus (HPV) vaccination. Australia has a purpose built National HPV Vaccination Program Register for monitoring coverage, however notification of doses administered to young women in the community during the national catch-up program (2007-2009) was not compulsory. In 2011, we undertook a population-based mobile phone survey of young women to independently estimate HPV vaccination coverage. Randomly generated mobile phone numbers were dialed to recruit women aged 22-30 (age eligible for HPV vaccination) to complete a computer assisted telephone interview. Consent was sought to validate self reported HPV vaccination status against the national register. Coverage rates were calculated based on self report and weighted to the age and state of residence structure of the Australian female population. These were compared with coverage estimates from the register using Australian Bureau of Statistics estimated resident populations as the denominator. Among the 1379 participants, the national estimate for self reported HPV vaccination coverage for doses 1/2/3, respectively, weighted for age and state of residence, was 64/59/53%. This compares with coverage of 55/45/32% and 49/40/28% based on register records, using 2007 and 2011 population data as the denominators respectively. Some significant differences in coverage between the states were identified. 20% (223) of women returned a consent form allowing validation of doses against the register and provider records: among these women 85.6% (538) of self reported doses were confirmed. We confirmed that coverage rates for young women vaccinated in the community (at age 18-26 years) are underestimated by the national register and that under-notification is greater for second and third doses. Using 2011 population estimates, rather than estimates contemporaneous with the program rollout, reduces register-based coverage estimates further because of large population increases due to immigration since the program. Copyright © 2013 Elsevier Ltd. All rights reserved.

Vaccination coverage according to doses received and timely administered based on an electronic immunization registry, Araraquara-SP, Brazil, 2012-2014.

PubMed

Tauil, Márcia de Cantuária; Sato, Ana Paula Sayuri; Costa, Ângela Aparecida; Inenami, Marta; Ferreira, Vinícius Leati de Rossi; Waldman, Eliseu Alves

2017-01-01

to describe vaccine coverage by type of vaccine at 12 and 24 months of age. descriptive cohort study with children born in 2012, living in Araraquara-SP, Brazil, recorded in the Information System on Live Births (Sinasc); a manual linkage of Sinasc data with an electronic immunization registry (EIR) was performed; the assessment was based on vaccination status according to São Paulo State recommendations, and on doses received and timely administered. 2,740 children were registered on Sinasc and 99.6% of them were included into EIR; among the 2,612 (95.3%) children studied, the triple viral vaccine (measles, mumps and rubella) had the lowest coverage at 12 months for received dose (74.8%) and at 24 months for timely vaccination (53.5%) and received doses (88.0%). coverage was higher than 90% for most vaccines; however, delayed vaccination was observed, which indicates the need to intensify actions aimed at timely vaccination.

Health professionals in the process of vaccination against hepatitis B in two basic units of Belo Horizonte: a qualitative evaluation.

PubMed

Lages, Annelisa Santos; França, Elisabeth Barboza; Freitas, Maria Imaculada de Fátima

2013-06-01

According to the Vaccine Coverage Survey, performed in 2007, the immunization coverage against hepatitis B in Belo Horizonte, for infants under one year old, was below the level proposed by the Brazilian National Program of Immunization. This vaccine was used as basis for evaluating the involvement of health professionals in the process of vaccination in two Basic Health Units (UBS, acronym in Portuguese) in the city. This study is qualitative and uses the notions of Social Representations Theory and the method of Structural Analysis of Narrative to carry out the interviews and data analysis. The results show flaws related to controlling and use of the mirror card and the parent orientation, and also the monitoring of vaccination coverage (VC) and use of VC data as input for planning health actions. It was observed that the working process in the UBS is focused on routine tasks, with low creativity of the professionals, which includes representations that maintain strong tendency to value activities focused on the health of individuals to the detriment of public health actions. In conclusion, the vaccination process fault can be overcome with a greater appreciation of everyday actions and with a much better use of local information about vaccination, and some necessary adjustments within the UBS to improve public health actions.

Global threshold dynamics of an SIVS model with waning vaccine-induced immunity and nonlinear incidence.

PubMed

Yang, Junyuan; Martcheva, Maia; Wang, Lin

2015-10-01

Vaccination is the most effective method of preventing the spread of infectious diseases. For many diseases, vaccine-induced immunity is not life long and the duration of immunity is not always fixed. In this paper, we propose an SIVS model taking the waning of vaccine-induced immunity and general nonlinear incidence into consideration. Our analysis shows that the model exhibits global threshold dynamics in the sense that if the basic reproduction number is less than 1, then the disease-free equilibrium is globally asymptotically stable implying the disease dies out; while if the basic reproduction number is larger than 1, then the endemic equilibrium is globally asymptotically stable indicating that the disease persists. This global threshold result indicates that if the vaccination coverage rate is below a critical value, then the disease always persists and only if the vaccination coverage rate is above the critical value, the disease can be eradicated. Copyright © 2015 Elsevier Inc. All rights reserved.

Vaccination coverage survey versus administrative data in the assessment of mass yellow fever immunization in internally displaced persons--Liberia, 2004.

PubMed

Huhn, Gregory D; Brown, Jennifer; Perea, William; Berthe, Adama; Otero, Hansel; LiBeau, Genevieve; Maksha, Nuhu; Sankoh, Mohammed; Montgomery, Susan; Marfin, Anthony; Admassu, Mekonnen

2006-02-06

Yellow fever (YF) is a mosquito-borne vaccine-preventable disease with high mortality. In West Africa, low population immunity increases the risk of epidemic transmission. A cluster survey was conducted to determine the effectiveness of a mass immunization campaign using 17D YF vaccine in internally displaced person (IDP) camps following a reported outbreak of YF in Liberia in February 2004. Administrative data of vaccination coverage were reviewed. A cluster sample size was determined among 17,384 shelters using an 80% vaccination coverage threshold. A questionnaire eliciting demographic information, household size, and vaccination status was distributed to randomly selected IDPs. Data were analyzed to compare vaccination coverage rates of administrative versus survey data. Among 87,000 persons estimated living in IDP camps, administrative data recorded 49,395 (57%) YF vaccinated persons. A total of 237 IDPs were surveyed. Of survey respondents, 215 (91.9%, 95% CI 88.4-95.4) reported being vaccinated during the campaign and 196 (83.5%, 95% CI 78.6-88.5) possessed a valid campaign vaccination card. The median number of IDPs living in a shelter was 4 (range, 1-8) and 69,536 persons overall were estimated to be living in IDP camps. Coverage rates from a rapid survey exceeded 90% by self-report and 80% by evidence of a vaccination card, indicating that the YF immunization campaign was effective. Survey results suggested that administrative data overestimated the camp population by at least 20%. An emergency, mop-up vaccination campaign was avoided. Coverage surveys can be vital in the evaluation of emergency vaccination campaigns by influencing both imminent and future immunization strategies.

Evaluation of pneumococcal and influenza vaccination coverage in rheumatology patients receiving biological therapy in a regional referral hospital.

PubMed

Fernández-Prada, María; Brandy-García, Anahy María; Rodríguez-Fonseca, Omar Darío; Huerta-González, Ismael; Fernández-Noval, Federico; Martínez-Ortega, Carmen

2018-05-08

Vaccination coverage for seasonal influenza and pneumococcus in rheumatology patients receiving biological treatment. To identify variables that predict vaccination adherence. Descriptive cross-sectional study. The study involved rheumatology patients who initiated biological therapy between 01/01/2016 and 12/31/2016 in a regional referral hospital. Variables included sociodemographic information, diagnostic data, treating physician, referral to the vaccine unit and vaccination against pneumococcus with 13-valent pneumococcal conjugate vaccine (PCV13) and 23-valent pneumococcal polysaccharide vaccine (PPSV23), as well as seasonal influenza (2016/17). Univariate, bivariate (Chi-square) and multivariate analysis (logistic regression) were performed. The differences were considered significant (P<.05) and the PASW v.18 software package was used. In all, 222 patients were included. Vaccination coverage was: PCV13, 80.2%; PPSV23, 77.9%; influenza 2016/17, 78.8%; PCV13+PPSV23, 75.2%; PCV13+PPSV23+influenza 2016/17, 68.9%. Axial spondylitis had the highest coverage (>80%) for pneumococcal vaccination and combination of pneumococcal with influenza. Overall, 27% of the patients were not referred to the unit. The treating physician was associated with statistical significance in each vaccine alone or combined, but referral to the vaccine unit was independently associated with the highest vaccination coverage (P<.001) in all cases. Compared to the scientific literature, we consider that the coverage of our patients against pneumococcus and influenza is high. Referral of these patients to the vaccine unit is the key to guarantee a correct immunization and to minimize some of the possible infectious adverse effects of biological therapies. Copyright © 2018 Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. Publicado por Elsevier España, S.L.U. All rights reserved.

The estimated impact of human papillomavirus vaccine coverage on the lifetime cervical cancer burden among girls currently aged 12 years and younger in the United States.

PubMed

Chesson, Harrell W; Ekwueme, Donatus U; Saraiya, Mona; Dunne, Eileen F; Markowitz, Lauri E

2014-11-01

Using a previously published dynamic model, we illustrate the potential benefits of human papillomavirus vaccination among girls currently 12 years or younger in the United States. Increasing vaccine coverage of young girls to 80% would avert 53,300 lifetime cervical cancer cases versus 30% coverage and 28,800 cases versus 50% coverage.

Enabling skin vaccination using new delivery technologies

PubMed Central

Kim, Yeu-Chun; Prausnitz, Mark R.

2011-01-01

The skin is known to be a highly immunogenic site for vaccination, but few vaccines in clinical use target skin largely because conventional intradermal injection is difficult and unreliable to perform. Now, a number of new or newly adapted delivery technologies have been shown to administer vaccine to the skin either by non-invasive or minimally invasive methods. Non-invasive methods include high-velocity powder and liquid jet injection, as well as diffusion-based patches in combination with skin abrasion, thermal ablation, ultrasound, electroporation, and chemical enhancers. Minimally invasive methods are generally based on small needles, including solid microneedle patches, hollow microneedle injections, and tattoo guns. The introduction of these advanced delivery technologies can make the skin a site for simple, reliable vaccination that increases vaccine immunogenicity and offers logistical advantages to improve the speed and coverage of vaccination. PMID:21799951

Enabling skin vaccination using new delivery technologies

PubMed Central

Kim, Yeu-Chun; Prausnitz, Mark R.

2011-01-01

The skin is known to be a highly immunogenic site for vaccination, but few vaccines in clinical use target skin largely because conventional intradermal injection is difficult and unreliable to perform. Now, a number of new or newly adapted delivery technologies have been shown to administer vaccine to the skin either by non-invasive or minimally invasive methods. Non-invasive methods include high-velocity powder and liquid jet injection, as well as diffusion-based patches in combination with skin abrasion, thermal ablation, ultrasound, electroporation, and chemical enhancers. Minimally invasive methods are generally based on small needles, including solid microneedle patches, hollow microneedle injections and tattoo guns. The introduction of these advanced delivery technologies can make the skin a site for simple, reliable vaccination that increases vaccine immunogenicity and offers logistical advantages to improve the speed and coverage of vaccination. PMID:21472533

Print News Coverage of School-Based HPV Vaccine Mandate

PubMed Central

Casciotti, Dana; Smith, Katherine C.; Andon, Lindsay; Vernick, Jon; Tsui, Amy; Klassen, Ann C.

2015-01-01

BACKGROUND In 2007, legislation was proposed in 24 states and the District of Columbia for school-based HPV vaccine mandates, and mandates were enacted in Texas, Virginia, and the District of Columbia. Media coverage of these events was extensive, and media messages both reflected and contributed to controversy surrounding these legislative activities. Messages communicated through the media are an important influence on adolescent and parent understanding of school-based vaccine mandates. METHODS We conducted structured text analysis of newspaper coverage, including quantitative analysis of 169 articles published in mandate jurisdictions from 2005-2009, and qualitative analysis of 63 articles from 2007. Our structured analysis identified topics, key stakeholders and sources, tone, and the presence of conflict. Qualitative thematic analysis identified key messages and issues. RESULTS Media coverage was often incomplete, providing little context about cervical cancer or screening. Skepticism and autonomy concerns were common. Messages reflected conflict and distrust of government activities, which could negatively impact this and other youth-focused public health initiatives. CONCLUSIONS If school health professionals are aware of the potential issues raised in media coverage of school-based health mandates, they will be more able to convey appropriate health education messages, and promote informed decision-making by parents and students. PMID:25099421

Universal Hepatitis B Vaccination Coverage in Children and Adolescents with Intellectual Disabilities

ERIC Educational Resources Information Center

Lin, Jin-Ding; Lin, Pei-Ying; Lin, Lan-Ping

2010-01-01

There is little information of hepatitis B vaccination coverage for people with intellectual disabilities (ID). The present paper aims to examine the completed hepatitis B vaccination coverage rate and its determinants of children and adolescents with ID in Taiwan. A cross-sectional questionnaire survey, with the entire response participants was…

Reactive strategies for containing developing outbreaks of pandemic influenza

PubMed Central

2011-01-01

Background In 2009 and the early part of 2010, the northern hemisphere had to cope with the first waves of the new influenza A (H1N1) pandemic. Despite high-profile vaccination campaigns in many countries, delays in administration of vaccination programs were common, and high vaccination coverage levels were not achieved. This experience suggests the need to explore the epidemiological and economic effectiveness of additional, reactive strategies for combating pandemic influenza. Methods We use a stochastic model of pandemic influenza to investigate realistic strategies that can be used in reaction to developing outbreaks. The model is calibrated to documented illness attack rates and basic reproductive number (R0) estimates, and constructed to represent a typical mid-sized North American city. Results Our model predicts an average illness attack rate of 34.1% in the absence of intervention, with total costs associated with morbidity and mortality of US$81 million for such a city. Attack rates and economic costs can be reduced to 5.4% and US$37 million, respectively, when low-coverage reactive vaccination and limited antiviral use are combined with practical, minimally disruptive social distancing strategies, including short-term, as-needed closure of individual schools, even when vaccine supply-chain-related delays occur. Results improve with increasing vaccination coverage and higher vaccine efficacy. Conclusions Such combination strategies can be substantially more effective than vaccination alone from epidemiological and economic standpoints, and warrant strong consideration by public health authorities when reacting to future outbreaks of pandemic influenza. PMID:21356128

Complete immunization coverage and its determinants among children in Malaysia: findings from the National Health and Morbidity Survey (NHMS) 2016.

PubMed

Lim, K K; Chan, Y Y; Noor Ani, A; Rohani, J; Siti Norfadhilah, Z A; Santhi, M R

2017-12-01

The success of the Expanded Program on Immunization among children will greatly reduce the burden of illness and disability from vaccine preventable diseases. The aim of the study was to evaluate the complete immunization coverage and its determinants among children aged 12-23 months in Malaysia. Cross-sectional study. Data on immunization were extracted from the 2016 National Health and Morbidity Survey. Complete immunization coverage was classified as received all recommended primary vaccine doses by the age of 12 months and verified by vaccination cards, and incompletely immunized if they received partially recommended vaccine dose or not received any recommended vaccine dose or had no vaccination card. The multiple logistic regression analyses were conducted to determine the sociodemographic factors associated with complete immunization coverage. The overall complete immunization coverage among children (verified by cards) was 86.4% (n = 8920, 95% confidence interval: 85.4-87.4). Multivariable logistic regression analyses model revealed that factors significantly associated with complete immunization coverage were ethnicity, occupation of the mother, head of household's education level, and head of household's occupation. While sex, citizenship, household income, mother's age, and marital status were not significantly associated with complete immunization coverage. According to the World Health Organization criteria, the present study demonstrated that the immunization coverage of 86.4% is still unsatisfactory. Thus, the current intervention program should be enhanced in order to achieve the 95% coverage for all antigens in the national vaccination program. Copyright © 2017 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

The role of television advertising in increasing pneumococcal vaccination coverage among the elderly, North Coast, New South Wales, 2006.

PubMed

Wallace, Cate; Corben, Paul; Turahui, John; Gilmour, Robin

2008-10-01

North Coast Area Health Service (NCAHS) conducted a seven week television advertising campaign to raise community awareness of the availability of free adult pneumococcal vaccination and to increase coverage among North Coast residents in high risk groups. Effectiveness of the campaign was evaluated by examining vaccine ordering patterns of North Coast vaccination providers from 2005/2006 as a proxy for vaccination coverage. In the months during and immediately following (June-September 2006) the advertising campaign, a significantly higher proportion of vaccines were despatched to North Coast immunisation service providers. The advertising campaign was an effective strategy to promote vaccination among NCAHS residents not immunised in the first year of the National Pneumococcal Program for Older Australians. This higher immunisation coverage is expected to contribute to the statewide trend of significant reductions in invasive pneumococcal disease (IPD) notifications.

Modeling Preventative Strategies against HPV-Related Disease in Developed Countries

PubMed Central

Canfell, Karen; Chesson, Harrell; Kulasingam, Shalini L.; Berkhof, Johannes; Diaz, Mireia; Kim, Jane J.

2013-01-01

Over the last five years, prophylactic vaccination against Human Papillomavirus (HPV) in pre-adolescent females has been introduced in most developed countries, supported by modeled evaluations which have almost universally found vaccination of pre-adolescent females to be cost-effective. Studies to date suggest that vaccination of pre-adolescent males may also be cost-effective at a cost per vaccinated individual ~US$400–500 if vaccination coverage in females cannot be increased above ~50%; but if it is possible, increasing coverage in females appears to be a better return on investment. Comparative evaluation of the quadrivalent (HPV16,18,6,11) and bivalent (HPV16,18) vaccines centers around the potential tradeoff between protection against anogenital warts and vaccine-specific levels of cross-protection against infections not targeted by the vaccines. Future evaluations will also need to consider the cost-effectiveness of a next generation nonavalent vaccine designed to protect against ~90% of cervical cancers. The timing of the effect of vaccination on cervical screening programs will be country-specific and will depend on vaccination catch-up age range and coverage and the age at which screening starts. Initial evaluations suggest that if screening remains unchanged it will be less cost-effective in vaccinated compared to unvaccinated women but, in the context of current vaccines, will remain an important prevention method. Comprehensive evaluation of new approaches to screening will need to consider the population-level effects of vaccination over time. New screening strategies of particular interest include delaying the start age of screening, increasing the screening interval and switching to primary HPV screening. Future evaluations of screening will also need to focus on the effects of disparities in screening and vaccination uptake, the potential effects of vaccination on screening participation, and the effects of imperfect compliance with screening recommendations. PMID:23199959

Annual public health and economic benefits of seasonal influenza vaccination: a European estimate.

PubMed

Preaud, Emmanuelle; Durand, Laure; Macabeo, Bérengère; Farkas, Norbert; Sloesen, Brigitte; Palache, Abraham; Shupo, Francis; Samson, Sandrine I

2014-08-07

Vaccination is currently the most effective means of preventing influenza infection. Yet evidence of vaccine performance, and the impact and value of seasonal influenza vaccination across risk groups and between seasons, continue to generate much discussion. Moreover, vaccination coverage is below recommended levels. A model was generated to assess the annual public health benefits and economic importance of influenza vaccination in 5 WHO recommended vaccination target groups (children 6 - 23 months of age; persons with underlying chronic health conditions; pregnant women; health care workers; and, the elderly, 65 years of age) in 27 countries of the European Union. Model estimations were based on standard calculation methods, conservative assumptions, age-based and country-specific data. Out of approximately 180 million Europeans for whom influenza vaccination is recommended, only about 80 million persons are vaccinated. Seasonal influenza vaccination currently prevents an annual average of between 1.6 million and 2.1 million cases of influenza, 45,300 to 65,600 hospitalizations, and 25,200 to 37,200 deaths. To reach the 75% vaccination coverage target set by the EU Council Recommendation in 2009, an additional 57.4 million person would need to be vaccinated in the elderly and other risk groups. By achieving the 75% target rate set in EU-27 countries, average annual influenza- related events averted would increase from current levels to an additional +1.6 to +1.7 million cases, +23,800 to +31,400 hospitalization, +9,800 to +14,300 deaths, +678,500 to +767,800 physician visits, and +883,800 to +1,015,100 lost days of work yearly. Influenza-related costs averted because of vaccination would increase by an additional + €190 to + €226 million yearly, in vaccination target groups. Full implementation of current influenza vaccination recommendations of 75% vaccination coverage rate (VCR) in Europe by the 2014-2015 influenza season could immediately reduce an important public health and economic burden.

A study of vaccine-induced immune pressure on breakthrough infections in the Phambili phase 2b HIV-1 vaccine efficacy trial

PubMed Central

Rolland, M.; Magaret, C.A.; Rademeyer, C.; Fiore-Gartland, A.; Edlefsen, P.T.; DeCamp, A.; Ahmed, H.; Ngandu, N.; Larsen, B.B.; Frahm, N.; Marais, J.; Thebus, R.; Geraghty, D.; Hural, J.; Corey, L.; Kublin, J.; Gray, G.; McElrath, M.J.; Mullins, J.I.; Gilbert, P.B.; Williamson, C.

2016-01-01

Introduction The Merck Adenovirus-5 Gag/Pol/Nef HIV-1 subtype-B vaccine evaluated in predominately subtype B epidemic regions (Step Study), while not preventing infection, exerted vaccine-induced immune pressure on HIV-1 breakthrough infections. Here we investigated if the same vaccine exerted immune pressure when tested in the Phambili Phase 2b study in a subtype C epidemic. Materials and methods A sieve analysis, which compares breakthrough viruses from placebo and vaccine arms, was performed on 277 near full-length genomes generated from 23 vaccine and 20 placebo recipients. Vaccine coverage was estimated by computing the percentage of 9-mers that were exact matches to the vaccine insert. Results There was significantly greater protein distances from the vaccine immunogen sequence in Gag (p = 0.045) and Nef (p = 0.021) in viruses infecting vaccine recipients compared to placebo recipients. Twenty-seven putative sites of vaccine-induced pressure were identified (p < 0.05) in Gag (n = 10), Pol (n = 7) and Nef (n = 10), although they did not remain significant after adjustment for multiple comparisons. We found the epitope sieve effect in Step was driven by HLA A*02:01; an allele which was found in low frequency in Phambili participants compared to Step participants. Furthermore, the coverage of the vaccine against subtype C Phambili viruses was 31%, 46% and 14% for Gag, Pol and Nef, respectively, compared to subtype B Step virus coverage of 56%, 61% and 26%, respectively. Discussion This study presents evidence of sieve effects in Gag and Nef; however could not confirm effects on specific amino acid sites. We propose that this weaker signal of vaccine immune pressure detected in the Phambili study compared to the Step study may have been influenced by differences in host genetics (HLA allele frequency) and reduced impact of vaccine-induced immune responses due to mismatch between the viral subtype in the vaccine and infecting subtypes. PMID:27756485

Human Papillomavirus Vaccination Coverage Among Girls Before 13 Years: A Birth Year Cohort Analysis of the National Immunization Survey-Teen, 2008-2013.

PubMed

Jeyarajah, Jenny; Elam-Evans, Laurie D; Stokley, Shannon; Smith, Philip J; Singleton, James A

2016-09-01

Routine human papillomavirus (HPV) vaccination is recommended at 11 or 12 years by the Advisory Committee on Immunization Practices. National Immunization Survey-Teen data were analyzed to evaluate, among girls, coverage with one or more doses of HPV vaccination, missed opportunities for HPV vaccination, and potential achievable coverage before 13 years. Results were stratified by birth year cohorts. HPV vaccination coverage before 13 years (≥1 HPV dose) increased from 28.4% for girls born in 1995 to 46.8% for girls born in 2000. Among girls born during 1999-2000 who had not received HPV vaccination before 13 years (57.2%), 80.1% had at least 1 missed opportunity to receive HPV vaccination before 13 years. Opportunities to vaccinate for HPV at age 11 to 12 years are missed. Strategies are needed to decrease these missed opportunities for HPV vaccination. This can be facilitated by the administration of all vaccines recommended for adolescents at the same visit. © The Author(s) 2015.

Methodology for the assessment of brucellosis management practices and its vaccination campaign: example in two Argentine districts.

PubMed

Aznar, M N; Arregui, M; Humblet, M F; Samartino, L E; Saegerman, C

2017-09-07

In Argentina, vaccination with Brucella abortus Strain 19 vaccine is mandatory. The objective of the study was to develop and test a method for evaluating, in an innovative way, some farmers' and veterinarians' management practices in relation to brucellosis and to assess the vaccination campaign and coverage. The work took place in Brandsen and Navarro districts. Four questionnaires were designed (for officials from Local Sanitary Entities, vaccinators, vet practitioners and farmers). Responses were coded as "ideal" (0) and "not ideal" (1). To assess the relative weight of each question ("item"), experts ranked the items according to their impact on management practices and vaccination. A weighted score was then calculated. A higher weighted score was assigned to the worse practices. Farmers obtaining a global weighted score above the third quartile were classified as "inappropriately managed farms", to be compared per type of production system and district. To assess the immunization coverage, female calves were sampled 30 to 50 days post vaccination; they were expected to react positively to serological diagnostic tests (DT+). There were significantly more inappropriately managed farms and higher global scores among beef farmers and in Brandsen. Eighty three percent (83%) of female calves were DT+, significantly under the ideal immunization coverage (95%). Only 48% of farms were considered well vaccinated. DT+ results were positively associated with the Brandsen district (OR = 25.94 [4.60-1146.21] and with the farms having more than 200 cow heads ((OR = 78.34 [4.09-1500.00]). On the contrary, DT+ were less associated with vaccinators being veterinary practitioners (OR = 0.07 [0.006-0.78]). Farmers are well advised by their veterinary practitioners but they should improve some management practices. The vaccination campaign is globally well implemented, but the immunization coverage and some vaccinators' practices should be improved. This study leads to a better understanding of the most common used management and control practices regarding brucellosis, which affect its epidemiology. Any vaccination campaign should be periodically assessed to highlight possible fails. The described methodology can be extrapolated to other countries and different contexts.

National- and state-level impact and cost-effectiveness of nonavalent HPV vaccination in the United States.

PubMed

Durham, David P; Ndeffo-Mbah, Martial L; Skrip, Laura A; Jones, Forrest K; Bauch, Chris T; Galvani, Alison P

2016-05-03

Every year in the United States more than 12,000 women are diagnosed with cervical cancer, a disease principally caused by human papillomavirus (HPV). Bivalent and quadrivalent HPV vaccines protect against 66% of HPV-associated cervical cancers, and a new nonavalent vaccine protects against an additional 15% of cervical cancers. However, vaccination policy varies across states, and migration between states interdependently dilutes state-specific vaccination policies. To quantify the economic and epidemiological impacts of switching to the nonavalent vaccine both for individual states and for the nation as a whole, we developed a model of HPV transmission and cervical cancer incidence that incorporates state-specific demographic dynamics, sexual behavior, and migratory patterns. At the national level, the nonavalent vaccine was shown to be cost-effective compared with the bivalent and quadrivalent vaccines at any coverage despite the greater per-dose cost of the new vaccine. Furthermore, the nonavalent vaccine remains cost-effective with up to an additional 40% coverage of the adolescent population, representing 80% of girls and 62% of boys. We find that expansion of coverage would have the greatest health impact in states with the lowest coverage because of the decreasing marginal returns of herd immunity. Our results show that if policies promoting nonavalent vaccine implementation and expansion of coverage are coordinated across multiple states, all states benefit both in health and in economic terms.

Influence of Population Demography and Immunization History on the Impact of an Antenatal Pertussis Program

PubMed Central

Campbell, Patricia Therese; McVernon, Jodie; McIntyre, Peter; Geard, Nicholas

2016-01-01

Background. Antenatal pertussis vaccination is being considered as a means to reduce the burden of infant pertussis in low- and middle-income countries (LMICs), but its likely impact in such settings is yet to be quantified. Methods. An individual-based model was used to simulate the demographic structure and dynamics of a population with characteristics similar to those of LMICs. Transmission of pertussis within this population was simulated to capture the incidence of infection in (1) the absence of vaccination; (2) with a primary course only (three doses of diphtheria, tetanus, and pertussis vaccines [DTP3] commencing in 1985, 1995, or 2005 at 20%, 50%, or 80% coverage); and (3) with the addition of an antenatal pertussis program. Results. Modeled annual incidence averaged over the period 2015–2024 reduced with increasing DTP3 coverage, regardless of the year childhood vaccination commenced. Over the same period, the proportion of infants born with passive protection did not change substantially compared with the prevaccination situation, regardless of DTP3 coverage and start year. We found minimal impact of antenatal vaccination on infection in all infants when mothers were eligible for a single antenatal dose. When mothers were eligible for multiple antenatal doses, incidence in infants aged 0–2 months was reduced by around 30%. This result did not hold for the full 0- to 1-year age group, for whom antenatal vaccination did not reduce infection levels. Conclusions. While antenatal vaccination could potentially reduce infant mortality in LMICs, broader gains at the population level are likely to be achieved by focusing efforts on increasing DTP3 coverage. PMID:27838675

Timeliness of Childhood Primary Immunization and Risk Factors Related with Delays: Evidence from the 2014 Zhejiang Provincial Vaccination Coverage Survey.

PubMed

Hu, Yu; Li, Qian; Chen, Yaping

2017-09-20

Background: this study aimed to assess both immunization coverage and timeliness, as well as reasons for non-vaccination, and identity the risk factors of delayed immunization, for the vaccines scheduled during the first year of life, in Zhejiang province, east China. Methods: A cluster survey among children aged 24-35 months was conducted. Demographic information and socio-economic characteristics of the selected child, the mother, and the household were collected. Immunization data were transcribed from immunization cards. Timeliness was assessed with Kaplan-Meier analysis for each vaccine given before 12 months of age, based on the time frame stipulated by the expanded program on immunization of China. Cox proportional hazard regression was applied to identify risk factors of delayed immunization. Results: A total of 2772 eligible children were surveyed. The age-appropriate coverage ranged from 25.4% (95% CI: 23.7-27.0%) for Bacillus Calmette-Guerin (BCG) to 91.3% (95% CI: 90.2-92.3%) for the first dose of oral poliomyelitis vaccine (OPV1). The most frequent reason for non-vaccination was parent's fear of adverse events of immunization. Delayed immunizations were associated with mother having a lower education level, mother having a job, delivery at home, increasing number of children per household, and having a lower household income. Conclusions: Although the timeliness of immunization has improved since 2011, necessary steps are still needed to achieve further improvement. Timeliness of immunization should be considered as another important indicator of expanded program on immunization (EPI) performance. Future interventions on vaccination coverage should take into consideration demographic and socio-economic risk factors identified in this study. The importance of adhering to the recommended schedule should be explained to parents.

Timeliness of Childhood Primary Immunization and Risk Factors Related with Delays: Evidence from the 2014 Zhejiang Provincial Vaccination Coverage Survey

PubMed Central

Hu, Yu; Li, Qian; Chen, Yaping

2017-01-01

Background: this study aimed to assess both immunization coverage and timeliness, as well as reasons for non-vaccination, and identity the risk factors of delayed immunization, for the vaccines scheduled during the first year of life, in Zhejiang province, east China. Methods: A cluster survey among children aged 24–35 months was conducted. Demographic information and socio-economic characteristics of the selected child, the mother, and the household were collected. Immunization data were transcribed from immunization cards. Timeliness was assessed with Kaplan–Meier analysis for each vaccine given before 12 months of age, based on the time frame stipulated by the expanded program on immunization of China. Cox proportional hazard regression was applied to identify risk factors of delayed immunization. Results: A total of 2772 eligible children were surveyed. The age-appropriate coverage ranged from 25.4% (95% CI: 23.7–27.0%) for Bacillus Calmette–Guerin (BCG) to 91.3% (95% CI: 90.2–92.3%) for the first dose of oral poliomyelitis vaccine (OPV1). The most frequent reason for non-vaccination was parent’s fear of adverse events of immunization. Delayed immunizations were associated with mother having a lower education level, mother having a job, delivery at home, increasing number of children per household, and having a lower household income. Conclusions: Although the timeliness of immunization has improved since 2011, necessary steps are still needed to achieve further improvement. Timeliness of immunization should be considered as another important indicator of expanded program on immunization (EPI) performance. Future interventions on vaccination coverage should take into consideration demographic and socio-economic risk factors identified in this study. The importance of adhering to the recommended schedule should be explained to parents. PMID:28930165

Maiden immunization coverage survey in the republic of South Sudan: a cross-sectional study providing baselines for future performance measurement

PubMed Central

Mbabazi, William; Lako, Anthony K; Ngemera, Daniel; Laku, Richard; Yehia, Mostafah; Nshakira, Nathan

2013-01-01

Introduction Since the comprehensive peace agreement was signed in 2005, institutionalization of immunization services in South Sudan remained a priority. Routine administrative reporting systems were established and showed that national coverage rates for DTP-3 rose from 20% in 2002 to 80% in 2011. This survey was conducted as part of an overall review of progress in implementation of the first EPI Multi-Year Plan for South Sudan 2007-2011. This report provides maiden community coverage estimates for immunization. Methods A cross sectional community survey was conducted between January and May 2012. Ten cluster surveys were conducted to generate state-specific coverage estimates. The WHO 30x7 cluster sampling method was employed. Data was collected using pre-tested, interviewer guided, structured questionnaires through house to house visits. Results The fully immunized children were 7.3%. Coverage for specific antigens were; BCG (28.3%), DTP-1(25.9%), DTP-3 (22.0%), Measles (16.8%). The drop-out rate between the first and third doses of DTP was 21.3%. Immunization coverage estimates based on card and history were higher, at 45.7% for DTP-3, 45.8% for MCV and 32.2% for full immunization. Majority of immunizations (80.8%) were received at health facilities compared to community service points (19.2%). The major reason for missed immunizations was inadequate information (41.1%). Conclusion The proportion of card-verified, fully vaccinated among children aged 12-23 months is very low at 7.3%. Future efforts to improve vaccination quality and coverage should prioritize training of vaccinators and program communication to levels equivalent or higher than investments in EPI cold chain systems since 2007. PMID:24876899

Social mobilisation, consent and acceptability: a review of human papillomavirus vaccination procedures in low and middle-income countries.

PubMed

Kabakama, Severin; Gallagher, Katherine E; Howard, Natasha; Mounier-Jack, Sandra; Burchett, Helen E D; Griffiths, Ulla K; Feletto, Marta; LaMontagne, D Scott; Watson-Jones, Deborah

2016-08-19

Social mobilisation during new vaccine introductions encourages acceptance, uptake and adherence to multi-dose schedules. Effective communication is considered especially important for human papillomavirus (HPV) vaccine, which targets girls of an often-novel age group. This study synthesised experiences and lessons learnt around social mobilisation, consent, and acceptability during 55 HPV vaccine demonstration projects and 8 national programmes in 37 low and middle-income countries (LMICs) between January 2007 and January 2015. A qualitative study design included: (i) a systematic review, in which 1,301 abstracts from five databases were screened and 41 publications included; (ii) soliciting 124 unpublished documents from governments and partner institutions; and (iii) conducting 27 key informant interviews. Data were extracted and analysed thematically. Additionally, first-dose coverage rates were categorised as above 90 %, 90-70 %, and below 70 %, and cross-tabulated with mobilisation timing, message content, materials and methods of delivery, and consent procedures. All but one delivery experience achieved over 70 % first-dose coverage; 60 % achieved over 90 %. Key informants emphasized the benefits of starting social mobilisation early and actively addressing rumours as they emerged. Interactive communication with parents appeared to achieve higher first-dose coverage than non-interactive messaging. Written parental consent (i.e., opt-in), though frequently used, resulted in lower reported coverage than implied consent (i.e., opt-out). Protection against cervical cancer was the primary reason for vaccine acceptability, whereas fear of adverse effects, exposure to rumours, lack of project/programme awareness, and schoolgirl absenteeism were major reasons for non-vaccination. Despite some challenges in obtaining parental consent and addressing rumours, experiences indicated effective social mobilisation and high HPV vaccine acceptability in LMICs. Social mobilisation, consent, and acceptability lessons were consistent across world regions and HPV vaccination projects/programmes. These can be used to guide HPV vaccination communication strategies without additional formative research.

Vaccination coverage and immunization timeliness among children aged 12-23 months in Senegal: a Kaplan-Meier and Cox regression analysis approach.

PubMed

Mbengue, Mouhamed Abdou Salam; Mboup, Aminata; Ly, Indou Deme; Faye, Adama; Camara, Fatou Bintou Niang; Thiam, Moussa; Ndiaye, Birahim Pierre; Dieye, Tandakha Ndiaye; Mboup, Souleymane

2017-01-01

Expanded programme on immunizations in resource-limited settings currently measure vaccination coverage defined as the proportion of children aged 12-23 months that have completed their vaccination. However, this indicator does not address the important question of when the scheduled vaccines were administered. We assessed the determinants of timely immunization to help the national EPI program manage vaccine-preventable diseases and impact positively on child survival in Senegal. Vaccination data were obtained from the Demographic and Health Survey (DHS) carried out across the 14 regions in the country. Children were aged between 12-23 months. The assessment of vaccination coverage was done with the health card and/or by the mother's recall of the vaccination act. For each vaccine, an assessment of delay in age-appropriate vaccination was done following WHO recommendations. Additionally, Kaplan-Meier survival function was used to estimate the proportion vaccinated by age and cox-proportional hazards models were used to examine risk factors for delays. A total of 2444 living children between 12-23 months of age were included in the analysis. The country vaccination was below the WHO recommended coverage level and, there was a gap in timeliness of children immunization. While BCG vaccine uptake was over 95%, coverage decreased with increasing number of Pentavalent vaccine doses (Penta 1: 95.6%, Penta 2: 93.5%: Penta 3: 89.2%). Median delay for BCG was 1.7 weeks. For polio at birth, the median delay was 5 days; all other vaccine doses had median delays of 2-4 weeks. For Penta 1 and Penta 3, 23.5% and 15.7% were given late respectively. A quarter of measles vaccines were not administered or were scheduled after the recommended age. Vaccinations that were not administered within the recommended age ranges were associated with mothers' poor education level, multiple siblings, low socio-economic status and living in rural areas. A significant delay in receipt of infant vaccines is found in Senegal while vaccine coverage is suboptimal. The national expanded program on immunization should consider measuring age at immunization or using seroepidemiological data to better monitor its impact.

Introducing auto-disable syringes to the national immunization programme in Madagascar.

PubMed Central

Drain, Paul K.; Ralaivao, Josoa S.; Rakotonandrasana, Alexander; Carnell, Mary A.

2003-01-01

OBJECTIVE: To evaluate the safety and coverage benefits of auto-disable (AD) syringes, weighed against the financial and logis- tical costs, and to create appropriate health policies in Madagascar. METHODS: Fifteen clinics in Madagascar, trained to use AD syringes, were randomized to implement an AD syringe only, mixed (AD syringes used only on non-routine immunization days), or sterilizable syringe only (control) programme. During a five-week period, data on administered vaccinations were collected, interviews were conducted, and observations were recorded. FINDINGS: The use of AD syringes improved coverage rates by significantly increasing the percentage of vaccines administered on non-routine immunization days (AD-only 4.3%, mixed 5.7%, control 1.1% (P<0.05)). AD-only clinics eliminated sterilization sessions for vaccinations, whereas mixed clinics reduced the number of sterilization sessions by 64%. AD syringes were five times more expensive than sterilizable syringes, which increased AD-only and mixed clinics' projected annual injection costs by 365% and 22%, respectively. However, introducing AD syringes for all vaccinations would only increase the national immunization budget by 2%. CONCLUSION: The use of AD syringes improved vaccination coverage rates by providing ready-to-use sterile syringes on non-routine immunization days and decreasing the number of sterilization sessions, thereby improving injection safety. The mixed programme was the most beneficial approach to phasing in AD syringes and diminishing logistical complications, and it had minimal costs. AD syringes, although more expensive, can feasibly be introduced into a developing country's immunization programme to improve vaccination safety and coverage. PMID:14576886

Spatial and socio-demographic predictors of time-to-immunization in a rural area in Kenya: Is equity attainable?

PubMed

Moïsi, Jennifer C; Kabuka, Jonathan; Mitingi, Dorah; Levine, Orin S; Scott, J Anthony G

2010-08-09

We conducted a vaccine coverage survey in Kilifi District, Kenya in order to identify predictors of childhood immunization. We calculated travel time to vaccine clinics and examined its relationship to immunization coverage and timeliness among the 2169 enrolled children (median age: 12.5 months). 86% had vaccine cards available, >95% had received three doses of DTP-HepB-Hib and polio vaccines and 88% of measles. Travel time did not affect vaccination coverage or timeliness. The Kenyan EPI reaches nearly all children in Kilifi and delays in vaccination are few, suggesting that vaccines will have maximal impact on child morbidity and mortality. Copyright 2010 Elsevier Ltd. All rights reserved.

The 5As: A practical taxonomy for the determinants of vaccine uptake.

PubMed

Thomson, Angus; Robinson, Karis; Vallée-Tourangeau, Gaëlle

2016-02-17

Suboptimal vaccine uptake in both childhood and adult immunisation programs limits their full potential impact on global health. A recent progress review of the Global Vaccine Action Plan stated that "countries should urgently identify barriers and bottlenecks and implement targeted approaches to increase and sustain coverage". However, vaccination coverage may be determined by a complex mix of demographic, structural, social and behavioral factors. To develop a practical taxonomy to organise the myriad possible root causes of a gap in vaccination coverage rates, we performed a narrative review of the literature and tested whether all non-socio-demographic determinants of coverage could be organised into 4 dimensions: Access, Affordability, Awareness and Acceptance. Forty-three studies were reviewed, from which we identified 23 primary determinants of vaccination uptake. We identified a fifth domain, Activation, which captured interventions such as SMS reminders which effectively nudge people towards getting vaccinated. The 5As taxonomy captured all identified determinants of vaccine uptake. This intuitive taxonomy has already facilitated mutual understanding of the primary determinants of suboptimal coverage within inter-sectorial working groups, a first step towards them developing targeted and effective solutions. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

Selecting a mix of prevention strategies against cervical cancer for maximum efficiency with an optimization program.

PubMed

Demarteau, Nadia; Breuer, Thomas; Standaert, Baudouin

2012-04-01

Screening and vaccination against human papillomavirus (HPV) can protect against cervical cancer. Neither alone can provide 100% protection. Consequently it raises the important question about the most efficient combination of screening at specified time intervals and vaccination to prevent cervical cancer. Our objective was to identify the mix of cervical cancer prevention strategies (screening and/or vaccination against HPV) that achieves maximum reduction in cancer cases within a fixed budget. We assessed the optimal mix of strategies for the prevention of cervical cancer using an optimization program. The evaluation used two models. One was a Markov cohort model used as the evaluation model to estimate the costs and outcomes of 52 different prevention strategies. The other was an optimization model in which the results of each prevention strategy of the previous model were entered as input data. The latter model determined the combination of the different prevention options to minimize cervical cancer under budget, screening coverage and vaccination coverage constraints. We applied the model in two countries with different healthcare organizations, epidemiology, screening practices, resource settings and treatment costs: the UK and Brazil. 100,000 women aged 12 years and above across the whole population over a 1-year period at steady state were included. The intervention was papanicolaou (Pap) smear screening programmes and/or vaccination against HPV with the bivalent HPV 16/18 vaccine (Cervarix® [Cervarix is a registered trademark of the GlaxoSmithKline group of companies]). The main outcome measures were optimal distribution of the population between different interventions (screening, vaccination, screening plus vaccination and no screening or vaccination) with the resulting number of cervical cancer and associated costs. In the base-case analysis (= same budget as today), the optimal prevention strategy would be, after introducing vaccination with a coverage rate of 80% in girls aged 12 years and retaining screening coverage at pre-vaccination levels (65% in the UK, 50% in Brazil), to increase the screening interval to 6 years (from 3) in the UK and to 5 years (from 3) in Brazil. This would result in a reduction of cervical cancer by 41% in the UK and by 54% in Brazil from pre-vaccination levels with no budget increase. Sensitivity analysis shows that vaccination alone at 80% coverage with no screening would achieve a cervical cancer reduction rate of 20% in the UK and 43% in Brazil compared with the pre-vaccination situation with a budget reduction of 30% and 14%, respectively. In both countries, the sharp reduction in cervical cancer is seen when the vaccine coverage rate exceeds the maximum screening coverage rate, or when screening coverage rate exceeds the maximum vaccine coverage rate, while maintaining the budget. As with any model, there are limitations to the value of predictions depending upon the assumptions made in each model. Spending the same budget that was used for screening and treatment of cervical cancer in the pre-vaccination era, results of the optimization program show that it would be possible to substantially reduce the number of cases by implementing an optimal combination of HPV vaccination (80% coverage) and screening at pre-vaccination coverage (65% UK, 50% Brazil) while extending the screening interval to every 6 years in the UK and 5 years in Brazil.

The web and public confidence in MMR vaccination in Italy.

PubMed

Aquino, Francesco; Donzelli, Gabriele; De Franco, Emanuela; Privitera, Gaetano; Lopalco, Pier Luigi; Carducci, Annalaura

2017-08-16

Measles, mumps and rubella (MMR) vaccination coverage in Italy has been decreasing starting from 2012 and, at the present, none of the Italian regions has achieved the goal of 95% coverage target. A decision of the Court of Justice of Rimini in March 2012 that awarded vaccine-injury compensation for a case of autism has been indicated as a probable trigger event leading to a reduction of vaccine confidence in Italy. The aim of the study was to explore the relationship between MMR vaccination coverage to online search trends and social network activity on the topic "autism and MMR vaccine", during the period 2010-2015. A significant inverse correlation was found between MMR vaccination coverage and Internet search activity, tweets and Facebook posts. New media might have played a role in spreading misinformation. Media monitoring could be useful to assess the level of vaccine hesitancy and to plan and target effective information campaigns. Copyright © 2017 Elsevier Ltd. All rights reserved.

An evaluation of voluntary 2-dose varicella vaccination coverage in New York City public schools.

PubMed

Doll, Margaret K; Rosen, Jennifer B; Bialek, Stephanie R; Szeto, Hiram; Zimmerman, Christopher M

2015-05-01

We assessed coverage for 2-dose varicella vaccination, which is not required for school entry, among New York City public school students and examined characteristics associated with receipt of 2 doses. We measured receipt of either at least 1 or 2 doses of varicella vaccine among students aged 4 years and older in a sample of 336 public schools (n = 223 864 students) during the 2010 to 2011 school year. Data came from merged student vaccination records from 2 administrative data systems. We conducted multivariable regression to assess associations of age, gender, race/ethnicity, and school location with 2-dose prevalence. Coverage with at least 1 varicella dose was 96.2% (95% confidence interval [CI] = 96.2%, 96.3%); coverage with at least 2 doses was 64.8% (95% CI = 64.6%, 64.9%). Increasing student age, non-Hispanic White race/ethnicity, and attendance at school in Staten Island were associated with lower 2-dose coverage. A 2-dose varicella vaccine requirement for school entry would likely improve 2-dose coverage, eliminate coverage disparities, and prevent disease.

Meningococcal Conjugate and Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis Vaccination Among HIV-infected Youth.

PubMed

Setse, Rosanna W; Siberry, George K; Moss, William J; Wheeling, John; Bohannon, Beverly A; Dominguez, Kenneth L

2016-05-01

The meningococcal conjugate vaccine (MCV4) and the tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine (Tdap) were first recommended for adolescents in the US in 2005. The goal of our study was to determine MCV4 and Tdap vaccines coverage among perinatally and behaviorally HIV-infected adolescents in 2006 and to compare coverage estimates in our study population to similarly aged healthy youth in 2006. Longitudinal Epidemiologic Study to Gain Insight into HIV/AIDS in Children and Youth (LEGACY) is a retrospective cohort study of HIV-infected youth in 22 HIV specialty clinics across the US. Among LEGACY participants ≥11 years of age in 2006, we conducted a cross-sectional analysis to determine MCV4, Tdap and MCV4/Tdap vaccine coverage. We compared vaccine coverage among our study population to coverage among similarly aged youth in the 2006 National Immunization Survey for Teens (NIS-Teen Survey). Multivariable mixed effects logistic regression modeling was used to examine associations between MCV4/Tdap vaccination and mode of HIV transmission. MCV4 and Tdap coverage rates among 326 eligible participants were 31.6% and 28.8%, respectively. Among adolescents 13-17 years of age, MCV4 and Tdap coverage was significantly higher among HIV-infected youth than among youth in the 2006 NIS-Teen Survey (P <0.01). In multivariable analysis, perinatally HIV-infected youth were significantly more likely to have received MCV4/Tdap vaccination compared with their behaviorally infected counterparts (adjusted odds ratio: 5.1; 95% confidence interval: 2.0, 12.7). HIV-infected youth with CD4 cell counts of 200-499 cells/μL were more likely to have had MCV4/Tdap vaccination compared with those with CD4 counts ≥500 cells/μL (adjusted odds ratio: 2.2; 95% confidence interval: 1.2, 4.3). Participants with plasma HIV RNA viral loads of >400 copies/mL were significantly less likely to have received MCV4/Tdap vaccination (P < 0.05). MCV4 and Tdap coverage among HIV-infected youth was suboptimal but higher than for healthy adolescents in the 2006 NIS-Teen Survey. Perinatal HIV infection was associated with increased likelihood of vaccination. Specific measures are needed to improve vaccine coverage among adolescents in the US.

Successful introduction of an underutilized elderly pneumococcal vaccine in a national immunization program by integrating the pre-existing public health infrastructure.

PubMed

Yang, Tae Un; Kim, Eunsung; Park, Young-Joon; Kim, Dongwook; Kwon, Yoon Hyung; Shin, Jae Kyong; Park, Ok

2016-03-18

Although pneumococcal vaccines had been recommended for the elderly population in South Korea for a considerable period of time, the coverage has been well below the optimal level. To increase the vaccination rate with integrating the pre-existing public health infrastructure and governmental funding, the Korean government introduced an elderly pneumococcal vaccination into the national immunization program with a 23-valent pneumococcal polysaccharide vaccine in May 2013. The aim of this study was to assess the performance of the program in increasing the vaccine coverage rate and maintaining stable vaccine supply and safe vaccination during the 20 months of the program. We qualitatively and quantitatively analyzed the process of introducing and the outcomes of the program in terms of the systematic organization, efficiency, and stability at the national level. A staggered introduction during the first year utilizing the public sector, with a target coverage of 60%, was implemented based on the public demand for an elderly pneumococcal vaccination, vaccine supply capacity, vaccine delivery capacity, safety, and sustainability. During the 20-month program period, the pneumococcal vaccine coverage rate among the population aged ≥65 years increased from 5.0% to 57.3% without a noticeable vaccine shortage or safety issues. A web-based integrated immunization information system, which includes the immunization registry, vaccine supply chain management, and surveillance of adverse events following immunization, reduced programmatic errors and harmonized the overall performance of the program. Introduction of an elderly pneumococcal vaccination in the national immunization program based on strong government commitment, meticulous preparation, financial support, and the pre-existing public health infrastructure resulted in an efficient, stable, and sustainable increase in vaccination coverage. Copyright © 2016. Published by Elsevier Ltd.

Timely measles vaccination in Tianjin, China: a cross-sectional study of immunization records and mothers.

PubMed

Wagner, Abram L; Zhang, Ying; Montgomery, JoLynn P; Ding, Yaxing; Carlson, Bradley F; Boulton, Matthew L

2014-08-29

Measles is a highly infectious disease, and timely administration of two doses of vaccine can ensure adequate protection against measles for all ages in a population. This study aims to estimate the proportion of children aged 8 months to 6 years vaccinated on time with measles-containing vaccines (MCV) and vaccinated during the 2008 and 2010 measles supplementary immunization activities. This study also characterizes differences in mean age at vaccination and vaccination timeliness by demographic characteristics, and describes maternal knowledge of measles vaccination. Immunization records were selected from a convenience sample of immunization clinics in Tianjin, China. From the records, overall vaccination coverage and timely vaccination coverage were calculated for different demographic groups. Mothers were also interviewed at these clinics to ascertain their knowledge of measles vaccination. Within the 329 immunization clinic records, child's birth year and district of residence were found to be significant predictors of different measures of vaccine timeliness. Children born in 2009 had a lower age at MCV dose 2 administration (17.96 months) than children born in 2005 (22.00 months). Children living in Hebei, a district in the urban center of Tianjin were less likely to be vaccinated late than children living in districts further from the urban core of Tianjin. From the 31 interviews with mothers, most women believed that timely vaccination was very important and more than one dose was very necessary; most did not know whether their child needed another dose. When reviewing MCV coverage in China, most studies do not consider timeliness. However, this study shows that overall vaccination coverage can greatly overestimate vaccination coverage within certain segments of the population, such as young infants.

Are healthcare workers’ intentions to vaccinate related to their knowledge, beliefs and attitudes? a systematic review

PubMed Central

2013-01-01

Background The Summit of Independent European Vaccination Experts (SIEVE) recommended in 2007 that efforts be made to improve healthcare workers’ knowledge and beliefs about vaccines, and their attitudes towards them, to increase vaccination coverage. The aim of the study was to compile and analyze the areas of disagreement in the existing evidence about the relationship between healthcare workers’ knowledge, beliefs and attitudes about vaccines and their intentions to vaccinate the populations they serve. Methods We conducted a systematic search in four electronic databases for studies published in any of seven different languages between February 1998 and June 2009. We included studies conducted in developed countries that used statistical methods to relate or associate the variables included in our research question. Two independent reviewers verified that the studies met the inclusion criteria, assessed the quality of the studies and extracted their relevant characteristics. The data were descriptively analyzed. Results Of the 2354 references identified in the initial search, 15 studies met the inclusion criteria. The diversity in the study designs and in the methods used to measure the variables made it impossible to integrate the results, and each study had to be assessed individually. All the studies found an association in the direction postulated by the SIEVE experts: among healthcare workers, higher awareness, beliefs that are more aligned with scientific evidence and more favorable attitudes toward vaccination were associated with greater intentions to vaccinate. All the studies included were cross-sectional; thus, no causal relationship between the variables was established. Conclusion The results suggest that interventions aimed at improving healthcare workers’ knowledge, beliefs and attitudes about vaccines should be encouraged, and their impact on vaccination coverage should be assessed. PMID:23421987

Topics associated with conflict in print news coverage of the HPV vaccine during 2005 to 2009

PubMed Central

Casciotti, Dana M; Smith, Katherine C; Klassen, Ann Carroll

2015-01-01

HPV vaccines represent a significant advancement for cancer prevention, but vaccination against a sexually transmitted infection and possible vaccine mandates have created considerable negative publicity. We sought to understand media portrayal of vaccine-related controversy, and potential influences on attitudes and vaccine acceptance. We analyzed characteristics of media coverage of the HPV vaccine in 13 US newspapers between June 2005-May 2009, as well as relationships between conflict and pro-vaccine tone and specific story characteristics. The four-year timeframe was selected to capture coverage during the development of the vaccine, the period immediately pre- and post-approval, and the time of widespread recommendation and initial uptake. This allowed the exploration of a range of issues and provided an understanding of how coverage changed over time. Analysis included 447 news stories and opinion pieces, the majority of which were published in 2007. Most articles were positive (pro-vaccine) in tone, prompted by research/scientific advancement or legislative activities. We deemed 66% of all stories conflict-containing. Fewer articles from 2005–2006 and 2008–2009 contained conflict than those from 2007, suggesting a peak period of concern, followed by gradual acceptance of the HPV vaccine. Legislative activities and content related to sexual activity were sources of conflict in HPV vaccine media messages. Health communication strategies can be improved by understanding and addressing potential sources of conflict in news coverage of public health initiatives. PMID:25668659

The Vaccination of 35,000 Dogs in 20 Working Days Using Combined Static Point and Door-to-Door Methods in Blantyre, Malawi

PubMed Central

Gibson, Andrew D; Handel, Ian G; Shervell, Kate; Roux, Tarryn; Mayer, Dagmar; Muyila, Stanford; Maruwo, Golden B; Nkhulungo, Edwin M. S; Foster, Rachel A; Chikungwa, Patrick; Chimera, Bernard; Bronsvoort, Barend M.deC; Mellanby, Richard J; Gamble, Luke

2016-01-01

An estimated 60,000 people die of rabies annually. The vast majority of cases of human rabies develop following a bite from an infected dog. Rabies can be controlled in both human and canine populations through widespread vaccination of dogs. Rabies is particularly problematic in Malawi, costing the country an estimated 13 million USD and 484 human deaths annually, with an increasing paediatric incidence in Blantyre City. Consequently, the aim of this study was to vaccinate a minimum of 75% of all the dogs within Blantyre city during a one month period. Blantyre’s 25 administrative wards were divided into 204 working zones. For initial planning, a mean human:dog ratio from the literature enabled estimation of dog population size and dog surveys were then performed in 29 working zones in order to assess dog distribution by land type. Vaccination was conducted at static point stations at weekends, at a total of 44 sites, with each operating for an average of 1.3 days. On Monday to Wednesday, door-to-door vaccination sessions were undertaken in the areas surrounding the preceding static point stations. 23,442 dogs were vaccinated at static point stations and 11,774 dogs were vaccinated during door-to-door vaccinations. At the end of the 20 day vaccination programme, an assessment of vaccination coverage through door-to-door surveys found that of 10,919 dogs observed, 8,661 were vaccinated resulting in a vaccination coverage of 79.3% (95%CI 78.6–80.1%). The estimated human:dog ratio for Blantyre city was 18.1:1. Mobile technology facilitated the collection of data as well as efficient direction and coordination of vaccination teams in near real time. This study demonstrates the feasibility of vaccinating large numbers of dogs at a high vaccination coverage, over a short time period in a large African city. PMID:27414810

Immunization coverage and predictive factors for complete and age-appropriate vaccination among preschoolers in Athens, Greece: a cross- sectional study

PubMed Central

2013-01-01

Background In Greece, several new childhood vaccines were introduced recently but were reimbursed gradually and at different time points. The aim of this study was to assess immunization coverage and identify factors influencing complete and age-appropriate vaccination among children attending public nurseries in the municipal district of Athens. Methods A cross-sectional study, using stratified sampling was performed. Immunization history was obtained from vaccination booklets. Demographic and socioeconomic data were obtained from school registries and telephone interviews. Vaccination rates were estimated by sample weighted proportions while associations between complete and age-appropriate immunization and potential determinants by logistic regression analysis. Results A total of 731 children (mean age: 46, median: 48, range: 10–65 months) were included. Overall immunization coverage with traditional vaccines (DTP, polio, Hib, HBV, 1st dose MMR) was satisfactory, exceeding 90%, but the administration of booster doses was delayed (range: 33.7- 97.4%, at 60 months of age). Complete vaccination rates were lower for new vaccines (Men C, PCV7, varicella, hepatitis A), ranging between 61-92%. In addition, a significant delay in timely administration of Men C, PCV7, as well as HBV was noted (22.9%, 16.0% and 27.7% at 12 months of age, respectively). Child’s age was strongly associated with incomplete vaccination with all vaccines (p< 0.001), while as immigrant status was a predictor of incomplete (p=0.034) and delayed vaccination (p<0.001) with traditional vaccines. Increasing household size and higher maternal education were negatively associated with the receipt of all and newly licensed vaccines, respectively (p=0.035). Conclusions Our findings highlight the need to monitor uptake of new vaccines and improve age- appropriate administration of booster doses as well as early vaccination against hepatitis B. Immigrant status, increased household size and high maternal education may warrant targeted intervention. PMID:24083352

How orthodox protestant parents decide on the vaccination of their children: a qualitative study

PubMed Central

2012-01-01

Background Despite high vaccination coverage, there have recently been epidemics of vaccine preventable diseases in the Netherlands, largely confined to an orthodox protestant minority with religious objections to vaccination. The orthodox protestant minority consists of various denominations with either low, intermediate or high vaccination coverage. All orthodox protestant denominations leave the final decision to vaccinate or not up to their individual members. Methods To gain insight into how orthodox protestant parents decide on vaccination, what arguments they use, and the consequences of their decisions, we conducted an in-depth interview study of both vaccinating and non-vaccinating orthodox protestant parents selected via purposeful sampling. The interviews were thematically coded by two analysts using the software program Atlas.ti. The initial coding results were reviewed, discussed, and refined by the analysts until consensus was reached. Emerging concepts were assessed for consistency using the constant comparative method from grounded theory. Results After 27 interviews, data saturation was reached. Based on characteristics of the decision-making process (tradition vs. deliberation) and outcome (vaccinate or not), 4 subgroups of parents could be distinguished: traditionally non-vaccinating parents, deliberately non-vaccinating parents, deliberately vaccinating parents, and traditionally vaccinating parents. Except for the traditionally vaccinating parents, all used predominantly religious arguments to justify their vaccination decisions. Also with the exception of the traditionally vaccinating parents, all reported facing fears that they had made the wrong decision. This fear was most tangible among the deliberately vaccinating parents who thought they might be punished immediately by God for vaccinating their children and interpreted any side effects as a sign to stop vaccinating. Conclusions Policy makers and health care professionals should stimulate orthodox protestant parents to make a deliberate vaccination choice but also realize that a deliberate choice does not necessarily mean a choice to vaccinate. PMID:22672710

The association between travel time to health facilities and childhood vaccine coverage in rural Ethiopia. A community based cross sectional study.

PubMed

Okwaraji, Yemisrach B; Mulholland, Kim; Schellenberg, Joanna R M Armstrong; Andarge, Gashaw; Admassu, Mengesha; Edmond, Karen M

2012-06-22

Few studies have examined associations between access to health care and childhood vaccine coverage in remote communities that lack motorised transport. This study assessed whether travel time to health facilities was associated with childhood vaccine coverage in a remote area of Ethiopia. This was a cross-sectional study using data from 775 children aged 12-59 months who participated in a household survey between January -July 2010 in Dabat district, north-western Ethiopia. 208 households were randomly selected from each kebele. All children in a household were eligible for inclusion if they were aged between 12-59 months at the time of data collection. Travel time to vaccine providers was collected using a geographical information system (GIS). The primary outcome was the percentage of children in the study population who were vaccinated with the third infant Pentavalent vaccine ([Diphtheria, Tetanus,-Pertussis Hepatitis B, Haemophilus influenza type b] Penta3) in the five years before the survey. We also assessed effects on BCG, Penta1, Penta2 and Measles vaccines. Analysis was conducted using Poisson regression models with robust standard error estimation and the Wald test. Missing vaccination data ranged from 4.6% (36/775) for BCG to 16.4% (127/775) for Penta3 vaccine. In children with complete vaccination records, BCG vaccine had the highest coverage (97.3% [719/739]), Penta3 coverage was (92.9% [602/648]) and Measles vaccine had the lowest coverage (81.7% [564/690]). Children living ≥60mins from a health post were significantly less likely (adjRR = 0.85 [0.79-0.92] p value < =0.001) to receive Penta3 vaccine compared to children living <30mins from a health post. This effect was not modified by household wealth (p value = 0.240). Travel time also had a highly significant association with BCG (adjRR = 0.95 [0.93-0.98] p value =0.002) and Measles (adjRR = 0.88 [0.79-0.97] p value =0.027) vaccine coverage. Travel time to vaccine providers in health posts appeared to be a barrier to the delivery of infant vaccines in this remote Ethiopian community. New vaccine delivery strategies are needed for the hardest to reach children in the African region.

Præventis, the immunisation register of the Netherlands: a tool to evaluate the National Immunisation Programme.

PubMed

van Lier, A; Oomen, P; de Hoogh, P; Drijfhout, I; Elsinghorst, B; Kemmeren, J; Conyn-van Spaendonck, M; de Melker, H

2012-04-26

Vaccination coverage is an important performance indicator of any national immunisation programme (NIP). To monitor the vaccination coverage in the Netherlands, an electronic national immunisation register called ‘Præventis’ was implemented in 2005. Præventis has a link with the population register and can produce letters of invitation for the NIP, register and validate administered vaccinations. The database is used to monitor the vaccination process, produce reminder letters, control the stock of vaccines and provides information used for paying the fees to the different executive organisations involved. Præventis provides a crucial tool for the evaluation of the NIP by producing (sub)national vaccination coverage estimates with high accuracy and allowing additional research: identifying populations at high risk for low coverage based on existing data, conducting specific studies where individuals included in the immunisation register are approached for further research, using vaccination coverage data for the interpretation of (sero)surveillance data, and linking the immunisation register with disease registers to address vaccine safety or vaccine effectiveness. The ability to combine Præventis data with data from other databases or disease registers and the ability to approach individuals with additional research questions offers opportunities to identify areas of priority for improving the Dutch NIP.

Assessment of Routine Immunization Coverage in Nyala Locality, Reasons behind Incomplete Immunization in South Darfur State, Sudan

PubMed Central

Ismail, Ismail Tibin Adam; El-Tayeb, Elsadeg Mahgoob; Omer, Mohammed Diaaeldin F.A.; Eltahir, Yassir Mohammed; El-Sayed, El-Tayeb Ahmed; Deribe, Kebede

2014-01-01

Little is known about the coverage of routine immunization service in South Darfur state, Sudan. Therefore, this study was conducted to determine the vaccination rate and barriers for vaccination. A cross-sectional community-based study was undertaken in Nyala locality, south Darfur, Sudan, including urban, rural and Internal Displaced Peoples (IDPs) population in proportional representation. Survey data were collected by a questionnaire which was applied face to face to parents of 213 children 12-23 months. The collected data was then analyzed with SPSS software package. Results showed that vaccination coverage as revealed by showed vaccination card alone was 63.4% while it was increased to 82.2% when both history and cards were used. Some (5.6%) of children were completely non-vaccinated. The factors contributing to the low vaccination coverage were found to be knowledge problems of mothers (51%), access problems (15%) and attitude problems (34%). Children whose mother attended antenatal care and those from urban areas were more likely to complete their immunization schedule. In conclusion, the vaccination coverage in the studied area was low compared to the national coverage. Efforts to increase vaccination converge and completion of the scheduled plan should focus on addressing concerns of caregivers particularly side effects and strengthening the Expanded Programmer on Immunization services in rural areas. PMID:25729558

Assessment of Routine Immunization Coverage in Nyala Locality, Reasons behind Incomplete Immunization in South Darfur State, Sudan.

PubMed

Ismail, Ismail Tibin Adam; El-Tayeb, Elsadeg Mahgoob; Omer, Mohammed Diaaeldin F A; Eltahir, Yassir Mohammed; El-Sayed, El-Tayeb Ahmed; Deribe, Kebede

2014-02-25

Little is known about the coverage of routine immunization service in South Darfur state, Sudan. Therefore, this study was conducted to determine the vaccination rate and barriers for vaccination. A cross-sectional community-based study was undertaken in Nyala locality, south Darfur, Sudan, including urban, rural and Internal Displaced Peoples (IDPs) population in proportional representation. Survey data were collected by a questionnaire which was applied face to face to parents of 213 children 12-23 months. The collected data was then analyzed with SPSS software package. Results showed that vaccination coverage as revealed by showed vaccination card alone was 63.4% while it was increased to 82.2% when both history and cards were used. Some (5.6%) of children were completely non-vaccinated. The factors contributing to the low vaccination coverage were found to be knowledge problems of mothers (51%), access problems (15%) and attitude problems (34%). Children whose mother attended antenatal care and those from urban areas were more likely to complete their immunization schedule. In conclusion, the vaccination coverage in the studied area was low compared to the national coverage. Efforts to increase vaccination converge and completion of the scheduled plan should focus on addressing concerns of caregivers particularly side effects and strengthening the Expanded Programmer on Immunization services in rural areas.

How close are countries of the WHO European Region to achieving the goal of vaccinating 75% of key risk groups against influenza? Results from national surveys on seasonal influenza vaccination programmes, 2008/2009 to 2014/2015.

PubMed

Jorgensen, Pernille; Mereckiene, Jolita; Cotter, Suzanne; Johansen, Kari; Tsolova, Svetla; Brown, Caroline

2018-01-25

Influenza vaccination is recommended especially for persons at risk of complications. In 2003, the World Health Assembly urged Member States (MS) to increase vaccination coverage to 75% among older persons by 2010. To assess progress towards the 2010 vaccination goal and describe seasonal influenza vaccination recommendations in the World Health Organization (WHO) European Region. Data on seasonal influenza vaccine recommendations, dose distribution, and target group coverage were obtained from two sources: European Union and European Economic Area MS data were extracted from influenza vaccination surveys covering seven seasons (2008/2009-2014/2015) published by the Vaccine European New Integrated Collaboration Effort and European Centre for Disease Prevention and Control. For the remaining WHO European MS, a separate survey on policies and uptake for all seasons (2008/2009-2014/2015) was distributed to national immunization programmes in 2015. Data was available from 49 of 53 MS. All but two had a national influenza vaccination policy. High-income countries distributed considerably higher number of vaccines per capita (median; 139.2 per 1000 population) compared to lower-middle-income countries (median; 6.1 per 1000 population). Most countries recommended vaccination for older persons, individuals with chronic disease, healthcare workers, and pregnant women. Children were included in < 50% of national policies. Only one country reached 75% coverage in older persons (2014/2015), while a number of countries reported declining vaccination uptake. Coverage of target groups was overall low, but with large variations between countries. Vaccination coverage was not monitored for several groups. Despite policy recommendations, influenza vaccination uptake remains suboptimal. Low levels of vaccination is not only a missed opportunity for preventing influenza in vulnerable groups, but could negatively affect pandemic preparedness. Improved understanding of barriers to influenza vaccination is needed to increase uptake and reverse negative trends. Furthermore, implementation of vaccination coverage monitoring is critical for assessing performance and impact of the programmes. Copyright © 2017. Published by Elsevier Ltd.

Household survey analysis of the impact of comprehensive strategies to improve the expanded programme on immunisation at the county level in western China, 2006–2010

PubMed Central

Zhou, Yuqing; Xing, Yi; Liang, Xiaofeng; Yue, Chenyan; Zhu, Xu; Hipgrave, David

2016-01-01

Objective To evaluate interventions to improve routine vaccination coverage and caregiver knowledge in China's remote west, where routine immunisation is relatively weak. Design Prospective pre–post (2006–2010) evaluation in project counties; retrospective comparison based on 2004 administrative data at baseline and surveyed post-intervention (2010) data in selected non-project counties. Setting Four project counties and one non-project county in each of four provinces. Participants 3390 children in project counties at baseline, and 3299 in project and 830 in non-project counties post-intervention; and 3279 caregivers at baseline, and 3389 in project and 830 in non-project counties post-intervention. Intervention Multicomponent inexpensive knowledge-strengthening and service-strengthening and innovative, multisectoral engagement. Data collection Standard 30-cluster household surveys of vaccine coverage and caregiver interviews pre-intervention and post-intervention in each project county. Similar surveys in one non-project county selected by local authorities in each province post-intervention. Administrative data on vaccination coverage in non-project counties at baseline. Primary outcome measures Changes in vaccine coverage between baseline and project completion (2010); comparative caregiver knowledge in all counties in 2010. Analysis Crude (χ2) analysis of changes and differences in vaccination coverage and related knowledge. Multiple logistic regression to assess associations with timely coverage. Results Timely coverage of four routine vaccines increased by 21% (p<0.001) and hepatitis B (HepB) birth dose by 35% (p<0.001) over baseline in project counties. Comparison with non-project counties revealed secular improvement in most provinces, except new vaccine coverage was mostly higher in project counties. Ethnicity, province, birthplace, vaccination site, dual-parental out-migration and parental knowledge had significant associations with coverage. Knowledge increased for all variables but one in project counties (highest p<0.05) and was substantially higher than in non-project counties (p<0.01). Conclusions Comprehensive but inexpensive strategies improved vaccination coverage and caretaker knowledge in western China. Establishing multisectoral leadership, involving the education sector and including immunisation in public-sector performance standards, are affordable and effective interventions. PMID:26966053

Fully immunized child: coverage, timing and sequencing of routine immunization in an urban poor settlement in Nairobi, Kenya.

PubMed

Mutua, Martin Kavao; Kimani-Murage, Elizabeth; Ngomi, Nicholas; Ravn, Henrik; Mwaniki, Peter; Echoka, Elizabeth

2016-01-01

More efforts have been put in place to increase full immunization coverage rates in the last decade. Little is known about the levels and consequences of delaying or vaccinating children in different schedules. Vaccine effectiveness depends on the timing of its administration, and it is not optimal if given early, delayed or not given as recommended. Evidence of non-specific effects of vaccines is well documented and could be linked to timing and sequencing of immunization. This paper documents the levels of coverage, timing and sequencing of routine childhood vaccines. The study was conducted between 2007 and 2014 in two informal urban settlements in Nairobi. A total of 3856 children, aged 12-23 months and having a vaccination card seen were included in analysis. Vaccination dates recorded from the cards seen were used to define full immunization coverage, timeliness and sequencing. Proportions, medians and Kaplan-Meier curves were used to assess and describe the levels of full immunization coverage, vaccination delays and sequencing. The findings indicate that 67 % of the children were fully immunized by 12 months of age. Missing measles and third doses of polio and pentavalent vaccine were the main reason for not being fully immunized. Delays were highest for third doses of polio and pentavalent and measles. About 22 % of fully immunized children had vaccines in an out-of-sequence manner with 18 % not receiving pentavalent together with polio vaccine as recommended. Results show higher levels of missed opportunities and low coverage of routine childhood vaccinations given at later ages. New strategies are needed to enable health care providers and parents/guardians to work together to increase the levels of completion of all required vaccinations. In particular, more focus is needed on vaccines given in multiple doses (polio, pentavalent and pneumococcal conjugate vaccines).

Evaluation of the impact of the 2012 Rhode Island health care worker influenza vaccination regulations: implementation process and vaccination coverage.

PubMed

Kim, Hanna; Lindley, Megan C; Dube, Donna; Kalayil, Elizabeth J; Paiva, Kristi A; Raymond, Patricia

2015-01-01

In October 2012, the Rhode Island Department of Health (HEALTH) amended its health care worker (HCW) vaccination regulations to require all HCWs to receive annual influenza vaccination or wear a surgical mask during direct patient contact when influenza is widespread. Unvaccinated HCWs failing to wear a mask are subject to a fine and disciplinary action. To describe the implementation of the 2012 Rhode Island HCW influenza vaccination regulations and examine their impact on vaccination coverage. Two data sources were used: (1) a survey of all health care facilities subject to the HCW regulations and (2) HCW influenza vaccination coverage data reported to HEALTH by health care facilities. Descriptive statistics and paired t tests were performed using SAS Release 9.2. For the 2012-2013 influenza season, 271 inpatient and outpatient health care facilities in Rhode Island were subject to the HCW regulations. Increase in HCW influenza vaccination coverage. Of the 271 facilities, 117 facilities completed the survey (43.2%) and 160 facilities reported vaccination data to HEALTH (59.0%). Between the 2011-2012 and 2012-2013 influenza seasons, the proportion of facilities having a masking policy, as required by the revised regulations, increased from 9.4% to 94.0% (P < .001). However, the proportion of facilities implementing Advisory Committee on Immunization Practices-recommended strategies to promote HCW influenza vaccination did not increase. The majority of facilities perceived benefits to collecting HCW influenza vaccination data, including strengthening infection prevention efforts (83.2%) and improving patient and coworker safety (75.2%). Concurrent with the new regulations, influenza vaccination coverage among employee HCWs in Rhode Island increased from 69.7% in the 2011-2012 influenza season to 87.2% in the 2012-2013 season. Rhode Island's experience demonstrates that statewide HCW influenza vaccination requirements incorporating mask wearing and moderate penalties for noncompliance can be effective in improving influenza vaccination coverage among HCWs.

Evaluation of the Impact of the 2012 Rhode Island Health Care Worker Influenza Vaccination Regulations: Implementation Process and Vaccination Coverage

PubMed Central

Kim, Hanna; Lindley, Megan C.; Dube, Donna; Kalayil, Elizabeth J.; Paiva, Kristi A.; Raymond, Patricia

2015-01-01

Context In October 2012, the Rhode Island Department of Health (HEALTH) amended its health care worker (HCW) vaccination regulations to require all HCWs to receive annual influenza vaccination or wear a surgical mask during direct patient contact when influenza is widespread. Unvaccinated HCWs failing to wear a mask are subject to a fine and disciplinary action. Objective To describe the implementation of the 2012 Rhode Island HCW influenza vaccination regulations and examine their impact on vaccination coverage. Design Two data sources were used: (1) a survey of all health care facilities subject to the HCW regulations and (2) HCW influenza vaccination coverage data reported to HEALTH by health care facilities. Descriptive statistics and paired t tests were performed using SAS Release 9.2. Setting and participants For the 2012-2013 influenza season, 271 inpatient and outpatient health care facilities in Rhode Island were subject to the HCW regulations. Main Outcome Measure Increase in HCW influenza vaccination coverage. Results Of the 271 facilities, 117 facilities completed the survey (43.2%) and 160 facilities reported vaccination data to HEALTH (59.0%). Between the 2011-2012 and 2012-2013 influenza seasons, the proportion of facilities having a masking policy, as required by the revised regulations, increased from 9.4% to 94.0% (P< .001). However, the proportion of facilities implementing Advisory Committee on Immunization Practices–recommended strategies to promote HCW influenza vaccination did not increase. The majority of facilities perceived benefits to collecting HCW influenza vaccination data, including strengthening infection prevention efforts (83.2%) and improving patient and coworker safety (75.2%). Concurrent with the new regulations, influenza vaccination coverage among employee HCWs in Rhode Island increased from 69.7% in the 2011-2012 influenza season to 87.2% in the 2012-2013 season. Conclusion Rhode Island's experience demonstrates that statewide HCW influenza vaccination requirements incorporating mask wearing and moderate penalties for noncompliance can be effective in improving influenza vaccination coverage among HCWs. PMID:25105280

Incorporating economies of scale in the cost estimation in economic evaluation of PCV and HPV vaccination programmes in the Philippines: a game changer?

PubMed

Suwanthawornkul, Thanthima; Praditsitthikorn, Naiyana; Kulpeng, Wantanee; Haasis, Manuel Alexander; Guerrero, Anna Melissa; Teerawattananon, Yot

2018-01-01

Many economic evaluations ignore economies of scale in their cost estimation, which means that cost parameters are assumed to have a linear relationship with the level of production. Economies of scale is the situation when the average total cost of producing a product decreases with increasing volume caused by reducing the variable costs due to more efficient operation. This study investigates the significance of applying the economies of scale concept: the saving in costs gained by an increased level of production in economic evaluation of pneumococcal conjugate vaccines (PCV) and human papillomavirus (HPV) vaccinations. The fixed and variable costs of providing partial (20% coverage) and universal (100% coverage) vaccination programs in the Philippines were estimated using various methods, including costs of conducting questionnaire survey, focus-group discussion, and analysis of secondary data. Costing parameters were utilised as inputs for the two economic evaluation models for PCV and HPV. Incremental cost-effectiveness ratios (ICERs) and 5-year budget impacts with and without applying economies of scale to the costing parameters for partial and universal coverage were compared in order to determine the effect of these different costing approaches. The program costs of the partial coverage for the two immunisation programs were not very different when applying and not applying the economies of scale concept. Nevertheless, the program costs for universal coverage were 0.26 and 0.32 times lower when applying economies of scale compared to not applying economies of scale for the pneumococcal and human papillomavirus vaccinations, respectively. ICERs varied by up to 98% for pneumococcal vaccinations, whereas the change in ICERs in the human papillomavirus vaccination depended on both the costs of cervical cancer screening and the vaccination program. This results in a significant difference in the 5-year budget impact, accounting for 30 and 40% of reduction in the 5-year budget impact for the pneumococcal and human papillomavirus vaccination programs. This study demonstrated the feasibility and importance of applying economies of scale in the cost estimation in economic evaluation, which would lead to different conclusions in terms of value for money regarding the interventions, particularly with population-wide interventions such as vaccination programs. The economies of scale approach to costing is recommended for the creation of methodological guidelines for conducting economic evaluations.

Determinants and Coverage of Vaccination in Children in Western Kenya from a 2003 Cross-Sectional Survey

PubMed Central

Calhoun, Lisa M.; van Eijk, Anna M.; Lindblade, Kim A.; Odhiambo, Frank O.; Wilson, Mark L.; Winterbauer, Elizabeth; Slutsker, Laurence; Hamel, Mary J.

2014-01-01

This study assesses full and timely vaccination coverage and factors associated with full vaccination in children ages 12–23 months in Gem, Nyanza Province, Kenya in 2003. A simple random sample of 1,769 households was selected, and guardians were invited to bring children under 5 years of age to participate in a survey. Full vaccination coverage was 31.1% among 244 children. Only 2.2% received all vaccinations in the target month for each vaccination. In multivariate logistic regression, children of mothers of higher parity (odds ratio [OR] = 0.27, 95% confidence interval [95% CI] = 0.13–0.65, P ≤ 0.01), children of mothers with lower maternal education (OR = 0.35, 95% CI = 0.13–0.97, P ≤ 0.05), or children in households with the spouse absent versus present (OR = 0.40, 95% CI = 0.17–0.91, P ≤ 0.05) were less likely to be fully vaccinated. These data serve as a baseline from which changes in vaccination coverage will be measured as interventions to improve vaccination timeliness are introduced. PMID:24343886

Determinants and coverage of vaccination in children in western Kenya from a 2003 cross-sectional survey.

PubMed

Calhoun, Lisa M; van Eijk, Anna M; Lindblade, Kim A; Odhiambo, Frank O; Wilson, Mark L; Winterbauer, Elizabeth; Slutsker, Laurence; Hamel, Mary J

2014-02-01

This study assesses full and timely vaccination coverage and factors associated with full vaccination in children ages 12-23 months in Gem, Nyanza Province, Kenya in 2003. A simple random sample of 1,769 households was selected, and guardians were invited to bring children under 5 years of age to participate in a survey. Full vaccination coverage was 31.1% among 244 children. Only 2.2% received all vaccinations in the target month for each vaccination. In multivariate logistic regression, children of mothers of higher parity (odds ratio [OR] = 0.27, 95% confidence interval [95% CI] = 0.13-0.65, P ≤ 0.01), children of mothers with lower maternal education (OR = 0.35, 95% CI = 0.13-0.97, P ≤ 0.05), or children in households with the spouse absent versus present (OR = 0.40, 95% CI = 0.17-0.91, P ≤ 0.05) were less likely to be fully vaccinated. These data serve as a baseline from which changes in vaccination coverage will be measured as interventions to improve vaccination timeliness are introduced.

Cost-effectiveness of HPV vaccination in the prevention of cervical cancer in Malaysia.

PubMed

Ezat, Wan Puteh Sharifa; Aljunid, Syed

2010-01-01

Cervical cancers (CC) demonstrate the second highest incidence of female cancers in Malaysia. The costs of chronic management have a high impact on nation's health cost and patient's quality of life that can be avoided by better screening and HPV vaccination. Respondents were interviewed from six public Gynecology-Oncology hospitals. Methods include experts' panel discussions to estimate treatment costs by severity and direct interviews with respondents using costing and SF-36 quality of life (QOL) questionnaires. Three options were compared i.e. screening via Pap smear; quadrivalent HPV Vaccination and combined strategy (screening plus vaccination). Scenario based sensitivity analysis using screening population coverage (40-80%) and costs of vaccine (RM 300-400/dose) were calculated. 502 cervical pre invasive and invasive cervical cancer (ICC) patients participated in the study. Mean age was 53.3 +/- 11.2 years, educated till secondary level (39.4%), Malays (44.2%) and married for 27.73 +/- 12.1 years. Life expectancy gained from vaccination is 13.04 years and average Quality Adjusted Life Years saved (QALYs) is 24.4 in vaccinated vs 6.29 in unvaccinated. Cost/QALYs for Pap smear at base case is RM 1,214.96/QALYs and RM 1,100.01 at increased screening coverage; for HPV Vaccination base case is at RM 35,346.79 and RM 46,530.08 when vaccination price is higher. In combined strategy, base case is RM 11,289.58; RM 7,712.74 at best case and RM 14,590.37 at worst case scenario. Incremental cost-effectiveness ratio (ICER) showed that screening at 70% coverage or higher is highly cost effective at RM 946.74 per QALYs saved and this is followed by combined strategy at RM 35,346.67 per QALYs saved. Vaccination increase life expectancy with better QOL of women when cancer can be avoided. Cost effective strategies will include increasing the Pap smear coverage to 70% or higher. Since feasibility and long term screening adherence is doubtful among Malaysian women, vaccination of young women is a more cost effective strategy against cervical cancers.

Modelling the impact of a combined varicella and zoster vaccination programme on the epidemiology of varicella zoster virus in England.

PubMed

van Hoek, Albert Jan; Melegaro, Alessia; Zagheni, Emelio; Edmunds, W John; Gay, Nigel

2011-03-16

This study updates previous work on modelling the incidence of varicella and Herpes Zoster (HZ) following the introduction of childhood vaccination. The updated model includes new data on age-specific contact patterns, as well as data on the efficacy of zoster vaccination in the elderly and allows for HZ among vaccinees. The current study also looks at two-dose varicella childhood programmes, and assesses the combined impact of varicella vaccination in childhood and zoster vaccination of the elderly. The results suggest that a two-dose schedule is likely to reduce the incidence of varicella to very low levels, provided first dose coverage is around 90% and second dose coverage is in excess of 70%. Single dose varicella vaccination programmes are expected to result in large numbers of breakthrough cases. Childhood vaccination is expected to increase the incidence of zoster for more than 40 years after introduction of the programme, the magnitude of this increase being influenced primarily by the duration of boosting following exposure to the varicella zoster virus. Though this increase in zoster incidence can be partly offset by vaccination of the elderly, the effectiveness of this combined strategy is limited, as much of the increase occurs in those adults too young to be vaccinated. Childhood vaccination at intermediate levels of coverage (70% and 60% for first and second dose coverage respectively) is expected to lead to an increase in adult varicella. At high coverage (90% and 80% coverage) this is unlikely to be the case. These results will be used to inform a cost-effectiveness analysis of combined varicella and zoster vaccination programmes. Copyright © 2011 Elsevier Ltd. All rights reserved.

[Influenza vaccination coverage (2011-2014) in healthcare workers from two health departments of the Valencian Community and hospital services more vulnerable to the flu.

PubMed

Tuells, José; García-Román, Vicente; Duro-Torrijos, José Luis

2018-04-05

Health care workers can transmit influenza to patients in health centers, therefore its vaccination is considered a preventive measure first order. The objective of this study was to know the coverage of vaccination against seasonal influenza in health professionals in two health departments of the Valencian Community (Torrevieja and Elx- Crevillent), in the seasons 2011-12, 2012-13 and 2013-14. TA cross-sectional descriptive study was carried out to determine the coverage of influenza vaccination through the Nominal Vaccine Registry (NVR) of the Conselleria de Sanitat de la Generalitat Valenciana. The services with the highest risk of contagion were detected through requests for PCR analysis in patients suspected of influenza during the 2013-14 season. A total of 2035 health professionals were surveyed who achieved an average vaccination coverage of 27.2% in the 2013-14 season, showing an upward trend from the 2011-12 season. Significant differences were observed between professional categories and, practitioners presented the lowest coverage. A total of 192 PCR requests were recorded in both departments. The services which concentrate a greater number of requests were: Internal Medicine (n = 100), urgency service (n = 37), intensive care unit (n = 25) and Pediatrics ( n=154); The influenza vaccination coverage of these services in the 2013-14 seasons was 27.0%, 32.3%, 34.3% and 25.3%, respectively. Although they show an upward trend, vaccination coverage is low in health care personnel. Nurses are the best vaccinated. It would be appropriate to implement immunization strategies aimed specifically at services that, because of their activity, pose a greater risk to the patient.

Impact of rotavirus vaccination in Germany: rotavirus surveillance, hospitalization, side effects and comparison of vaccines.

PubMed

Uhlig, Ulrike; Kostev, Karel; Schuster, Volker; Koletzko, Sibylle; Uhlig, Holm H

2014-11-01

Although rotavirus (RV) vaccination was licensed in 2006, it was not included into the officially recommended German childhood vaccination schedule until 2013. Local differences in health policies in the past led to large differences in vaccination coverage rate among the federal states of Germany. This enables an ecologic study of RV vaccine effectiveness. We performed a population-based retrospective analysis of RV vaccination use, RV notification and hospitalization among 0 to 5-year-old children in Germany during 2006 to 2011/2012. We compared effectiveness of the 2 RV vaccines, Rotateq and Rotarix, in an ambulatory setting and analyzed potential side effects. We observed a significant reduction in RV notifications since introduction of RV vaccination. In areas attaining vaccine coverage of 64%, RV-related hospital admissions of 0 and 1-year-old children decreased by 60% compared with 19% reduction in the low vaccination coverage area. Decrease in RV-related hospitalizations of 0 and 1-year-old children was specific and significantly associated with vaccination coverage of the individual federal state (P < 0.0001, r = -0.68). There was no overall increase in intussusception rate or Kawasaki disease-related hospital admissions since introduction of RV vaccination. The 2 licensed RV vaccines had similar effectiveness in the ambulatory setting. Postmarketing data suggest that RV vaccination is efficient in reducing RV-related hospitalizations. There is no apparent difference in effectiveness for Rotarix and Rotateq.

Diphtheria in Lao PDR: Insufficient Coverage or Ineffective Vaccine?

PubMed

Nanthavong, Naphavanh; Black, Antony P; Nouanthong, Phonethipsavanh; Souvannaso, Chanthasone; Vilivong, Keooudomphone; Muller, Claude P; Goossens, Sylvie; Quet, Fabrice; Buisson, Yves

2015-01-01

During late 2012 and early 2013 several outbreaks of diphtheria were notified in the North of the Lao People's Democratic Republic. The aim of this study was to determine whether the re-emergence of this vaccine-preventable disease was due to insufficient vaccination coverage or reduction of vaccine effectiveness within the affected regions. A serosurvey was conducted in the Huaphan Province on a cluster sampling of 132 children aged 12-59 months. Serum samples, socio-demographic data, nutritional status and vaccination history were collected when available. Anti-diphtheria and anti-tetanus IgG antibody levels were measured by ELISA. Overall, 63.6% of participants had detectable diphtheria antibodies and 71.2% tetanus antibodies. Factors independently associated with non-vaccination against diphtheria were the distance from the health centre (OR: 6.35 [95% CI: 1.4-28.8], p = 0.01), the Lao Theung ethnicity (OR: 12.2 [95% CI:1,74-85, 4], p = 0.01) and the lack of advice on vaccination given at birth (OR: 9.8 [95% CI: 1.5-63.8], (p = 0.01) while the level of maternal edu-cation was a protective factor (OR: 0.08 [95% CI: 0.008-0.81], p = 0.03). Most respondents claimed financial difficulties as the main reason for non-vaccination. Out of 55 children whose vaccination certificates stated that they were given all 3 doses of diphtheria-containing vaccine, 83.6% had diphtheria antibodies and 92.7% had tetanus antibodies. Furthermore, despite a high prevalence of stunted and underweight children (53% and 25.8%, respectively), the low levels of anti-diphtheria antibodies were not correlated to the nutritional status. Our data highlight a significant deficit in both the vaccination coverage and diphtheria vaccine effectiveness within the Huaphan Province. Technical deficiencies in the methods of storage and distribution of vaccines as well as unreliability of vaccination cards are discussed. Several hypotheses are advanced to explain such a decline in immunity against diphtheria and recommendations are provided to prevent future outbreaks.

Spatial and environmental connectivity analysis in a cholera vaccine trial.

PubMed

Emch, Michael; Ali, Mohammad; Root, Elisabeth D; Yunus, Mohammad

2009-02-01

This paper develops theory and methods for vaccine trials that utilize spatial and environmental information. Satellite imagery is used to identify whether households are connected to one another via water bodies in a study area in rural Bangladesh. Then relationships between neighborhood-level cholera vaccine coverage and placebo incidence and neighborhood-level spatial variables are measured. The study hypothesis is that unvaccinated people who are environmentally connected to people who have been vaccinated will be at lower risk compared to unvaccinated people who are environmentally connected to people who have not been vaccinated. We use four datasets including: a cholera vaccine trial database, a longitudinal demographic database of the rural population from which the vaccine trial participants were selected, a household-level geographic information system (GIS) database of the same study area, and high resolution Quickbird satellite imagery. An environmental connectivity metric was constructed by integrating the satellite imagery with the vaccine and demographic databases linked with GIS. The results show that there is a relationship between neighborhood rates of cholera vaccination and placebo incidence. Thus, people are indirectly protected when more people in their environmentally connected neighborhood are vaccinated. This result is similar to our previous work that used a simpler Euclidean distance neighborhood to measure neighborhood vaccine coverage [Ali, M., Emch, M., von Seidlein, L., Yunus, M., Sack, D. A., Holmgren, J., et al. (2005). Herd immunity conferred by killed oral cholera vaccines in Bangladesh. Lancet, 366(9479), 44-49]. Our new method of measuring environmental connectivity is more precise since it takes into account the transmission mode of cholera and therefore this study validates our assertion that the oral cholera vaccine provides indirect protection in addition to direct protection.

Effect of vaccination programmes on mortality burden among children and young adults in the Netherlands during the 20th century: a historical analysis.

PubMed

van Wijhe, Maarten; McDonald, Scott A; de Melker, Hester E; Postma, Maarten J; Wallinga, Jacco

2016-05-01

In the 20th century, childhood mortality decreased rapidly, and vaccination programmes are frequently suggested as a contributing factor. However, quantification of this contribution is subject to debate or absent. We present historical data from the Netherlands that allow us to quantify the reduction in childhood mortality burden for vaccine-preventable diseases in this period as a function of vaccination coverage. We retrieved cause-specific and age-specific historical mortality data from Statistics Netherlands from 1903 to 2012 (for Dutch birth cohorts born from 1903 to 1992), and data for vaccination coverage since the start of vaccination programmes from the Dutch Health Care Inspectorate and the Dutch National Institute for Public Health and the Environment. We also obtained birth and migration data from Statistics Netherlands. We used a restricted mean life-time method to estimate cause-specific mortality burden among children and young adults for each birth cohort as the years of life lost up to age 20 years, excluding migration as a variable because this did not affect the results. To correct for long-term trends, we calculated the cause-specific contribution to the total childhood mortality burden. In the prevaccination era, the contribution to mortality burden was fairly constant for diphtheria (1·4%), pertussis (3·8%), and tetanus (0·1%). Around the start of mass vaccinations, these contributions to the mortality burden decreased rapidly to near zero. We noted similar patterns for poliomyelitis, mumps, and rubella. The number of deaths due to measles around the start of vaccination in the Netherlands were too few to detect an accelerated rate of decrease after mass vaccinations were started. We estimate that mass vaccination programmes averted 148 000 years of life lost up to age 20 years (95% prediction interval 110 000-201 000) among children born before 1992. This corresponds to about 9000 deaths averted (6000-12 000). Our historical time series analysis of mortality and vaccination coverage shows a strong association between increasing vaccination coverage and diminishing contribution of vaccine-preventable diseases to overall mortality. This analysis provides further evidence that mass vaccination programmes contributed to lowering childhood mortality burden. Dutch Ministry of Health, Welfare and Sport. Copyright © 2016 Elsevier Ltd. All rights reserved.

[The coverage of hepatitis A vaccine among 2-29 year olds and the reporting incidence of hepatitis A in China, 2014].

PubMed

Wang, F Z; Zheng, H; Liu, J H; Sun, X J; Miao, N; Shen, L P; Zhang, G M; Cui, F Q

2016-08-10

To evaluate the hepatitis A vaccine coverage among 2-29 year olds and the reported incidence rates of hepatitis A, in China. Based on data from the national sero-survey on hepatitis B in 2014, information on hepatitis A vaccine immunization was collected and the coverage of hepatitis A vaccine was analyzed with SAS software (Version 9.4). Incidence data on hepatitis A was also collected from the National Notifiable Disease Reporting System between 2004 and 2014, and analyzed using the micro-software Excel 2007. Totally, data involving 29 058 people aged 2-29 years were available for analysis and the overall hepatitis A vaccine coverage was 44.6%. The younger the age, the higher the coverage appeared. Among the 2-6 year and the 7-14 year olds, rates of hepatitis A vaccine coverage were 91.2% and 76.0% respectively. From 2004 to 2014, the incidence rates of hepatitis A in the whole population were declining, annually. The incidence rates showed continuously declining as 82.5%, 90.6%, 72.1% among children at the age groups of 2-6 years, 7-14 years and in the whole population, from 2007 to 2013. After the inclusion of hepatitis A vaccine into the Expanded Programe on Immunization (EPI), the coverage of hepatitis A vaccine among the 2-6 year olds increased to over 90%, with no obvious difference between the urban and rural areas. Incidence of hepatitis A in the 2-6 year olds showed a more rapid decline than that in the whole population.

Assessment of on-time vaccination coverage in population subgroups: A record linkage cohort study.

PubMed

Moore, Hannah C; Fathima, Parveen; Gidding, Heather F; de Klerk, Nicholas; Liu, Bette; Sheppeard, Vicky; Effler, Paul V; Snelling, Thomas L; McIntyre, Peter; Blyth, Christopher C

2018-05-31

Reported infant vaccination coverage at age 12 months in Australia is >90%. On-time coverage of the 2-4-6 month schedule and coverage in specific populations is rarely reported. We conducted a population-based cohort study of 1.9 million Australian births, 1996-2012, combining individual birth and perinatal records with immunisation records through probabilistic linkage. We assessed on-time coverage across 13 demographic and perinatal characteristics of diphtheria-tetanus-pertussis vaccines (DTP) defined as vaccination 14 days prior to the scheduled due date, to 30 days afterwards. On-time DTP vaccination coverage in non-Aboriginal infants was 88.1% for the 2-month dose, 82.0% for 4-month dose, and 76.7% for 6-month dose; 3-dose coverage was 91.3% when assessed at 12 months. On-time DTP coverage for Aboriginal infants was 77.0%, 66.5%, and 61.0% for the 2-4-6 month dose; 3-dose coverage at 12 months was 79.3%. Appreciable differences in on-time coverage were observed across population subgroups. On-time coverage in non-Aboriginal infants born to mothers with ≥3 previous pregnancies was 62.5% for the 6-month dose (47.9% for Aboriginal infants); up to 23.5 percentage points lower than for first-borns. Infants born to mothers who smoked during pregnancy had coverage 8.7-10.3 percentage points lower than infants born to non-smoking mothers for the 4- and 6-month dose. A linear relationship was apparent between increasing socio-economic disadvantage and decreasing on-time coverage. On-time coverage of the 2-4-6 month schedule is only 50-60% across specific population subgroups representing a significant avoidable public health risk. Aboriginal infants, multiparous mothers, and those who are socio-economically disadvantaged are key groups most likely to benefit from targeted programs addressing vaccine timeliness. Copyright © 2018. Published by Elsevier Ltd.

Introduction and Rollout of a New Group A Meningococcal Conjugate Vaccine (PsA-TT) in African Meningitis Belt Countries, 2010–2014

PubMed Central

Djingarey, Mamoudou H.; Diomandé, Fabien V. K.; Barry, Rodrigue; Kandolo, Denis; Shirehwa, Florence; Lingani, Clement; Novak, Ryan T.; Tevi-Benissan, Carol; Perea, William; Preziosi, Marie-Pierre; LaForce, F. Marc

2015-01-01

Background. A group A meningococcal conjugate vaccine (PsA-TT) was developed specifically for the African “meningitis belt” and was prequalified by the World Health Organization (WHO) in June 2010. The vaccine was first used widely in Burkina Faso, Mali, and Niger in December 2010 with great success. The remaining 23 meningitis belt countries wished to use this new vaccine. Methods. With the help of African countries, WHO developed a prioritization scheme and used or adapted existing immunization guidelines to mount PsA-TT vaccination campaigns. Vaccine requirements were harmonized with the Serum Institute of India, Ltd. Results. Burkina Faso was the first country to fully immunize its 1- to 29-year-old population in December 2010. Over the next 4 years, vaccine coverage was extended to 217 million Africans living in 15 meningitis belt countries. Conclusions. The new group A meningococcal conjugate vaccine was well received, with country coverage rates ranging from 85% to 95%. The rollout proceeded smoothly because countries at highest risk were immunized first while attention was paid to geographic contiguity to maximize herd protection. Community participation was exemplary. PMID:26553672

Impact of methodological "shortcuts" in conducting public health surveys: Results from a vaccination coverage survey

PubMed Central

Luman, Elizabeth T; Sablan, Mariana; Stokley, Shannon; McCauley, Mary M; Shaw, Kate M

2008-01-01

Background Lack of methodological rigor can cause survey error, leading to biased results and suboptimal public health response. This study focused on the potential impact of 3 methodological "shortcuts" pertaining to field surveys: relying on a single source for critical data, failing to repeatedly visit households to improve response rates, and excluding remote areas. Methods In a vaccination coverage survey of young children conducted in the Commonwealth of the Northern Mariana Islands in July 2005, 3 sources of vaccination information were used, multiple follow-up visits were made, and all inhabited areas were included in the sampling frame. Results are calculated with and without these strategies. Results Most children had at least 2 sources of data; vaccination coverage estimated from any single source was substantially lower than from all sources combined. Eligibility was ascertained for 79% of households after the initial visit and for 94% of households after follow-up visits; vaccination coverage rates were similar with and without follow-up. Coverage among children on remote islands differed substantially from that of their counterparts on the main island indicating a programmatic need for locality-specific information; excluding remote islands from the survey would have had little effect on overall estimates due to small populations and divergent results. Conclusion Strategies to reduce sources of survey error should be maximized in public health surveys. The impact of the 3 strategies illustrated here will vary depending on the primary outcomes of interest and local situations. Survey limitations such as potential for error should be well-documented, and the likely direction and magnitude of bias should be considered. PMID:18371195

A Content Analysis of Newspaper Coverage of the Seasonal Flu Vaccine in Ontario, Canada, October 2001 to March 2011.

PubMed

Meyer, Samantha B; Lu, Stephanie K; Hoffman-Goetz, Laurie; Smale, Bryan; MacDougall, Heather; Pearce, Alex R

2016-10-01

Seasonal flu vaccine uptake has fallen dramatically over the past decade in Ontario, Canada, despite promotional efforts by public health officials. Media can be particularly influential in shaping the public response to seasonal flu vaccine campaigns. We therefore sought to identify the nature of the relationship between risk messages about getting the seasonal flu vaccine in newspaper coverage and the uptake of the vaccine by Ontarians between 2001 and 2010. A content analysis was conducted to quantify risk messages in newspaper content for each year of analysis. The quantification allowed us to test the correlation between the frequency of risk messages and vaccination rates. During the time period 2001-2010, vaccination rates were positively and significantly related to the frequency of risk messages in newspaper coverage (r = .691, p < .05). The most commonly identified risk messages related to the flu vaccine being ineffective, the flu vaccine being poorly understood by science, and the flu vaccine causing harm. Newspaper coverage plays an important role in shaping public response to seasonal flu vaccine campaigns. Public health officials should work alongside media to ensure that the public are exposed to information necessary for making informed decisions regarding vaccination.

Infectious Disease Risk and Vaccination in Northern Syria after 5 Years of Civil War: The MSF Experience.

PubMed

de Lima Pereira, Alan; Southgate, Rosamund; Ahmed, Hikmet; O'Connor, Penelope; Cramond, Vanessa; Lenglet, Annick

2018-02-02

In 2015, following an influx of population into Kobanê in northern Syria, Médecins Sans Frontières (MSF) in collaboration with the Kobanê Health Administration (KHA) initiated primary healthcare activities. A vaccination coverage survey and vaccine-preventable disease (VPD) risk analysis were undertaken to clarify the VPD risk and vaccination needs. This was followed by a measles Supplementary Immunization Activity (SIA). We describe the methods and results used for this prioritisation activity around vaccination in Kobanê in 2015. We implemented a pre-SIA survey in 135 randomly-selected households in Kobanê using a vaccination history questionnaire for all children <5 years. We conducted a VPD Risk Analysis using MSF 'Preventive Vaccination in Humanitarian Emergencies' guidance to prioritize antigens with the highest public health threat for mass vaccination activities. A Measles SIA was then implemented and followed by vaccine coverage survey in 282 randomly-selected households targeting children <5 years. The pre-SIA survey showed that 168/212 children (79.3%; 95%CI=72.7-84.6%) had received one vaccine or more in their lifetime. Forty-three children (20.3%; 95%CI: 15.1-26.6%) had received all vaccines due by their age; only one was <12 months old and this child had received all vaccinations outside of Syria. The VPD Risk Analysis prioritised measles, Haemophilus Influenza type B (Hib) and Pneumococcus vaccinations. In the measles SIA, 3410 children aged 6-59 months were vaccinated. The use of multiple small vaccination sites to reduce risks associated with crowds in this active conflict setting was noted as a lesson learnt. The post-SIA survey estimated 82% (95%CI: 76.9-85.9%; n=229/280) measles vaccination coverage in children 6-59 months. As a result of the conflict in Syria, the progressive collapse of the health care system in Kobanê has resulted in low vaccine coverage rates, particularly in younger age groups. The repeated displacements of the population, attacks on health institutions and exodus of healthcare workers, challenge the resumption of routine immunization in this conflict setting and limit the use of SIAs to ensure sustainable immunity to VPDs. We have shown that the risk for several VPDs in Kobanê remains high. We call on all health actors and the international community to work towards re-establishment of routine immunisation activities as a priority to ensure that children who have had no access to vaccination in the last five years are adequately protected for VPDs as soon as possible.

Perceptions and Attitudes of Patients About Adult Vaccination and Their Vaccination Status: Still a Long Way to Go?

PubMed

Ozisik, Lale; Calik Basaran, Nursel; Oz, S Gul; Sain Guven, Gulay; Durusu Tanriover, Mine

2017-06-29

BACKGROUND Immunization is one of the most effective public health measures to prevent disease, but vaccination rates in adult populations still remain below the targets. Patient and physician attitudes about vaccination are important for adult vaccination. In this study, we aimed to determine patient attitudes and perceptions about vaccination and the vaccination coverage rates of adult patients in a university hospital in Turkey. MATERIAL AND METHODS A survey was conducted between October 2014 and May 2015 at the Internal Medicine Outpatient Clinics of a university hospital. Adult patients were asked to fill out a questionnaire on their perceptions and attitudes about vaccination and their vaccination status. RESULTS We interviewed 512 patients ages 19-64 years. Eighty percent of the study population thought that adults should be vaccinated, while only 36.1% of the patients stated that vaccination was ever recommended to them in their adult life. Forty-eight percent of the patients stated that they were vaccinated at least once in their adulthood. The most commonly received vaccine was tetanus vaccine in general, while influenza vaccine was the leading vaccine among patients with chronic medical conditions. While 71.4% of the patients to whom vaccination was recommended received the vaccine, 34.9% of the patients received a vaccine without any recommendation. CONCLUSIONS Although the vaccine coverage rates among adults in this survey were low, the perceptions of patients about adult vaccination were mainly positive and of many of them positively reacted when their physician recommended a vaccine.

Determinants of vaccination coverage in rural Nigeria.

PubMed

Odusanya, Olumuyiwa O; Alufohai, Ewan F; Meurice, Francois P; Ahonkhai, Vincent I

2008-11-05

Childhood immunization is a cost effective public health strategy. Expanded Programme on Immunisation (EPI) services have been provided in a rural Nigerian community (Sabongidda-Ora, Edo State) at no cost to the community since 1998 through a privately financed vaccination project (private public partnership). The objective of this survey was to assess vaccination coverage and its determinants in this rural community in Nigeria A cross-sectional survey was conducted in September 2006, which included the use of interviewer-administered questionnaire to assess knowledge of mothers of children aged 12-23 months and vaccination coverage. Survey participants were selected following the World Health Organization's (WHO) immunization coverage cluster survey design. Vaccination coverage was assessed by vaccination card and maternal history. A child was said to be fully immunized if he or she had received all of the following vaccines: a dose of Bacille Calmette Guerin (BCG), three doses of oral polio (OPV), three doses of diphtheria, pertussis and tetanus (DPT), three doses of hepatitis B (HB) and one dose of measles by the time he or she was enrolled in the survey, i.e. between the ages of 12-23 months. Knowledge of the mothers was graded as satisfactory if mothers had at least a score of 3 out of a maximum of 5 points. Logistic regression was performed to identify determinants of full immunization status. Three hundred and thirty-nine mothers and 339 children (each mother had one eligible child) were included in the survey. Most of the mothers (99.1%) had very positive attitudes to immunization and > 55% were generally knowledgeable about symptoms of vaccine preventable diseases except for difficulty in breathing (as symptom of diphtheria). Two hundred and ninety-five mothers (87.0%) had a satisfactory level of knowledge. Vaccination coverage against all the seven childhood vaccine preventable diseases was 61.9% although it was significantly higher (p = 0.002) amongst those who had a vaccination card (131/188, 69.7%) than in those assessed by maternal history (79/151, 52.3%). Multiple logistic regression showed that mothers' knowledge of immunization (p = 0.006) and vaccination at a privately funded health facility (p < 0.001) were significantly correlated with the rate of full immunization. Eight years after initiation of this privately financed vaccination project (private-public partnership), vaccination coverage in this rural community is at a level that provides high protection (81%) against DPT/OPV. Completeness of vaccination was significantly correlated with knowledge of mothers on immunization and adequate attention should be given to this if high coverage levels are to be sustained.

High agreement between the new Mongolian electronic immunization register and written immunization records: a health centre based audit

PubMed Central

Mungun, Tuya; Dorj, Narangerel; Volody, Baigal; Chuluundorj, Uranjargal; Munkhbat, Enkhtuya; Danzan, Gerelmaa; Nguyen, Cattram D; La Vincente, Sophie; Russell, Fiona

2017-01-01

Introduction Monitoring of vaccination coverage is vital for the prevention and control of vaccine-preventable diseases. Electronic immunization registers have been increasingly adopted to assist with the monitoring of vaccine coverage; however, there is limited literature about the use of electronic registers in low- and middle-income countries such as Mongolia. We aimed to determine the accuracy and completeness of the newly introduced electronic immunization register for calculating vaccination coverage and determining vaccine effectiveness within two districts in Mongolia in comparison to written health provider records. Methods We conducted a cross-sectional record review among children 2–23 months of age vaccinated at immunization clinics within the two districts. We linked data from written records with the electronic immunization register using the national identification number to determine the completeness and accuracy of the electronic register. Results Both completeness (90.9%; 95% CI: 88.4–93.4) and accuracy (93.3%; 95% CI: 84.1–97.4) of the electronic immunization register were high when compared to written records. The increase in completeness over time indicated a delay in data entry. Conclusion Through this audit, we have demonstrated concordance between a newly introduced electronic register and health provider records in a middle-income country setting. Based on this experience, we recommend that electronic registers be accompanied by routine quality assurance procedures for the monitoring of vaccination programmes in such settings. PMID:29051836

The Impact of Imitation on Vaccination Behavior in Social Contact Networks

PubMed Central

Ndeffo Mbah, Martial L.; Liu, Jingzhou; Bauch, Chris T.; Tekel, Yonas I.; Medlock, Jan; Meyers, Lauren Ancel; Galvani, Alison P.

2012-01-01

Previous game-theoretic studies of vaccination behavior typically have often assumed that populations are homogeneously mixed and that individuals are fully rational. In reality, there is heterogeneity in the number of contacts per individual, and individuals tend to imitate others who appear to have adopted successful strategies. Here, we use network-based mathematical models to study the effects of both imitation behavior and contact heterogeneity on vaccination coverage and disease dynamics. We integrate contact network epidemiological models with a framework for decision-making, within which individuals make their decisions either based purely on payoff maximization or by imitating the vaccination behavior of a social contact. Simulations suggest that when the cost of vaccination is high imitation behavior may decrease vaccination coverage. However, when the cost of vaccination is small relative to that of infection, imitation behavior increases vaccination coverage, but, surprisingly, also increases the magnitude of epidemics through the clustering of non-vaccinators within the network. Thus, imitation behavior may impede the eradication of infectious diseases. Calculations that ignore behavioral clustering caused by imitation may significantly underestimate the levels of vaccination coverage required to attain herd immunity. PMID:22511859

Impact of a website based educational program for increasing vaccination coverage among adolescents.

PubMed

Esposito, Susanna; Bianchini, Sonia; Tagliabue, Claudia; Umbrello, Giulia; Madini, Barbara; Di Pietro, Giada; Principi, Nicola

2018-04-03

Data regarding the use of technology to improve adolescent knowledge on vaccines are scarce. The main aim of this study was to evaluate whether different web-based educational programmes for adolescents might increase their vaccination coverage. Overall, 917 unvaccinated adolescents (389 males, 42.4%; mean age ± standard deviation, 14.0 ± 2.2 years) were randomized 1:1:1 into the following groups: no intervention (n = 334), website educational program only (n = 281), or website plus face to face lesson (n = 302) groups. The use of the website plus the lesson significantly increased the overall knowledge of various aspects of vaccine-preventable disease and reduced the fear of vaccines (p < 0.001). A significant increase in vaccination coverage was observed for tetanus, diphtheria, acellular pertussis and conjugated meningococcal ACYW vaccines in the 2 groups using the website (p < 0.001), and better results were observed in the group that had also received the lesson; in this last group, significant results were observed in the increase in vaccination coverage for meningococcal B vaccine (p < 0.001). Overall, the majority of the participants liked the experience of the website, although they considered it important to further discuss vaccines with parents, experts and teachers. This study is the first to evaluate website based education of adolescents while considering all of the vaccines recommended for this age group. Our results demonstrate the possibility of increasing vaccination coverage by using a website based educational program with tailored information. However, to be most effective, this program should be supplemented with face-to-face discussions of vaccines at school and at home. Thus, specific education should also include teachers and parents so that they will be prepared to discuss with adolescents what is true and false in the vaccination field.

Beyond Rational Decision-Making: Modelling the Influence of Cognitive Biases on the Dynamics of Vaccination Coverage.

PubMed

Voinson, Marina; Billiard, Sylvain; Alvergne, Alexandra

2015-01-01

Theoretical studies predict that it is not possible to eradicate a disease under voluntary vaccination because of the emergence of non-vaccinating "free-riders" when vaccination coverage increases. A central tenet of this approach is that human behaviour follows an economic model of rational choice. Yet, empirical studies reveal that vaccination decisions do not necessarily maximize individual self-interest. Here we investigate the dynamics of vaccination coverage using an approach that dispenses with payoff maximization and assumes that risk perception results from the interaction between epidemiology and cognitive biases. We consider a behaviour-incidence model in which individuals perceive actual epidemiological risks as a function of their opinion of vaccination. As a result of confirmation bias, sceptical individuals (negative opinion) overestimate infection cost while pro-vaccines individuals (positive opinion) overestimate vaccination cost. We considered a feedback between individuals and their environment as individuals could change their opinion, and thus the way they perceive risks, as a function of both the epidemiology and the most common opinion in the population. For all parameter values investigated, the infection is never eradicated under voluntary vaccination. For moderately contagious diseases, oscillations in vaccination coverage emerge because individuals process epidemiological information differently depending on their opinion. Conformism does not generate oscillations but slows down the cultural response to epidemiological change. Failure to eradicate vaccine preventable disease emerges from the model because of cognitive biases that maintain heterogeneity in how people perceive risks. Thus, assumptions of economic rationality and payoff maximization are not mandatory for predicting commonly observed dynamics of vaccination coverage. This model shows that alternative notions of rationality, such as that of ecological rationality whereby individuals use simple cognitive heuristics, offer promising new avenues for modelling vaccination behaviour.

Ranking viruses: measures of positional importance within networks define core viruses for rational polyvalent vaccine development.

PubMed

Anderson, Tavis K; Laegreid, William W; Cerutti, Francesco; Osorio, Fernando A; Nelson, Eric A; Christopher-Hennings, Jane; Goldberg, Tony L

2012-06-15

The extraordinary genetic and antigenic variability of RNA viruses is arguably the greatest challenge to the development of broadly effective vaccines. No single viral variant can induce sufficiently broad immunity, and incorporating all known naturally circulating variants into one multivalent vaccine is not feasible. Furthermore, no objective strategies currently exist to select actual viral variants that should be included or excluded in polyvalent vaccines. To address this problem, we demonstrate a method based on graph theory that quantifies the relative importance of viral variants. We demonstrate our method through application to the envelope glycoprotein gene of a particularly diverse RNA virus of pigs: porcine reproductive and respiratory syndrome virus (PRRSV). Using distance matrices derived from sequence nucleotide difference, amino acid difference and evolutionary distance, we constructed viral networks and used common network statistics to assign each sequence an objective ranking of relative 'importance'. To validate our approach, we use an independent published algorithm to score our top-ranked wild-type variants for coverage of putative T-cell epitopes across the 9383 sequences in our dataset. Top-ranked viruses achieve significantly higher coverage than low-ranked viruses, and top-ranked viruses achieve nearly equal coverage as a synthetic mosaic protein constructed in silico from the same set of 9383 sequences. Our approach relies on the network structure of PRRSV but applies to any diverse RNA virus because it identifies subsets of viral variants that are most important to overall viral diversity. We suggest that this method, through the objective quantification of variant importance, provides criteria for choosing viral variants for further characterization, diagnostics, surveillance and ultimately polyvalent vaccine development.

To close the childhood immunization gap, we need a richer understanding of parents' decision-making.

PubMed

Corben, Paul; Leask, Julie

2016-12-01

Vaccination is widely acknowledged as one of the most successful public health interventions globally and in most high-income countries childhood vaccination coverage rates are moderately high. Yet in many instances, immunisation rates remain below aspirational targets and have shown only modest progress toward those targets in recent years, despite concerted efforts to improve uptake. In part, coverage rates reflect individual parents' vaccination attitudes and decisions and, because vaccination decision-making is complex and context-specific, it remains challenging at individual and community levels to assist parents to make positive decisions. Consequently, in the search for opportunities to improve immunisation coverage, there has been a renewed research focus on parents' decision-making. This review provides an overview of the literature surrounding parents' vaccination decision-making, offering suggestions for where efforts to increase vaccination coverage should be targeted and identifying areas for further research.

Too Late to Vaccinate? The Incremental Benefits and Cost-effectiveness of a Delayed Catch-up Program Using the 4-Valent Human Papillomavirus Vaccine in Norway

PubMed Central

Burger, Emily A.; Sy, Stephen; Nygård, Mari; Kristiansen, Ivar S.; Kim, Jane J.

2015-01-01

Background Human papillomavirus (HPV) vaccines are ideally administered before HPV exposure; therefore, catch-up programs for girls past adolescence have not been readily funded. We evaluated the benefits and cost-effectiveness of a delayed, 1-year female catch-up vaccination program in Norway. Methods We calibrated a dynamic HPV transmission model to Norwegian data and projected the costs and benefits associated with 8 HPV-related conditions while varying the upper vaccination age limit to 20, 22, 24, or 26 years. We explored the impact of vaccine protection in women with prior vaccine-targeted HPV infections, vaccine cost, coverage, and natural- and vaccine-induced immunity. Results The incremental benefits and cost-effectiveness decreased as the upper age limit for catch-up increased. Assuming a vaccine cost of $150/dose, vaccination up to age 20 years remained below Norway's willingness-to-pay threshold (approximately $83 000/quality-adjusted life year gained); extension to age 22 years was cost-effective at a lower cost per dose ($50–$75). At high levels of vaccine protection in women with prior HPV exposure, vaccinating up to age 26 years was cost-effective. Results were stable with lower coverage. Conclusions HPV vaccination catch-up programs, 5 years after routine implementation, may be warranted; however, even at low vaccine cost per dose, the cost-effectiveness of vaccinating beyond age 22 years remains uncertain. PMID:25057044

Vaccination coverage and factors influencing routine vaccination status in 12 high risk health zones in the Province of Kinshasa City, Democratic Republic of Congo (DRC), 2015.

PubMed

Mwamba, Guillaume Ngoie; Yoloyolo, Norbert; Masembe, Yolande; Nsambu, Muriel Nzazi; Nzuzi, Cathy; Tshekoya, Patrice; Dah, Barthelemy; Kaya, Guylain

2017-01-01

Vaccination coverage of the first dose of diphtheria-tetanus-pertussis-hepatitis B- Haemophilus influenza type b (pentavalent) vaccine for the City-Province of Kinshasain the years 2012 - 2014 wasbelow the national objective of 92%, with coverage less than 80% reported in 12 of the 35 health zones (HZ). The purpose of this study was to discern potential contributing factors to low vaccination coverage in Kinshasa. We conducted a multi-stage cluster household study of children 6 - 11 months in households residing in their current neighborhood for at least 3 months in the 12 high risk HZ in Kinshasa. Additional information on vaccination status of the children was collected at the health facility. Of the 1,513 households with a child 6-11 months old, 81% were eligible and participated. Among the 1224 children surveyed, 96% had received the first dose of pentavalent vaccine; 84% had received the third dose; and 71% had received all recommended vaccines for their age. Longer travel time to get to health facility (p=0.04) and shorter length of residence in the neighborhood (p=0.04) showed significant differences in relation to incomplete vaccination. Forty percent of children received their most recent vaccination in a facility outside of their HZ of residence. This survey found vaccination coverage in 12 HZs in Kinshasa was higher than estimates derived from administrative reports. The large percentage of children vaccinated outside of their HZ of residence demonstrates the challenge to use of the Reaching Every District strategy in urban areas.

Prevention of HPV-related cancers in Norway: cost-effectiveness of expanding the HPV vaccination program to include pre-adolescent boys.

PubMed

Burger, Emily A; Sy, Stephen; Nygård, Mari; Kristiansen, Ivar S; Kim, Jane J

2014-01-01

Increasingly, countries have introduced female vaccination against human papillomavirus (HPV), causally linked to several cancers and genital warts, but few have recommended vaccination of boys. Declining vaccine prices and strong evidence of vaccine impact on reducing HPV-related conditions in both women and men prompt countries to reevaluate whether HPV vaccination of boys is warranted. A previously-published dynamic model of HPV transmission was empirically calibrated to Norway. Reductions in the incidence of HPV, including both direct and indirect benefits, were applied to a natural history model of cervical cancer, and to incidence-based models for other non-cervical HPV-related diseases. We calculated the health outcomes and costs of the different HPV-related conditions under a gender-neutral vaccination program compared to a female-only program. Vaccine price had a decisive impact on results. For example, assuming 71% coverage, high vaccine efficacy and a reasonable vaccine tender price of $75 per dose, we found vaccinating both girls and boys fell below a commonly cited cost-effectiveness threshold in Norway ($83,000/quality-adjusted life year (QALY) gained) when including vaccine benefit for all HPV-related diseases. However, at the current market price, including boys would not be considered 'good value for money.' For settings with a lower cost-effectiveness threshold ($30,000/QALY), it would not be considered cost-effective to expand the current program to include boys, unless the vaccine price was less than $36/dose. Increasing vaccination coverage to 90% among girls was more effective and less costly than the benefits achieved by vaccinating both genders with 71% coverage. At the anticipated tender price, expanding the HPV vaccination program to boys may be cost-effective and may warrant a change in the current female-only vaccination policy in Norway. However, increasing coverage in girls is uniformly more effective and cost-effective than expanding vaccination coverage to boys and should be considered a priority.

2009-2010 seasonal influenza vaccination coverage among college students from 8 universities in North Carolina.

PubMed

Poehling, Katherine A; Blocker, Jill; Ip, Edward H; Peters, Timothy R; Wolfson, Mark

2012-01-01

The authors sought to describe the 2009-2010 seasonal influenza vaccine coverage of college students. A total of 4,090 college students from 8 North Carolina universities participated in a confidential, Web-based survey in October-November 2009. Associations between self-reported 2009-2010 seasonal influenza vaccination and demographic characteristics, campus activities, parental education, and e-mail usage were assessed by bivariate analyses and by a mixed-effects model adjusting for clustering by university. Overall, 20% of students (range 14%-30% by university) reported receiving 2009-2010 seasonal influenza vaccine. Being a freshman, attending a private university, having a college-educated parent, and participating in academic clubs/honor societies predicted receipt of influenza vaccine in the mixed-effects model. The self-reported 2009-2010 influenza vaccine coverage was one-quarter of the 2020 Healthy People goal (80%) for healthy persons 18 to 64 years of age. College campuses have the opportunity to enhance influenza vaccine coverage among its diverse student populations.

Seasonal Influenza Vaccination in Health Care Workers. A Pre-Post Intervention Study in an Italian Paediatric Hospital.

PubMed

Gilardi, Francesco; Castelli Gattinara, Guido; Vinci, Maria Rosaria; Ciofi Degli Atti, Marta; Santilli, Veronica; Brugaletta, Rita; Santoro, Annapaola; Montanaro, Rosina; Lavorato, Luisa; Raponi, Massimiliano; Zaffina, Salvatore

2018-04-24

Despite relevant recommendations and evidences on the efficacy of influenza vaccination in health care workers (HCWs), vaccination coverage rates in Europe and Italy currently do not exceed 25%. Aim of the study is to measure the variations in vaccination coverage rates in an Italian pediatric hospital after a promotion campaign performed in the period October⁻December 2017. The design is a pre-post intervention study. The intervention is based on a wide communication campaign and an expanded offer of easy vaccination on site. The study was carried out at Bambino Gesù Children’s hospital in Rome, Italy, on the whole population of HCWs. Univariate and multivariate statistical analyses were performed. Vaccination coverage rate increased in 2017/18 campaign compared with the 2016/17 one (+95 HCWs vaccinated; +4.4%). The highest increases were detected in males (+45.7%), youngest employees (+142.9%), mean age of employment (+175%), other HCWs (+209.1%), Emergency Area (+151.6%) and Imaging Diagnostic Department (+200.0%). At multivariate logistic regression, working in some departments and being nurses represents a higher risk of being unvaccinated. Although the vaccination coverage rate remained low, a continuous increase of the coverage rate and development of a different consciousness in HCWs was highlighted. The study significantly identified the target for future campaigns.

Variation in adult vaccination policies across Europe: an overview from VENICE network on vaccine recommendations, funding and coverage.

PubMed

Kanitz, Elisabeth E; Wu, Lauren A; Giambi, Cristina; Strikas, Raymond A; Levy-Bruhl, Daniel; Stefanoff, Pawel; Mereckiene, Jolita; Appelgren, Eva; D'Ancona, Fortunato

2012-07-27

In 2010-2011, in the framework of the VENICE project, we surveyed European Union (EU) and Economic Area (EEA) countries to fill the gap of information regarding vaccination policies in adults. This project was carried out in collaboration with the United States National Vaccine Program Office, who conducted a similar survey in all developed countries. VENICE representatives of all 29 EU/EEA-countries received an online questionnaire including vaccination schedule, recommendations, funding and coverage in adults for 17 vaccine-preventable diseases. The response rate was 100%. The definition of age threshold for adulthood for the purpose of vaccination ranged from 15 to 19 years (median=18 years). EU/EEA-countries recommend between 4 and 16 vaccines for adults (median=11 vaccines). Tetanus and diphtheria vaccines are recommended to all adults in 22 and 21 countries respectively. The other vaccines are mostly recommended to specific risk groups; recommendations for seasonal influenza and hepatitis B exist in all surveyed countries. Six countries have a comprehensive summary document or schedule describing all vaccines which are recommended for adults. None of the surveyed countries was able to provide coverage estimates for all the recommended adult vaccines. Vaccination policies for adults are not consistent across Europe, including the meaning of "recommended vaccine" which is not comparable among countries. Coverage data for adults should be collected routinely like for children vaccination. Copyright © 2012 Elsevier Ltd. All rights reserved.

Vaccination coverage of children with rare genetic diseases and attitudes of their parents toward vaccines

PubMed Central

Esposito, Susanna; Cerutti, Marta; Milani, Donatella; Menni, Francesca; Principi, Nicola

2016-01-01

Abstract Despite the fact that the achievement of appropriate immunization coverage for routine vaccines is a priority for health authorities worldwide, vaccination delays or missed opportunities for immunization are common in children with chronic diseases. The main aim of this cross-sectional study was to evaluate immunization coverage and the timeliness of vaccination in children suffering from 3 different rare genetic diseases: Rubinstein-Taybi syndrome (RSTS), Sotos syndrome (SS), and Beckwith-Wiedemann syndrome (BWS). A total of 57 children with genetic diseases (15 with RSTS, 14 children with SS, and 28 with BWS) and 57 healthy controls with similar characteristics were enrolled. The coverage of all the recommended vaccines in children with genetic syndromes was significantly lower than that observed in healthy controls (p < 0.05 for all the comparisons). However, when vaccinated, all of the patients, independent of the genetic syndrome from which they suffer, were administered the primary series and the booster doses at a similar time to healthy controls. In comparison with parents of healthy controls, parents of children with genetic diseases were found to more frequently have negative attitudes toward vaccination (p < 0.05 for all the comparisons), mainly for fear of the emergence of adverse events or deterioration of the underlying disease. This study shows that vaccination coverage is poor in pediatric patients with RSTS, BWS, and SS and significantly lower than that observed in healthy children. These results highlight the need for educational programs specifically aimed at both parents and pediatricians to increase immunization coverage in children with these rare genetic diseases. PMID:26337545

Estimates of the Public Health Impact of a Pediatric Vaccination Program Using an Intranasal Tetravalent Live-Attenuated Influenza Vaccine in Belgium.

PubMed

Gerlier, Laetitia; Lamotte, Mark; Dos Santos Mendes, Sofia; Damm, Oliver; Schwehm, Markus; Eichner, Martin

2016-08-01

Our objectives were to estimate the public health outcomes of vaccinating Belgian children using an intranasal tetravalent live-attenuated influenza vaccine (QLAIV) combined with current coverage of high-risk/elderly individuals using the trivalent inactivated vaccine. We used a deterministic, age-structured, dynamic model to simulate seasonal influenza transmission in the Belgian population under the current coverage or after extending vaccination with QLAIV to healthy children aged 2-17 years. Differential equations describe demographic changes, exposure to infectious individuals, infection recovery, and immunity dynamics. The basic reproduction number (R 0) was calibrated to the observed number of influenza doctor visits/year. Vaccine efficacy was 80 % (live-attenuated) and 59-68 % (inactivated). The 10-year incidence of symptomatic influenza was calculated with different coverage scenarios (add-on to current coverage). Model calibration yielded R 0 = 1.1. QLAIV coverage of 75 % of those aged 2-17 years averted 374,000 symptomatic cases/year (57 % of the current number), 244,000 of which were among adults (indirect effect). Vaccinating 75 % of those aged 2-11 years and 50 % of those aged 12-17 years averted 333,200 cases/year (213,000 adult cases/year). Vaccinating only healthy children aged 2-5 years generated direct protection but limited indirect protection, even with 90 % coverage (40,800 averted adult cases/year; -8.4 %). Targeting all children averted twice as many high-risk cases as targeting high-risk children only (8485 vs. 4965/year with 75 % coverage). Sensitivity analyses showed the robustness of results. The model highlights the direct and indirect protection benefits when vaccinating healthy children with QLAIV in Belgium. Policies targeting only high-risk individuals or the youngest provide limited herd protection, as school-age children are important influenza vectors in the community.

Lessons learned and applied

PubMed Central

Hebert, Corey Joseph; Hall, Corey M.; Odoms, La’ Nyia J.

2012-01-01

Most vaccines available in the United States (US) have been incorporated into vaccination schedules for infants and young children, age groups particularly at risk of contracting infectious diseases. High universal vaccination coverage is responsible for substantially reducing or nearly eliminating many of the diseases that once killed thousands of children each year in the US. Despite the success of infant vaccinations, periods of low vaccination coverage and the limited immunogenicity and duration of protection of certain vaccines have resulted in sporadic outbreaks, allowing some diseases to spread in communities. These challenges suggest that expanded vaccination coverage to younger infants and adolescents, and more immunogenic vaccines, may be needed in some instances. This review focuses on the importance of infant immunization and explores the successes and challenges of current early childhood vaccination programs and how these lessons may be applied to other invasive diseases, such as meningococcal disease. PMID:22617834

Factors associated with routine immunization coverage of children under one year old in Lao People's Democratic Republic.

PubMed

Phoummalaysith, Bounfeng; Yamamoto, Eiko; Xeuatvongsa, Anonh; Louangpradith, Viengsakhone; Keohavong, Bounxou; Saw, Yu Mon; Hamajima, Nobuyuki

2018-05-03

Routine vaccination is administered free of charge to all children under one year old in Lao People's Democratic Republic (Lao PDR) and the national goal is to achieve at least 95% coverage with all vaccines included in the national immunization program by 2025. In this study, factors related to the immunization system and characteristics of provinces and districts in Lao PDR were examined to evaluate the association with routine immunization coverage. Coverage rates for Bacillus Calmette-Guerin (BCG), Diphtheria-Tetanus-Pertussis-Hepatitis B (DTP-HepB), DTP-HepB-Hib (Haemophilus influenzae type B), polio (OPV), and measles (MCV1) vaccines from 2002 to 2014 collected through regular reporting system, were used to identify the immunization coverage trends in Lao PDR. Correlation analysis was performed using immunization coverage, characteristics of provinces or districts (population, population density, and proportion of poor villages and high-risk villages), and factors related to immunization service (including the proportions of the following: villages served by health facility levels, vaccine session types, and presence of well-functioning cold chain equipment). To determine factors associated with low coverage, provinces were categorized based on 80% of DTP-HepB-Hib3 coverage (<80% = low group; ≥80% = high group). Coverages of BCG, DTP-HepB3, OPV3 and MCV1 increased gradually from 2007 to 2014 (82.2-88.3% in 2014). However, BCG coverage showed the least improvement from 2002 to 2014. The coverage of each vaccine correlated with the coverage of the other vaccines and DTP-HepB-Hib dropout rate in provinces as well as districts. The provinces with low immunization coverage were correlated with higher proportions of poor villages. Routine immunization coverage has been improving in the last 13 years, but the national goal is not yet reached in Lao PDR. The results of this study suggest that BCG coverage and poor villages should be targeted to improve nationwide coverage. Copyright © 2018 Elsevier Ltd. All rights reserved.

Timeliness and completeness of vaccination and risk factors for low and late vaccine uptake in young children living in rural southern Tanzania.

PubMed

Le Polain de Waroux, Olivier; Schellenberg, Joanna R Armstrong; Manzi, Fatuma; Mrisho, Mwifadhi; Shirima, Kizito; Mshinda, Hassan; Alonso, Pedro; Tanner, Marcel; Schellenberg, David M

2013-06-01

We studied coverage and timeliness of vaccination and risk factors for low and delayed vaccine uptake in children aged <2 years in rural Tanzania. We used data from a cluster survey conducted in 2004, which included 1403 children. Risk factors were analysed by log-binomial regression adjusted for the clustering. The analysis was restricted to BCG, first and third dose of Diphtheria-Tetanus-Pertussis vaccines (DTP-1 and DTP-3) and first dose of measles-containing vaccine (MCV-1). Coverage for BCG, DTP-1, DTP-3 and MCV-1 was 94%, 96%, 90% and 86%, respectively. Delayed vaccination (>1 month after the recommended age) occurred in 398/1205 (33%) children for BCG, 404/1189 (34%) for DTP-1, 683/990 (69%) for DTP-3 and 296/643 (46%) for MCV-1. Coverage was lower for all vaccines except DTP-1 in children living ≥5 km from a healthcare facility. Delayed uptake was associated with poverty. Low and delayed MCV-1 vaccination was associated with low maternal education. Delayed BCG vaccination was associated with ethnicity and rainy season. Despite reasonably high vaccination coverage, we observed substantial vaccination delays, particularly for DTP-3 and MCV-1. We found specific factors associated with low and/or delayed vaccine uptake. These findings can help to improve strategies to reach children who remain inadequately protected.

Hepatitis B vaccination coverage and risk factors associated with incomplete vaccination of children born to hepatitis B surface antigen-positive mothers, Denmark, 2006 to 2010.

PubMed

Kunoee, Asja; Nielsen, Jens; Cowan, Susan

2016-01-01

In Denmark, universal screening of pregnant women for hepatitis B has been in place since November 2005, with the first two years as a trial period with enhanced surveillance. It is unknown what the change to universal screening without enhanced surveillance has meant for vaccination coverage among children born to hepatitis B surface antigen (HBsAg)-positive mothers and what risk factors exist for incomplete vaccination. This retrospective cohort study included 699 children of mothers positive for HBsAg. Information on vaccination and risk factors was collected from central registers. In total, 93% (651/699) of the children were vaccinated within 48 hours of birth, with considerable variation between birthplaces. Only 64% (306/475) of the children had received all four vaccinations through their general practitioner (GP) at the age of two years, and 10% (47/475) of the children had received no hepatitis B vaccinations at all. Enhanced surveillance was correlated positively with coverage of birth vaccination but not with coverage at the GP. No or few prenatal examinations were a risk factor for incomplete vaccination at the GP. Maternity wards and GPs are encouraged to revise their vaccination procedures and routines for pregnant women, mothers with chronic HBV infection and their children.

Measuring HPV vaccination coverage in Australia: comparing two alternative population-based denominators.

PubMed

Barbaro, Bianca; Brotherton, Julia M L

2015-08-01

To compare the use of two alternative population-based denominators in calculating HPV vaccine coverage in Australia by age groups, jurisdiction and remoteness areas. Data from the National HPV Vaccination Program Register (NHVPR) were analysed at Local Government Area (LGA) level, by state/territory and by the Australian Standard Geographical Classification Remoteness Structure. The proportion of females vaccinated was calculated using both the ABS ERP and Medicare enrolments as the denominator. HPV vaccine coverage estimates were slightly higher using Medicare enrolments than using the ABS estimated resident population nationally (70.8% compared with 70.4% for 12 to 17-year-old females, and 33.3% compared with 31.9% for 18 to 26-year-old females, respectively.) The greatest differences in coverage were found in the remote areas of Australia. There is minimal difference between coverage estimates made using the two denominators except in Remote and Very Remote areas where small residential populations make interpretation more difficult. Adoption of Medicare enrolments for the denominator in the ongoing program would make minimal, if any, difference to routine coverage estimates. © 2015 Public Health Association of Australia.

A 60-year review on the changing epidemiology of measles in capital Beijing, China, 1951-2011

PubMed Central

2013-01-01

Background China pledged to join the global effort to eliminate measles by 2012. To improve measles control strategy, the epidemic trend and population immunity of measles were investigated in 1951–2011 in Beijing. Methods The changing trend of measles since 1951 was described based on measles surveillance data from Beijing Centre of Disease Control and Prevention (CDC). The measles vaccination coverage and antibody level were assessed by routinely reported measles vaccination data and twenty-one sero-epidemiological surveys. Results The incidence of measles has decreased significantly from 593.5/100,000 in 1951 (peaked at 2721.0/100,000 in 1955), to 0.5/100,000 in 2011 due to increasing vaccination coverage of 95%-99%. Incidence rebounded from 6.6/100,000 to 24.5/100,000 since 2005 and decreased after measles vaccine (MV) supplementary immunization activities (SIAs) in 2010. Measles antibody positive rate was 85%-95% in most of years since 1981. High-risk districts were spotted in Chaoyang, Fengtai and Changping districts in recent 15 years. Age-specific incidence and proportion of measles varied over time. The most affected population were younger children of 1–4 years before 1978, older children of 5–14 years in 1978–1996, infant of <1 years and adults of ≥15 years in period of aim to measles elimination. Conclusion Strategies at different stages had a prevailing effect on the epidemic dynamics of measles in recent 60 years in Beijing. It will be essential to validate reported vaccination coverage, improve vaccination coverage in adults and strengthen measles surveillance in the anticipated elimination campaign for measles. PMID:24143899

Correlation Between Pediatrician Supply and Public Health in Japan as Evidenced by Vaccination Coverage in 2010: Secondary Data Analysis

PubMed Central

Sakai, Rie; Fink, Günther; Wang, Wei; Kawachi, Ichiro

2015-01-01

Background In industrialized countries, assessment of the causal effect of physician supply on population health has yielded mixed results. Since the scope of child vaccination is an indicator of preventive health service utilization, this study investigates the correlation between vaccination coverage and pediatrician supply as a reflection of overall pediatric health during a time of increasing pediatrician numbers in Japan. Methods Cross-sectional data were collected from publicly available sources for 2010. Dependent variables were vaccination coverage for measles and diphtheria, pertussis, and tetanus (DPT) by region. The primary predictor of interest was number of pediatricians per 10 000-child population (pediatrician density) at the municipality level. Multivariate logistic regression models were used to estimate associations of interest, conditional on a large range of demographic and infrastructure-related factors as covariates, including non-pediatric physician density, total population, per capita income, occupation, unemployment rate, prevalence of single motherhood, number of hospital beds per capita, length of roads, crime rate, accident rate, and metropolitan area code as urban/rural status. The percentage of the population who completed college-level education or higher in 2010 was included in the model as a proxy for education level. Results Pediatrician density was positively and significantly associated with vaccination coverage for both vaccine series. On average, each unit of pediatrician density increased odds by 1.012 for measles (95% confidence interval, 1.010–1.015) and 1.019 for DPT (95% confidence interval, 1.016–1.022). Conclusions Policies increasing pediatrician supply contribute to improved preventive healthcare services utilization, such as immunizations, and presumably improved child health status in Japan. PMID:25817986

Evaluation of impact of measles rubella campaign on vaccination coverage and routine immunization services in Bangladesh.

PubMed

Uddin, Md Jasim; Adhikary, Gourab; Ali, Md Wazed; Ahmed, Shahabuddin; Shamsuzzaman, Md; Odell, Chris; Hashiguchi, Lauren; Lim, Stephen S; Alam, Nurul

2016-08-12

Like other countries in Asia, measles-rubella (MR) vaccine coverage in Bangladesh is suboptimal whereas 90-95 % coverage is needed for elimination of these diseases. The Ministry of Health and Family Welfare (MOHFW) of the Government of Bangladesh implemented MR campaign in January-February 2014 to increase MR vaccination coverage. Strategically, the MOHFW used both routine immunization centres and educational institutions for providing vaccine to the children aged 9 months to <15 years. The evaluation was carried out to assess the impact of the campaign on MR vaccination and routine immunization services. Both quantitative and qualitative evaluations were done before and after implementation of the campaign. Quantitative data were presented with mean (standard deviation, SD) for continuous variables and with proportion for categorical variables. The overall and age- and sex-specific coverage rates were calculated for each region and then combined. Categorical variables were compared by chi-square statistics. Multiple logistic regression analysis were performed to estimate odds ratios (OR) and 95 % confidence intervals (CI) of coverage associated with covariates, with adjustment for other covariates. Qualitative data were analyzed using content analysis. The evaluations found MR coverage was very low (<13 %) before the campaign and it rose to 90 % after the campaign. The pre-post campaign difference in MR coverage in each stratum was highly significant (p < 0.001). The campaign achieved high coverage despite relatively low level (23 %) of interpersonal communication with caregivers through registration process. Child registration was associated with higher MR coverage (OR 2.91, 95 % CI 1.91-4.44). Children who attended school were more likely to be vaccinated (OR 8.97, 95 % CI 6.17-13.04) compared to those who did not attend school. Children of caregivers with primary or secondary or higher education had higher coverage compared to children of caregivers with no formal education. Most caregivers mentioned contribution of the campaign in vaccination for the children not previously vaccinated. The results of the evaluation indicated that the campaign was successful in terms of improving MR coverage and routine immunization services. The evaluation provided an important guideline for future evaluation of similar efforts in Bangladesh and elsewhere.

Understanding the role of the news media in HPV vaccine uptake in the United States: Synthesis and commentary.

PubMed

Gollust, Sarah E; LoRusso, Susan M; Nagler, Rebekah H; Fowler, Erika Franklin

2016-06-02

Vaccination rates for the human papillomavirus (HPV) vaccine fall below targets and only 2 states and the District of Columbia require the vaccine for middle school-age children. Messages conveyed through news media-to parents, providers, policymakers, and the general public-may contribute to sluggish vaccination rates and policy action. In this commentary, we review the findings from 13 published studies of news media coverage of the HPV vaccine in the United States since FDA licensure in 2006. We find 2 important themes in news coverage: a rising focus on political controversy and a consistent emphasis on the vaccine as for girls, even beyond the point when the vaccine was recommended for boys. These political and gendered messages have consequences for public understanding of the vaccine. Future research should continue to monitor news media depictions of the HPV vaccine to assess whether political controversy will remain a pronounced theme of coverage or whether the media ultimately depict the vaccine as a routine public health service.

Recommendation system for immunization coverage and monitoring.

PubMed

Bhatti, Uzair Aslam; Huang, Mengxing; Wang, Hao; Zhang, Yu; Mehmood, Anum; Di, Wu

2018-01-02

Immunization averts an expected 2 to 3 million deaths every year from diphtheria, tetanus, pertussis (whooping cough), and measles; however, an additional 1.5 million deaths could be avoided if vaccination coverage was improved worldwide. 1 1 Data source for immunization records of 1.5 M: http://www.who.int/mediacentre/factsheets/fs378/en/ New vaccination technologies provide earlier diagnoses, personalized treatments and a wide range of other benefits for both patients and health care professionals. Childhood diseases that were commonplace less than a generation ago have become rare because of vaccines. However, 100% vaccination coverage is still the target to avoid further mortality. Governments have launched special campaigns to create an awareness of vaccination. In this paper, we have focused on data mining algorithms for big data using a collaborative approach for vaccination datasets to resolve problems with planning vaccinations in children, stocking vaccines, and tracking and monitoring non-vaccinated children appropriately. Geographical mapping of vaccination records helps to tackle red zone areas, where vaccination rates are poor, while green zone areas, where vaccination rates are good, can be monitored to enable health care staff to plan the administration of vaccines. Our recommendation algorithm assists in these processes by using deep data mining and by accessing records of other hospitals to highlight locations with lower rates of vaccination. The overall performance of the model is good. The model has been implemented in hospitals to control vaccination across the coverage area.

Hepatitis B vaccination coverage among adults aged ≥18 years traveling to a country of high or intermediate endemicity, United States, 2015.

PubMed

Lu, Peng-Jun; O'Halloran, Alissa C; Williams, Walter W; Nelson, Noele P

2018-04-28

Persons from the United States who travel to developing countries are at substantial risk for hepatitis B virus (HBV) infection. Hepatitis B vaccine has been recommended for adults at increased risk for infection, including travelers to high or intermediate hepatitis B endemic countries. To assess hepatitis B vaccination coverage among adults ≥18 years traveling to a country of high or intermediate endemicity from the United States. Data from the 2015 National Health Interview Survey (NHIS) were analyzed to determine hepatitis B vaccination coverage (≥1 dose) and series completion (≥3 doses) among persons aged ≥18 years who reported traveling to a country of high or intermediate hepatitis B endemicity. Multivariable logistic regression and predictive marginal analyses were conducted to identify factors independently associated with hepatitis B vaccination. In 2015, hepatitis B vaccination coverage (≥1 dose) among adults aged ≥18 years who reported traveling to high or intermediate hepatitis B endemic countries was 38.6%, significantly higher compared with 25.9% among non-travelers. Series completion (≥3 doses) was 31.7% and 21.2%, respectively (P < 0.05). On multivariable analysis among all respondents, travel status was significantly associated with hepatitis B vaccination coverage and series completion. Other characteristics independently associated with vaccination (≥1 dose, and ≥3 doses) among travelers included age, race/ethnicity, educational level, duration of US residence, number of physician contacts in the past year, status of ever being tested for HIV, and healthcare personnel status. Although travel to a country of high or intermediate hepatitis B endemicity was associated with higher likelihood of hepatitis B vaccination, hepatitis B vaccination coverage was low among adult travelers to these areas. Healthcare providers should ask their patients about travel plans and recommend and offer travel related vaccinations to their patients or refer them to alternate sites for vaccination. Published by Elsevier Ltd.

Hepatitis B vaccination coverage among adults aged ≥ 18 years traveling to a country of high or intermediate endemicity, United States, 2015.

PubMed

Lu, Peng-Jun; O'Halloran, Alissa C; Williams, Walter W; Nelson, Noele P

2018-04-25

Persons from the United States who travel to developing countries are at substantial risk for hepatitis B virus (HBV) infection. Hepatitis B vaccine has been recommended for adults at increased risk for infection, including travelers to high or intermediate hepatitis B endemic countries. To assess hepatitis B vaccination coverage among adults ≥ 18 years traveling to a country of high or intermediate endemicity from the United States. Data from the 2015 National Health Interview Survey (NHIS) were analyzed to determine hepatitis B vaccination coverage (≥1 dose) and series completion (≥3 doses) among persons aged ≥ 18 years who reported traveling to a country of high or intermediate hepatitis B endemicity. Multivariable logistic regression and predictive marginal analyses were conducted to identify factors independently associated with hepatitis B vaccination. In 2015, hepatitis B vaccination coverage (≥1 dose) among adults aged ≥ 18 years who reported traveling to high or intermediate hepatitis B endemic countries was 38.6%, significantly higher compared with 25.9% among non-travelers. Series completion (≥3 doses) was 31.7% and 21.2%, respectively (P < 0.05). On multivariable analysis among all respondents, travel status was significantly associated with hepatitis B vaccination coverage and series completion. Other characteristics independently associated with vaccination (≥1 dose, and ≥ 3 doses) among travelers included age, race/ethnicity, educational level, duration of U.S. residence, number of physician contacts in the past year, status of ever being tested for HIV, and healthcare personnel status. Although travel to a country of high or intermediate hepatitis B endemicity was associated with higher likelihood of hepatitis B vaccination, hepatitis B vaccination coverage was low among adult travelers to these areas. Healthcare providers should ask their patients about travel plans and recommend and offer travel related vaccinations to their patients or refer them to alternate sites for vaccination. Published by Elsevier Ltd.

Adolescent Immunization Coverage and Implementation of New School Requirements in Michigan, 2010

PubMed Central

DeVita, Stefanie F.; Vranesich, Patricia A.; Boulton, Matthew L.

2014-01-01

Objectives. We examined the effect of Michigan’s new school rules and vaccine coadministration on time to completion of all the school-required vaccine series, the individual adolescent vaccines newly required for sixth grade in 2010, and initiation of the human papillomavirus (HPV) vaccine series, which was recommended but not required for girls. Methods. Data were derived from the Michigan Care Improvement Registry, a statewide Immunization Information System. We assessed the immunization status of Michigan children enrolled in sixth grade in 2009 or 2010. We used univariable and multivariable Cox regression models to identify significant associations between each factor and school completeness. Results. Enrollment in sixth grade in 2010 and coadministration of adolescent vaccines at the first adolescent visit were significantly associated with completion of the vaccines required for Michigan’s sixth graders. Children enrolled in sixth grade in 2010 had higher coverage with the newly required adolescent vaccines by age 13 years than did sixth graders in 2009, but there was little difference in the rate of HPV vaccine initiation among girls. Conclusions. Education and outreach efforts, particularly regarding the importance and benefits of coadministration of all recommended vaccines in adolescents, should be directed toward health care providers, parents, and adolescents. PMID:24922144

Can influenza vaccination coverage among healthcare workers influence the risk of nosocomial influenza-like illness in hospitalized patients?

PubMed

Amodio, E; Restivo, V; Firenze, A; Mammina, C; Tramuto, F; Vitale, F

2014-03-01

Approximately 20% of healthcare workers are infected with influenza each year, causing nosocomial outbreaks and staff shortages. Despite influenza vaccination of healthcare workers representing the most effective preventive strategy, coverage remains low. To analyse the risk of nosocomial influenza-like illness (NILI) among patients admitted to an acute care hospital in relation to influenza vaccination coverage among healthcare workers. Data collected over seven consecutive influenza seasons (2005-2012) in an Italian acute care hospital were analysed retrospectively. Three different sources of data were used: hospital discharge records; influenza vaccination coverage among healthcare workers; and incidence of ILI in the general population. Clinical modification codes from the International Classification of Diseases, 9(th) Revision were used to define NILI. Overall, 62,343 hospitalized patients were included in the study, 185 (0.03%) of whom were identified as NILI cases. Over the study period, influenza vaccination coverage among healthcare workers decreased from 13.2% to 3.1% (P < 0.001), whereas the frequency of NILI in hospitalized patients increased from 1.1‰ to 5.7‰ (P < 0.001). A significant inverse association was observed between influenza vaccination coverage among healthcare workers and rate of NILI among patients (adjusted odds ratio 0.97, 95% confidence interval 0.94-0.99). Increasing influenza vaccination coverage among healthcare workers could reduce the risk of NILI in patients hospitalized in acute hospitals. This study offers a reliable and cost-saving methodology that could help hospital management to assess and make known the benefits of influenza vaccination among healthcare workers. Copyright © 2014 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Human Papillomavirus Vaccination Uptake before and after the Affordable Care Act: Variation According to Insurance Status, Race, and Education (NHANES 2006-2014).

PubMed

Corriero, Rosemary; Gay, Jennifer L; Robb, Sara Wagner; Stowe, Ellen W

2018-02-01

The purpose of the study was to compare human papillomavirus (HPV) vaccination rates before and after Affordable Care Act (ACA) implementation among women, and examine differences according to insurance status and other sociodemographic variables. This was a cross-sectional analysis of the National Health and Nutrition Examination Survey questionnaire data. Participants (n = 4599) were from a random sample of the United States population. HPV vaccination status and number of doses received according to age, income, education, race, and insurance coverage. Over time, the proportion of women reporting HPV vaccination increased from 16.4% to 27.6%, and reporting vaccination completion (3 doses) increased from 56.8% to 67.2%. After ACA implementation, respondents were 3.3 times more likely to be vaccinated compared with before ACA implementation (95% confidence interval [CI], 2.0-5.5) adjusting for age, race, and insurance coverage. Similarly, respondents were more likely to have received 2 (odds ratio, 2.8; 95% CI, 1.5-5.3) or 3 doses (odds ratio, 5.8; 95% CI, 2.5-13.6). Vaccination uptake increased in a comparison of waves of data from before and after ACA implementation. This increase in vaccination coverage could be related to the increased preventative service coverage, which includes vaccines, required by the ACA. Future studies might focus on the role insurance has on vaccination uptake, and meeting Healthy People 2020 objectives for vaccination coverage. Copyright © 2017 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

Cost-effectiveness of canine vaccination to prevent human rabies in rural Tanzania.

PubMed

Fitzpatrick, Meagan C; Hampson, Katie; Cleaveland, Sarah; Mzimbiri, Imam; Lankester, Felix; Lembo, Tiziana; Meyers, Lauren A; Paltiel, A David; Galvani, Alison P

2014-01-21

The annual mortality rate of human rabies in rural Africa is 3.6 deaths per 100 000 persons. Rabies can be prevented with prompt postexposure prophylaxis, but this is costly and often inaccessible in rural Africa. Because 99% of human exposures occur through rabid dogs, canine vaccination also prevents transmission of rabies to humans. To evaluate the cost-effectiveness of rabies control through annual canine vaccination campaigns in rural sub-Saharan Africa. We model transmission dynamics in dogs and wildlife and assess empirical uncertainty in the biological variables to make probability-based evaluations of cost-effectiveness. Epidemiologic variables from a contact-tracing study and literature and cost data from ongoing vaccination campaigns. Two districts of rural Tanzania: Ngorongoro and Serengeti. 10 years. Health policymaker. Vaccination coverage ranging from 0% to 95% in increments of 5%. Life-years for health outcomes and 2010 U.S. dollars for economic outcomes. Annual canine vaccination campaigns were very cost-effective in both districts compared with no canine vaccination. In Serengeti, annual campaigns with as much as 70% coverage were cost-saving. Across a wide range of variable assumptions and levels of societal willingness to pay for life-years, the optimal vaccination coverage for Serengeti was 70%. In Ngorongoro, although optimal coverage depended on willingness to pay, vaccination campaigns were always cost-effective and lifesaving and therefore preferred. Canine vaccination was very cost-effective in both districts, but there was greater uncertainty about the optimal coverage in Ngorongoro. Annual canine rabies vaccination campaigns conferred extraordinary value and dramatically reduced the health burden of rabies. National Institutes of Health.

Comparative cost-effectiveness of HPV vaccines in the prevention of cervical cancer in Malaysia.

PubMed

Ezat, Sharifa W P; Aljunid, Syed

2010-01-01

Cervical cancer (CC) had the second highest incidence of female cancers in Malaysia in 2003-2006. Prevention is possible by both Pap smear screening and HPV vaccination with either the bivalent vaccine (BV) or the quadrivalent vaccine (QV). In the present study, cost effectiveness options were compared for three programs i.e. screening via Pap smear; modeling of HPV vaccination (QV and BV) and combined strategy (screening plus vaccination). A scenario based sensitivity analysis was conducted using screening population coverages (40-80%) and costs of vaccines (RM 100-200/dose) were calculated. This was an economic burden, cross sectional study in 2006-2009 of respondents interviewed from six public Gynecology-Oncology hospitals. Methods included expert panel discussions to estimate treatment costs of CC, genital warts and vulva/vagina cancers by severity and direct interviews with respondents using costing and SF-36 quality of life questionnaires. A total of 502 cervical cancer patients participated with a mean age at 53.3±11.2 years and a mean marriage length of 27.7±12.1 years, Malays accounting for 44.2%. Cost/quality adjusted life year (QALY) for Pap smear in the base case was RM 1,215 and RM 1,100 at increased screening coverage. With QV only, in base case it was RM 15,662 and RM 24,203 when the vaccination price was increased. With BV only, the respective figures were RM 1,359,057 and RM 2,530,018. For QV combined strategy cost/QALY in the base case it was RM 4,937, reducing to RM 3,395 in the best case and rising to RM 7,992 in the worst case scenario. With the BV combined strategy, these three cost/QALYs were RM 6,624, RM 4,033 and RM 10,543. Incremental cost-effectiveness ratio (ICER) showed that screening at 70% coverage or higher was highly cost effective at RM 946.74 per QALYs saved but this was preceded by best case combined strategy with QV at RM 515.29 per QALYs saved. QV is more cost effective than BV. The QV combined strategy had a higher CE than any method including Pap smear screening at high population coverage.

Immunisation coverage annual report, 2011.

PubMed

Hull, Brynley P; Dey, Aditi; Menzies, Rob I; Brotherton, Julia M; McIntyre, Peter B

2013-12-31

This, the 5th annual immunisation coverage report, documents trends during 2011 for a range of standard measures derived from Australian Childhood Immunisation Register data, and National Human Papillomavirus (HPV) Vaccination Program Register data. The proportion of children 'fully vaccinated' at 12, 24 and 60 months of age was 91.4%, 92.2% and 89.5% respectively. Although pneumococcal vaccine had similar coverage at 12 months to other vaccines, coverage was lower for rotavirus at 12 months (83.8%) and varicella at 24 months (83.9%). By late 2011, the percentage of children who received the 1st dose of DTPa vaccine dose at less than 8 weeks of age was greater than 50% in 3 jurisdictions, the Australian Capital Territory, Victoria, and Queensland and at 70% for New South Wales and Tasmania. Although coverage at 12 months of age was lower among Indigenous children than non-Indigenous children in all jurisdictions, the extent of the difference varied. Overall, coverage at 24 months of age exceeded that at 12 months of age nationally. At 60 months of age, there was dramatic variation between individual jurisdictions, ranging from coverage 8% lower in Indigenous children in South Australia to 6% higher in the Northern Territory. As previously documented, vaccines recommended for Indigenous children only (hepatitis A and pneumococcal polysaccharide vaccine) had suboptimal coverage at 60% and 68%, respectively. On-time receipt (before 49 months of age) of vaccines by Indigenous children at the 60-month milestone age improved between 2010 (18%) and 2011 (19%) but the disparity in on-time vaccination between Indigenous and non-Indigenous children increased at all 3 age milestones. The percentage of vaccine objectors in 2011 (1.7%) has increased from 2007 when it was 1.1%. Coverage data for the 3rd dose of HPV from the national HPV register in the school catch up program was 71% but was substantially lower for the catch-up program for women outside school (39%-67%), although this was an improvement from 2010. This work is copyright. Apart from any use as permitted under the Copyright Act 1968, no part may be reproduced by any process without prior written permission from the Commonwealth. Requests and inquiries concerning reproduction and rights should be addressed to the Commonwealth Copyright Administration, Attorney General's Department, Robert Garran Offices, National Circuit, Barton ACT 2600 or posted at http://www.ag.gov.au/cca.

[Immunization and equity in the Regional Initiative of the Mesoamerican Health Initiative].

PubMed

Franco-Paredes, Carlos; Hernández-Ramos, Isabel; Santos-Preciado, José Ignacio

2011-01-01

National immunization rates indicate high vaccine coverage in Mesoamerica, but there is growing evidence that the most vulnerable groups are not being reached by immunization programs. Therefore, there is likely low effective vaccine coverage in the region, leading to persistent and growing health inequity. The planning phase of this project was from June to December 2009. The project will be conducted in the target populations which includes children under five, pregnant women, and women of child-bearing age from the most vulnerable populations within countries of the Mesoamerican region, as indicated geographically by a low human development index (HDI) and/or high prevalence of poverty at the municipal level and through the use of participatory methods to define poverty and vulnerability in local contexts. We defined three lines of action for vaccine-preventable disease interventions: 1) pilot projects to fill gaps in knowledge; 2) strengthening immunization policy; and 3) implementation of evidence-based practices. Health system strengthening through health equity is the central regional objective of the immunization workgroup. We hope to have a transformational impact on health systems so as to improve effective coverage, including vaccine and other integrated primary healthcare services.

[Adverse events self-declaration system and influenza vaccination coverage of healthcare workers in a tertiary hospital].

PubMed

Velasco Munoz, Cesar; Sequera, Víctor-Guillermo; Vilajeliu, Alba; Aldea, Marta; Mena, Guillermo; Quesada, Sebastiana; Varela, Pilar; Olivé, Victoria; Bayas, José M; Trilla, Antoni

2016-02-19

During the influenza vaccination campaign 2011-2012 we established a self-declaration system of adverse events (AEs) in healthcare workers (HCW). The aim of this study is to describe the vaccinated population and analyse vaccination coverage and self-declared AEs after the voluntary flu vaccination in a university hospital in Barcelona. Observational study. We used the HCW immunization record to calculate the vaccination coverage. We collected AEs using a voluntary, anonymous, self-administered survey during the 2011-2012 flu vaccination campaign. We performed a logistic regression model to determine the associated factors to declare AEs. The influenza vaccination coverage in HCW was 30.5% (n=1,507/4,944). We received completed surveys from 358 vaccinated HCW (23.8% of all vaccinated). We registered AEs in 186 respondents to the survey (52.0% of all respondents). Of these, 75.3% (n=140) reported local symptoms after the flu vaccination, 9.7% (n=18) reported systemic symptoms and 15.1% (n=28) both local and systemic symptoms. No serious AEs were self-reported. Female sex and aged under 35 were both factors associated with declaring AEs. Our self-reporting system did not register serious AEs in HCW, resulting in an opportunity to improve HCW trust in flu vaccination. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

Vaccination and All-Cause Child Mortality From 1985 to 2011: Global Evidence From the Demographic and Health Surveys

PubMed Central

McGovern, Mark E.; Canning, David

2015-01-01

Based on models with calibrated parameters for infection, case fatality rates, and vaccine efficacy, basic childhood vaccinations have been estimated to be highly cost effective. We estimated the association of vaccination with mortality directly from survey data. Using 149 cross-sectional Demographic and Health Surveys, we determined the relationship between vaccination coverage and the probability of dying between birth and 5 years of age at the survey cluster level. Our data included approximately 1 million children in 68,490 clusters from 62 countries. We considered the childhood measles, bacillus Calmette-Guérin, diphtheria-pertussis-tetanus, polio, and maternal tetanus vaccinations. Using modified Poisson regression to estimate the relative risk of child mortality in each cluster, we also adjusted for selection bias that resulted from the vaccination status of dead children not being reported. Childhood vaccination, and in particular measles and tetanus vaccination, is associated with substantial reductions in childhood mortality. We estimated that children in clusters with complete vaccination coverage have a relative risk of mortality that is 0.73 (95% confidence interval: 0.68, 0.77) times that of children in a cluster with no vaccinations. Although widely used, basic vaccines still have coverage rates well below 100% in many countries, and our results emphasize the effectiveness of increasing coverage rates in order to reduce child mortality. PMID:26453618

Implementation of flu vaccination in community pharmacies: Understanding the barriers and enablers.

PubMed

Kirkdale, C L; Nebout, G; Taitel, M; Rubin, J; Jacinto, I; Horta, R; Megerlin, F; Thornley, T

2017-01-01

Improving influenza vaccination coverage has been, and still remains a challenge internationally. There are now many examples where countries have pursued a pharmacist-led influenza vaccination service in order to enhance vaccination coverage of at-risk populations. England, Portugal and the United States are successful examples where their experience implementing this service can now be explored retrospectively and learnt from. This review aims to provide evidence to help overcome barriers to commissioning and implementation of such services in countries new to the experience. Implementation is influenced by differing regulatory frameworks underpinning the provision of pharmacist-led influenza vaccination, methods of remuneration, training, and operating procedures. Practical aspects such as the facilities required, how patient records are maintained and how patients and other healthcare professionals are engaged also have an impact. These examples illustrate how community pharmacists can be trained to deliver influenza vaccinations safely, and coupled with their accessibility and convenience, can provide a complementary service to that already provided by family doctors and nurses to deliver influenza vaccinations for the benefit of patients. Copyright © 2016 Académie Nationale de Pharmacie. Published by Elsevier Masson SAS. All rights reserved.

System factors to explain H1N1 state vaccination rates for adults in US emergency response to pandemic.

PubMed

Davila-Payan, Carlo; Swann, Julie; Wortley, Pascale M

2014-05-23

During the 2009-2010 H1N1 pandemic, vaccine in short supply was allocated to states pro rata by population, yet the vaccination rates of adults differed by state. States also differed in their campaign processes and decisions. Analyzing the campaign provides an opportunity to identify specific approaches that may result in higher vaccine uptake in a future event of this nature. To determine supply chain and system factors associated with higher state H1N1 vaccination coverage for adults in a system where vaccine was in short supply. Regression analysis of factors predicting state-specific H1N1 vaccination coverage in adults. Independent variables included state campaign information, demographics, preventive or health-seeking behavior, preparedness funding, providers, state characteristics, and H1N1-specific state data. The best model explained the variation in state-specific adult vaccination coverage with an adjusted R-squared of 0.76. We found that higher H1N1 coverage of adults is associated with program aspects including shorter lead-times (i.e., the number of days between when doses were allocated to a state and were shipped, including the time for states to order the doses) and less vaccine directed to specialist locations. Higher vaccination coverage is also positively associated with the maximum number of ship-to locations, past seasonal influenza vaccination coverage, the percentage of women with a Pap smear, the percentage of the population that is Hispanic, and negatively associated with a long duration of the epidemic peak. Long lead-times may be a function of system structure or of efficiency and may suggest monitoring or redesign of distribution processes. Sending vaccine to sites with broad access could be useful when covering a general population. Existing infrastructure may be reflected in the maximum number of ship-to locations, so strengthening routine influenza vaccination programs may help during emergency vaccinations also. Future research could continue to inform program decisions. Copyright © 2013 The Authors. Published by Elsevier Ltd.. All rights reserved.

Estimates and determinants of HPV non-vaccination and vaccine refusal in girls 12 to 14 y of age in Canada: Results from the Childhood National Immunization Coverage Survey, 2013

PubMed Central

Gilbert, Nicolas L.; Gilmour, Heather; Dubé, Ève; Wilson, Sarah E.; Laroche, Julie

2016-01-01

ABSTRACT Since the introduction of HPV vaccination programs in Canada in 2007, coverage has been below public health goals in many provinces and territories. This analysis investigated the determinants of HPV non-vaccination and vaccine refusal. Data from the Childhood National Immunization Coverage Survey (CNICS) 2013 were used to estimate the prevalence of HPV non-vaccination and parental vaccine refusal in girls aged 12–14 years, for Canada and the provinces and territories. Multivariate logistic regression was used to examine factors associated with non-vaccination and vaccine refusal, after adjusting for potential confounders. An estimated 27.7% of 12–14 y old girls had not been vaccinated against HPV, and 14.4% of parents reported refusing the vaccine. The magnitude of non-vaccination and vaccine refusal varied by province or territory and also by responding parent's country of birth. In addition, higher education was associated with a higher risk of refusal of the HPV vaccine. Rates of HPV non-vaccination and of refusal of the HPV vaccine differ and are influenced by different variables. These findings warrant further investigation. PMID:26942572

Distributing insecticide-treated bednets during measles vaccination: a low-cost means of achieving high and equitable coverage.

PubMed Central

Grabowsky, Mark; Nobiya, Theresa; Ahun, Mercy; Donna, Rose; Lengor, Miata; Zimmerman, Drake; Ladd, Holly; Hoekstra, Edward; Bello, Aliu; Baffoe-Wilmot, Aba; Amofah, George

2005-01-01

OBJECTIVE: To achieve high and equitable coverage of insecticide-treated bednets by integrating their distribution into a measles vaccination campaign. METHODS: In December 2002 in the Lawra district in Ghana, a measles vaccination campaign lasting 1 week targeted all children aged 9 months-15 years. Families with one or more children less than five years old were targeted to receive a free insecticide-treated bednet. The Ghana Health Service, with support from the Ghana Red Cross and UNICEF, provided logistical support, volunteer workers and social mobilization during the campaign. Volunteers visited homes to inform caregivers about the campaign and encourage them to participate. We assessed pre-campaign coverage of bednets by interviewing caregivers leaving vaccination and distribution sites. Five months after distribution, a two-stage cluster survey using population-proportional sampling assessed bednet coverage, retention and use. Both the pre-campaign and post-campaign survey assessed household wealth using an asset inventory. FINDINGS: At the campaign exit interview 636/776 (82.0%) caregivers reported that they had received a home visit by a Red Cross volunteer before the campaign and that 32/776 (4.1%) of the youngest children in each household who were less than 5 years of age slept under an insecticide-treated bednet. Five months after distribution caregivers reported that 204/219 (93.2%) of children aged 9 months to 5 years had been vaccinated during the campaign; 234/248 (94.4%) of households were observed to have an insecticide-treated bednet; and 170/249 (68.3%) were observed to have a net hung over a bed. Altogether 222/248 (89.5%) caregivers reported receiving at least one insecticide-treated bednet during the campaign, and 153/254 (60.2%) said that on the previous night their youngest child had slept under a bednet received during the campaign. For households in the poorest quintile, post-campaign coverage of insecticide-treated bednets was 10 times higher than pre-campaign coverage of households in the wealthiest quintile (46/51 (90.2%) versus 14/156 (9.0%)). The marginal operational cost was 0.32 US dollars per insecticide-treated bednet delivered. CONCLUSION: These findings suggest that linking bednet distribution to measles vaccination campaigns may provide an important opportunity for achieving high and equitable coverage of bednets. PMID:15798843

Free-Roaming Dog Population Estimation and Status of the Dog Population Management and Rabies Control Program in Dhaka City, Bangladesh

PubMed Central

Tenzin, Tenzin; Ahmed, Rubaiya; Debnath, Nitish C.; Ahmed, Garba; Yamage, Mat

2015-01-01

Beginning January 2012, a humane method of dog population management using a Catch-Neuter-Vaccinate-Release (CNVR) program was implemented in Dhaka City, Bangladesh as part of the national rabies control program. To enable this program, the size and distribution of the free-roaming dog population needed to be estimated. We present the results of a dog population survey and a pilot assessment of the CNVR program coverage in Dhaka City. Free-roaming dog population surveys were undertaken in 18 wards of Dhaka City on consecutive days using mark-resight methods. Data was analyzed using Lincoln-Petersen index-Chapman correction methods. The CNVR program was assessed over the two years (2012–2013) whilst the coverage of the CNVR program was assessed by estimating the proportion of dogs that were ear-notched (processed dogs) via dog population surveys. The free-roaming dog population was estimated to be 1,242 (95 % CI: 1205–1278) in the 18 sampled wards and 18,585 dogs in Dhaka City (52 dogs/km2) with an estimated human-to-free-roaming dog ratio of 828:1. During the two year CNVR program, a total of 6,665 dogs (3,357 male and 3,308 female) were neutered and vaccinated against rabies in 29 of the 92 city wards. A pilot population survey indicated a mean CNVR coverage of 60.6% (range 19.2–79.3%) with only eight wards achieving > 70% coverage. Given that the coverage in many neighborhoods was below the WHO-recommended threshold level of 70% for rabies eradications and since the CNVR program takes considerable time to implement throughout the entire Dhaka City area, a mass dog vaccination program in the non-CNVR coverage area is recommended to create herd immunity. The findings from this study are expected to guide dog population management and the rabies control program in Dhaka City and elsewhere in Bangladesh. PMID:25978406

Free-roaming dog population estimation and status of the dog population management and rabies control program in Dhaka City, Bangladesh.

PubMed

Tenzin, Tenzin; Ahmed, Rubaiya; Debnath, Nitish C; Ahmed, Garba; Yamage, Mat

2015-05-01

Beginning January 2012, a humane method of dog population management using a Catch-Neuter-Vaccinate-Release (CNVR) program was implemented in Dhaka City, Bangladesh as part of the national rabies control program. To enable this program, the size and distribution of the free-roaming dog population needed to be estimated. We present the results of a dog population survey and a pilot assessment of the CNVR program coverage in Dhaka City. Free-roaming dog population surveys were undertaken in 18 wards of Dhaka City on consecutive days using mark-resight methods. Data was analyzed using Lincoln-Petersen index-Chapman correction methods. The CNVR program was assessed over the two years (2012-2013) whilst the coverage of the CNVR program was assessed by estimating the proportion of dogs that were ear-notched (processed dogs) via dog population surveys. The free-roaming dog population was estimated to be 1,242 (95 % CI: 1205-1278) in the 18 sampled wards and 18,585 dogs in Dhaka City (52 dogs/km2) with an estimated human-to-free-roaming dog ratio of 828:1. During the two year CNVR program, a total of 6,665 dogs (3,357 male and 3,308 female) were neutered and vaccinated against rabies in 29 of the 92 city wards. A pilot population survey indicated a mean CNVR coverage of 60.6% (range 19.2-79.3%) with only eight wards achieving > 70% coverage. Given that the coverage in many neighborhoods was below the WHO-recommended threshold level of 70% for rabies eradications and since the CNVR program takes considerable time to implement throughout the entire Dhaka City area, a mass dog vaccination program in the non-CNVR coverage area is recommended to create herd immunity. The findings from this study are expected to guide dog population management and the rabies control program in Dhaka City and elsewhere in Bangladesh.

Receipt of Recommended Adolescent Vaccines Among Youth With Special Health Care Needs.

PubMed

McRee, Annie-Laurie; Maslow, Gary R; Reiter, Paul L

2017-05-01

We examined vaccination coverage among youth with special health care needs (YSHCN) using data from parents of adolescents (11-17 years) who responded to a statewide survey in 2010-2012 (n = 2156). Using a validated screening tool, we identified 29% of adolescents as YSHCN. Weighted multivariable logistic regression assessed associations between special health care needs and receipt of tetanus booster, meningococcal, and human papillomavirus (HPV) vaccines. Only 12% of youth had received all 3 vaccines, with greater coverage for individual vaccines (tetanus booster, 91%; meningococcal, 32%; HPV, 26%). YSHCN had greater odds of HPV vaccination than other youth (33% vs 23%, OR = 1.70, 95% CI = 1.16-2.50) but vaccination coverage was similar ( P ≥ .05) for other outcomes. In subgroup analyses, HPV vaccination also differed depending on the number and type of special health care needs identified. Findings highlight low levels of vaccination overall and missed opportunities to administer recommended vaccines among all youth, including YSHCN.

Childhood vaccination in informal urban settlements in Nairobi, Kenya: who gets vaccinated?

PubMed

Mutua, Martin K; Kimani-Murage, Elizabeth; Ettarh, Remare R

2011-01-04

Recent trends in global vaccination coverage have shown increases with most countries reaching 90% DTP3 coverage in 2008, although pockets of undervaccination continue to persist in parts of sub-Saharan Africa particularly in the urban slums. The objectives of this study were to determine the vaccination status of children aged between 12-23 months living in two slums of Nairobi and to identify the risk factors associated with incomplete vaccination. The study was carried out as part of a longitudinal Maternal and Child Health study undertaken in Korogocho and Viwandani slums of Nairobi. These slums host the Nairobi Urban Health and Demographic Surveillance System (NUHDSS) run by the African Population and Health Research Centre (APHRC). All women from the NUHDSS area who gave birth since September 2006 were enrolled in the project and administered a questionnaire which asked about the vaccination history of their children. For the purpose of this study, we used data from 1848 children aged 12-23 months who were expected to have received all the WHO-recommended vaccinations. The vaccination details were collected during the first visit about four months after birth with follow-up visits repeated thereafter at four month intervals. Full vaccination was defined as receiving all the basic childhood vaccinations by the end of 24 months of life, whereas up-to-date (UTD) vaccination referred to receipt of BCG, OPV 1-3, DTP 1-3, and measles vaccinations within the first 12 months of life. All vaccination data were obtained from vaccination cards which were sighted during the household visit as well as by recall from mothers. Multivariate models were used to identify the risk factors associated with incomplete vaccination. Measles coverage was substantially lower than that for the other vaccines when determined using only vaccination cards or in addition to maternal recall. Up-to-date (UTD) coverage with all vaccinations at 12 months was 41.3% and 51.8% with and without the birth dose of OPV, respectively. Full vaccination coverage (57.5%) was higher than up-to-date coverage (51.8%) at 12 months overall, and in both slum settlements, using data from cards. Multivariate analysis showed that household assets and expenditure, ethnicity, place of delivery, mother's level of education, age and parity were all predictors of full vaccination among children living in the slums. The findings show the extent to which children resident in slums are underserved with vaccination and indicate that service delivery of immunization services in the urban slums needs to be reassessed to ensure that all children are reached.

How orthodox protestant parents decide on the vaccination of their children: a qualitative study.

PubMed

Ruijs, Wilhelmina L M; Hautvast, Jeannine L A; van Ijzendoorn, Giovanna; van Ansem, Wilke J C; van der Velden, Koos; Hulscher, Marlies E J L

2012-06-06

Despite high vaccination coverage, there have recently been epidemics of vaccine preventable diseases in the Netherlands, largely confined to an orthodox protestant minority with religious objections to vaccination. The orthodox protestant minority consists of various denominations with either low, intermediate or high vaccination coverage. All orthodox protestant denominations leave the final decision to vaccinate or not up to their individual members. To gain insight into how orthodox protestant parents decide on vaccination, what arguments they use, and the consequences of their decisions, we conducted an in-depth interview study of both vaccinating and non-vaccinating orthodox protestant parents selected via purposeful sampling. The interviews were thematically coded by two analysts using the software program Atlas.ti. The initial coding results were reviewed, discussed, and refined by the analysts until consensus was reached. Emerging concepts were assessed for consistency using the constant comparative method from grounded theory. After 27 interviews, data saturation was reached. Based on characteristics of the decision-making process (tradition vs. deliberation) and outcome (vaccinate or not), 4 subgroups of parents could be distinguished: traditionally non-vaccinating parents, deliberately non-vaccinating parents, deliberately vaccinating parents, and traditionally vaccinating parents. Except for the traditionally vaccinating parents, all used predominantly religious arguments to justify their vaccination decisions. Also with the exception of the traditionally vaccinating parents, all reported facing fears that they had made the wrong decision. This fear was most tangible among the deliberately vaccinating parents who thought they might be punished immediately by God for vaccinating their children and interpreted any side effects as a sign to stop vaccinating. Policy makers and health care professionals should stimulate orthodox protestant parents to make a deliberate vaccination choice but also realize that a deliberate choice does not necessarily mean a choice to vaccinate.

Effectiveness of interventions that apply new media to improve vaccine uptake and vaccine coverage.

PubMed

Odone, Anna; Ferrari, Antonio; Spagnoli, Francesca; Visciarelli, Sara; Shefer, Abigail; Pasquarella, Cesira; Signorelli, Carlo

2015-01-01

Vaccine-preventable diseases (VPD) are still a major cause of morbidity and mortality worldwide. In high and middle-income settings, immunization coverage is relatively high. However, in many countries coverage rates of routinely recommended vaccines are still below the targets established by international and national advisory committees. Progress in the field of communication technology might provide useful tools to enhance immunization strategies. To systematically collect and summarize the available evidence on the effectiveness of interventions that apply new media to promote vaccination uptake and increase vaccination coverage. We conducted a systematic literature review. Studies published from January 1999 to September 2013 were identified by searching electronic resources (Pubmed, Embase), manual searches of references and expert consultation. Study setting We focused on interventions that targeted recommended vaccinations for children, adolescents and adults and: (1) aimed at increasing community demand for immunizations, or (2) were provider-based interventions. We limited the study setting to countries that are members of the Organisation for Economic Co-operation and Development (OECD). The primary outcome was a measure of vaccination (vaccine uptake or vaccine coverage). Considered secondary outcomes included willingness to receive immunization, attitudes and perceptions toward vaccination, and perceived helpfulness of the intervention. Nineteen studies were included in the systematic review. The majority of the studies were conducted in the US (74%, n = 14); 68% (n = 13) of the studies were experimental, the rest having an observational study design. Eleven (58%) reported results on the primary outcome. Retrieved studies explored the role of: text messaging (n.7, 37%), smartphone applications (n.1, 5%), Youtube videos (n.1, 5%), Facebook (n.1, 5%), targeted websites and portals (n.4, 21%), software for physicians and health professionals (n.4, 21%), and email communication (n.1, 5%). There is some evidence that text messaging, accessing immunization campaign websites, using patient-held web-based portals and computerized reminders increase immunization coverage rates. Insufficient evidence is available on the use of social networks, email communication and smartphone applications. Although there is great potential for improving vaccine uptake and vaccine coverage by implementing programs and interventions that apply new media, scant data are available and further rigorous research - including cost-effectiveness assessments - is needed.

Effectiveness of a smartphone app on improving immunization of children in rural Sichuan Province, China: a cluster randomized controlled trial.

PubMed

Chen, Li; Du, Xiaozhen; Zhang, Lin; van Velthoven, Michelle Helena; Wu, Qiong; Yang, Ruikan; Cao, Ying; Wang, Wei; Xie, Lihui; Rao, Xiuqin; Zhang, Yanfeng; Koepsell, Jeanne Catherine

2016-08-31

The aim of this study was to assess the effectiveness of an EPI smartphone application (EPI app) on improving vaccination coverage in rural Sichuan Province, China. This matched-pair cluster randomized controlled study included 32 village doctors, matched in 16 pairs, and took place from 2013 to 2015. Village doctors in the intervention group used the EPI app and reminder text messages while village doctors in the control group used their usual procedures and text messages. The primary outcome was full vaccination coverage with all five vaccines (1 dose of BCG, 3 doses of hepatitis B, 3 doses of OPV, 3 doses of DPT and 1 dose of measles vaccine), and the secondary outcome was coverage with each dose of the five individual vaccines. We also conducted qualitative interviews with village doctors to understand perceptions on using the EPI app and how this changed their vaccination work. The full vaccination coverage increased statistically significant from baseline to end-line in both the intervention (67 % [95 % CI:58-75 %] to 84 % [95 % CI:76-90 %], P = 0.028) and control group (71 % [95 % CI:62-79 %] to 82 % [95 % CI:74-88 %], P = 0.014). The intervention group had higher increase in full vaccination coverage from baseline to end-line compared to the control group (17 % vs 10 %), but this was not statistically significant (P = 0.164). Village doctors found it more convenient to use the EPI app to manage child vaccination and also reported saving time by looking up information of caregivers and contacting caregivers for overdue vaccinations quicker. However, village doctors found it hard to manage children who migrated out of the counties. This study showed that an app and text messages can be used by village doctors to improve full vaccination coverage, though no significant increase in vaccination coverage was found when assessing the effect of the app on its own. Village doctors using EPI app reported having improved their working efficiency of managing childhood vaccination. Future studies should be conducted to evaluate the impact of more integrated approach of mHealth intervention on child immunization. Chinese Clinical Trials Registry (ChiCTR): ChiCTR-TRC- 13003960 , registered on December 6, 2013.

Effectiveness of interventions that apply new media to improve vaccine uptake and vaccine coverage

PubMed Central

Odone, Anna; Ferrari, Antonio; Spagnoli, Francesca; Visciarelli, Sara; Shefer, Abigail; Pasquarella, Cesira; Signorelli, Carlo

2014-01-01

Background Vaccine-preventable diseases (VPD) are still a major cause of morbidity and mortality worldwide. In high and middle-income settings, immunization coverage is relatively high. However, in many countries coverage rates of routinely recommended vaccines are still below the targets established by international and national advisory committees. Progress in the field of communication technology might provide useful tools to enhance immunization strategies. Objective To systematically collect and summarize the available evidence on the effectiveness of interventions that apply new media to promote vaccination uptake and increase vaccination coverage. Design We conducted a systematic literature review. Studies published from January 1999 to September 2013 were identified by searching electronic resources (Pubmed, Embase), manual searches of references and expert consultation. Study setting We focused on interventions that targeted recommended vaccinations for children, adolescents and adults and: (1) aimed at increasing community demand for immunizations, or (2) were provider-based interventions. We limited the study setting to countries that are members of the Organisation for Economic Co-operation and Development (OECD). Main outcome measures The primary outcome was a measure of vaccination (vaccine uptake or vaccine coverage). Considered secondary outcomes included willingness to receive immunization, attitudes and perceptions toward vaccination, and perceived helpfulness of the intervention. Results Nineteen studies were included in the systematic review. The majority of the studies were conducted in the US (74%, n = 14); 68% (n = 13) of the studies were experimental, the rest having an observational study design. Eleven (58%) reported results on the primary outcome. Retrieved studies explored the role of: text messaging (n.7, 37%), smartphone applications (n.1, 5%), Youtube videos (n.1, 5%), Facebook (n.1, 5%), targeted websites and portals (n.4, 21%), software for physicians and health professionals (n.4, 21%), and email communication (n.1, 5%). There is some evidence that text messaging, accessing immunization campaign websites, using patient-held web-based portals and computerized reminders increase immunization coverage rates. Insufficient evidence is available on the use of social networks, email communication and smartphone applications. Conclusion Although there is great potential for improving vaccine uptake and vaccine coverage by implementing programs and interventions that apply new media, scant data are available and further rigorous research - including cost-effectiveness assessments - is needed. PMID:25483518

The impact of an educational intervention on parents' decisions to vaccinate their <60-month-old children against influenza

PubMed Central

Choi, Aery; Kim, Yun Kyung; Eun, Byung Wook; Jo, Dae Sun

2017-01-01

Purpose Seasonal influenza can be prevented by vaccination. Disease prevention in children aged <60 months is of particular importance because of the associated familial and societal burden. Considering that caretakers make the decision to vaccinate their children, the identification of drivers and barriers to vaccination is essential to increase influenza vaccination coverage. Methods A total of 639 parents participated in the pre- and posteducational survey and 450 parents participated in the study via telephone interviews. The participating parents were asked to rank their agreement with each statement of the survey questionnaire on a scale from 1 (strongly disagree) to 5 (strongly agree), and the scores between pre- and postintervention were compared. Results Before the educational intervention, 105 out of 639 participants reported not to agree to vaccinate their children against influenza. After the intervention, 46 out of the 105 parents changed their opinions about childhood vaccination. The physicians' recommendation received the highest agreement score and was the most important driver to vaccination, whereas the cost of vaccination was the strongest factor for not vaccinating children. In general, the participants significantly changed the agreement scores between pre- and postintervention. However, the unfavorable opinions about vaccination and the convenience of receiving the influenza vaccine did not change significantly. Conclusion The results of this study indicate that a specific educational intervention involving caregivers is very effective in increasing the influenza vaccination coverage of children aged less than 60 months. PMID:29042867

Impact of school-entry and education mandates by states on HPV vaccination coverage: Analysis of the 2009-2013 National Immunization Survey-Teen.

PubMed

Perkins, Rebecca B; Lin, Mengyun; Wallington, Sherrie F; Hanchate, Amresh D

2016-06-02

To determine the effectiveness of existing school entry and education mandates on HPV vaccination coverage, we compared coverage among girls residing in states and jurisdictions with and without education and school-entry mandates. Virginia and the District of Columbia enacted school entry mandates, though both laws included liberal opt-out provisions. Ten additional states had mandates requiring distribution of education to parents or provision of education within school curricula. Using data from the National Immunization Survey-Teen from 2009-2013, we estimated multilevel logistic regression models to compare coverage with HPV vaccines for girls ages 13-17 residing in states and jurisdictions with and without school entry and education mandates, adjusting for demographic factors, healthcare access, and provider recommendation. Girls residing in states and jurisdictions with HPV vaccine school entry mandates (DC and VA) and education mandates (LA, MI, CO, IN, IA, IL, NJ, NC, TX, and WA) did not have higher HPV vaccine series initiation or completion than those living in states without mandates for any year (2009-2013). Similar results were seen when comparing girls ages 13-14 to those ages 15-17, and after adjustment for known covariates of vaccination. States and jurisdictions with school-entry and education mandates do not currently have higher HPV vaccination coverage than states without such legislation. Liberal opt-out language in existing school entry mandates may weaken their impact. Policy-makers contemplating legislation to improve vaccination coverage should be aware of the limitations of existing mandates.

Heterogeneity in the spread and control of infectious disease: consequences for the elimination of canine rabies

NASA Astrophysics Data System (ADS)

Ferguson, Elaine A.; Hampson, Katie; Cleaveland, Sarah; Consunji, Ramona; Deray, Raffy; Friar, John; Haydon, Daniel T.; Jimenez, Joji; Pancipane, Marlon; Townsend, Sunny E.

2015-12-01

Understanding the factors influencing vaccination campaign effectiveness is vital in designing efficient disease elimination programmes. We investigated the importance of spatial heterogeneity in vaccination coverage and human-mediated dog movements for the elimination of endemic canine rabies by mass dog vaccination in Region VI of the Philippines (Western Visayas). Household survey data was used to parameterise a spatially-explicit rabies transmission model with realistic dog movement and vaccination coverage scenarios, assuming a basic reproduction number for rabies drawn from the literature. This showed that heterogeneous vaccination reduces elimination prospects relative to homogeneous vaccination at the same overall level. Had the three vaccination campaigns completed in Region VI in 2010-2012 been homogeneous, they would have eliminated rabies with high probability. However, given the observed heterogeneity, three further campaigns may be required to achieve elimination with probability 0.95. We recommend that heterogeneity be reduced in future campaigns through targeted efforts in low coverage areas, even at the expense of reduced coverage in previously high coverage areas. Reported human-mediated dog movements did not reduce elimination probability, so expending limited resources on restricting dog movements is unnecessary in this endemic setting. Enhanced surveillance will be necessary post-elimination, however, given the reintroduction risk from long-distance dog movements.

Increasing influenza vaccination coverage in recommended population groups in Europe.

PubMed

Blank, Patricia R; Szucs, Thomas D

2009-04-01

The clinical and economic burden of seasonal influenza is frequently underestimated. The cornerstone of controlling and preventing influenza is vaccination. National and international guidelines aim to implement immunization programs and targeted vaccination-coverage rates, which should help to enhance the vaccine uptake, especially in the at-risk population. This review purposes to highlight the vaccination guidelines and the actual vaccination situation in four target groups (the elderly, people with underlying chronic conditions, healthcare workers and children) from a European point of view.

Inferior rabies vaccine quality and low immunization coverage in dogs (Canis familiaris) in China

PubMed Central

HU, R. L.; FOOKS, A. R.; ZHANG, S. F.; LIU, Y.; ZHANG, F.

2008-01-01

SUMMARY Human rabies in China continues to increase exponentially, largely due to an inadequate veterinary infrastructure and poor vaccine coverage of naive dogs. We performed an epidemiological survey of rabies both in humans and animals, examined vaccine quality for animal use, evaluated the vaccination coverage in dogs, and checked the dog samples for the presence of rabies virus. The lack of surveillance in dog rabies, together with the low immunization coverage (up to 2·8% in rural areas) and the high percentage of rabies virus prevalence (up to 6·4%) in dogs, suggests that the dog population is a continual threat for rabies transmission from dogs to humans in China. Results also indicated that the quality of rabies vaccines for animal use did not satisfy all of the requirements for an efficacious vaccine capable of fully eliminating rabies. These data suggest that the factors noted above are highly correlated with the high incidence of human rabies in China. PMID:18177524

Self-enforcing regional vaccination agreements

PubMed Central

Klepac, Petra; Grenfell, Bryan T.; Laxminarayan, Ramanan

2016-01-01

In a highly interconnected world, immunizing infections are a transboundary problem, and their control and elimination require international cooperation and coordination. In the absence of a global or regional body that can impose a universal vaccination strategy, each individual country sets its own strategy. Mobility of populations across borders can promote free-riding, because a country can benefit from the vaccination efforts of its neighbours, which can result in vaccination coverage lower than the global optimum. Here we explore whether voluntary coalitions that reward countries that join by cooperatively increasing vaccination coverage can solve this problem. We use dynamic epidemiological models embedded in a game-theoretic framework in order to identify conditions in which coalitions are self-enforcing and therefore stable, and thus successful at promoting a cooperative vaccination strategy. We find that countries can achieve significantly greater vaccination coverage at a lower cost by forming coalitions than when acting independently, provided a coalition has the tools to deter free-riding. Furthermore, when economically or epidemiologically asymmetric countries form coalitions, realized coverage is regionally more consistent than in the absence of coalitions. PMID:26790996

HPV Vaccination: Attitude and Knowledge among German Gynecologists

PubMed Central

Kolben, T. M.; Dannecker, C.; Baltateanu, K.; Goess, C.; Starrach, T.; Semmlinger, A.; Ditsch, N.; Gallwas, J.; Mahner, S.; Friese, K.; Kolben, T.

2016-01-01

Purpose: In order to achieve a higher vaccination rate, education on HPV as well as options for prophylaxis performed by doctors is of great importance. One opportunity to increase the protection against HPV would be vaccinating boys. This study evaluated attitude and knowledge among German gynecologists regarding HPV vaccination, especially in boys. Material and Methods: A questionnaire with 42 questions about demographics, attitude and knowledge about HPV and HPV vaccination was sent to members of the German Society for Gynecology and Obstetrics (DGGG). Results: 998 out of 6567 addressed gynecologists participated. Knowledge about HPV, associated diseases and possible HPV vaccines was high among participants. The attitude towards vaccination in boys as well as girls was positive. Only 8.2 % refused to vaccinate their sons whereas 2.2 % refused to do this for their daughters. However, only few gynecologists vaccinated their daughters and sons against HPV. Main reason for girls was an age outside of vaccination guidelines; for boys it was the lack of cost coverage. Conclusion: The willingness of gynecologists to perform HPV vaccination in boys is as high as for girls. However, sons of gynecologists are only rarely vaccinated against HPV. Main reason is the lack of cost coverage. Vaccinating boys could decrease the disease burden in males, as well as protect women by interrupting ways of transmission. Since the main argument against vaccination of boys is only of financial nature, the necessity of a vaccination recommendation for boys needs to be re-evaluated taking into account the cost-reduced 2-dose vaccination scheme. PMID:27761028

HPV Vaccination: Attitude and Knowledge among German Gynecologists.

PubMed

Kolben, T M; Dannecker, C; Baltateanu, K; Goess, C; Starrach, T; Semmlinger, A; Ditsch, N; Gallwas, J; Mahner, S; Friese, K; Kolben, T

2016-10-01

Purpose: In order to achieve a higher vaccination rate, education on HPV as well as options for prophylaxis performed by doctors is of great importance. One opportunity to increase the protection against HPV would be vaccinating boys. This study evaluated attitude and knowledge among German gynecologists regarding HPV vaccination, especially in boys. Material and Methods: A questionnaire with 42 questions about demographics, attitude and knowledge about HPV and HPV vaccination was sent to members of the German Society for Gynecology and Obstetrics (DGGG). Results: 998 out of 6567 addressed gynecologists participated. Knowledge about HPV, associated diseases and possible HPV vaccines was high among participants. The attitude towards vaccination in boys as well as girls was positive. Only 8.2 % refused to vaccinate their sons whereas 2.2 % refused to do this for their daughters. However, only few gynecologists vaccinated their daughters and sons against HPV. Main reason for girls was an age outside of vaccination guidelines; for boys it was the lack of cost coverage. Conclusion: The willingness of gynecologists to perform HPV vaccination in boys is as high as for girls. However, sons of gynecologists are only rarely vaccinated against HPV. Main reason is the lack of cost coverage. Vaccinating boys could decrease the disease burden in males, as well as protect women by interrupting ways of transmission. Since the main argument against vaccination of boys is only of financial nature, the necessity of a vaccination recommendation for boys needs to be re-evaluated taking into account the cost-reduced 2-dose vaccination scheme.

Maternal Tetanus Toxoid Vaccination and Neonatal Mortality in Rural North India

PubMed Central

Singh, Abhishek; Pallikadavath, Saseendran; Ogollah, Reuben; Stones, William

2012-01-01

Objectives Preventable neonatal mortality due to tetanus infection remains common. We aimed to examine antenatal vaccination impact in a context of continuing high neonatal mortality in rural northern India. Methods and Findings Using the third round of the Indian National Family Health Survey (NFHS) 2005–06, mortality of most recent singleton births was analysed in discrete-time logistic model with maternal tetanus vaccination, together with antenatal care utilisation and supplementation with iron and folic acid. 59% of mothers reported receiving antenatal care, 48% reported receiving iron and folic acid supplementation and 68% reported receiving two or more doses of tetanus toxoid (TT) vaccination. The odds of all-cause neonatal death were reduced following one or more antenatal dose of TT with odds ratios (OR) of 0.46 (95% CI 0.26 to 0.78) after one dose and 0.45 (95% CI 0.31 to 0.66) after two or more doses. Reported utilisation of antenatal care and iron-folic acid supplementation did not influence neonatal mortality. In the statistical model, 16% (95% CI 5% to 27%) of neonatal deaths could be attributed to a lack of at least two doses of TT vaccination during pregnancy, representing an estimated 78,632 neonatal deaths in absolute terms. Conclusions Substantial gains in newborn survival could be achieved in rural North India through increased coverage of antenatal TT vaccination. The apparent substantial protective effect of a single antenatal dose of TT requires further study. It may reflect greater population vaccination coverage and indicates that health programming should prioritise universal antenatal coverage with at least one dose. PMID:23152814

Using Mobile Phones to Improve Vaccination Uptake in 21 Low- and Middle-Income Countries: Systematic Review

PubMed Central

Brown, Elizabeth; Devereux, Sara; Fairhead, Cassandra; Holeman, Isaac

2017-01-01

Background The benefits of vaccination have been comprehensively proven; however, disparities in coverage persist because of poor health system management, limited resources, and parental knowledge and attitudes. Evidence suggests that health interventions that engage local parties in communication strategies improve vaccination uptake. As mobile technology is widely used to improve health communication, mobile health (mHealth) interventions might be used to increase coverage. Objective The aim of this study was to conduct a systematic review of the available literature on the use of mHealth to improve vaccination in low- and middle-income countries with large numbers of unvaccinated children. Methods In February 2017, MEDLINE (Medical Literature Analysis and Retrieval System Online), Scopus, and Web of Science, as well as three health organization websites—Communication Initiative Network, TechNet-21, and PATH—were searched to identify mHealth intervention studies on vaccination uptake in 21 countries. Results Ten peer-reviewed studies and 11 studies from white or gray literature were included. Nine took place in India, three in Pakistan, two each in Malawi and Nigeria, and one each in Bangladesh, Zambia, Zimbabwe, and Kenya. Ten peer-reviewed studies and 7 white or gray studies demonstrated improved vaccination uptake after interventions, including appointment reminders, mobile phone apps, and prerecorded messages. Conclusions Although the potential for mHealth interventions to improve vaccination coverage seems clear, the evidence for such interventions is not. The dearth of studies in countries facing the greatest barriers to immunization impedes the prospects for evidence-based policy and practice in these settings. PMID:28978495

Combinations of Quality and Frequency of Immunization Activities to Stop and Prevent Poliovirus Transmission in the High-Risk Area of Northwest Nigeria

PubMed Central

Duintjer Tebbens, Radboud J.; Pallansch, Mark A.; Wassilak, Steven G. F.; Cochi, Stephen L.; Thompson, Kimberly M.

2015-01-01

Background Frequent supplemental immunization activities (SIAs) with the oral poliovirus vaccine (OPV) represent the primary strategy to interrupt poliovirus transmission in the last endemic areas. Materials and Methods Using a differential-equation based poliovirus transmission model tailored to high-risk areas in Nigeria, we perform one-way and multi-way sensitivity analyses to demonstrate the impact of different assumptions about routine immunization (RI) and the frequency and quality of SIAs on population immunity to transmission and persistence or emergence of circulating vaccine-derived polioviruses (cVDPVs) after OPV cessation. Results More trivalent OPV use remains critical to avoid serotype 2 cVDPVs. RI schedules with or without inactivated polio vaccine (IPV) could significantly improve population immunity if coverage increases well above current levels in under-vaccinated subpopulations. Similarly, the impact of SIAs on overall population immunity and cVDPV risks depends on their ability to reach under-vaccinated groups (i.e., SIA quality). Lower SIA coverage in the under-vaccinated subpopulation results in a higher frequency of SIAs needed to maintain high enough population immunity to avoid cVDPVs after OPV cessation. Conclusions National immunization program managers in northwest Nigeria should recognize the benefits of increasing RI and SIA quality. Sufficiently improving RI coverage and improving SIA quality will reduce the frequency of SIAs required to stop and prevent future poliovirus transmission. Better information about the incremental costs to identify and reach under-vaccinated children would help determine the optimal balance between spending to increase SIA and RI quality and spending to increase SIA frequency. PMID:26068928

Risk factors for low vaccination coverage among Roma children in disadvantaged settlements in Belgrade, Serbia.

PubMed

Stojanovski, Kristefer; McWeeney, Gerry; Emiroglu, Nedret; Ostlin, Piroska; Koller, Theadora; Licari, Lucianne; Kaluski, Dorit Nitzan

2012-08-10

Full vaccination coverage for children under 59 months of age in Serbia is over 90%. This study assesses vaccination coverage and examines its association with birth registration among Roma children who resided in disadvantaged settlements in Belgrade, Serbia. The First Roma Health and Nutrition Survey in Belgrade settlements, 2009, was conducted among households of 468 Roma children between the ages of 6-59 months. The 2005 WHO Immunization Coverage Cluster Survey sampling methodology was employed. Vaccinations were recorded using children's vaccination cards and through verification steps carried out in the Primary Health Care Centers. For those who had health records the information on vaccination was recorded. About 88% of children had vaccination cards. The mean rate of age appropriate full immunization was 16% for OPV and DTP and 14.3% for MMR. Multivariate analyses indicated that children whose births were registered with the civil authorities were more likely to have their vaccination cards [OR=6.1, CI (2.5, 15.0)] and to have their full, age appropriate, series vaccinations for DTP, OPV, MMR and HepB [OR=3.8, CI (1.5, 10.0), OR=3.2, CI (1.5, 6.6), OR=4.8, CI (1.1, 21.0), OR=5.4, CI (1.4, 21.6), respectively]. The immunization coverage among Roma children in settlements is far below the WHO/UNICEF MDG4 target in achieving prevention and control of vaccine preventable diseases. It demonstrates the need to include "invisible" populations into the health systems in continuous, integrated, comprehensive, accessible and sensitive modes. Copyright © 2012 Elsevier Ltd. All rights reserved.

Characterization of Heterogeneity in Childhood Immunization Coverage in Central Florida Using Immunization Registry Data.

PubMed

Thompson, Kimberly M; Logan, Grace E

2016-07-01

Despite high vaccine coverage in the United States in general, and in the State of Florida specifically, some children miss scheduled vaccines due to health system failures or vaccine refusal by their parents. Recent experiences with outbreaks in the United States suggest that geographic clustering of un(der)vaccinated populations represent a threat to the elimination status of some vaccine-preventable diseases. Immunization registries continue to expand and play an important role in efforts to track vaccine coverage and use. Using nearly 700,000 de-identified immunization records from the Florida Department of Health immunization information system (Florida SHOTS™) for children born during 2003-2014, we explored heterogeneity and potential clustering of un(der)vaccinated children in six counties in central Florida-Brevard, Lake, Orange, Oseola, Polk, and Seminole-that represent a high-risk area for importation due to family tourist attractions in the area. By zip code, we mapped the population density, the percent of children with religious exemptions, the percent of children on track or overdue for each vaccine series without and with exemptions, and the numbers of children with no recorded dose of each vaccine. Overall, we found some heterogeneity in coverage among the counties and zip codes, but relatively consistent and high coverage. We found that some children with an exemption in the system received the vaccines we analyzed, but exemption represents a clear risk factor for un(der)immunization. We identified many challenges associated with using immunization registry data for spatial analysis and potential opportunities to improve registries to better support future analyses. © 2015 Society for Risk Analysis.

Assessing vaccination coverage in infants, survey studies versus the Flemish immunisation register: achieving the best of both worlds.

PubMed

Braeckman, Tessa; Lernout, Tinne; Top, Geert; Paeps, Annick; Roelants, Mathieu; Hoppenbrouwers, Karel; Van Damme, Pierre; Theeten, Heidi

2014-01-09

Infant immunisation coverage in Flanders, Belgium, is monitored through repeated coverage surveys. With the increased use of Vaccinnet, the web-based ordering system for vaccines in Flanders set up in 2004 and linked to an immunisation register, this database could become an alternative to quickly estimate vaccination coverage. To evaluate its current accuracy, coverage estimates generated from Vaccinnet alone were compared with estimates from the most recent survey (2012) that combined interview data with data from Vaccinnet and medical files. Coverage rates from registrations in Vaccinnet were systematically lower than the corresponding estimates obtained through the survey (mean difference 7.7%). This difference increased by dose number for vaccines that require multiple doses. Differences in administration date between the two sources were observed for 3.8-8.2% of registered doses. Underparticipation in Vaccinnet thus significantly impacts on the register-based immunisation coverage estimates, amplified by underregistration of administered doses among vaccinators using Vaccinnet. Therefore, survey studies, despite being labour-intensive and expensive, currently provide more complete and reliable results than register-based estimates alone in Flanders. However, further improvement of Vaccinnet's completeness will likely allow more accurate estimates in the nearby future. Copyright © 2013 Elsevier Ltd. All rights reserved.

Routine immunization in Pakistan: comparison of multiple data sources and identification of factors associated with vaccination.

PubMed

Imran, Hafsa; Raja, Dania; Grassly, Nicholas C; Wadood, M Zubair; Safdar, Rana M; O'Reilly, Kathleen M

2018-03-01

Within Pakistan, estimates of vaccination coverage with the pentavalent vaccine, oral polio vaccine (OPV) and measles vaccine (MV) in 2011 were reported to be 74%, 75% and 53%, respectively. These national estimates may mask regional variation. The reasons for this variation have not been explored. Data from the Multiple Indicator Cluster Surveys (MICS) for Balochistan and Punjab (2010-2011) are analysed to examine factors associated with receiving three or more doses of the pentavalent vaccine and one or more MVs using regression modelling. Pentavalent and OPV estimates from the MICS were compared to vaccine dose histories from surveillance for acute flaccid paralysis (AFP; poliomyelitis) to ascertain agreement. Adjusted coverage of children 12-23 months of age were estimated to be 16.0%, 75.5% and 34.2% in Balochistan and 58.0%, 87.7% and 72.6% in Punjab for the pentavalent vaccine, OPV and MV, respectively. Maternal education, healthcare utilization and wealth were associated with receiving the pentavalent vaccine and the MV. There was a strong correlation of district estimates of vaccination coverage between AFP and MICS data, but AFP estimates of pentavalent coverage in Punjab were biased toward higher values. National estimates mask variation and estimates from individual surveys should be considered alongside other estimates. The development of strategies targeted towards poorly educated parents within low-wealth quintiles that may not typically access healthcare could improve vaccination rates.

MMR vaccination status of children exempted from school-entry immunization mandates

PubMed Central

Sethuraman, Karthik; Omer, Saad B.; Hanlon, Alexandra L.; Levy, Michael Z.; Salmon, Daniel

2015-01-01

BACKGROUND Child immunizations are one of the most successful public health interventions of the past century. Still, parental vaccine hesitancy is widespread and increasing. One manifestation of this are rising rates of nonmedical or “personal beliefs” exemptions (PBEs) from school-entry immunization mandates. Exemptions have been shown to be associated with increased risk of disease outbreak, but the strength of this association depends critically on the true vaccination status of exempted children, which has not been assessed. OBJECTIVE To estimate the true measles-mumps-rubella (MMR) vaccination status of children with PBEs. METHODS We use administrative data collected by the California Department of Public Health in 2009 and imputation to estimate the MMR vaccination status of children with PBEs under varying scenarios. RESULTS Results from 2009 surveillance data indicate MMR1/MMR2 coverage of 18–47% among children with PBEs at typical schools and 11–34% among children with PBEs at schools with high PBE rates. Imputation scenarios point to much higher coverage (64–92% for MMR1 and 25–58% for MMR2 at typical schools; 49–90% for MMR1 and 16–63% for MMR2 at high PBE schools) but still below levels needed to maintain herd immunity against measles. CONCLUSIONS These coverage estimates suggest that prior analyses of the relative risk of measles associated with vaccine refusal underestimate that risk by an order of magnitude of 2–10 times. PMID:26431991

Household experience and costs of seeking measles vaccination in rural Guinea-Bissau.

PubMed

Byberg, S; Fisker, A B; Rodrigues, A; Balde, I; Enemark, U; Aaby, P; Benn, C S; Griffiths, U K

2017-01-01

Children younger than 12 months of age are eligible for childhood vaccines through the public health system in Guinea-Bissau. To limit open vial wastage, a restrictive vial opening policy has been implemented; 10-dose measles vaccine vials are only opened if six or more children aged 9-11 months are present at the vaccination post. Consequently, mothers who bring their child for measles vaccination can be told to return another day. We aimed to describe the household experience and estimate household costs of seeking measles vaccination in rural Guinea-Bissau. Within a national sample of village clusters under demographic surveillance, we interviewed mothers of children aged 9-21 months about their experience with seeking measles vaccination. From information about time and money spent, we calculated household costs of seeking measles vaccination. We interviewed mothers of 1308 children of whom 1043 (80%) had sought measles vaccination at least once. Measles vaccination coverage was 70% (910/1308). Coverage decreased with increasing distance to the health centre. On average, mothers who had taken their child for vaccination took their child 1.4 times. Mean costs of achieving 70% coverage were 2.04 USD (SD 3.86) per child taken for vaccination. Half of the mothers spent more than 2 h seeking vaccination and 11% spent money on transportation. We found several indications of missed opportunities for measles vaccination resulting in suboptimal coverage. The household costs comprised 3.3% of the average monthly income and should be taken into account when assessing the costs of delivering vaccinations. © 2016 John Wiley & Sons Ltd.

Is Colombia reaching the goals on infant immunization coverage? A quantitative survey from 80 municipalities.

PubMed

Narváez, Javier; Osorio, May Bibiana; Castañeda-Orjuela, Carlos; Alvis Zakzuk, Nelson; Cediel, Natalia; Chocontá-Piraquive, Luz Ángela; de La Hoz-Restrepo, Fernando

2017-03-13

This study aimed to evaluate the coverage of the Colombian Expanded Program on Immunization among children less than 6years old, to evaluate the timeliness of immunization, to assess the coverage of newly introduced vaccines, and to identify factors associated with lack of immunization. We conducted a cross-sectional survey in 80 municipalities of Colombia, using a two-stage cluster random sampling. We attempted to contact all children less than 6years old living in the sampled blocks, and asked their caregivers to provide immunization record cards. We also collected basic sociodemographic information. We reached 81% of the attempted household contacts, identifying 18,232 children; of them, 14,805 (83%) had an immunization record card. Coverage for traditional vaccines was above 90%: BCG (tuberculosis) 95.7% (95%CI: 95.1-96.4), pentavalent vaccine 93.3% (92.4-94.3), MMR (measles, mumps, rubella) initial dose 94.5% (93.5-95.6); but it was lower for recently introduced vaccines: rotavirus 80% (77.8-82.1), influenza 48.4% (45.9-50.8). Results for timely vaccination were not equally successful: pentavalent vaccine 44.2% (41.4-47.1), MMR initial dose 71.2% (68.9-73.4). Mother's education was significantly associated with higher immunization odds. Older age, a greater number of siblings, low socioeconomic status, and not having health insurance were significantly associated with lower immunization odds. There was significant heterogeneity in immunization rates by municipality across the country. Although absolute immunization coverage for traditional vaccines met the goal of 90% for the 80 municipalities combined, disparities in coverage across municipalities, delayed immunization, and decline of coverage with age, are common problems in Colombia that may result in reduced protection. Newly introduced vaccines require additional efforts to reach the goal. These results highlight the association of health inequities with low immunization coverage and delayed immunization. Identification of vulnerable populations and their missed opportunities for vaccination may help to improve the reach of immunization programs. Copyright © 2017 Elsevier Ltd. All rights reserved.

Inequity in childhood immunization in India: a systematic review.

PubMed

Mathew, Joseph L

2012-03-01

Despite a reduction in disease burden of vaccine preventable diseases through childhood immunization, considerable progress needs to be made in terms of ensuring efficiency and equity of vaccination coverage. To conduct a systematic review to identify and explore factors associated with inequities in routine vaccination of children in India. Publications reporting vaccination inequity were retrieved through a systematic search of Medline and websites of the WHO, UNICEF and demographic health surveys in India. No restrictions were applied in terms of study designs. The primary outcome measure was complete vaccination or immunization defined as per the standard WHO definition. There were three nationwide data sets viz. the three National Family Health Surveys (NFHS), a research study conducted by the Indian Council of Medical Research (ICMR) and a UNICEF coverage evaluation survey. In addition, several publications representing different population groups or geographic regions were available. A small number of publications were reanalyses of data from the NFHS series. There is considerable inequity in vaccination coverage in different states. Within states, traditionally poor performing states have greater inequities, although there are significant inequities even within better performing states. There are significant inequities in childhood vaccination based on various factors related to individual (gender, birth order), family (area of residence, wealth, parental education), demography (religion, caste), and the society (access to health-care, community literacy level) characteristics. Girls fare uniformly worse than boys and higher birth order infants have lower vaccination coverage. Urban infants have higher coverage than rural infants and those living in urban slums. There is an almost direct relationship between household wealth and vaccination rates. The vaccination rates are lower among infants with mothers having no or low literacy, and families with insufficient empowerment of women. Paternal literacy has an inconsistent positive relationship with infant vaccination. There is a relationship between religion and caste and childhood vaccination. Access to health services and other infrastructure, is associated with better vaccination coverage of infants. The precise impact of specific risk factors operating singly or in combination cannot be calculated from this systematic review. This systematic review identifies and explores factors associated with inequity in childhood immunization in India; and provides information for urgent action to redress the imbalances.

Post-licensure deployment of oral cholera vaccines: a systematic review

PubMed Central

Martin, Stephen; Lopez, Anna Lena; Bellos, Anna; Ali, Mohammad; Alberti, Kathryn; Anh, Dang Duc; Costa, Alejandro; Grais, Rebecca F; Legros, Dominique; Luquero, Francisco J; Ghai, Megan B; Perea, William; Sack, David A

2014-01-01

Abstract Objective To describe and analyse the characteristics of oral cholera vaccination campaigns; including location, target population, logistics, vaccine coverage and delivery costs. Methods We searched PubMed, the World Health Organization (WHO) website and the Cochrane database with no date or language restrictions. We contacted public health personnel, experts in the field and in ministries of health and did targeted web searches. Findings A total of 33 documents were included in the analysis. One country, Viet Nam, incorporates oral cholera vaccination into its public health programme and has administered approximately 10.9 million vaccine doses between 1997 and 2012. In addition, over 3 million doses of the two WHO pre-qualified oral cholera vaccines have been administered in more than 16 campaigns around the world between 1997 and 2014. These campaigns have either been pre-emptive or reactive and have taken place under diverse conditions, such as in refugee camps or natural disasters. Estimated two-dose coverage ranged from 46 to 88% of the target population. Approximate delivery cost per fully immunized person ranged from 0.11–3.99 United States dollars. Conclusion Experience with oral cholera vaccination campaigns continues to increase. Public health officials may draw on this experience and conduct oral cholera vaccination campaigns more frequently. PMID:25552772

Bad news: The influence of news coverage and Google searches on Gardasil adverse event reporting.

PubMed

Faasse, Kate; Porsius, Jarry T; Faasse, Jonathan; Martin, Leslie R

2017-12-14

Human papilloma virus vaccines are a safe and effective tool for reducing HPV infections that can cause cervical cancer. However, uptake of these vaccines has been suboptimal, with many people holding negative beliefs and misconceptions. Such beliefs have been linked with the experience of unpleasant side effects following medical treatment, and media coverage may heighten such concerns. The present study sought to assess the influence of news coverage (number of news articles per month) on adverse event reporting in response to Gardasil vaccination in New Zealand over a 7.5-year period, and whether the influence of news coverage was mediated by internet search activity (Google search volumes). Multiple linear regression analyses and simple mediation analyses were used, controlling for year and number of vaccinations delivered. News coverage in the previous month, and Google search volumes in the same month, were significant predictors of adverse event reporting, after accounting for vaccination rates and year. Concurrent Google search volumes partially mediated the effect of prior news coverage. The results suggest that some of the adverse events reported were not related to the vaccination itself, but to news coverage and internet search volumes, which may have contributed to public concerns about potentially unpleasant or harmful outcomes. These findings have implications for the importance of psychological and social factors in adverse event reporting, and the role of the news media in disseminating health information. Copyright © 2017 Elsevier Ltd. All rights reserved.

Surveillance of pertussis: methods and implementation.

PubMed

Guiso, Nicole; Wirsing von König, Carl Heinz

2016-07-01

Pertussis or whooping cough is a respiratory disease caused by Bordetella pertussis or, to a lesser extent, by B. parapertussis. Vaccines against pertussis have been widely used for more than 50 years and have led to a significant reduction of morbidity and mortality. However, even in countries with a high vaccine coverage, the disease is still not well controlled. Surveillance is urgently needed. This review summarizes surveillance methods and gives examples that may be used when setting up a surveillance program or analyzing an outbreak. Expert commentary: Pertussis surveillance is urgently required in order to define the burden of disease, to adapt vaccine strategies according to the type of pertussis vaccine used and to follow the evolution of the bacteria.

Understanding the role of the news media in HPV vaccine uptake in the United States: Synthesis and commentary

PubMed Central

Gollust, Sarah E.; LoRusso, Susan M.; Nagler, Rebekah H.; Fowler, Erika Franklin

2016-01-01

ABSTRACT Vaccination rates for the human papillomavirus (HPV) vaccine fall below targets and only 2 states and the District of Columbia require the vaccine for middle school-age children. Messages conveyed through news media—to parents, providers, policymakers, and the general public—may contribute to sluggish vaccination rates and policy action. In this commentary, we review the findings from 13 published studies of news media coverage of the HPV vaccine in the United States since FDA licensure in 2006. We find 2 important themes in news coverage: a rising focus on political controversy and a consistent emphasis on the vaccine as for girls, even beyond the point when the vaccine was recommended for boys. These political and gendered messages have consequences for public understanding of the vaccine. Future research should continue to monitor news media depictions of the HPV vaccine to assess whether political controversy will remain a pronounced theme of coverage or whether the media ultimately depict the vaccine as a routine public health service. PMID:26554612

Evaluation of the mass measles vaccination campaign in Guangdong Province, China.

PubMed

Peng, Zhi Qiang; Chen, Wei Shi; He, Qun; Peng, Guo Wen; Wu, Cheng Gang; Xu, Ning; Zhao, Zhan Jie; Shu, Jun; Tan, Qiu; Zheng, Hui Zhen; Lin, Li Feng; Deng, Hui Hong; Lin, Jin Yan; Zhang, Yong Hui

2012-02-01

To evaluate the mass measles vaccination campaign of 2009 in Guangdong Province, China. Data on the campaign implementation, measles surveillance, and serological surveillance were reviewed and analyzed by statistical methods. Rapid coverage surveys showed that 98.09% of children were vaccinated during the campaign. The coverage of migrant children increased significantly from 67.10% to 97.32% (p<0.01). From May to December 2009, after the campaign, the number of measles cases was reduced by 93.04% compared with the same period of 2008. The antibody positive rate in children aged less than 15 years reached above 95%. More than 1 million migrant children were identified and vaccinated during the campaign. Flyers, notices of information from doctors, and television programs were the best methods to inform parents of the campaign. Awareness of the campaign by residents increased significantly from 91.86% to 97.10% (p<0.01) through the use of social mobilization materials. A massive vaccination campaign approach for controlling measles in a developing region like Guangdong Province with a vast migrant population has proved effective. Comprehensive mobilization, communication with the mass media, and support from government departments were critical to the success of the campaign. Copyright © 2011 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Perceptions matter: beliefs about influenza vaccine and vaccination behavior among elderly white, black and Hispanic Americans.

PubMed

Wooten, Karen G; Wortley, Pascale M; Singleton, James A; Euler, Gary L

2012-11-06

Knowledge and beliefs about influenza vaccine that differ across racial or ethnic groups may promote racial or ethnic disparities in vaccination. To identify associations between vaccination behavior and personal beliefs about influenza vaccine by race or ethnicity and education levels among the U.S. elderly population. Data from a national telephone survey conducted in 2004 were used for this study. Responses for 3875 adults ≥ 65 years of age were analyzed using logistic regression methods. Racial and ethnic differences in beliefs were observed. For example, whites were more likely to believe influenza vaccine is very effective in preventing influenza compared to blacks and Hispanics (whites, 60%; blacks, 47%, and Hispanics, 51%, p<0.01). Among adults who believed the vaccine is very effective, self-reported vaccination was substantially higher across all racial/ethnic groups (whites, 93%; blacks, 76%; Hispanics, 78%) compared to adults who believed the vaccine was only somewhat effective (whites 67%; blacks 61%, Hispanics 61%). Also, vaccination coverage differed by education level and personal beliefs of whites, blacks, and Hispanics. Knowledge and beliefs about influenza vaccine may be important determinants of influenza vaccination among racial/ethnic groups. Strategies to increase coverage should highlight the burden of influenza disease in racial and ethnic populations, the benefits and safety of vaccinations and personal vulnerability to influenza disease if not vaccinated. For greater effectiveness, factors associated with the education levels of some communities may need to be considered when developing or implementing new strategies that target specific racial or ethnic groups. Published by Elsevier Ltd.

Effect of the Global Alliance for Vaccines and Immunisation on diphtheria, tetanus, and pertussis vaccine coverage: an independent assessment.

PubMed

Lu, Chunling; Michaud, Catherine M; Gakidou, Emmanuela; Khan, Kashif; Murray, Christopher J L

2006-09-23

The Global Alliance for Vaccines and Immunisation (GAVI) was created in 1999 to enable even the poorest countries to provide vaccines to all children. We aimed to assess the effect of GAVI on combined diphtheria, tetanus, and pertussis vaccine (DTP3) coverage. We examined the relation between DTP3 coverage for GAVI recipient countries from 1995 to 2004 and immunisation services support (ISS) and non-ISS expenditure per surviving child, controlling for income per head and local political governance variables. We analysed DTP3 coverage reported by governments and estimated by WHO/UNICEF. We also investigated the effect of GAVI on country reporting behaviour. In countries with DTP3 coverage of 65% or less at baseline, ISS spending per surviving child had a significant positive effect on DTP3 coverage (p=0.0005). This effect was not present in countries with DTP3 coverage of 65-80% or 80% or more at baseline. If ISS expenditure only is assessed, the estimated cost per additional child immunised in countries with baseline coverage of 65% or less is US$14 and if ISS and non-ISS expenditures are included the cost per child is almost $20. The success of ISS funding in countries with baseline DTP3 coverage of 65% or less provides evidence that a public-private partnership can work to reverse a negative trend in global health and that performance-related disbursement can work in some settings. Because ISS funding seems to have no effect in countries with baseline coverage greater than 65%, GAVI should consider redistributing its resources to countries with the lowest coverage.

Measles seroprevalence, outbreaks, and vaccine coverage in Rwanda.

PubMed

Seruyange, Eric; Gahutu, Jean-Bosco; Mambo Muvunyi, Claude; Uwimana, Zena G; Gatera, Maurice; Twagirumugabe, Theogene; Katare, Swaibu; Karenzi, Ben; Bergström, Tomas

2016-01-01

Measles outbreaks are reported after insufficient vaccine coverage, especially in countries recovering from natural disaster or conflict. We compared seroprevalence to measles in blood donors in Rwanda and Sweden and explored distribution of active cases of measles and vaccine coverage in Rwanda. 516 Rwandan and 215 Swedish blood donors were assayed for measles-specific immunoglobulin G (IgG) by enzyme-linked immunosorbent assay (ELISA). Data on vaccine coverage and acute cases in Rwanda from 1980 to 2014 were collected, and IgM on serum samples and polymerase chain reaction (PCR) on nasopharyngeal (NPH) swabs from suspected measles cases during 2010-2011 were analysed. The seroprevalence of measles IgG was significantly higher in Swedish blood donors (92.6%; 95% CI: 89.1-96.1%) compared to Rwandan subjects (71.5%; 95% CI: 67.6-75.4%) and more pronounced <35 years of age. The OD values were significantly lower in the Rwandan blood donors as compared to Swedish subjects (p < 0.00001). However, effective measles vaccine coverage was concomitant with decrease in measles cases in Rwanda, with the exception of an outbreak in 1995 following the 1994 genocide. 76/544 serum samples were IgM positive and 21/31 NPH swabs were PCR positive for measles, determined by sequencing to be of genotype B3. Measles seroprevalence was lower in Rwandan blood donors compared to Swedish subjects. Despite this, the number of reported measles cases in Rwanda rapidly decreased during the study period, concomitant with increased vaccine coverage. Taken together, the circulation of measles was limited in Rwanda and vaccine coverage was favourable, but seroprevalence and IgG levels were low especially in younger age groups.

Socioeconomic inequalities and vaccination coverage: results of an immunisation coverage survey in 27 Brazilian capitals, 2007-2008.

PubMed

Barata, Rita Barradas; Ribeiro, Manoel Carlos Sampaio de Almeida; de Moraes, José Cássio; Flannery, Brendan

2012-10-01

Since 1988, Brazil's Unified Health System has sought to provide universal and equal access to immunisations. Inequalities in immunisation may be examined by contrasting vaccination coverage among children in the highest versus the lowest socioeconomic strata. The authors examined coverage with routine infant immunisations from a survey of Brazilian children according to socioeconomic stratum of residence census tract. The authors conducted a household cluster survey in census tracts systematically selected from five socioeconomic strata, according to average household income and head of household education, in 26 Brazilian capitals and the federal district. The authors calculated coverage with recommended vaccinations among children until 18 months of age, according to socioeconomic quintile of residence census tract, and examined factors associated with incomplete vaccination. Among 17,295 children with immunisation cards, 14,538 (82.6%) had received all recommended vaccinations by 18 months of age. Among children residing in census tracts in the highest socioeconomic stratum, 77.2% were completely immunised by 18 months of age versus 81.2%-86.2% of children residing in the four census tract quintiles with lower socioeconomic indicators (p<0.01). Census tracts in the highest socioeconomic quintile had significantly lower coverage for bacille Calmette-Guérin, oral polio and hepatitis B vaccines than those with lower socioeconomic indicators. In multivariable analysis, higher birth order and residing in the highest socioeconomic quintile were associated with incomplete vaccination. After adjusting for interaction between socioeconomic strata of residence census tract and household wealth index, only birth order remained significant. Evidence from Brazilian capitals shows success in achieving high immunisation coverage among poorer children. Strategies are needed to reach children in wealthier areas.

Vaccination Week in the Americas, 2011: an opportunity to assess the routine vaccination program in the Bolivarian Republic of Venezuela.

PubMed

Sánchez, Daniel; Sodha, Samir V; Kurtis, Hannah J; Ghisays, Gladys; Wannemuehler, Kathleen A; Danovaro-Holliday, M Carolina; Ropero-Álvarez, Alba María

2015-04-17

Vaccination Week in the Americas (VWA) is an annual initiative in countries and territories of the Americas every April to highlight the work of national expanded programs on immunization (EPI) and increase access to vaccination services for high-risk population groups. In 2011, as part of VWA, Venezuela targeted children aged less than 6 years in 25 priority border municipalities using social mobilization to increase institution-based vaccination. Implementation of social communication activities was decentralized to the local level. We conducted a survey in one border municipality of Venezuela to evaluate the outcome of VWA 2011 and provide a snapshot of the overall performance of the routine EPI at that level. We conducted a coverage survey, using stratified cluster sampling, in the Venezuelan municipality of Bolivar (bordering Colombia) in August 2011. We collected information for children aged <6 years through caregiver interviews and transcription of vaccination card data. We estimated each child's eligibility to receive a specific vaccine dose during VWA 2011 and whether or not they were actually vaccinated during VWA activities. We also estimated baseline vaccination coverage, timeliness and 95% confidence intervals (CI), and used chi-square tests to compare coverage across age cohorts, taking into account the sampling design. We surveyed 839 children from 698 households; 93% of children had a vaccination card. Among households surveyed, 216 (31%) caregivers reported having heard about a vaccination activity during April or May 2011. Of the 528 children eligible to receive a vaccine during VWA, 24% received at least one dose, while 13% received all doses due. Overall, baseline coverage with routine vaccines, as measured by the survey, was >85%, with a few exceptions. Low levels of VWA awareness among caregivers probably contributed to the limited vaccination of eligible children during the VWA activities in Bolivar in 2011. However, vaccine coverage for most EPI vaccines was high. Additionally, high vaccination card availability and high participation in VWA among those caregivers aware of it in 2011 suggest public trust in the EPI program in the municipality. Health authorities have used survey findings to inform changes to the routine EPI and better VWA implementation in subsequent years.

Immunization delivery in the second year of life in Ghana: the need for a multi-faceted approach

PubMed Central

Nyaku, Mawuli; Wardle, Melissa; Eng, Jodi Vanden; Ametewee, Lynnette; Bonsu, George; Larbi Opare, Joseph Kwadwo; Conklin, Laura

2017-01-01

Introduction in 2012, pneumococcal conjugate vaccine (PCV), rotavirus vaccine and a second dose of measles-containing vaccine (MCV2) were introduced into the Expanded Program on Immunization (EPI) in Ghana. According to Ghana’s EPI schedule, PCV and rotavirus vaccine are given in the first year of life and MCV2 in the second year of life (2YL) at 18 months. Although coverage with the last doses of PCV and rotavirus vaccine reached almost 90% coverage within four years of introduction, MCV2 coverage did not rise above 70%. The World Health Organization Global Measles and Rubella Strategic Plan established a 2020 milestone to achieve at least 95% coverage with the first and second doses of measles-containing vaccine in each district and nationally. We developed a project to address challenges to delivery of immunizations and other child health services at the 18-month visit and throughout the 2YL. Methods from March to April 2016, we conducted a cluster survey of households (HHs) with children 24-35 months of age in three regions in Ghana to assess knowledge, attitudes and beliefs among caregivers about immunization during the 2YL and to collect childhood vaccination history data using vaccination cards. Three independent samples were selected from the Northern (NR), Volta (VR), and Greater Accra (GAR) regions. A survey and direct observations were performed a ta representative sample of health facilities (HFs) providing immunization services in the same regions to further characterize barriers to immunization access, utilization and delivery in the 2YL. Results data on a total of 464 children ages 24-35 months were collected in the HH survey: 211 in NR, 153 in VR, and 100 in GAR (response rate > 99%). First dose of measles-containing vaccine (MCV1) coverage was (NR: 87%, VR: 96%, GAR: 99%); however, MCV2 coverage was lower (NR: 60%, VR: 83%, GAR: 70%). MCV1 to MCV2 dropout was 32% in NR, 14% in VR, and 31% in GAR. Caregiver awareness of immunization against measles was 69% in NR, 75% in VR, and 68% in GAR yet less than half knew the recommended ages for receiving the vaccine, (NR: 4%, VR: 9%, GAR: 44%). Among 160 HFs participating in the survey (>50 in each region), most lacked a defaulter tracing system (NR: 94%,VR: 76%,GAR: 85%). A varying proportion of HCWs correctly indicated how to record a catch-up first dose of MCV administered to an 18-month-old child in the 12-23 month immunization register (NR: 38%, VR: 55%, GAR: 67%) and on the vaccination card (NR: 54%, VR: 53%, GAR: 76%). Although more than half of caregivers would accept text messages, (NR: 57%, VR: 78%, GAR: 96%) including reminders, related to their child’s immunizations, < 10% HFs were utilizing this practice. Conclusion challenges encountered with the establishment of an immunization visit beyond the first year of life included knowledge gaps among caregivers, high dropout rates between MCV1 and MCV2 in all study regions, and a lack of defaulter tracing systems in most healthcare facilities providing childhood immunizations. Targeted strategies that promote behavioral, cultural, and policy changes are needed to strengthen 2YL child health service delivery and improve vaccination coverage. PMID:29296139

Implementing the communication for development strategy to improve knowledge and coverage of measles vaccination in western Chinese immunization programs: a before-and-after evaluation.

PubMed

Lu, Ming; Chu, Yao-Zhu; Yu, Wen-Zhou; Scherpbier, Robert; Zhou, Yu-Qing; Zhu, Xu; Su, Qi-Ru; Duan, Meng-Juan; Zhang, Xuan; Cui, Fu-Qiang; Wang, Hua-Qing; Zhou, Yi-Biao; Jiang, Qing-Wu

2017-04-24

Communication for Development (C4D) is a strategy promoted by the United Nations Children's Fund to foster positive and measurable changes at the individual, family, community, social, and policy levels of society. In western China, C4D activities have previously been conducted as part of province-level immunization programs. In this study, we evaluated the association of C4D with changes in parental knowledge of immunization services, measles disease, and measles vaccine, and changes in their children's measles vaccine coverage. From April 2013 to April 2014, C4D activities were implemented as part of provincial immunization programs in the Inner Mongolia, Guangxi, Chongqing, Guizhou, Tibet, Shaanxi, Gansu, Ningxia, and Qinghai provinces. We used a before-and-after study design and employed face-to-face interviews to assess changes in parental knowledge and vaccination coverage. We surveyed 2 107 households at baseline and 2 070 households after 1 year of C4D activities. Following C4D, 95% of caregivers were aware of the vaccination record check requirement for entry into kindergarten and primary school; 80% of caregivers were aware that migrant children were eligible for free vaccination; more than 70% of caregivers knew that measles is a respiratory infectious disease; and 90% of caregivers knew the symptoms of measles. Caregivers' willingness to take their children to the clinic for vaccination increased from 51.3% at baseline to 67.4% in the post-C4D survey. Coverage of one-dose measles-containing vaccine (MCV) increased from 83.8% at baseline to 90.1% after C4D. One-dose MCV coverage was greater than 95% in the Guangxi, Shaanxi, and Gansu provinces. Two-dose MCV coverage increased from 68.5 to 77.6%. House-to-house communication was the most popular C4D activity among caregivers (91.6% favoring), followed by posters and educational talks (64.8 and 49.9% favoring). C4D is associated with increased caregiver knowledge about measles, increased willingness to seek immunization services for their children, and increased measles vaccination coverage. Tailored communication strategies based on insights gained from these analyses may be able to increase vaccination coverage in hard-to-reach areas. C4D should be considered for larger scale implementation in China.

Can Flanders resist the measles outbreak? Assessing vaccination coverage in different age groups among Flemish residents.

PubMed

Braeckman, T; Theeten, H; Roelants, M; Blaizot, S; Hoppenbrouwers, K; Maertens, K; Van Damme, P; Vandermeulen, C

2018-05-02

The Belgian strategic plan to eliminate measles contains several vaccination strategies including routine immunisation programmes and catch-up campaigns. A new expanded programme on immunisation-based survey (2016) assessed the uptake of the recommended measles-mumps-rubella (MMR) vaccine in three different cohorts: toddlers, adolescents and parents of toddlers. A two-stage cluster sampling technique was used to select 875 toddlers (age 18-24 months) and 1250 adolescents (born in 2000) from 107 municipalities in Flanders. After consent of the parent(s), 746 (85.2%) families of toddlers and 1012 (81.0%) families of adolescents were interviewed at home. Measles vaccination coverage was high at 18-24 months (96.2%) and 81.5% were vaccinated at recommended age. Toddlers who had two siblings or a non-working mother or changed vaccinator were more at risk for not being vaccinated. Coverage of the teenager dose reached 93.5% and was lower in adolescents with educational underachievement or whose mother was part-time working or with a non-Belgian background. Only 56.0% of mothers and 48.3% of fathers remembered having received at least one measles-containing vaccine. Although measles vaccination coverage in toddlers meets the required standards for elimination, administration of the teenager dose of MMR vaccine and parent compliance to the recent measles catch-up campaign in Flanders leave room for improvement.

Mass media coverage of HPV vaccination in Romania: a content analysis.

PubMed

Penţa, Marcela A; Băban, Adriana

2014-12-01

Romania has the highest cervical cancer burden in Europe. Despite the implementation of two human papillomavirus (HPV) vaccination programmes, the uptake remained extremely low and the programmes were discontinued. Given that media are a common source of information for the public and may influence vaccination decisions, this article sought to explore the content and quality of HPV vaccine media coverage in Romania. We conducted a content analysis of 271 media reports (from newspapers, magazines, videos and informational websites) published online between November 2007 and January 2012. Overall, results indicated that 31.4% of the materials were neutral, 28% were negative or extremely negative, 17% were mixed, while 23.6% were positive towards the vaccine. The most dominant vaccine-related concerns were side effects and insufficient testing. Elementary information about the vaccine and HPV was constantly left out and sometimes inaccuracies were found. Negatively disposed reports were more likely to contain incorrect data about vaccine efficacy and less likely to provide comprehensive information about the vaccine and HPV-related diseases. Some dimensions of media coverage varied across time and media outlets. The present findings suggest that educational interventions are greatly needed as a response to suboptimal and incomplete media coverage of HPV vaccination. © The Author 2014. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Impact of Adverse Events Following Immunization in Viet Nam in 2013 on chronic hepatitis B infection.

PubMed

Li, Xi; Wiesen, Eric; Diorditsa, Sergey; Toda, Kohei; Duong, Thi Hong; Nguyen, Lien Huong; Nguyen, Van Cuong; Nguyen, Tran Hien

2016-02-03

Adverse Events Following Immunization in Viet Nam in 2013 led to substantial reductions in hepatitis B vaccination coverage (both the birth dose and the three-dose series). In order to estimate the impact of the reduction in vaccination coverage on hepatitis B transmission and future mortality, a widely-used mathematical model was applied to the data from Viet Nam. Using the model, we estimated the number of chronic infections and deaths that are expected to occur in the birth cohort in 2013 and the number of excessive infections and deaths attributable to the drop in immunization coverage in 2013. An excess of 90,137 chronic infections and 17,456 future deaths were estimated to occur in the 2013 birth cohort due to the drop in vaccination coverage. This analysis highlights the importance of maintaining high vaccination coverage and swiftly responding to reported Adverse Events Following Immunization in order to regain consumer confidence in the hepatitis B vaccine. Copyright © 2015 World Health Organization; licensee Elsevier. Published by Elsevier Ltd.. All rights reserved.

Seasonal influenza vaccination coverage and its determinants among nursing homes personnel in western France.

PubMed

Elias, Christelle; Fournier, Anna; Vasiliu, Anca; Beix, Nicolas; Demillac, Rémi; Tillaut, Hélène; Guillois, Yvonnick; Eyebe, Serge; Mollo, Bastien; Crépey, Pascal

2017-07-07

Influenza-associated deaths is an important risk for the elderly in nursing homes (NHs) worldwide. Vaccination coverage among residents is high but poorly effective due to immunosenescence. Hence, vaccination of personnel is an efficient way to protect residents. Our objective was to quantify the seasonal influenza vaccination (IV) coverage among NH for elderly workers and identify its determinants in France. We conducted a cross-sectional study in March 2016 in a randomized sample of NHs of the Ille-et-Vilaine department of Brittany, in western France. A standardized questionnaire was administered to a randomized sample of NH workers for face-to-face interviews. General data about the establishment was also collected. Among the 33 NHs surveyed, IV coverage for the 2015-2016 season among permanent workers was estimated at 20% (95% Confidence Interval (CI) 15.3%-26.4%) ranging from 0% to 69% depending on the establishments surveyed. Moreover, IV was associated with having previously experienced a "severe" influenza episode in the past (Prevalence Ratio 1.48, 95% CI 1.01-2.17), and varied by professional categories (p < 0.004) with better coverage among administrative staff. Better knowledge about influenza prevention tools was also correlated (p < 0.001) with a higher IV coverage. Individual perceptions of vaccination benefits had a significant influence on the IV coverage (p < 0.001). Although IV coverage did not reach a high rate, our study showed that personnel considered themselves sufficiently informed about IV. IV coverage remains low in the NH worker population in Ille-et-Vilaine and also possibly in France. Strong variations of IV coverage among NHs suggest that management and working environment play an important role. To overcome vaccine "hesitancy", specific communication tools may be required to be adapted to the various NH professionals to improve influenza prevention.

An Evaluation of Voluntary Varicella Vaccination Coverage in Zhejiang Province, East China.

PubMed

Hu, Yu; Chen, Yaping; Zhang, Bing; Li, Qian

2016-06-03

In 2014 a 2-doses varicella vaccine (VarV) schedule was recommended by the Zhejiang Provincial Center for Disease Control and Prevention. We aimed to assess the coverage of the 1st dose of VarV (VarV₁) and the 2nd dose of VarV (VarV₂) among children aged 2-6 years through the Zhejiang Provincial Immunization Information System (ZJIIS) and to explore the determinants associated with the VarV coverage. Children aged 2-6 years (born from 1 January 2009 to 31 December 2013) registered in ZJIIS were enrolled. Anonymized individual records of target children were extracted from the ZJIIS database on 1 January 2016, including their VarV and (measles-containing vaccine) MCV vaccination information. The VarV₁ and VarV₂ coverage rates were evaluated for each birth cohorts. The coverage of VarV also was estimated among strata defined by cities, gender and immigration status. We also evaluated the difference in coverage between VarV and MCV. A total of 3,028,222 children aged 2-6 years were enrolled. The coverage of VarV₁ ranged from 84.8% to 87.9% in the 2009-2013 birth cohorts, while the coverage of VarV₂ increased from 31.8% for the 2009 birth cohort to 48.7% for the 2011 birth cohort. Higher coverage rates for both VarV₁ and VarV₂ were observed among resident children in relevant birth cohorts. The coverage rates of VarV₁ and VarV₂ were lower than those for the 1st and 2nd dose of MCV, which were above 95%. The proportion of children who were vaccinated with VarV₁ at the recommended age increased from 34.6% for the 2009 birth cohort to 75.2% for the 2013 birth cohort, while the proportion of children who were vaccinated with VarV₂ at the recommended age increased from 19.7% for the 2009 birth cohort to 48.7% for the 2011 birth cohort. Our study showed a rapid increasing VarV₂ coverage of children, indicating a growing acceptance of the 2-doses VarV schedule among children's caregivers and physicians after the new recommendation released. We highlighted the necessity for a 2-doses VarV vaccination school-entry requirement to achieve the high coverage of >90% and to eliminate disparities in coverage among sub-populations. We also recommended continuous monitoring of the VarV coverage via ZJIIS over time.

Predictors to parental knowledge about childhood immunisation/EPI vaccines in two health districts in Cameroon prior to the introduction of 13-valent Pneumococcal Conjugate Vaccines (PCV-13)

PubMed Central

Libwea, John Njuma; Kobela, Marie; Ollgren, Jukka; Emah, Irene; Tchio, Robert; Nohynek, Hanna

2014-01-01

Introduction Pneumonia is vaccine-preventable, but the increasing death toll resulting from the disease in Sub-Saharan Africa is alarming. Several factors account for vaccine failing to reach every child, besides incomplete vaccine coverage. Most of these include the perceptions of parents/guardians and healthcare providers. Previous studies on the introduction of new vaccines have focused on experimental trials, coverage figures and vaccine efficacy in developed countries. Little is known on the factors which may hinder the implementation process despite the huge challenges this may encounter in developing countries. This study described the knowledge, attitude and practices (KAP) of parents/guardians on pneumonia and immunisations/EPI vaccines; identify predictive parental socio-economic/demographic characteristics that of good knowledge on pneumonia infections, routine EPI vaccines and the PCV-13. Finally, the study described health center personnel perceptions about immunisations. Methods The WHO's immunisation coverage cluster survey design was used, involving parents/guardians (n = 205) of children aged 0-59 months and health centre personnel (n = 13) directly concerned with vaccination activities between July-September 2010 in two health districts in Yaounde, Cameroon. Descriptive statistics and multivariate logistic models were used to analyse the parental/guardian data while the health personnel data was only analysed descriptively using SPSS version 17.0. Results Only 19% of the parents/guardians were aware of the availability of the PCV-13. Logistic modelling identified important associations between parental socio-economic/demographic factors and good knowledge on pneumonia disease burden and prevention. Conclusion According to parents/guardians a short and clear message on the dangers of pneumonia and the need for prevention provided to parents/guardians during sensitisation/out-reach campaigns and use of social network avenues would be primordial, if the PCV-13 is to reach every child. PMID:25396013

Increasing the demand for childhood vaccination in developing countries: a systematic review

PubMed Central

2009-01-01

Background Attempts to maintain or increase vaccination coverage almost all focus on supply side interventions: improving availability and delivery of vaccines. The effectiveness and cost-effectiveness of efforts to increase demand is uncertain. Methods We performed a systematic review of studies that provided quantitative estimates of the impact of demand side interventions on uptake of routine childhood vaccination. We retrieved studies published up to Sept 2008. Results The initial search retrieved 468 potentially eligible studies, including four systematic reviews and eight original studies of the impact of interventions to increase demand for vaccination. We identified only two randomised controlled trials. Interventions with an impact on vaccination uptake included knowledge translation (KT) (mass media, village resource rooms and community discussions) and non-KT initiatives (incentives, economic empowerment, household visits by extension workers). Most claimed to increase vaccine coverage by 20 to 30%. Estimates of the cost per vaccinated child varied considerably with several in the range of $10-20 per vaccinated child. Conclusion Most studies reviewed here represented a low level of evidence. Mass media campaigns may be effective, but the impact depends on access to media and may be costly if run at a local level. The persistence of positive effects has not been investigated. The economics of demand side interventions have not been adequately assessed, but available data suggest that some may be very cost-effective. PMID:19828063

Variations in influenza vaccination coverage among the high-risk population in Sweden in 2003/4 and 2004/5: a population survey

PubMed Central

Kroneman, Madelon W; van Essen, Gerrit A

2007-01-01

Background In Sweden, the vaccination campaign is the individual responsibility of the counties, which results in different arrangements. The aim of this study was to find out whether influenza vaccination coverage rates (VCRs) had increased between 2003/4 and 2004/5 among population at high risk and to find out the influence of personal preferences, demographic characteristics and health care system characteristics on VCRs. Methods An average sample of 2500 persons was interviewed each season (2003/4 and 2004/5). The respondents were asked whether they had had an influenza vaccination, whether they suffered from chronic conditions and the reasons of non-vaccination. For every county the relevant health care system characteristics were collected via a questionnaire sent to the medical officers of communicable diseases. Results No difference in VCR was found between the two seasons. Personal invitations strongly increased the chance of having had a vaccination. For the elderly, the number of different health care professionals in a region involved in administering vaccines decreased this chance. Conclusion Sweden remained below the WHO-recommendations for population at high risk due to disease. To meet the 2010 WHO-recommendation further action may be necessary to increase vaccine uptake. Increasing the number of personal invitations and restricting the number of different administrators responsible for vaccination may be effective in increasing VCRs among the elderly. PMID:17570837

Benefits of pharmacist-led flu vaccination services in community pharmacy.

PubMed

Kirkdale, C L; Nebout, G; Megerlin, F; Thornley, T

2017-01-01

Seasonal influenza is a major cause of excess winter deaths and increased hospital admissions. There is a high level of economic burden associated with the infection. Although vaccination targets have been set to tackle this international issue, many countries struggle to reach these coverage targets for their at-risk populations using traditional delivery methods. Traditional providers include family doctors and nurses; however, pharmacist-led influenza vaccination has become a more commonly utilised aid to support vaccination targets. Community pharmacies are convenient and widely accessible and evaluations consistently demonstrate that patients are satisfied with pharmacist-led vaccinations. Allowing community pharmacists to administer influenza vaccination as an alternative option for delivery helps to increase the coverage rate of vaccination. In addition, commissioning community pharmacists to provide this service has been shown to contribute to achieving targets for those at-risk. Pharmacist-led influenza vaccination services can create value for payors and reduce pressure on health systems. This review aims to demonstrate the success of pharmacy-led influenza vaccinations, and the impact it has had in driving up immunisation rates within other countries. Experiences of countries such as England, Portugal and the United States provide evidence to demonstrate the benefit to both the patient and the health system. Copyright © 2016 Académie Nationale de Pharmacie. Published by Elsevier Masson SAS. All rights reserved.

Assessing providers' vaccination behaviors during routine immunization in India.

PubMed

Cohen, Megan A; Gargano, Lisa M; Thacker, Naveen; Choudhury, Panna; Weiss, Paul S; Arora, Manisha; Orenstein, Walter A; Omer, Saad B; Hughes, James M

2015-08-01

Progress has been made toward improving routine immunization coverage in India, but universal coverage has not been achieved. Little is known about how providers' vaccination behaviors affect coverage rates. The purpose of this study was to identify provider behaviors that served as barriers to vaccination that could lead to missed opportunities to vaccinate. We conducted a study of health-care providers' vaccination behaviors during clinic visits for children <3 years of age. Information on provider behaviors was collected through parent report and direct observation. Compared with illness visits, parents were eight times more likely to report vaccination status was verified (p < 0.001) and three times more likely to report receiving counseling on immunization (p = 0.022) during vaccination visits. Training of all vaccination practitioners should focus on behaviors such as the necessity of verifying vaccination status regardless of visit type, stressing the importance of counseling parents on immunization and emphasizing what is a valid contraindication to vaccination. © The Author [2015]. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Cost-Effectiveness of Dengue Vaccination Programs in Brazil

PubMed Central

Shim, Eunha

2017-01-01

The first approved dengue vaccine, CYD-TDV, a chimeric, live-attenuated, tetravalent dengue virus vaccine, was recently licensed in 13 countries, including Brazil. In light of recent vaccine approval, we modeled the cost-effectiveness of potential vaccination policies mathematically based on data from recent vaccine efficacy trials that indicated that vaccine efficacy was lower in seronegative individuals than in seropositive individuals. In our analysis, we investigated several vaccination programs, including routine vaccination, with various vaccine coverage levels and those with and without large catch-up campaigns. As it is unclear whether the vaccine protects against infection or just against disease, our model incorporated both direct and indirect effects of vaccination. We found that in the presence of vaccine-induced indirect protection, the cost-effectiveness of dengue vaccination decreased with increasing vaccine coverage levels because the marginal returns of herd immunity decreases with vaccine coverage. All routine dengue vaccination programs that we considered were cost-effective, reducing dengue incidence significantly. Specifically, a routine dengue vaccination of 9-year-olds would be cost-effective when the cost of vaccination per individual is less than $262. Furthermore, the combination of routine vaccination and large catch-up campaigns resulted in a greater reduction of dengue burden (by up to 93%) than routine vaccination alone, making it a cost-effective intervention as long as the cost per course of vaccination is $255 or less. Our results show that dengue vaccination would be cost-effective in Brazil even with a relatively low vaccine efficacy in seronegative individuals. PMID:28500811

Estimating the clinical benefits of vaccinating boys and girls against HPV-related diseases in Europe

PubMed Central

2013-01-01

Background HPV is related to a number of cancer types, causing a considerable burden in both genders in Europe. Female vaccination programs can substantially reduce the incidence of HPV-related diseases in women and, to some extent, men through herd immunity. The objective was to estimate the incremental benefit of vaccinating boys and girls using the quadrivalent HPV vaccine in Europe versus girls-only vaccination. Incremental benefits in terms of reduction in the incidence of HPV 6, 11, 16 and 18-related diseases (including cervical, vaginal, vulvar, anal, penile, and head and neck carcinomas and genital warts) were assessed. Methods The analysis was performed using a model constructed in Microsoft®Excel, based on a previously-published dynamic transmission model of HPV vaccination and published European epidemiological data on incidence of HPV-related diseases. The incremental benefits of vaccinating 12-year old girls and boys versus girls-only vaccination was assessed (70% vaccine coverage were assumed for both). Sensitivity analyses around vaccine coverage and duration of protection were performed. Results Compared with screening alone, girls-only vaccination led to 84% reduction in HPV 16/18-related carcinomas in females and a 61% reduction in males. Vaccination of girls and boys led to a 90% reduction in HPV 16/18-related carcinomas in females and 86% reduction in males versus screening alone. Relative to a girls-only program, vaccination of girls and boys led to a reduction in female and male HPV-related carcinomas of 40% and 65%, respectively and a reduction in the incidence of HPV 6/11-related genital warts of 58% for females and 71% for males versus girls-only vaccination. Conclusions In Europe, the vaccination of 12-year old boys and girls against HPV 6, 11, 16 and 18 would be associated with substantial additional clinical benefits in terms of reduced incidence of HPV-related genital warts and carcinomas versus girls-only vaccination. The incremental benefits of adding boys vaccination are highly dependent on coverage in girls. Therefore, further analyses should be performed taking into account the country-specific situation. In addition to clinical benefits, substantial economic benefits are also anticipated and warrant further investigation as do the social and ethical implications of including boys in vaccination programs. PMID:23298365

Assessment of eight HPV vaccination programs implemented in lowest income countries.

PubMed

Ladner, Joël; Besson, Marie-Hélène; Hampshire, Rachel; Tapert, Lisa; Chirenje, Mike; Saba, Joseph

2012-05-23

Cervix cancer, preventable, continues to be the third most common cancer in women worldwide, especially in lowest income countries. Prophylactic HPV vaccination should help to reduce the morbidity and mortality associated with cervical cancer. The purpose of the study was to describe the results of and key concerns in eight HPV vaccination programs conducted in seven lowest income countries through the Gardasil Access Program (GAP). The GAP provides free HPV vaccine to organizations and institutions in lowest income countries. The HPV vaccination programs were entirely developed, implemented and managed by local institutions. Institutions submitted application forms with institution characteristics, target population, communication delivery strategies. After completion of the vaccination campaign (3 doses), institutions provided a final project report with data on doses administered and vaccination models. Two indicators were calculated, the program vaccination coverage and adherence. Qualitative data were also collected in the following areas: government and community involvement; communication, and sensitization; training and logistics resources, and challenges. A total of eight programs were implemented in seven countries. The eight programs initially targeted a total of 87,580 girls, of which 76,983 received the full 3-dose vaccine course, with mean program vaccination coverage of 87.8%; the mean adherence between the first and third doses of vaccine was 90.9%. Three programs used school-based delivery models, 2 used health facility-based models, and 3 used mixed models that included schools and health facilities. Models that included school-based vaccination were most effective at reaching girls aged 9-13 years. Mixed models comprising school and health facility-based vaccination had better overall performance compared with models using just one of the methods. Increased rates of program coverage and adherence were positively correlated with the number of vaccination sites. Qualitative key insights from the school models showed a high level of coordination and logistics to facilitate vaccination administration, a lower risk of girls being lost to follow-up and vaccinations conducted within the academic year limit the number of girls lost to follow-up. Mixed models that incorporate both schools and health facilities appear to be the most effective at delivering HPV vaccine. This study provides lessons for development of public health programs and policies as countries go forward in national decision-making for HPV vaccination.

Low uptake of influenza vaccine among university students: evaluating predictors beyond cost and safety concerns.

PubMed

Bednarczyk, Robert A; Chu, Samantha L; Sickler, Heather; Shaw, Jana; Nadeau, Jessica A; McNutt, Louise-Anne

2015-03-30

Annual influenza vaccine coverage for young adults (including college students) remains low, despite a 2011 US recommendation for annual immunization of all people 6 months and older. College students are at high risk for influenza morbidity given close living and social spaces and extended travel during semester breaks when influenza circulation typically increases. We evaluated influenza vaccine uptake following an on-campus vaccine campaign at a large, public New York State university. Consecutive students visiting the University Health Center were recruited for a self-administered, anonymous, written survey. Students were asked about recent influenza vaccination, barriers to influenza vaccination, and willingness to get vaccinated to protect other vulnerable individuals they may encounter. Frequencies and proportions were evaluated. Of 653 students approached, 600 completed surveys (92% response proportion); respondents were primarily female (61%) and non-Hispanic white (59%). Influenza vaccine coverage was low (28%). Compared to coverage among non-Hispanic white students (30%), coverage was similar among Hispanic (30%) and other race/ethnicity students (28%) and lowest among non-Hispanic black students (17%). Among the unvaccinated, the most commonly selected vaccination barriers were "Too lazy to get the vaccine" (32%) and "Don't need the vaccine because I'm healthy" (29%); 6% of unvaccinated students cited cost as a barrier. After being informed that influenza vaccination of young, healthy people can protect other vulnerable individuals (e.g., infants, elderly), 71% of unvaccinated students indicated this would increase their willingness to get vaccinated. Influenza vaccine uptake among college students is very low. While making vaccine easily obtained may increase vaccine uptake, college students need to be motivated to get vaccinated. Typically healthy students may not perceive a need for influenza vaccine. Education about vaccinating healthy individuals to prevent the spread of influenza to close contacts, such as vulnerable family members, may provide this motivation to get vaccinated. Copyright © 2015 Elsevier Ltd. All rights reserved.

Knowledge and awareness of HPV vaccine and acceptability to vaccinate in sub-Saharan Africa: a systematic review.

PubMed

Perlman, Stacey; Wamai, Richard G; Bain, Paul A; Welty, Thomas; Welty, Edith; Ogembo, Javier Gordon

2014-01-01

We assessed the knowledge and awareness of cervical cancer, HPV and HPV vaccine, and willingness and acceptability to vaccinate in sub-Saharan African (SSA) countries. We further identified countries that fulfill the two GAVI Alliance eligibility criteria to support nationwide HPV vaccination. We conducted a systematic review of peer-reviewed studies on the knowledge and awareness of cervical cancer, HPV and HPV vaccine, and willingness and acceptability to vaccinate. Trends in Diphtheria-tetanus-pertussis (DTP3) vaccine coverage in SSA countries from 1990-2011 were extracted from the World Health Organization database. The review revealed high levels of willingness and acceptability of HPV vaccine but low levels of knowledge and awareness of cervical cancer, HPV or HPV vaccine. We identified only six countries to have met the two GAVI Alliance requirements for supporting introduction of HPV vaccine: 1) the ability to deliver multi-dose vaccines for no less than 50% of the target vaccination cohort in an average size district, and 2) achieving over 70% coverage of DTP3 vaccine nationally. From 2008 through 2011 all SSA countries, with the exception of Mauritania and Nigeria, have reached or maintained DTP3 coverage at 70% or above. There is an urgent need for more education to inform the public about HPV, HPV vaccine, and cervical cancer, particularly to key demographics, (adolescents, parents and healthcare professionals), to leverage high levels of willingness and acceptability of HPV vaccine towards successful implementation of HPV vaccination programs. There is unpreparedness in most SSA countries to roll out national HPV vaccination as per the GAVI Alliance eligibility criteria for supporting introduction of the vaccine. In countries that have met 70% DTP3 coverage, pilot programs need to be rolled out to identify the best practice and strategies for delivering HPV vaccines to adolescents and also to qualify for GAVI Alliance support.

Opinions of employees of the National Institute of Public Health--National Institute of Hygiene in Warsaw on influenza vaccination.

PubMed

Supranowicz, Piotr; Brydak, Lidia Bernadeta

2013-01-01

Improving influenza vaccination coverage is an important action to prevent influenza epidemics and reduce the costs caused by the epidemics. Recognising the motives to be vaccinated or failure to vaccinate, especially among health care workers, is needed. The aim of presented papers is: 1) recognising the influenza vaccination coverage among NIPH-NIH employees, 2) examining the determinants of decision be vaccinated/not vaccinated, 3) estimating the effectiveness of influenza vaccination in relation to sickness absence due to respiratory infection. The study was carried out in NIPH-NIH by e-mail questionnaire. Out of 345 employees, 187 (54,2%) participated in the study. The questionnaire contained information on influenza vaccination and determinants that would potentially affect the decision to vaccinate. 18,7% of the participants was vaccinated in the previous epidemic season and the half of employees were vaccinated at least one time in the previous 10 seasons. Only every fourth family/occupational doctor encouraged their patients to vaccinate. The NIPH-NIH employees would be more likely to be vaccinated, if the employer has provided free vaccines. The estimation of influenza vaccination effectiveness in decreasing the sickness absence due to respiratory infection amounted 37%. Our findings confirmed that influenza vaccination contributes to noticeable decreasing of sickness absence. Providing free vaccination against influenza by employer could increase considerably the coverage.

User-Centered Design for Developing Interventions to Improve Clinician Recommendation of Human Papillomavirus Vaccination

PubMed Central

Henninger, Michelle L; McMullen, Carmit K; Firemark, Alison J; Naleway, Allison L; Henrikson, Nora B; Turcotte, Joseph A

2017-01-01

Introduction Human papillomavirus (HPV) is the most common sexually transmitted infection in the US and is associated with multiple types of cancer. Although effective HPV vaccines have been available since 2006, coverage rates in the US remain much lower than with other adolescent vaccinations. Prior research has shown that a strong recommendation from a clinician is a critical determinant in HPV vaccine uptake and coverage. However, few published studies to date have specifically addressed the issue of helping clinicians communicate more effectively with their patients about the HPV vaccine. Objective To develop one or more novel interventions for helping clinicians make strong and effective recommendations for HPV vaccination. Methods Using principles of user-centered design, we conducted qualitative interviews, interviews with persons from analogous industries, and a data synthesis workshop with multiple stakeholders. Results Five potential intervention strategies targeted at health care clinicians, youth, and their parents were developed. The two most popular choices to pursue were a values-based communication strategy and a puberty education workbook. Conclusion User-centered design is a useful strategy for developing potential interventions to improve the rate and success of clinicians recommending the HPV vaccine. Further research is needed to test the effectiveness and acceptability of these interventions in clinical settings. PMID:28898195

Dissolving polymer microneedle patches for influenza vaccination.

PubMed

Sullivan, Sean P; Koutsonanos, Dimitrios G; Del Pilar Martin, Maria; Lee, Jeong Woo; Zarnitsyn, Vladimir; Choi, Seong-O; Murthy, Niren; Compans, Richard W; Skountzou, Ioanna; Prausnitz, Mark R

2010-08-01

Influenza prophylaxis would benefit from a vaccination method enabling simplified logistics and improved immunogenicity without the dangers posed by hypodermic needles. Here we introduce dissolving microneedle patches for influenza vaccination using a simple patch-based system that targets delivery to skin's antigen-presenting cells. Microneedles were fabricated using a biocompatible polymer encapsulating inactivated influenza virus vaccine for insertion and dissolution in the skin within minutes. Microneedle vaccination generated robust antibody and cellular immune responses in mice that provided complete protection against lethal challenge. Compared to conventional intramuscular injection, microneedle vaccination resulted in more efficient lung virus clearance and enhanced cellular recall responses after challenge. These results suggest that dissolving microneedle patches can provide a new technology for simpler and safer vaccination with improved immunogenicity that could facilitate increased vaccination coverage.

Receipt of human papillomavirus vaccine among privately insured adult women in a U.S. Midwestern Health Maintenance Organization.

PubMed

Kharbanda, Elyse Olshen; Parker, Emily; Nordin, James D; Hedblom, Brita; Rolnick, Sharon J

2013-11-01

To describe human papillomavirus (HPV) vaccine coverage among adult privately insured women including variation in coverage by race/ethnicity. This cross-sectional, observational study included women 18-26 years of age with continuous enrollment in a U.S. Midwestern health insurance plan and at least one visit to a plan affiliated practice. Vaccination data came from insurance claims and the electronic medical record. Primary outcomes were: receipt of at least 1 HPV vaccine (HPV1) and completion of the 3-dose HPV vaccine series (HPV3). Coverage was described for the entire cohort and stratified by race/ethnicity. For a subset of women, automated data was compared to personal recall. As of June 2010, among 2546 privately insured women 18-26 years, 72.7% had received their first HPV vaccine and 57.9% completed the 3-dose series. Compared to white women, African American and Asian women had significantly lower coverage for HPV1 and HPV3. There was 94.5% (95% CI: 88.5-100%) agreement between personal recall and claims/EMR for receiving HPV1. In this cohort of privately insured women, a majority received HPV1 and more than half completed the 3-dose vaccine series. Marked disparities in receipt of HPV vaccine by race/ethnicity were observed. © 2013.

Measuring Adolescent Human Papillomavirus Vaccine Coverage: A Match of Sexually Transmitted Disease Clinic and Immunization Registry Data.

PubMed

Pathela, Preeti; Jamison, Kelly; Papadouka, Vikki; Kabir, Rezaul; Markowitz, Lauri E; Dunne, Eileen F; Schillinger, Julia A

2016-12-01

Human papillomavirus (HPV) vaccine is recommended for adolescents. By the end of 2013, 64% of female and 40% of male New York City residents aged 13-18 years had received ≥1 HPV vaccine dose. Adolescents attending sexually transmitted disease (STD) clinics are at high risk for HPV exposure and could benefit from vaccination. Our objective was to estimate HPV vaccination coverage for this population. We matched records of New York City's STD clinic patients aged 13-18 years during 2010-2013 with the Citywide Immunization Registry. We assessed HPV vaccine initiation (≥1 dose) and series completion (≥3 doses among those who initiated) as of clinic visit date and by patient demographics. We compared receipt of ≥1 dose for HPV, tetanus-diphtheria-acellular pertussis, and meningococcal conjugate vaccine. Eighty-two percent of clinic attendees (13,505/16,364) had records in the Citywide Immunization Registry. Receipt of ≥1 HPV dose increased during 2010-2013 (females: 57.6%-69.7%; males: 1.5%-36.3%). Among females, ≥1-dose coverage was lowest among whites (53.4%) and highest among Hispanics (73.3%); among males, ≥1-dose coverage was lowest among whites (6.9%) and highest among Asians (20.9%). Series completion averaged 57.7% (females) and 28.0% (males), with little variation by race/ethnicity or poverty level. Receipt of ≥1 dose was 59.7% for HPV, 82% for tetanus-diphtheria-acellular pertussis, and 76% for meningococcal conjugate vaccines. HPV vaccine initiation and completion were low among adolescent STD clinic patients; coverage was lower compared with other recommended vaccines. STD clinics may be good venues for delivering HPV vaccine, thereby enhancing efforts to improve HPV vaccination. Copyright © 2016 Society for Adolescent Health and Medicine. All rights reserved.

Adolescent vaccination: coverage achieved by ages 13-15 years, and vaccinations received as recommended during ages 11-12 years, National Health Interview Survey 1997-2003.

PubMed

McCauley, Mary Mason; Stokley, Shannon; Stevenson, John; Fishbein, Daniel B

2008-12-01

To present progress toward Healthy People 2010 vaccination objectives for adolescents aged 13-15 years, and to determine how much catch-up and routine vaccination was administered at the recommended ages of 11-12 years. Data from the 1997-2003 National Health Interview Survey were evaluated. In the first analysis, vaccination coverage levels for adolescents aged 13-15 years were determined for each survey year. Main outcome measures include the percent of adolescents who had received the three-dose hepatitis B vaccine (Hep B) series, the two-dose measles/mumps/rubella vaccine (MMR) series, the tetanus and diphtheria toxoids (Td) booster, and one dose of varicella vaccine. In the second analysis, data from all survey years were combined and vaccination dates were analyzed to determine the percentage of adolescents who were missing any vaccines at ages 11-12 and received them at that age. Data for varicella vaccine were sufficient only for the first analysis. Among the approximately 15%-20% of respondents who reported vaccination history from records in the home and who were reporting on a 13-15-year-old, coverage with three doses of Hep B increased significantly during 1997-2001, from 15.2% to 55.0%. Coverage with MMR and Td fluctuated, with no significant increase; highs were 76.7% for MMR in 2003 and 36.2% for Td in 2002. Examination of vaccination dates for all surveyed adolescents showed that among 11-12-year-olds who needed catch-up vaccine, 0.6%-31.3% were brought up to date for Hep B and 22.1%-31.8% were brought up to date for MMR. For Td, 2.6%-15.4% of 11-12-year-olds who had not previously received Td received the vaccine. Vaccination coverage among adolescents aged 13-15 years was below the Healthy People 2010 goals of 90%, but generally increased over the survey years. However, the suboptimal delivery of needed vaccines during ages 11 and 12 is concerning in light of recent vaccine recommendations targeted at this age. Continuing to focus on strategies to make adolescent preventive care, including vaccination, a new norm is essential.

Antecedent causes of a measles resurgence in the Democratic Republic of the Congo

PubMed Central

Scobie, Heather Melissa; Ilunga, Benoît Kebela; Mulumba, Audry; Shidi, Calixte; Coulibaly, Tiekoura; Obama, Ricardo; Tamfum, Jean-Jacques Muyembe; Simbu, Elisabeth Pukuta; Smit, Sheilagh Brigitte; Masresha, Balcha; Perry, Robert Tyrrell; Alleman, Mary Margaret; Kretsinger, Katrina; Goodson, James

2015-01-01

Introduction Despite accelerated measles control efforts, a massive measles resurgence occurred in the Democratic Republic of the Congo (DRC) starting in mid-2010, prompting an investigation into likely causes. Methods We conducted a descriptive epidemiological analysis using measles immunization and surveillance data to understand the causes of the measles resurgence and to develop recommendations for elimination efforts in DRC. Results During 2004-2012, performance indicator targets for case-based surveillance and routine measles vaccination were not met. Estimated coverage with the routine first dose of measles-containing vaccine (MCV1) increased from 57% to 73%. Phased supplementary immunization activities (SIAs) were conducted starting in 2002, in some cases with sub-optimal coverage (≤95%). In 2010, SIAs in five of 11 provinces were not implemented as planned, resulting in a prolonged interval between SIAs, and a missed birth cohort in one province. During July 1, 2010-December 30, 2012, high measles attack rates (>100 cases per 100,000 population) occurred in provinces that had estimated MCV1 coverage lower than the national estimate and did not implement planned 2010 SIAs. The majority of confirmed case-patients were aged <10 years (87%) and unvaccinated or with unknown vaccination status (75%). Surveillance detected two genotype B3 and one genotype B2 measles virus strains that were previously identified in the region. Conclusion The resurgence was likely caused by an accumulation of unvaccinated, measles-susceptible children due to low MCV1 coverage and suboptimal SIA implementation. To achieve the regional goal of measles elimination by 2020, efforts are needed in DRC to improve case-based surveillance and increase two-dose measles vaccination coverage through routine services and SIAs. PMID:26401224

Vaccinating Girls and Boys with Different Human Papillomavirus Vaccines: Can It Optimise Population-Level Effectiveness?

PubMed

Drolet, Mélanie; Boily, Marie-Claude; Van de Velde, Nicolas; Franco, Eduardo L; Brisson, Marc

2013-01-01

Decision-makers may consider vaccinating girls and boys with different HPV vaccines to benefit from their respective strengths; the quadrivalent (HPV4) prevents anogenital warts (AGW) whilst the bivalent (HPV2) may confer greater cross-protection. We compared, to a girls-only vaccination program with HPV4, the impact of vaccinating: 1) both genders with HPV4, and 2) boys with HPV4 and girls with HPV2. We used an individual-based transmission-dynamic model of heterosexual HPV infection and diseases. Our base-case scenario assumed lifelong efficacy of 100% against vaccine types, and 46,29,8,18,6% and 77,43,79,8,0% efficacy against HPV-31,-33,-45,-52,-58 for HPV4 and HPV2, respectively. Assuming 70% vaccination coverage and lifelong cross-protection, vaccinating boys has little additional benefit on AGW prevention, irrespective of the vaccine used for girls. Furthermore, using HPV4 for boys and HPV2 for girls produces greater incremental reductions in SCC incidence than using HPV4 for both genders (12 vs 7 percentage points). At 50% vaccination coverage, vaccinating boys produces incremental reductions in AGW of 17 percentage points if both genders are vaccinated with HPV4, but increases female incidence by 16 percentage points if girls are switched to HPV2 (heterosexual male incidence is incrementally reduced by 24 percentage points in both scenarios). Higher incremental reductions in SCC incidence are predicted when vaccinating boys with HPV4 and girls with HPV2 versus vaccinating both genders with HPV4 (16 vs 12 percentage points). Results are sensitive to vaccination coverage and the relative duration of protection of the vaccines. Vaccinating girls with HPV2 and boys with HPV4 can optimize SCC prevention if HPV2 has higher/longer cross-protection, but can increase AGW incidence if vaccination coverage is low among boys.

First Outbreak Response Using an Oral Cholera Vaccine in Africa: Vaccine Coverage, Acceptability and Surveillance of Adverse Events, Guinea, 2012

PubMed Central

Luquero, Francisco J.; Grout, Lise; Ciglenecki, Iza; Sakoba, Keita; Traore, Bala; Heile, Melat; Dialo, Alpha Amadou; Itama, Christian; Serafini, Micaela; Legros, Dominique; Grais, Rebecca F.

2013-01-01

Background Despite World Health Organization (WHO) prequalification of two safe and effective oral cholera vaccines (OCV), concerns about the acceptability, potential diversion of resources, cost and feasibility of implementing timely campaigns has discouraged their use. In 2012, the Ministry of Health of Guinea, with the support of Médecins Sans Frontières organized the first mass vaccination campaign using a two-dose OCV (Shanchol) as an additional control measure to respond to the on-going nationwide epidemic. Overall, 316,250 vaccines were delivered. Here, we present the results of vaccination coverage, acceptability and surveillance of adverse events. Methodology/Principal Findings We performed a cross-sectional cluster survey and implemented adverse event surveillance. The study population included individuals older than 12 months, eligible for vaccination, and residing in the areas targeted for vaccination (Forécariah and Boffa, Guinea). Data sources were household interviews with verification by vaccination card and notifications of adverse events from surveillance at vaccination posts and health centres. In total 5,248 people were included in the survey, 3,993 in Boffa and 1,255 in Forécariah. Overall, 89.4% [95%CI:86.4–91.8%] and 87.7% [95%CI:84.2–90.6%] were vaccinated during the first round and 79.8% [95%CI:75.6–83.4%] and 82.9% [95%CI:76.6–87.7%] during the second round in Boffa and Forécariah respectively. The two dose vaccine coverage (including card and oral reporting) was 75.8% [95%CI: 71.2–75.9%] in Boffa and 75.9% [95%CI: 69.8–80.9%] in Forécariah respectively. Vaccination coverage was higher in children. The main reason for non-vaccination was absence. No severe adverse events were notified. Conclusions/Significance The well-accepted mass vaccination campaign reached high coverage in a remote area with a mobile population. Although OCV should not be foreseen as the long-term solution for global cholera control, they should be integrated as an additional tool into the response. PMID:24147164

An approximation of herd effect due to vaccinating children against seasonal influenza – a potential solution to the incorporation of indirect effects into static models

PubMed Central

2013-01-01

Background Indirect herd effect from vaccination of children offers potential for improving the effectiveness of influenza prevention in the remaining unvaccinated population. Static models used in cost-effectiveness analyses cannot dynamically capture herd effects. The objective of this study was to develop a methodology to allow herd effect associated with vaccinating children against seasonal influenza to be incorporated into static models evaluating the cost-effectiveness of influenza vaccination. Methods Two previously published linear equations for approximation of herd effects in general were compared with the results of a structured literature review undertaken using PubMed searches to identify data on herd effects specific to influenza vaccination. A linear function was fitted to point estimates from the literature using the sum of squared residuals. Results The literature review identified 21 publications on 20 studies for inclusion. Six studies provided data on a mathematical relationship between effective vaccine coverage in subgroups and reduction of influenza infection in a larger unvaccinated population. These supported a linear relationship when effective vaccine coverage in a subgroup population was between 20% and 80%. Three studies evaluating herd effect at a community level, specifically induced by vaccinating children, provided point estimates for fitting linear equations. The fitted linear equation for herd protection in the target population for vaccination (children) was slightly less conservative than a previously published equation for herd effects in general. The fitted linear equation for herd protection in the non-target population was considerably less conservative than the previously published equation. Conclusions This method of approximating herd effect requires simple adjustments to the annual baseline risk of influenza in static models: (1) for the age group targeted by the childhood vaccination strategy (i.e. children); and (2) for other age groups not targeted (e.g. adults and/or elderly). Two approximations provide a linear relationship between effective coverage and reduction in the risk of infection. The first is a conservative approximation, recommended as a base-case for cost-effectiveness evaluations. The second, fitted to data extracted from a structured literature review, provides a less conservative estimate of herd effect, recommended for sensitivity analyses. PMID:23339290

Rotavirus vaccine coverage and factors associated with uptake using linked data: Ontario, Canada

PubMed Central

Chung, Hannah; Schwartz, Kevin L.; Guttmann, Astrid; Deeks, Shelley L.; Kwong, Jeffrey C.; Crowcroft, Natasha S.; Wing, Laura; Tu, Karen

2018-01-01

Background In August 2011, Ontario, Canada introduced a rotavirus immunization program using Rotarix™ vaccine. No assessments of rotavirus vaccine coverage have been previously conducted in Ontario. Methods We assessed vaccine coverage (series initiation and completion) and factors associated with uptake using the Electronic Medical Record Administrative data Linked Database (EMRALD), a collection of family physician electronic medical records (EMR) linked to health administrative data. Series initiation (1 dose) and series completion (2 doses) before and after the program’s introduction were calculated. To identify factors associated with series initiation and completion, adjusted odds ratios (aOR) and 95% confidence intervals (95%CI) were calculated using logistic regression. Results A total of 12,525 children were included. Series completion increased each year of the program (73%, 79% and 84%, respectively). Factors associated with series initiation included high continuity of care (aOR = 2.15; 95%CI, 1.61–2.87), maternal influenza vaccination (aOR = 1.55; 95%CI,1.24–1.93), maternal immmigration to Canada in the last five years (aOR = 1.47; 95% CI, 1.05–2.04), and having no siblings (aOR = 1.62; 95%CI,1.30–2.03). Relative to the first program year, infants were more likely to initiate the series in the second year (aOR = 1.71; 95% CI 1.39–2.10) and third year (aOR = 2.02; 95% CI 1.56–2.61) of the program. Infants receiving care from physicians with large practices were less likely to initiate the series (aOR 0.91; 95%CI, 0.88–0.94, per 100 patients rostered) and less likely to complete the series (aOR 0.94; 95%CI, 0.91–0.97, per 100 patients rostered). Additional associations were identified for series completion. Conclusions Family physician delivery achieved moderately high coverage in the program’s first three years. This assessment demonstrates the usefulness of EMR data for evaluating vaccine coverage. Important insights into factors associated with initiation or completion (i.e. high continuity of care, smaller roster sizes, rural practice location) suggest areas for research and potential program supports. PMID:29444167

An Agent-Based Model of School Closing in Under-Vacccinated Communities During Measles Outbreaks.

PubMed

Getz, Wayne M; Carlson, Colin; Dougherty, Eric; Porco Francis, Travis C; Salter, Richard

2016-04-01

The winter 2014-15 measles outbreak in the US represents a significant crisis in the emergence of a functionally extirpated pathogen. Conclusively linking this outbreak to decreases in the measles/mumps/rubella (MMR) vaccination rate (driven by anti-vaccine sentiment) is critical to motivating MMR vaccination. We used the NOVA modeling platform to build a stochastic, spatially-structured, individual-based SEIR model of outbreaks, under the assumption that R 0 ≈ 7 for measles. We show this implies that herd immunity requires vaccination coverage of greater than approximately 85%. We used a network structured version of our NOVA model that involved two communities, one at the relatively low coverage of 85% coverage and one at the higher coverage of 95%, both of which had 400-student schools embedded, as well as students occasionally visiting superspreading sites (e.g. high-density theme parks, cinemas, etc.). These two vaccination coverage levels are within the range of values occurring across California counties. Transmission rates at schools and superspreading sites were arbitrarily set to respectively 5 and 15 times background community rates. Simulations of our model demonstrate that a 'send unvaccinated students home' policy in low coverage counties is extremely effective at shutting down outbreaks of measles.

An Agent-Based Model of School Closing in Under-Vacccinated Communities During Measles Outbreaks

PubMed Central

Getz, Wayne M.; Carlson, Colin; Dougherty, Eric; Porco, Travis C.; Salter, Richard

2016-01-01

The winter 2014–15 measles outbreak in the US represents a significant crisis in the emergence of a functionally extirpated pathogen. Conclusively linking this outbreak to decreases in the measles/mumps/rubella (MMR) vaccination rate (driven by anti-vaccine sentiment) is critical to motivating MMR vaccination. We used the NOVA modeling platform to build a stochastic, spatially-structured, individual-based SEIR model of outbreaks, under the assumption that R0 ≈ 7 for measles. We show this implies that herd immunity requires vaccination coverage of greater than approximately 85%. We used a network structured version of our NOVA model that involved two communities, one at the relatively low coverage of 85% coverage and one at the higher coverage of 95%, both of which had 400-student schools embedded, as well as students occasionally visiting superspreading sites (e.g. high-density theme parks, cinemas, etc.). These two vaccination coverage levels are within the range of values occurring across California counties. Transmission rates at schools and superspreading sites were arbitrarily set to respectively 5 and 15 times background community rates. Simulations of our model demonstrate that a ‘send unvaccinated students home’ policy in low coverage counties is extremely effective at shutting down outbreaks of measles. PMID:27668297

Vaccination and all-cause child mortality from 1985 to 2011: global evidence from the Demographic and Health Surveys.

PubMed

McGovern, Mark E; Canning, David

2015-11-01

Based on models with calibrated parameters for infection, case fatality rates, and vaccine efficacy, basic childhood vaccinations have been estimated to be highly cost effective. We estimated the association of vaccination with mortality directly from survey data. Using 149 cross-sectional Demographic and Health Surveys, we determined the relationship between vaccination coverage and the probability of dying between birth and 5 years of age at the survey cluster level. Our data included approximately 1 million children in 68,490 clusters from 62 countries. We considered the childhood measles, bacillus Calmette-Guérin, diphtheria-pertussis-tetanus, polio, and maternal tetanus vaccinations. Using modified Poisson regression to estimate the relative risk of child mortality in each cluster, we also adjusted for selection bias that resulted from the vaccination status of dead children not being reported. Childhood vaccination, and in particular measles and tetanus vaccination, is associated with substantial reductions in childhood mortality. We estimated that children in clusters with complete vaccination coverage have a relative risk of mortality that is 0.73 (95% confidence interval: 0.68, 0.77) times that of children in a cluster with no vaccinations. Although widely used, basic vaccines still have coverage rates well below 100% in many countries, and our results emphasize the effectiveness of increasing coverage rates in order to reduce child mortality. © The Author 2015. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Factors Associated with Influenza Vaccination of Hospitalized Elderly Patients in Spain.

PubMed

Domínguez, Àngela; Soldevila, Núria; Toledo, Diana; Godoy, Pere; Castilla, Jesús; Force, Lluís; Morales, María; Mayoral, José María; Egurrola, Mikel; Tamames, Sonia; Martín, Vicente; Astray, Jenaro

2016-01-01

Vaccination of the elderly is an important factor in limiting the impact of influenza in the community. The aim of this study was to investigate the factors associated with influenza vaccination coverage in hospitalized patients aged ≥ 65 years hospitalized due to causes unrelated to influenza in Spain. We carried out a cross-sectional study. Bivariate analysis was performed comparing vaccinated and unvaccinated patients, taking in to account sociodemographic variables and medical risk conditions. Multivariate analysis was performed using multilevel regression models. We included 1038 patients: 602 (58%) had received the influenza vaccine in the 2013-14 season. Three or more general practitioner visits (OR = 1.61; 95% CI 1.19-2.18); influenza vaccination in any of the 3 previous seasons (OR = 13.57; 95% CI 9.45-19.48); and 23-valent pneumococcal polysaccharide vaccination (OR = 1.97; 95% CI 1.38-2.80) were associated with receiving the influenza vaccine. Vaccination coverage of hospitalized elderly people is low in Spain and some predisposing characteristics influence vaccination coverage. Healthcare workers should take these characteristics into account and be encouraged to proactively propose influenza vaccination to all patients aged ≥ 65 years.

Assessment of immunization registry databases as supplemental sources of data to improve ascertainment of vaccination coverage estimates in the national immunization survey.

PubMed

Khare, Meena; Piccinino, Linda; Barker, Lawrence E; Linkins, Robert W

2006-08-01

To evaluate the use of immunization registry data to supplement missing or incomplete vaccination data reported by immunization providers (referred to as "providers" hereafter) in the National Immunization Survey. Cross-sectional, random-digit-dialing, telephone survey to measure vaccination coverage among children aged 19 to 35 months in the United States. Four sites with mature (with >67% of provider participation in the area) immunization registries. Of the 639 children with complete household interviews, interviewers had consent from the respondents for 569 (89.0%) children to contact their providers and for 556 (87.0%) children to contact both providers and registries. Percentages of children up-to-date for vaccines based on data from providers, registries, and both sources combined. According to provider-reported data, weighted estimates of coverage for the recommended childhood vaccine series 4:3:1:3 at the 4 sites were 65.6%, 78.8%, 81.6%, and 77.0%. According to registry data, these coverage rates were consistently lower: 31.7% (P<.05), 65.4%, 71.9%, and 61.8%, respectively. When all unique vaccine doses were combined from both sources, the pooled 4:3:1:3 coverage rates increased to 72.0%, 92.0%, 88.7%, and 80.2%, respectively. The quality and completeness of vaccination histories from the registries were inconsistent and varied by sites. Vaccination coverage estimates were the lowest when only registry-reported data were used and were the highest when provider- and registry-reported histories were combined. Although registries enrolled and matched more children, vaccination histories were missing, incomplete, and inconsistent. The quality and completeness of the registry data must be improved and must be comparable across all states before further consideration may be given to supplement or replace the provider-reported National Immunization Survey data.

Evaluation of potentially achievable vaccination coverage of the second dose of measles containing vaccine with simultaneous administration and risk factors for missed opportunities among children in Zhejiang province, east China.

PubMed

Hu, Yu; Chen, Yaping; Wang, Ying; Liang, Hui

2018-04-03

This study aimed to evaluate the potential achievable coverage of the second dose of measles containing vaccine (MCV2) when the protocol of simultaneous administration of childhood vaccines was fully implemented. Risk factors for missed opportunity (MO) for simultaneous administration of MCV2 were also investigated. Children born from 1 January 2005 to 31 December 2014 and registered in Zhejiang provincial immunization information system were enrolled in this study. The MO of simultaneous administration of MCV2, the actual age-appropriate coverage (AAC) of MCV2 and the potentially achievable coverage (PAC) of MCV2 were evaluated and compared across different birth cohorts, by different socio-demographic variables. For the 2014 birth cohort, logistic regression model was used to detect the risk factors of MOs, from both socio-demographic and vaccination service providing aspects. Compared to the AAC, the PAC of MCV2 increased significantly from 2005 birth cohort to 2014 birth cohort (p<0.001), with a median of 12.7 percentage points. Higher birth order of children, resident children, higher maternal education background, higher socio-economic development level of resident areas, less frequent vaccination service, and shorter vaccination service time were significant risk factors of MO for simultaneous administration of MCV2, with all p-value < 0.05. The findings in this study suggest that fully utilization of all opportunities for simultaneous administration of all age-eligible vaccine doses at the same vaccination visit is critical for achieving the coverage target of 95% for MCV2. Future interventions focusing on the group with risk factors observed could substantially eliminate MOs for simultaneous administration of MCV2, further to improve the coverage of fully immunization of MCV, and finally achieve the goal of eliminating measles.

Census and vaccination coverage of owned dog populations in four resource-limited rural communities, Mpumalanga province, South Africa.

PubMed

Conan, Anne; Geerdes, Joy A C; Akerele, Oluyemisi A; Reininghaus, Bjorn; Simpson, Gregory J G; Knobel, Darryn

2017-09-22

Dogs (Canis familiaris) are often free-roaming in sub-Saharan African countries. Rabies virus circulates in many of these populations and presents a public health issue. Mass vaccination of dog populations is the recommended method to decrease the number of dog and human rabies cases. We describe and compare four populations of dogs and their vaccination coverage in four different villages (Hluvukani, Athol, Utah and Dixie) in Bushbuckridge Municipality, Mpumalanga province, South Africa. Cross-sectional surveys were conducted in the villages of Athol, Utah and Dixie, while data from a Health and Demographic Surveillance System were used to describe the dog population in Hluvukani village. All households of the villages were visited to obtain information on the number, sex, age and rabies vaccination status of dogs. From May to October 2013, 2969 households were visited in the four villages and 942 owned dogs were reported. The populations were all young and skewed towards males. No differences were observed in the sex and age distributions (puppies 0-3 months excluded) among the villages. Athol had a higher proportion of dog-owning households than Hluvukani and Utah. Vaccination coverages were all above the 20% - 40% threshold required for herd immunity to rabies (38% in Hluvukani, 51% in Athol, 65% in Dixie and 74% in Utah). For the preparation of vaccination campaigns, we recommend the use of the relatively stable dog:human ratio (between 1:12 and 1:16) to estimate the number of dogs per village in Bushbuckridge Municipality.

Vaccination coverage survey in Dhaka District.

PubMed

Khan, M N A; Rahman, M L; Awal Miah, A; Islam, M S; Musa, S A J M; Tofail, F

2005-08-01

A survey was conducted in Dhaka District to measure the level of routine immunization coverage of children (12-23 months), to assess the tetanus toxoid (TT) immunization coverage among mothers of children (12-23 month), to evaluate EPI program continuity (dropout rates) and quality (percent of Invalid doses, vaccination card availability etc.) For this purpose, a thirty cluster cross-sectional survey was conducted in October 2002 to assess the immunization coverage in Dhaka. In this survey 30 clusters were randomly selected from a list of villages in 63 Unions of Dhaka following probability proportion to size (PPS) sampling procedure. A total of 210 children was studied using pre-tested structured questionnaire. Descriptive statistics was employed using software SPSS package for data analysis. The study showed that the routine immunization coverage in Dhaka among children by 12 months of age by card + history was 97% for BCG, 97% for Diphtheria, Pertussis Tetanus (DPT 1) and Oral Polio Vaccine (OPV 1), 75% for DPT3 and OPV3 and 67% for measles. Sixty six percent of all children surveyed had received valid doses of all vaccines by 12 months (fully immunized child). Programme access as measured by crude DPT1 coverage was better in Keranigonj (97%). Vaccination cards retention rate for children was 84%. Invalid DPT (1,2 or 3) doses were given to 25% of vaccinated children; 18% of measles doses were invalid. Surprisingly, major cause for invalid doses were not due to early immunizations or due to card lost but for giving tick in the card, instead of writing a valid date. DPT1 and DPT3 and DPT1- Measles drop out rates were 5% and 13% respectively. Major reason parents gave for never vaccinating their children (zero dose children) was (43%), major reasons for incomplete vaccination was lack of knowledge regarding subsequent doses (46%). TT surveys were also conducted for mothers of the children surveyed for vaccination coverage (mothers between 15-49 year old). Valid TT 1-5 coverage by card+ history was 97%, 55%, 44%, 24% and 11%, respectively. Card retention rate for TT was 67%. The findings of this study revealed that access to child and TT immunizations were good. But high dropouts and invalid doses reduced these percentages of fully immunized child to 66%. Programmatic strategy must be undertaken to reduce the existing high dropout rate in both child and TT immunizations.

Human Papillomavirus vaccination in general practice in France, three years after the implementation of a targeted vaccine recommendation based on age and sexual history.

PubMed

Thierry, Pascale; Lasserre, Andrea; Rossignol, Louise; Kernéis, Solen; Blaizeau, Fanette; Stheneur, Chantal; Blanchon, Thierry; Levy-Bruhl, Daniel; Hanslik, Thomas

2016-01-01

In France, vaccination against human papilloma virus (HPV) was recommended in 2007 for all 14-year-old girls as well as "catch-up" vaccination for girls between 15-23 y of age either before or within one year of becoming sexually active. We evaluated the vaccine coverage according to the eligibility for vaccination in a sample of young girls aged 14 to 23 years, who were seen in general practices. A survey was proposed to 706 general practitioners (GPs) and carried out from July to September 2010. GPs, also called "family doctor," are physicians whose practice is not restricted to a specific field of medicine but instead covers a variety of medical problems in patients of all ages. Each participating GP included, retrospectively, the last female patient aged 14-17 y and the last female patient aged 18-23 y whom he had seen. A questionnaire collected information regarding the GP and the patients' characteristics. The vaccine coverage was determined according to the eligibility for vaccination, i.e. the coverage among younger women (14-17) and among those sexually active in the second age range (18-23). Sexual activity status was assessed by GP, according to information stated in the medical record. The 363 participating physicians (response rate 51.4%) included 712 patients (357 in the 14- to 17-year-old group and 355 in the 15- to 23-year-old group) in their responses. The rate of the vaccination coverage in the 14- to 17-year-old group was 55%. Among the girls in the 18- to 23-year-old group, 126 were eligible, and their vaccination coverage rate was 82%. The evaluation of the eligibility by the GPs was incorrect in 36% of the cases. Of the 712 patients, 6% of the girls had been vaccinated without a need for the vaccination, and 26% of the girls had not been vaccinated, although they needed to be vaccinated. Regarding the vaccine uptake, vaccination at the age of 14 was not as effective as vaccinating the older population for which vaccination was indicated as a catch-up program, based on sexual history. However, in more than one-third of the older population, difficulties remained regarding the determination of eligibility, according to the sexual history of the patient.

Implementation research: reactive mass vaccination with single-dose oral cholera vaccine, Zambia

PubMed Central

Zulu, Gideon; Voute, Caroline; Ferreras, Eva; Muleya, Clara Mbwili; Malama, Kennedy; Pezzoli, Lorenzo; Mufunda, Jacob; Robert, Hugues; Uzzeni, Florent; Luquero, Francisco J; Chizema, Elizabeth; Ciglenecki, Iza

2018-01-01

Abstract Objective To describe the implementation and feasibility of an innovative mass vaccination strategy – based on single-dose oral cholera vaccine – to curb a cholera epidemic in a large urban setting. Method In April 2016, in the early stages of a cholera outbreak in Lusaka, Zambia, the health ministry collaborated with Médecins Sans Frontières and the World Health Organization in organizing a mass vaccination campaign, based on single-dose oral cholera vaccine. Over a period of 17 days, partners mobilized 1700 health ministry staff and community volunteers for community sensitization, social mobilization and vaccination activities in 10 townships. On each day, doses of vaccine were delivered to vaccination sites and administrative coverage was estimated. Findings Overall, vaccination teams administered 424 100 doses of vaccine to an estimated target population of 578 043, resulting in an estimated administrative coverage of 73.4%. After the campaign, few cholera cases were reported and there was no evidence of the disease spreading within the vaccinated areas. The total cost of the campaign – 2.31 United States dollars (US$) per dose – included the relatively low cost of local delivery – US$ 0.41 per dose. Conclusion We found that an early and large-scale targeted reactive campaign using a single-dose oral vaccine, organized in response to a cholera epidemic within a large city, to be feasible and appeared effective. While cholera vaccines remain in short supply, the maximization of the number of vaccines in response to a cholera epidemic, by the use of just one dose per member of an at-risk community, should be considered. PMID:29403111

Support for immunization registries among parents of vaccinated and unvaccinated school-aged children: a case control study

PubMed Central

Linkins, Robert W; Salmon, Daniel A; Omer, Saad B; Pan, William KY; Stokley, Shannon; Halsey, Neal A

2006-01-01

Background Immunizations have reduced childhood vaccine preventable disease incidence by 98–100%. Continued vaccine preventable disease control depends on high immunization coverage. Immunization registries help ensure high coverage by recording childhood immunizations administered, generating reminders when immunizations are due, calculating immunization coverage and identifying pockets needing immunization services, and improving vaccine safety by reducing over-immunization and providing data for post-licensure vaccine safety studies. Despite substantial resources directed towards registry development in the U.S., only 48% of children were enrolled in a registry in 2004. Parental attitudes likely impact child participation. Consequently, the purpose of this study was to assess the attitudes of parents of vaccinated and unvaccinated school-aged children regarding: support for immunization registries; laws authorizing registries and mandating provider reporting; opt-in versus opt-out registry participation; and financial worth and responsibility of registry development and implementation. Methods A case control study of parents of 815 children exempt from school vaccination requirements and 1630 fully vaccinated children was conducted. Children were recruited from 112 elementary schools in Colorado, Massachusetts, Missouri, and Washington. Surveys administered to the parents, asked about views on registries and perceived utility and safety of vaccines. Parental views were summarized and logistic regression models compared differences between parents of exempt and vaccinated children. Results Surveys were completed by 56.1% of respondents. Fewer than 10% of parents were aware of immunization registries in their communities. Among parents aware of registries, exempt children were more likely to be enrolled (65.0%) than vaccinated children (26.5%) (p value = 0.01). A substantial proportion of parents of exempt children support immunization registries, particularly if registries offer choice for participation. Few parents of vaccinated (6.8%) and exempt children (6.7%) were aware of laws authorizing immunization registries. Support for laws authorizing registries and requiring health care providers to report to registries was more common among parents of vaccinated than exempt children. Most parents believed that the government, vaccine companies or insurance companies should pay for registries. Conclusion Parental support for registries was relatively high. Parental support for immunization registries may increase with greater parental awareness of the risks of vaccine preventable diseases and utility of vaccination. PMID:16995946

[Rubella seroprevalence in 234 military young women aged between 19 and 31 years].

PubMed

Senèze, Catherine; Haus-Cheymol, Rachel; Hanslik, Thomas

2008-12-01

The main objectives of this study were to estimate, among young French women joining the french army, 1) their protective immunity against rubella, 2) the origin of this immunity (immunization or infection), 3) the rubella vaccine coverage and 4) the knowledge of these subjects on the disease and its methods of prevention. The study was conducted between December 1(st) 2006 and April 30(th) 2007 among 234 military women born 1976 to 1987. The results of rubella serology were obtained either in the medical files or after prescription of a serology. The dates of vaccination were collected on the military medical files and on the personal health records. A questionnaire was used to estimate the knowledge of these women on rubella. 234 women were included in our study. Results of serology were available for 224 of them. The serologic susceptibility to rubella virus was 6.7%. The mean age at the time of the serological investigation was 21.9 years. The vaccinal history was able to be collected for 45% of the immune women and 7 of the 15 non-immune women. Among the immune women, 74% had an antecedent of vaccination against rubella. The rate of rubella vaccine coverage was estimated at 70.5%. The proportion of the non-vaccinated immune women decreased during time, for the benefit of the vaccinated immune women. The knowledge on rubella disease did not differ according to the maternal status of the women. Near a quarter of them ignored the disastrous consequences for he foetus. This study shows a high seroprevalence of about 93% while the rubella vaccine coverage is estimated at 70.5%, letting suppose the persistence of the wild virus. The prevention campaigns and the efforts begun to vaccine all the non-immune women of childbearing age must be pursued.

Challenges in Cost-Effectiveness Analysis Modelling of HPV Vaccines in Low- and Middle-Income Countries: A Systematic Review and Practice Recommendations.

PubMed

Ekwunife, Obinna I; O'Mahony, James F; Gerber Grote, Andreas; Mosch, Christoph; Paeck, Tatjana; Lhachimi, Stefan K

2017-01-01

Low- and middle-income countries (LMICs) face a number of challenges in implementing cervical cancer prevention programmes that do not apply in high-income countries. This review assessed how context-specific challenges of implementing cervical cancer prevention strategies in LMICs were accounted for in existing cost-effectiveness analysis (CEA) models of human papillomavirus (HPV) vaccination. The databases of MEDLINE, EMBASE, NHS Economic Evaluation Database, EconLit, Web of Science, and the Center for the Evaluation of Value and Risk in Health (CEA) Registry were searched for studies published from 2006 to 2015. A descriptive, narrative, and interpretative synthesis of data was undertaken. Of the 33 studies included in the review, the majority acknowledged cost per vaccinated girl (CVG) (26 studies) and vaccine coverage rate (21 studies) as particular challenges for LMICs, while nine studies identified screening coverage rate as a challenge. Most of the studies estimated CVG as a composite of different cost items. However, the basis for the items within this composite cost was unclear. The majority used an assumption rather than an observed rate to represent screening and vaccination coverage rates. CVG, vaccine coverage and screening coverage were shown by some studies through sensitivity analyses to reverse the conclusions regarding cost-effectiveness, thereby significantly affecting policy recommendations. While many studies recognized aspects of the particular challenges of HPV vaccination in LMICs, greater efforts need to be made in adapting models to account for these challenges. These include adapting costings of HPV vaccine delivery from other countries, learning from the outcomes of cervical cancer screening programmes in the same geographical region, and taking into account the country's previous experience with other vaccination programmes.

Measles transmission following the tsunami in a population with a high one-dose vaccination coverage, Tamil Nadu, India 2004–2005

PubMed Central

Mohan, Arumugam; Murhekar, Manoj V; Wairgkar, Niteen S; Hutin, Yvan J; Gupte, Mohan D

2006-01-01

Background On 26 December 2004, a tsunami struck the coast of the state of Tamil Nadu, India, where one-dose measles coverage exceeded 95%. On 29 December, supplemental measles immunization activities targeted children 6 to 60 months of age in affected villages. On 30 December, Cuddalore, a tsunami-affected district in Tamil Nadu reported a cluster of measles cases. We investigated this cluster to estimate the magnitude of the problem and to propose recommendations for control. Methods We received notification of WHO-defined measles cases through stimulated passive surveillance. We collected information regarding date of onset, age, sex, vaccination status and residence. We collected samples for IgM antibodies and genotype studies. We modeled the accumulation of susceptible individuals over the time on the basis of vaccination coverage, vaccine efficacy and birth rate. Results We identified 101 measles cases and detected IgM antibodies against measles virus in eight of 11 sera. Cases were reported from tsunami-affected (n = 71) and unaffected villages (n = 30) with attack rates of 1.3 and 1.7 per 1000, respectively. 42% of cases in tsunami-affected villages had an onset date within 14 days of the tsunami. The median ages of case-patients in tsunami-affected and un-affected areas were 54 months and 60 months respectively (p = 0.471). 36% of cases from tsunami-affected areas were above 60 months of age. Phylogenetic analyses indicated that the sequences of virus belonged to genotype D8 that circulated in Tamil Nadu. Conclusion Measles virus circulated in Cuddalore district following the tsunami, although there was no association between the two events. Transmission despite high one-dose vaccination coverage pointed to the limitations of this vaccination strategy. A second opportunity for measles immunization may help reducing measles mortality and morbidity in such areas. Children from 6 month to 14 years of age must be targeted for supplemental immunization during complex emergencies. PMID:16984629

Maiden immunization coverage survey in the republic of South Sudan: a cross-sectional study providing baselines for future performance measurement.

PubMed

Mbabazi, William; Lako, Anthony K; Ngemera, Daniel; Laku, Richard; Yehia, Mostafah; Nshakira, Nathan

2013-01-01

Since the comprehensive peace agreement was signed in 2005, institutionalization of immunization services in South Sudan remained a priority. Routine administrative reporting systems were established and showed that national coverage rates for DTP-3 rose from 20% in 2002 to 80% in 2011. This survey was conducted as part of an overall review of progress in implementation of the first EPI Multi-Year Plan for South Sudan 2007-2011. This report provides maiden community coverage estimates for immunization. A cross sectional community survey was conducted between January and May 2012. Ten cluster surveys were conducted to generate state-specific coverage estimates. The WHO 30x7 cluster sampling method was employed. Data was collected using pre-tested, interviewer guided, structured questionnaires through house to house visits. The fully immunized children were 7.3%. Coverage for specific antigens were; BCG (28.3%), DTP-1(25.9%), DTP-3 (22.0%), Measles (16.8%). The drop-out rate between the first and third doses of DTP was 21.3%. Immunization coverage estimates based on card and history were higher, at 45.7% for DTP-3, 45.8% for MCV and 32.2% for full immunization. Majority of immunizations (80.8%) were received at health facilities compared to community service points (19.2%). The major reason for missed immunizations was inadequate information (41.1%). The proportion of card-verified, fully vaccinated among children aged 12-23 months is very low at 7.3%. Future efforts to improve vaccination quality and coverage should prioritize training of vaccinators and program communication to levels equivalent or higher than investments in EPI cold chain systems since 2007.

Inspecting the Mechanism: A Longitudinal Analysis of Socioeconomic Status Differences in Perceived Influenza Risks, Vaccination Intentions and Vaccination Behaviors during the 2009-2010 Influenza Pandemic

PubMed Central

Maurer, Jürgen

2015-01-01

Background Influenza vaccination is strongly associated with socioeconomic status, but there is only limited evidence on the respective roles of socioeconomic differences in vaccination intentions vs. corresponding differences in follow through on initial vaccination plans for subsequent socioeconomic differences in vaccine uptake. Methods Nonparametric mean smoothing, linear regression and Probit models were used to analyze longitudinal survey data on perceived influenza risks, behavioral vaccination intentions and vaccination behavior of adults during the 2009-10 influenza A/H1N1 (“Swine Flu”) pandemic in the United States. Perceived influenza risks and behavioral vaccination intentions were elicited prior to the availability of H1N1 vaccine using a probability scale question format. H1N1 vaccine uptake was assessed at the end of the pandemic. Results Education, income and health insurance coverage displayed positive associations with behavioral intentions to get vaccinated for pandemic influenza while employment was negatively associated with stated H1N1 vaccination intentions. Education and health insurance coverage also displayed significant positive associations with pandemic vaccine uptake. Moreover, behavioral vaccination intentions showed a strong and statistically significant positive partial association with later H1N1 vaccination. Incorporating vaccination intentions in a statistical model for H1N1 vaccine uptake further highlighted higher levels of follow through on initial vaccination plans among persons with higher education levels and health insurance. Limitations Sampling bias, misreporting in self-reported data, and limited generalizability to non-pandemic influenza are potential limitations of the analysis. Conclusions Closing the socioeconomic gap in influenza vaccination requires multi-pronged strategies that not only increase vaccination intentions by improving knowledge, attitudes and beliefs but also facilitate follow through on initial vaccination plans by improving behavioral control and access to vaccination for individuals with low education, employed persons and the uninsured. PMID:26416814

Ethnicity and immunization coverage among schools in Israel.

PubMed

Yitshak-Sade, Maayan; Davidovitch, Nadav; Novack, Lena; Grotto, Itamar

2016-10-01

Recent years have seen a global trend of declining immunization rates of recommended vaccines that is more pronounced among school-age children. Ethnic disparities in child immunization rates have been reported in several countries. We investigated an effect of ethnicity on the vaccination rates of immunizations routinely administered within schools in Israel. Data were collected from the Ministry of Health database regarding immunization coverage for all registered Israeli schools (3736) in the years 2009-2011. Negative binomial regression was used to assess the association between school ethnicity and immunization coverage while controlling for school characteristics. The lowest immunization coverage was found in Bedouin schools (median values of 75.1%, 81.5% and 0% for the first, second and eighth grades, respectively) in 2011. During this year, vaccination coverage in the first and second grades in Jewish schools was 1.51 and 1.35 times higher, respectively, compared to Bedouin schools. In the years 2009 and 2010, no significant increase in risk for lower vaccination rate was observed in Bedouin schools, and children in Arab and Druze schools were more likely to have been vaccinated. The lower vaccination refusal rate found in Bedouin schools supports the hypothesis that difficulties related to accessibility constitute the main problem rather than noncompliance with the recommended vaccination protocol for school-age children, featuring higher socio-economic status groups. Our study emphasizes the importance of identifying, beyond the national-level data, subpopulation groups at risk for non-vaccination. This knowledge is essential to administrative-level policy-makers for the allocation of resources and the planning of intervention programs.

Coverage of recommended vaccinations in subjects with diabetes mellitus and ischemic heart disease: results for women and men.

PubMed

Dorner, Thomas Ernst; Ràsky, Eva; Stein, Katharina Viktoria; Stronegger, Willibald Julius; Kautzky-Willer, Alexandra; Rieder, Anita

2011-03-01

Vaccination is an important public health strategy to prevent adverse health outcomes in the general population and in subjects with chronic diseases. It was the aim of this study to compare data on coverage of recommended vaccinations in men and women with diabetes mellitus and after myocardial infarction (MI) and to analyse trends in three different interview surveys: 1991, 1999 and 2006-07. The data show a rise in influenza vaccination coverage rate in men and women in the general population and in high-risk groups. However, coverage rates in all analysed groups were still strikingly low. Although in soft reported earlier surveys women were vaccinated more often than men, there was a reverse trend observed in the most recent survey. In the survey of 2006-07, men with diabetes or after MI had a higher chance of being vaccinated against influenza when compared to men without these diseases (age adjusted OR: 1.61; 95% CI: 1.29-1.99 and 1.61; 95% CI: 1.21-2.15, respectively). This was, however, not the case in women (OR: 1.10; 95% CI: 0.89-1.35 and 0.87; 95% CI: 0.58-1.33, respectively). Neither men nor women with diabetes mellitus or MI had a significantly higher chance of having pneumococcal vaccination when compared to subjects without these diseases. The observed sex-specific differences demand more research regarding the underlying causes. Strategies to reach higher vaccination coverage in men and women are needed.

Can increasing adult vaccination rates reduce lost time and increase productivity?

PubMed

Rittle, Chad

2014-12-01

This article addresses limited vaccination coverage by providing an overview of the epidemiology of influenza, pertussis, and pneumonia, and the impact these diseases have on work attendance for the worker, the worker's family, and employer profit. Studies focused on the cost of vaccination programs, lost work time, lost employee productivity and acute disease treatment are discussed, as well as strategies for increasing vaccination coverage to reduce overall health care costs for employers. Communicating the benefits of universal vaccination for employees and their families and combating vaccine misinformation among employees are outlined. Copyright 2014, SLACK Incorporated.

Risk factors for delay in age-appropriate vaccinations among Gambian children.

PubMed

Odutola, Aderonke; Afolabi, Muhammed O; Ogundare, Ezra O; Lowe-Jallow, Yamu Ndow; Worwui, Archibald; Okebe, Joseph; Ota, Martin O

2015-08-28

Vaccination has been shown to reduce mortality and morbidity due to vaccine-preventable diseases. However, these diseases are still responsible for majority of childhood deaths worldwide especially in the developing countries. This may be due to low vaccine coverage or delay in receipt of age-appropriate vaccines. We studied the timeliness of routine vaccinations among children aged 12-59 months attending infant welfare clinics in semi-urban areas of The Gambia, a country with high vaccine coverage. A cross-sectional survey was conducted in four health centres in the Western Region of the Gambia. Vaccination dates were obtained from health cards and timeliness assessed based on the recommended age ranges for BCG (birth-8 weeks), Diphtheria-Pertussis-Tetanus (6 weeks-4 months; 10 weeks-5 months; 14 weeks-6 months) and measles vaccines (38 weeks-12 months). Risk factors for delay in age-appropriate vaccinations were determined using logistic regression. Analysis was limited to BCG, third dose of Diphtheria-Pertussis -Tetanus (DPT3) and measles vaccines. Vaccination records of 1154 children were studied. Overall, 63.3% (95 % CI 60.6-66.1%) of the children had a delay in the recommended time to receiving at least one of the studied vaccines. The proportion of children with delayed vaccinations increased from BCG [5.8% (95 % CI 4.5-7.0%)] to DPT3 [60.4% (95 % CI 57.9%-63.0%)] but was comparatively low for the measles vaccine [10.8% (95 % CI 9.1%-12.5%)]. Mothers of affected children gave reasons for the delay, and their profile correlated with type of occupation, place of birth and mode of transportation to the health facilities. Despite high vaccination coverage reported in The Gambia, a significant proportion of the children's vaccines were delayed for reasons related to health services as well as profile of mothers. These findings are likely to obtain in several countries and should be addressed by programme managers in order to improve and optimize the impact of the immunization coverage rates.

Cost-effectiveness of HPV vaccination in the context of high cervical cancer incidence and low screening coverage.

PubMed

Võrno, Triin; Lutsar, Katrin; Uusküla, Anneli; Padrik, Lee; Raud, Terje; Reile, Rainer; Nahkur, Oliver; Kiivet, Raul-Allan

2017-11-01

Estonia has high cervical cancer incidence and low screening coverage. We modelled the impact of population-based bivalent, quadrivalent or nonavalent HPV vaccination alongside cervical cancer screening. A Markov cohort model of the natural history of HPV infection was used to assess the cost-effectiveness of vaccinating a cohort of 12-year-old girls with bivalent, quadrivalent or nonavalent vaccine in two doses in a national, school-based vaccination programme. The model followed the natural progression of HPV infection into subsequent genital warts (GW); premalignant lesions (CIN1-3); cervical, oropharyngeal, vulvar, vaginal and anal cancer. Vaccine coverage was assumed to be 70%. A time horizon of 88years (up to 100years of age) was used to capture all lifetime vaccination costs and benefits. Costs and utilities were discounted using an annual discount rate of 5%. Vaccination of 12-year-old girls alongside screening compared to screening alone had an incremental cost-effectiveness ratio (ICER) of €14,007 (bivalent), €14,067 (quadrivalent) and €11,633 (nonavalent) per quality-adjusted life-year (QALY) in the base-case scenario and ranged between €5367-21,711, €5142-21,800 and €4563-18,142, respectively, in sensitivity analysis. The results were most sensitive to changes in discount rate, vaccination regimen, vaccine prices and cervical cancer screening coverage. Vaccination of 12-year-old girls alongside current cervical cancer screening can be considered a cost-effective intervention in Estonia. Adding HPV vaccination to the national immunisation schedule is expected to prevent a considerable number of HPV infections, genital warts, premalignant lesions, HPV related cancers and deaths. Although in our model ICERs varied slightly depending on the vaccine used, they generally fell within the same range. Cost-effectiveness of HPV vaccination was found to be most dependent on vaccine cost and duration of vaccine immunity, but not on the type of vaccine used. Copyright © 2017 Elsevier Ltd. All rights reserved.

Determinants of dog owner-charged rabies vaccination in Kinshasa, Democratic Republic of Congo

PubMed Central

Tshilenge, Georges Mbuyi; Mbao, Victor; Njoumemi, Zakariaou; Masumu, Justin

2017-01-01

Rabies is a preventable fatal disease that causes about 61,000 human deaths annually around the world, mostly in developing countries. In Africa, several studies have shown that vaccination of pets is effective in controlling the disease. An annual vaccination coverage of 70% is recommended by the World Health Organization as a control threshold. The effective control of rabies requires vaccination coverage of owned dogs. Identification of the factors determining dog owners’ choice to vaccinate is necessary for evidence-based policy-making. However, for the Democratic Republic of Congo (DRC), the limited data on rabies vaccination coverage makes it difficult for its control and formulation of appropriate policies. A cross-sectional study was conducted in Kinshasa (Lemba commune) with dog-owning households and owned dogs as study populations. The association between dog vaccination and independent factors (household socio-demographics characteristics, dog characteristics, knowledge of rabies and location of veterinary offices/clinics) was performed with Epi-info 7. The Odds Ratio (OR) and p-value < 0.05 were used to determine levels of significance. A total of 166 households owning dogs and 218 owned dogs were investigated. 47% of the dogs had been vaccinated within one year preceding the survey which is higher than the critical coverage (25 to 40%) necessary to interrupt rabies transmission but below the 70% threshold recommended by WHO for control. The determinants of vaccination included socio-economic level of the household (OR = 2.9, p<0.05), formal education level of the dog owner (OR = 4, p<0.05), type of residence (OR = 4.6, p<0.05), knowledge of rabies disease (OR = 8.0, p<0.05), knowledge of location of veterinary offices/clinics (OR = 3.4, p<0.05), dog gender (OR = 1.6, p<0.05) and dog breed (OR = 2.1, p<0.05). This study shows that the vaccination coverage in this area can easily reach the WHO threshold if supplemented by mass vaccination campaigns. PMID:29059205

Determinants of dog owner-charged rabies vaccination in Kinshasa, Democratic Republic of Congo.

PubMed

Kazadi, Eric Kawaya; Tshilenge, Georges Mbuyi; Mbao, Victor; Njoumemi, Zakariaou; Masumu, Justin

2017-01-01

Rabies is a preventable fatal disease that causes about 61,000 human deaths annually around the world, mostly in developing countries. In Africa, several studies have shown that vaccination of pets is effective in controlling the disease. An annual vaccination coverage of 70% is recommended by the World Health Organization as a control threshold. The effective control of rabies requires vaccination coverage of owned dogs. Identification of the factors determining dog owners' choice to vaccinate is necessary for evidence-based policy-making. However, for the Democratic Republic of Congo (DRC), the limited data on rabies vaccination coverage makes it difficult for its control and formulation of appropriate policies. A cross-sectional study was conducted in Kinshasa (Lemba commune) with dog-owning households and owned dogs as study populations. The association between dog vaccination and independent factors (household socio-demographics characteristics, dog characteristics, knowledge of rabies and location of veterinary offices/clinics) was performed with Epi-info 7. The Odds Ratio (OR) and p-value < 0.05 were used to determine levels of significance. A total of 166 households owning dogs and 218 owned dogs were investigated. 47% of the dogs had been vaccinated within one year preceding the survey which is higher than the critical coverage (25 to 40%) necessary to interrupt rabies transmission but below the 70% threshold recommended by WHO for control. The determinants of vaccination included socio-economic level of the household (OR = 2.9, p<0.05), formal education level of the dog owner (OR = 4, p<0.05), type of residence (OR = 4.6, p<0.05), knowledge of rabies disease (OR = 8.0, p<0.05), knowledge of location of veterinary offices/clinics (OR = 3.4, p<0.05), dog gender (OR = 1.6, p<0.05) and dog breed (OR = 2.1, p<0.05). This study shows that the vaccination coverage in this area can easily reach the WHO threshold if supplemented by mass vaccination campaigns.

Vaccination against meningococcus C. vaccinal coverage in the French target population.

PubMed

Stahl, J-P; Cohen, R; Denis, F; Gaudelus, J; Lery, T; Lepetit, H; Martinot, A

2013-02-01

Immunization against meningococcus C has been recommended in France since 2009 (infants from 12 to 24 months of age, and catch up vaccination up to 25 years of age). It has been reimbursed since January 2010. We had for aim to assess the vaccine coverage in 2011. The study population included mothers of children targeted by the recommendation. They were recruited using Internet data (quotas based on the French National Institute of Statistics (INSEE) data based on a census made in 2007) based on the Institut des Mamans panel and its partners. The mothers had completed a standardized questionnaire and reported all vaccinations mentioned in their child's health-record. We included 3000 mothers of children, 0 to 35 months of age, (1000 for each of the following age range: 0-11 months, 12-23 months, 24-35 months), and 2250 mothers of teenagers, 14 to 16 years of age. Vaccination was deemed "essential/useful" for respectively 90.2% (CI 95%: 89.2-91.3) and 87.8% (CI 95%: 86.4-89.2) of mothers. Vaccine coverage levels were 32.3% (12-23 months), 57.3% (24-35 months), and 21.3% (14-16 years). Two years after the Ministry of Health's decision to reimburse this vaccine, vaccine coverage levels were much lower than they should have been, to expect effectiveness of the vaccination policy. Only 21.3% of teenagers had been vaccinated, and 32.3% of infants during the second year of life. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

Achieving high coverage in Rwanda's national human papillomavirus vaccination programme.

PubMed

Binagwaho, Agnes; Wagner, Claire M; Gatera, Maurice; Karema, Corine; Nutt, Cameron T; Ngabo, Fidele

2012-08-01

Virtually all women who have cervical cancer are infected with the human papillomavirus (HPV). Of the 275,000 women who die from cervical cancer every year, 88% live in developing countries. Two vaccines against the HPV have been approved. However, vaccine implementation in low-income countries tends to lag behind implementation in high-income countries by 15 to 20 years. In 2011, Rwanda's Ministry of Health partnered with Merck to offer the Gardasil HPV vaccine to all girls of appropriate age. The Ministry formed a "public-private community partnership" to ensure effective and equitable delivery. Thanks to a strong national focus on health systems strengthening, more than 90% of all Rwandan infants aged 12-23 months receive all basic immunizations recommended by the World Health Organization. In 2011, Rwanda's HPV vaccination programme achieved 93.23% coverage after the first three-dose course of vaccination among girls in grade six. This was made possible through school-based vaccination and community involvement in identifying girls absent from or not enrolled in school. A nationwide sensitization campaign preceded delivery of the first dose. Through a series of innovative partnerships, Rwanda reduced the historical two-decade gap in vaccine introduction between high- and low-income countries to just five years. High coverage rates were achieved due to a delivery strategy that built on Rwanda's strong vaccination system and human resources framework. Following the GAVI Alliance's decision to begin financing HPV vaccination, Rwanda's example should motivate other countries to explore universal HPV vaccine coverage, although implementation must be tailored to the local context.

Vaccination coverage among children under two years of age based on electronic immunization registry in Southern Brazil.

PubMed

Luhm, Karin Regina; Cardoso, Maria Regina Alves; Waldman, Eliseu Alves

2011-02-01

To evaluate the immunization program for 12 and 24-month-old children based on electronic immunization registry. A descriptive study of a random sample of 2,637 children born in 2002 living in the city of Curitiba, Southern Brazil was performed. Data was collected from local electronic immunization registers and the National Live Birth Information System, as well as from a household survey for cases with incomplete records. Coverage at 12 and 24 months was estimated and analyzed according to the socioeconomic characteristics of each administrative district and the child's enrollment status in the health care service. The coverage, completeness, and record duplication in the registry were analyzed. Coverage of immunization was 95.3% at 12 months, with no disparities among administrative districts, and 90.3% at 24 months, with higher coverage in a district with lower socioeconomic conditions (p < 0.01). The proportion of vaccines, according to type, given before and after the recommended age reached 0.9% and 32.2%, respectively. In the surveyed sample, electronic immunization registry coverage was 98%, underreporting of vaccine doses was 11%, and record duplication was 20.6%. Groups with highest coverage included children with permanent records, children with three or more appointments through the National Unified Health Care System, and children seen within Primary Health Care Facilities fully adopting the Family Health Strategy. Vaccination coverage in Curitiba was high and homogeneous among districts, and health service enrollment status was an important factor in these results. The electronic immunization registry was a useful tool for monitoring vaccine coverage; however, it will be important to determine cost-effectiveness prior to wide-scale adoption by the National Immunization Program.

Strengthening routine immunization systems to improve global vaccination coverage.

PubMed

Sodha, S V; Dietz, V

2015-03-01

Global coverage with the third dose of diphtheria-tetanus-pertussis vaccine among children under 1 year of age stagnated at ∼ 83-84% during 2008-13. Annual World Health Organization and UNICEF-derived national vaccination coverage estimates. Incomplete vaccination is associated with poor socioeconomic status, lower education, non-use of maternal-child health services, living in conflict-affected areas, missed immunization opportunities and cancelled vaccination sessions. Vaccination platforms must expand to include older ages including the second year of life. Immunization programmes, including eradication and elimination initiatives such as those for polio and measles, must integrate within the broader health system. The Global Vaccine Action Plan (GVAP) 2011-20 is a framework for strengthening immunization systems, emphasizing country ownership, shared responsibility, equity, integration, sustainability and innovation. Immunization programmes should identify, monitor and evaluate gaps and interventions within the GVAP framework. Published by Oxford University Press 2015. This work is written by (a) US Government employee(s) and is in the public domain in the US.

Seasonal Influenza Vaccine Effectiveness in Preventing Laboratory Confirmed Influenza in 2014-2015 Season in Turkey: A Test-Negative Case Control Study

PubMed Central

Hekimoğlu, Can Hüseyin; Emek, Mestan; Avcı, Emine; Topal, Selmur; Demiröz, Mustafa; Ergör, Gül

2018-01-01

Background: Influenza has an important public health impact worldwide with its considerable annual morbidity among persons with or without risk factors and its serious complications among persons in high-risk groups. The seasonal influenza vaccine is essential for preventing the burden of influenza in a population. Since the vaccine is reformulated each season according to the virus serotypes in circulation, its effectiveness can vary from season to season. Vaccine effectiveness is defined as the relative risk reduction in vaccinated individuals in observational studies. Aims: To calculate influenza vaccine effectiveness in preventing laboratory-confirmed influenza in the Turkish population for the first time using the national sentinel surveillance data in the 2014-2015 influenza season. Study Design: Test-negative case-control study. Methods: We compared vaccination odds of influenza positive cases to influenza negative controls in the national influenza surveillance in Turkey to estimate influenza vaccine effectiveness. Results: The influenza vaccine effectiveness against influenza A (H1N1) (68.4%, 95% CI: -2.9 to 90.3) and B (44.6%, 95% CI: -27.9 to 66.6) were moderate, and the influenza vaccine effectiveness against influenza A (H3N2) (75.0%, 95% CI: -86.1 to 96.7) was relatively high; all had low precision given the low vaccination coverage. Overall, the influenza vaccination coverage rate was 4.2% (95% CI: 3.5 to 5.0), which is not sufficient to control the burden of influenza. Conclusion: In Turkey, national surveillance for influenza should be strengthened and utilised annually for the assessment of influenza vaccine effectiveness with more precision. Annual influenza vaccine effectiveness in Turkey should continue to be monitored as part of the national sentinel influenza surveillance. PMID:28903887

Meningococcal vaccine introduction in Mali through mass campaigns and its impact on the health system

PubMed Central

Mounier-Jack, Sandra; Burchett, Helen Elizabeth Denise; Griffiths, Ulla Kou; Konate, Mamadou; Diarra, Kassibo Sira

2014-01-01

Objective: To evaluate the impact of the meningococcal A (MenA) vaccine introduction in Mali through mass campaigns on the routine immunization program and the wider health system. Methods: We used a mixed-methods case-study design, combining semi-structured interviews with 31 key informants, a survey among 18 health facilities, and analysis of routine health facility data on number of routine vaccinations and antenatal consultations before, during, and after the MenA vaccine campaign in December 2010. Survey and interview data were collected at the national level and in 2 regions in July and August 2011, with additional interviews in January 2012. Findings: Many health system functions were not affected—either positively or negatively—by the MenA vaccine introduction. The majority of effects were felt on the immunization program. Benefits included strengthened communication and social mobilization, surveillance, and provider skills. Drawbacks included the interruption of routine vaccination services in the majority of health facilities surveyed (67%). The average daily number of children receiving routine vaccinations was 79% to 87% lower during the 10-day campaign period than during other periods of the month. Antenatal care consultations were also reduced during the campaign period by 10% to 15%. Key informants argued that, with an average of 14 campaigns per year, mass campaigns would have a substantial cumulative negative effect on routine health services. Many also argued that the MenA campaign missed potential opportunities for health systems strengthening because integration with other health services was lacking. Conclusion: The MenA vaccine introduction interrupted routine vaccination and other health services. When introducing a new vaccine through a campaign, coverage of routine health services should be monitored alongside campaign vaccine coverage to highlight where and how long services are disrupted and to mitigate risks to routine services. PMID:25276567

Provider communication about HPV vaccination: A systematic review

PubMed Central

Gilkey, Melissa B.; McRee, Annie-Laurie

2016-01-01

abstract Background. Improving HPV vaccination coverage in the US will require healthcare providers to recommend the vaccine more effectively. To inform quality improvement efforts, we systematically reviewed studies of provider communication about HPV vaccination. Methods. We searched MEDLINE, CINAHL, EMBASE, and POPLINE in August 2015 to identify studies of provider communication about HPV vaccination. Results. We identified 101 qualitative and quantitative studies. Providers less often recommended HPV vaccine if they were uncomfortable discussing sex, perceived parents as hesitant, or believed patients to be low risk. Patients less often received recommendations if they were younger, male, or from racial/ethnic minorities. Despite parents' preference for unambiguous recommendations, providers often sent mixed messages by failing to endorse HPV vaccine strongly, differentiating it from other vaccines, and presenting it as an “optional” vaccine that could be delayed. Conclusion. Interventions are needed to help providers deliver effective recommendations in the complex communication environment surrounding HPV vaccination. PMID:26838681

Vaccination coverage against pertussis in pregnant women of Catalonia in the first year of implementation of the immunisation program.

PubMed

Fernández-Cano, María Isabel; Espada-Trespalacios, Xavier; Reyes-Lacalle, Azahara; Manresa Domínguez, Josep Maria; Armadans-Gil, Lluís; Campins-Martí, Magda; Falguera-Puig, Gemma; Toran Monserrat, Pere

2017-11-01

The re-emergence of pertussis and the severity of its complications in infants younger than 3 months, were determining factors for starting a vaccination program for pregnant women in the third trimester of gestation in Catalonia in February 2014. This was the first autonomous community to introduce it in Spain. The aim of the study was to estimate the coverage of the program in its first year of implementation. A retrospective analysis was performed on the data from the Primary Care Centre computerised medical records of pregnant women attending Sexual and Reproductive Health Care centres of the Metropolitan Nord area of the province of Barcelona, part of the Catalan Institute of Health. The overall coverage was estimated, as well as the sociodemographic variables of Tdap vaccination of women who had registered a delivery of a live birth between August 2014 and August 2015. A total of 6,697 deliveries of live births were recorded, and 1,713 pregnant women were vaccinated, which represented an overall coverage of 25.6% (95% CI; 24.1-26.1). Vaccination coverage was higher in pregnant women under 18 years and Spanish women (P=.018 and P=.036, respectively). The estimation of vaccine coverage against pertussis in pregnant women in the third trimester of pregnancy, after the first year of implementation of the program in a health area of Catalonia was lower than the objective set. Strategies need to be designed in order to improve program coverage. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

Immunisation coverage in rural–urban migrant children in low and middle-income countries (LMICs): a systematic review and meta-analysis

PubMed Central

Awoh, Abiyemi Benita; Plugge, Emma

2016-01-01

Background The majority of children who die from vaccine-preventable diseases (VPDs) live in low-income and-middle-income countries (LMICs). With the rapid urbanisation and rural–urban migration ongoing in LMICs, available research suggests that migration status might be a determinant of immunisation coverage in LMICs, with rural–urban migrant (RUM) children being less likely to be immunised. Objectives To examine and synthesise the data on immunisation coverage in RUM children in LMICs and to compare coverage in these children with non-migrant children. Methods A multiple database search of published and unpublished literature on immunisation coverage for the routine Expanded Programme on Immunisation (EPI) vaccines in RUM children aged 5 years and below was conducted. Following a staged exclusion process, studies that met the inclusion criteria were assessed for quality and data extracted for meta-analysis. Results Eleven studies from three countries (China, India and Nigeria) were included in the review. There was substantial statistical heterogeneity between the studies, thus no summary estimate was reported for the meta-analysis. Data synthesis from the studies showed that the proportion of fully immunised RUM children was lower than the WHO bench-mark of 90% at the national level. RUMs were also less likely to be fully immunised than the urban-non-migrants and general population. For the individual EPI vaccines, all but two studies showed lower immunisation coverage in RUMs compared with the general population using national coverage estimates. Conclusions This review indicates that there is an association between rural–urban migration and immunisation coverage in LMICs with RUMs being less likely to be fully immunised than the urban non-migrants and the general population. Specific efforts to improve immunisation coverage in this subpopulation of urban residents will not only reduce morbidity and mortality from VPDs in migrants but will also reduce health inequity and the risk of infectious disease outbreaks in wider society. PMID:26347277

COVER (cover of vaccination evaluated rapidly): description of the England and Wales scheme.

PubMed

Begg, N T; Gill, O N; White, J M

1989-03-01

The COVER scheme, a method for the rapid evaluation of vaccine coverage in England and Wales, is described. The primary aim of the scheme is to improve cover by providing health district vaccination programme coordinators with relevant timely information. Quarterly data were obtained from, analysed and promptly fed back to, 126 health districts on cohorts of children who had recently attained the target ages for receiving the selected sentinel vaccines; 18 months for third diphtheria and third pertussis and 2 years for measles. Although the data suggested that vaccination cover is improving, national performance still falls well short of 90%, the 1990 target set by the World Health Organisation for countries in Europe.

Rates of coverage and determinants of complete vaccination of children in rural areas of Burkina Faso (1998-2003).

PubMed

Sia, Drissa; Fournier, Pierre; Kobiané, Jean-François; Sondo, Blaise K

2009-11-17

Burkina Faso's immunization program has benefited regularly from national and international support. However, national immunization coverage has been irregular, decreasing from 34.7% in 1993 to 29.3% in 1998, and then increasing to 43.9% in 2003. Undoubtedly, a variety of factors contributed to this pattern. This study aims to identify both individual and systemic factors associated with complete vaccination in 1998 and 2003 and relate them to variations in national and international policies and strategies on vaccination of rural Burkinabé children aged 12-23 months. Data from the 1998 and 2003 Demographic and Health Surveys and the Ministry of Health's 1997 and 2002 Statistical Yearbooks, as well as individual interviews with central and regional decision-makers and with field workers in Burkina's healthcare system, were used to carry out a multilevel study that included 805 children in 1998 and 1,360 children in 2003, aged 12-23 months, spread over 44 and 48 rural health districts respectively. In rural areas, complete vaccination coverage went from 25.9% in 1998 to 41.2% in 2003. District resources had no significant effect on coverage and the impact of education declined over time. The factors that continued to have the greatest impact on coverage rates were poverty, with its various dimensions, and the utilization of other healthcare services. However, these factors do not explain the persistent differences in complete vaccination between districts. In 2003, despite a trend toward district homogenization, differences between health districts still accounted for a 7.4% variance in complete vaccination. Complete vaccination coverage of children is improving in a context of worsening poverty. Education no longer represents an advantage in relation to vaccination. Continuity from prenatal care to institutional delivery creates a loyalty to healthcare services and is the most significant and stable explanatory factor associated with complete vaccination of children. Healthcare service utilization is the result of a dynamic process of interaction between communities and the healthcare system; understanding this process is the key to understanding better the factors underlying the complete vaccination of children.

Completeness and timeliness of vaccination and determinants for low and late uptake among young children in eastern China

PubMed Central

Hu, Yu; Chen, Yaping; Guo, Jing; Tang, Xuewen; Shen, Lingzhi

2014-01-01

Background: We studied completeness and timeliness of vaccination and determinants for low and delayed uptake in children born between 2008 and 2009 in Zhejiang province in eastern China. Methods: We used data from a cross-sectional cluster survey conducted in 2011, which included 1146 children born from 1 Jan 2008 to 31 Dec 2009. Various vaccination history, social-demographic factors, attitude and satisfaction toward immunization from caregivers were collected by a standard questionnaire. We restricted to the third dose of HepB, PV, and DPT (HepB3, PV3, and DPT3) as outcome variables for completeness of vaccination and restricted to the first dose of HepB, PV, DPT, and MCV(HepB1, PV1, DPT1, and MCV1) as outcome variables for timeliness of vaccination. The χ2 test and logistic regression analysis were applied to identify the determinants of completeness and timeliness of vaccination. Survival analysis by the Kaplan–Meier method was performed to present the timeliness vaccination. Results: Coverage for HepB1, HepB3, PV1, PV3, DPT1, DPT3, and MCV1 was 93.22%, 90.15%, 96.42%, 91.63%, 95.80%, 90.16%, and 92.70%, respectively. Timely vaccination occurred in 501/1146(43.72%) children for HepB1, 520/1146(45.38%) for PV1, 511/1146(44.59%) for DPT1, and 679/1146(59.25%) for MCV1. Completeness of specific vaccines was associated with mother’ age, immigration status, birth place of child, maternal education level, maternal occupation status, socio-economic development level of surveyed areas, satisfaction toward immunization service and distance of the house to immunization clinic. Timeliness of vaccination for specific vaccines was associated with mother’ age, maternal education level, immigration status, siblings, birth place, and distance of the house to immunization clinic. Conclusion: Despite reasonably high vaccination coverage, we observed substantial vaccination delays. We found specific factors associated with low and/or delayed vaccine uptake. These findings can help to improve strategies such as Reaching Every District (RED), out-reach vaccination services and health education to reach children who remain inadequately protected. PMID:24584000

Mapping HPV Vaccination and Cervical Cancer Screening Practice in the Pacific Region-Strengthening National and Regional Cervical Cancer Prevention

PubMed Central

Obel, J; McKenzie, J; Buenconsejo-Lum, LE; Durand, AM; Ekeroma, A; Souares, Y; Hoy, D; Baravilala, W; Garland, SM; Kjaer, SK; Roth, A

2015-01-01

Objective To provide background information for strengthening cervical cancer prevention in the Pacific by mapping current human papillomavirus (HPV) vaccination and cervical cancer screening practices, as well as intent and barriers to the introduction and maintenance of national HPV vaccination programmes in the region. Materials and Methods A cross-sectional questionnaire-based survey among ministry of health officials from 21 Pacific Island countries and territories (n=21). Results Cervical cancer prevention was rated as highly important, but implementation of prevention programs were insufficient, with only two of 21 countries and territories having achieved coverage of cervical cancer screening above 40%. Ten of 21 countries and territories had included HPV vaccination in their immunization schedule, but only two countries reported coverage of HPV vaccination above 60% among the targeted population. Key barriers to the introduction and continuation of HPV vaccination were reported to be: (i) Lack of sustainable financing for HPV vaccine programs; (ii) Lack of visible government endorsement; (iii) Critical public perception of the value and safety of the HPV vaccine; and (iv) Lack of clear guidelines and policies for HPV vaccination. Conclusion Current practices to prevent cervical cancer in the Pacific Region do not match the high burden of disease from cervical cancer. A regional approach, including reducing vaccine prices by bulk purchase of vaccine, technical support for implementation of prevention programs, operational research and advocacy could strengthen political momentum for cervical cancer prevention and avoid risking the lives of many women in the Pacific. PMID:25921158

Vaccination coverage among children in Germany estimated by analysis of health insurance claims data

PubMed Central

Rieck, Thorsten; Feig, Marcel; Eckmanns, Tim; Benzler, Justus; Siedler, Anette; Wichmann, Ole

2014-01-01

In Germany, the national routine childhood immunization schedule comprises 12 vaccinations. Primary immunizations should be completed by 24 mo of age. However, nationwide monitoring of vaccination coverage (VC) is performed only at school entry. We utilized health insurance claims data covering ~85% of the total population with the objectives to (1) assess VC of all recommended childhood vaccinations in birth-cohorts 2004–2009, (2) analyze cross-sectional (at 24 and 36 mo) and longitudinal trends, and (3) validate the method internally and externally. Counting vaccine doses in a retrospective cohort fashion, we assembled individual vaccination histories and summarized VC to nationwide figures. For most long-established vaccinations, VC at 24 mo was at moderate levels (~73–80%) and increased slightly across birth-cohorts. One dose measles VC was high (94%), but low (69%) for the second dose. VC with a full course of recently introduced varicella, pneumococcal, and meningococcal C vaccines increased across birth-cohorts from below 10% above 60%, 70%, and 80%, respectively. At 36 mo, VC had increased further by up to 15 percentage points depending on vaccination. Longitudinal analysis suggested a continued VC increase until school entry. Validation of VC figures with primary data showed an overall good agreement. In conclusion, analysis of health insurance claims data allows for the estimation of VC among children in Germany considering completeness and timeliness of vaccination series. This approach provides valid nationwide VC figures for all currently recommended pediatric vaccinations and fills the information gap between early infancy and late assessment at school entry. PMID:24192604

Informing rubella vaccination strategies in East Java, Indonesia through transmission modelling.

PubMed

Wu, Yue; Wood, James; Khandaker, Gulam; Waddington, Claire; Snelling, Thomas

2016-11-04

An estimated 110,000 babies are born with congenital rubella syndrome (CRS) worldwide annually; a significant proportion of cases occur in Southeast Asia. Rubella vaccine programs have led to successful control of rubella and CRS, and even the elimination of disease in many countries. However, if vaccination is poorly implemented it might increase the number of women reaching childbearing age who remain susceptible to rubella and thereby paradoxically increase CRS. We used an age-structured transmission model to compare seven alternative vaccine strategies for their impact on reducing CRS disease burden in East Java, a setting which is yet to implement a rubella vaccine program. We also investigated the robustness of model predictions to variation in vaccine coverage and other key epidemiological factors. Without rubella vaccination, approximately 700 babies are estimated to be born with CRS in East Java every year at an incidence of 0.77 per 1000live births. This incidence could be reduced to 0.0045 per 1000 live births associated with 99.9% annual reduction in rubella infections after 20 years if the existing two doses of measles vaccine are substituted with two doses of measles plus rubella combination vaccine with the same coverage (87.8% of 9-month-old infants and 80% of 6-year-old children). By comparison a single dose of rubella vaccine will take longer to reduce the burden of rubella and CRS and will be less robust to lower vaccine coverage. While the findings of this study should be informative for settings similar to East Java, the conclusions are dependent on vaccine coverage which would need consideration before applying to all of Indonesia and elsewhere in Asia. Copyright © 2016 Elsevier Ltd. All rights reserved.

Knowledge, Attitude and Practice of Pregnant Women towards Varicella and Their Children’s Varicella Vaccination: Evidence from Three Distrcits in Zhejiang Province, China

PubMed Central

Hu, Yu; Chen, Yaping; Wang, Ying; Liang, Hui

2017-01-01

Background: The objectives of this study were to examine the knowledge, attitudes and practice (KAP) towards varicella and varicella vaccine (VarV) vaccination among pregnant women in three distrcits in Zhejiang Province, China. Methods: From 1 January to 31 March 2014, pregnant women with ≥12 gestational weeks were recruited and received a self-administrated questionnaire. The first dose of VarV (VarV1) vaccination status of children from present pregnancy was extracted at 24 months of age from Zhejiang provincial immunization information system (ZJIIS). Three variables was defined as the main outcomes, which included: (1) knowing about both the availability of VarV and the number of doses required; (2) positive attitude towards the utility of varicella vaccination; (3) the vaccination coverage of VarV1, which meant the proportion of children having received the VarV1. Counts and proportions were used to describe the socio-demographic characteristics of study participants, and their relationship with study outcomes were tested using chi-square tests in univariate analysis and logistic regression in multivariable analysis. Results: A total of 629 pregnant women participated in this study. The majority of the participants (68.0%) answered correctly about the transmission route of varicella. The proportion of participants who heard about varicella vaccination was 76.5% and 66.8% knew that VarV was currently available. Only 13.5% of the participants answered correctly that the complete VarV series needed two doses. Age, immigration status, education level, household income, and number of children of the pregnant women were significant predictors of the KAP regarding the VarV vaccination. Conclusions: The current survey indicated that optimal KAP levels and coverage on VarV vaccination were observed in three districts of Zhejiang Province. Health education programs on varicella and VarV vaccination directed towards both pre-natal and post-natal women are needed, which will result in a better attitude on vaccination of VarV and in a high coverage of VarV. PMID:28946647

Introduction of inactivated poliovirus vaccine leading into the polio eradication endgame strategic plan; Hangzhou, China, 2010-2014.

PubMed

Liu, Yan; Wang, Jun; Liu, Shijun; Du, Jian; Wang, Liang; Gu, Wenwen; Xu, Yuyang; Zuo, Shuyan; Xu, Erping; An, Zhijie

2017-03-01

China's Expanded Program on Immunization (EPI) has provided 4 doses of oral poliovirus vaccine (OPV) since the 1970s. Inactivated poliovirus vaccine (IPV) became available in 2010 in Hangzhou as a private-sector, parent-chosen alternative to OPV. In 2015, WHO recommended that countries with all-OPV vaccination schedules introduce at least one dose of IPV, to mitigate risk associated with the withdrawal of type 2 OPV. We analyzed polio vaccine coverage and utilization in Hangzhou to determine patterns of IPV use and the occurrence of vaccine-associated paralytic polio (VAPP) in the various patterns identified. Children born between 2010 and 2014 and registered in Hangzhou's Immunization Information System (HZIIS) were included. VAPP cases were detected through the acute flaccid paralysis surveillance system. We used descriptive epidemiological methods to determine IPV and OPV usage patterns and VAPP occurrence. HZIIS data from 566,894 children were analyzed. Coverage levels of polio vaccine were greater than 92% for each birth cohort. Percentages of children using OPV-only, IPV-only, and IPV/OPV sequential schedules were 70.57%, 27.01% and 2.41%, respectively. IPV-only schedule utilization increased by birth cohort regardless of geographical area or whether the child was locally-born. The highest use of an all-IPV schedule (79.85%) was among urban, locally-born children in the 2014 birth cohort. Five VAPP cases were identified during the study years; all cases occurred following the first polio vaccine dose, which was always OPV for the cases. Type 2 vaccine virus was isolated from 2 VAPP cases, and type 2 and type 3 vaccine virus was isolated from one VAPP case. The incidence of VAPP in the 2010-2014 birth cohorts was 3.76 per 1million doses of OPV. Children in Hangzhou had high polio vaccination coverage. IPV-only schedule use increased by year, and was highest in urban areas among locally-born children. All cases of VAPP were associated with the first dose of OPV. Copyright © 2017 Elsevier Ltd. All rights reserved.

The impact of 2-dose routine measles, mumps, rubella, and varicella vaccination in France on the epidemiology of varicella and zoster using a dynamic model with an empirical contact matrix.

PubMed

Ouwens, Mario J N M; Littlewood, Kavi J; Sauboin, Christophe; Téhard, Bertrand; Denis, François; Boëlle, Pierre-Yves; Alain, Sophie

2015-04-01

Varicella has a high incidence affecting the vast majority of the population in France and can lead to severe complications. Almost every individual infected by varicella becomes susceptible to herpes zoster later in life due to reactivation of the latent virus. Zoster is characterized by pain that can be long-lasting in some cases and has no satisfactory treatment. Routine varicella vaccination can prevent varicella. The vaccination strategy of replacing both doses of measles, mumps, and rubella (MMR) with a combined MMR and varicella (MMRV) vaccine is a means of reaching high vaccination coverage for varicella immunization. The objective of this analysis was to assess the impact of routine varicella vaccination, with MMRV in place of MMR, on the incidence of varicella and zoster diseases in France and to assess the impact of exogenous boosting of zoster incidence, age shift in varicella cases, and other possible indirect effects. A dynamic transmission population-based model was developed using epidemiological data for France to determine the force of infection, as well as an empirically derived contact matrix to reduce assumptions underlying these key drivers of dynamic models. Scenario analyses tested assumptions regarding exogenous boosting, vaccine waning, vaccination coverage, risk of complications, and contact matrices. The model provides a good estimate of the incidence before varicella vaccination implementation in France. When routine varicella vaccination is introduced with French current coverage levels, varicella incidence is predicted to decrease by 57%, and related complications are expected to decrease by 76% over time. After vaccination, it is observed that exogenous boosting is the main driver of change in zoster incidence. When exogenous boosting is assumed, there is a temporary increase in zoster incidence before it gradually decreases, whereas without exogenous boosting, varicella vaccination leads to a gradual decrease in zoster incidence. Changing vaccine efficacy waning levels and coverage assumptions are still predicted to result in overall benefits with varicella vaccination. In conclusion, the model predicted that MMRV vaccination can significantly reduce varicella incidence. With suboptimal coverage, a limited age shift of varicella cases is predicted to occur post-vaccination with MMRV. However, it does not result in an increase in the number of complications. GSK study identifier: HO-12-6924. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

Bias of vaccination coverage in a household questionnaire survey in Japan.

PubMed

Hashimoto, Shuji; Kawado, Miyuki; Seko, Rumi; Kato, Masahiro; Okabe, Nobuhiko

2005-01-01

Although a household questionnaire survey is important for estimating vaccination coverage, it raises several problematic issues. A household survey was conducted on 900 subjects aged 2, 4, and 6 years living in Obu City, Japan, and a second survey for non-respondents to the first survey was then conducted. Questionnaires bearing a subject's name were used for half of the subjects, while the others were anonymous (the named and nameless groups, respectively). The vaccination dates of six kinds of vaccines, including poliovirus and measles vaccine, for those in the named group were reviewed using the administrative records at the Obu City Health Center. The response rate was 70.1% in the first survey and 84.1% in the first and second surveys combined. The response rate for both groups was nearly equal. Based on administrative records in the named group, the vaccination coverage in the respondents was 0.9-2.9% higher than that in total subjects, and that in the respondents to the first survey was 0.8-4.9% higher. There were very few inconsistencies in the vaccination status between responses to the questionnaire and data of administrative records among respondents in the named group. These results suggested that vaccination coverage from a household questionnaire survey in Japan might not be extremely biased by either non-responses or incorrect answers.

Perception about influenza and pneumococcal vaccines and vaccination coverage among patients with malignancies and their family members.

PubMed

Urun, Y; Akbulut, H; Demirkazik, A; Cay Senler, F; Utkan, G; Onur, H; Icli, F

2013-01-01

Although influenza and pneumococcal vaccinations for high-risk populations are recommended by current guidelines, vaccination coverage rate (VCR) is still low in patients with malignancies and the family members living with them. During the 2011-2012 seasonal influenza (SI), we surveyed 359 patients with solid or hematological malignancies Data were recorded in an especially designed questionnaire after face to face interview. The median patient age was 57 years (range 18-90) and 177 (49.3%) patients were female. Overall vaccination rate was 17% and 4.2% for influenza and pneumococcus, respectively. VCR among family members was 21.2%. The most common causes for not getting vaccinated were lack of knowledge for indication by the patients (33.5%), getting chemotherapy (22.1%), fear of side effects (12.5%), lack of efficacy (12.1%), and not advised by the attending physician (5.9%). VCR was very low among patients with cancer and their family members. To eliminate misconceptions and improve vaccination coverage in this population, educational programs for patients and for physicians focusing on safety and efficacy of vaccine are needed.

Maintaining high rates of measles immunization in Africa.

PubMed

Lessler, J; Moss, W J; Lowther, S A; Cummings, D A T

2011-07-01

Supplementary immunization activities (SIAs) are important in achieving high levels of population immunity to measles virus. Using data from a 2006 survey of measles vaccination in Lusaka, Zambia, we developed a model to predict measles immunity following routine vaccination and SIAs, and absent natural infection. Projected population immunity was compared between the current programme and alternatives, including supplementing routine vaccination with a second dose, or SIAs at 1-, 2-, 3-, 4- and 5-year intervals. Current routine vaccination plus frequent SIAs could maintain high levels of population immunity in children aged <5 years, even if each frequent SIA has low coverage (e.g. ≥ 72% for bi-annual 60% coverage SIAs vs. ≥ 69% for quadrennial 95% coverage SIAs). A second dose at 12 months with current coverage could achieve 81% immunity. Circulating measles virus will only increase population immunity. Public health officials should consider frequent SIAs when resources for a two-dose strategy are unavailable.

Hepatitis A vaccination coverage among adults 18-49 years traveling to a country of high or intermediate endemicity, United States.

PubMed

Lu, Peng-Jun; Byrd, Kathy K; Murphy, Trudy V

2013-05-01

Since 1996, hepatitis A vaccine (HepA) has been recommended for adults at increased risk for infection including travelers to high or intermediate hepatitis A endemic countries. In 2009, travel outside the United States and Canada was the most common exposure nationally reported for persons with hepatitis A virus (HAV) infection. To assess HepA vaccination coverage among adults 18-49 years traveling to a country of high or intermediate endemicity in the United States. We analyzed data from the 2010 National Health Interview Survey (NHIS), to determine self-reported HepA vaccination coverage (≥1 dose) and series completion (≥2 dose) among persons 18-49 years who traveled, since 1995, to a country of high or intermediate HAV endemicity. Multivariable logistic regression and predictive marginal analyses were conducted to identify factors independently associated with HepA vaccine receipt. In 2010, approximately 36.6% of adults 18-49 years reported traveling to high or intermediate hepatitis A endemic countries; among this group unadjusted HepA vaccination coverage was 26.6% compared to 12.7% among non-travelers (P-values<0.001) and series completion were 16.9% and 7.6%, respectively (P-values<0.001). On multivariable analysis among all respondents, travel status was an independent predictor of HepA coverage and series completion (both P-values<0.001). Among travelers, HepA coverage and series completion (≥2 doses) were higher for travelers 18-25 years (prevalence ratios 2.3, 2.8, respectively, P-values<0.001) and for travelers 26-39 years (prevalence ratios 1.5, 1.5, respectively, P-value<0.001, P-value=0.002, respectively) compared to travelers 40-49 years. Other characteristics independently associated with a higher likelihood of HepA receipt among travelers included Asian race/ethnicity, male sex, never having been married, having a high school or higher education, living in the western United States, having greater number of physician contacts or receipt of influenza vaccination in the previous year. HepB vaccination was excluded from the model because of the significant correlation between receipt of HepA vaccination and HepB vaccination could distort the model. Although travel to a country of high or intermediate hepatitis A endemicity was associated with higher likelihood of HepA vaccination in 2010 among adults 18-49 years, self-reported HepA vaccination coverage was low among adult travelers to these areas. Healthcare providers should ask their patients' upcoming travel plans and recommend and offer travel related vaccinations to their patients. Published by Elsevier Ltd.

The influence of performance-based payment on childhood immunisation coverage.

PubMed

Merilind, Eero; Salupere, Rauno; Västra, Katrin; Kalda, Ruth

2015-06-01

Pay-for-performance, also called the quality system (QS) in Estonia, was implemented in 2006 and one indicator for achievement is the childhood immunisation coverage rate. The WHO vaccination coverage in Europe for diphtheria, tetanus and pertussis, and measles in children aged around one year old should meet or exceed 90 per cent. The study was conducted using a database from the Estonian Health Insurance Fund. The study compared childhood immunisation coverage rates of all Estonian family physicians in two groups, joined and not joined to the quality system during the observation period 2006-2012. Immunisation coverage was calculated as the percentage of persons in the target age group who received a vaccine dose by a given age. The target level of immunisations in Estonia is set at 90 per cent and higher. Immunisation coverage rates of family doctors (FD) in Estonia showed significant differences between two groups of doctors: joined to the quality system and not joined. Doctors joined to the quality system met the 90 per cent vaccination criterion more frequently compared to doctors not joined to the quality system. Doctors not joined to the quality system were below the 90 per cent vaccination criterion in all vaccinations listed in the Estonian State Immunisation Schedule. Pay-for-performance as a financial incentive encourages higher levels of childhood immunisations. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Zika virus infection, associated microcephaly, and low yellow fever vaccination coverage in Brazil: is there any causal link?

PubMed

De Góes Cavalcanti, Luciano Pamplona; Tauil, Pedro Luiz; Alencar, Carlos Henrique; Oliveira, Wanderson; Teixeira, Mauro Martins; Heukelbach, Jorg

2016-06-30

Since the end of 2014, Zika virus (ZIKV) infection has been rapidly spreading in Brazil. To analyze the possible association of yellow fever vaccine with a protective effect against ZIKV-related microcephaly, the following spatial analyses were performed, using Brazilian municipalities as units: i) yellow fever vaccination coverage in Brazilian municipalities in individuals aged 15-49; ii) reported cases of microcephaly by municipality; and iii) confirmed cases of microcephaly related to ZIKV, by municipality. SaTScan software was used to identify clusters of municipalities for high risk of microcephaly. There were seven significant high risk clusters of confirmed microcephaly cases, with four of them located in the Northeast where yellow fever vaccination rates were the lowest. The clusters harbored only 2.9% of the total population of Brazil, but 15.2% of confirmed cases of microcephaly. We hypothesize that pregnant women in regions with high yellow fever vaccination coverage may pose their offspring to lower risk for development of microcephaly. There is an urgent need for systematic studies to confirm the possible link between low yellow fever vaccination coverage, Zika virus infection and microcephaly.

Prenatal vaccination education intervention improves both the mothers' knowledge and children's vaccination coverage: Evidence from randomized controlled trial from eastern China.

PubMed

Hu, Yu; Chen, Yaping; Wang, Ying; Song, Quanwei; Li, Qian

2017-06-03

To verify the effectiveness of prenatal vaccination education intervention on improving mother's vaccination knowledge and child's vaccination status in Zhejiang province, eastern China. Pregnant women with ≥ 12 gestational weeks were recruited and randomly assigned into the intervention group and the control group. The intervention group were given a vaccination education session while the control group were not. Two round surveys were performed before and 3 months after the intervention. The vaccination status of child was extracted at 12 months of age from immunization information system. The differences of the vaccination knowledge, the coverage, the completeness and the timeliness of vaccination between 2 groups were evaluated. The effectiveness of vaccination education intervention was assessed, under the control of the other demographic variables. Among the 1252 participants, 851 subjects replied to the post-survey. Significant improvements of vaccination knowledge between the pre- and the post- survey in the intervention group were observed (Mean ± S.D:1.8 ± 1.1 vs. 3.7 ± 1.2 for vaccines score and 2.7 ± 1.5 vs. 4.8 ± 1.0 for vaccine policy score, respectively). The coverage of fully vaccination was significantly higher in the intervention group (90.0% vs. 82.9%, P<0.01). The timeliness of fully vaccination was significantly higher in the intervention group (51.9% vs. 33.0%, P<0.01). In the intervention group, pregnant women were more likely to be with high score of knowledge (OR = 5.2, 95%CI: 2.6-8.8), and children were more likely to complete the full series of vaccination (OR = 3.4, 95%CI: 2.1-4.8), and children were more likely to complete the full series of vaccination in a timely manner (OR = 2.3, 95%CI: 1.6-3.5). Vaccination education in the pregnant women can effectively improve the knowledge regarding immunization and increase the coverage, the completeness and the timeliness of childhood vaccination. Strong partnership needs to be established between the obstetricians and the vaccination staff to improve the performance of NIP.

Relationship between Guillain-Barré syndrome, influenza-related hospitalizations, and influenza vaccine coverage.

PubMed

Iqbal, Shahed; Li, Rongxia; Gargiullo, Paul; Vellozzi, Claudia

2015-04-21

Some studies reported an increased risk of Guillain-Barré syndrome (GBS) within six weeks of influenza vaccination. It has also been suggested that this finding could have been confounded by influenza illnesses. We explored the complex relationship between influenza illness, influenza vaccination, and GBS, from an ecologic perspective using nationally representative data. We also studied seasonal patterns for GBS hospitalizations. Monthly hospitalization data (2000-2009) for GBS, and pneumonia and influenza (P&I) in the Nationwide Inpatient Sample were included. Seasonal influenza vaccination coverage for 2004-2005 through the 2008-2009 influenza seasons (August-May) was estimated from the National Health Interview Survey data. GBS seasonality was determined using Poisson regression. GBS and P&I temporal clusters were identified using scan statistics. The association between P&I and GBS hospitalizations in the same month (concurrent) or in the following month (lagged) were determined using negative binomial regression. Vaccine coverage increased over the years (from 19.7% during 2004-2005 to 35.5% during 2008-2009 season) but GBS hospitalization did not follow a similar pattern. Overall, a significant correlation between monthly P&I and GBS hospitalizations was observed (Spearman's correlation coefficient=0.7016, p<0.0001). A significant (p=0.001) cluster of P&I hospitalizations during December 2004-March 2005 overlapped a significant (p=0.001) cluster of GBS hospitalizations during January 2005-February 2005. After accounting for effects of monthly vaccine coverage and age, P&I hospitalization was significantly associated (p<0.0001) with GBS hospitalization in the concurrent month but not with GBS hospitalization in the following month. Monthly vaccine coverage was not associated with GBS hospitalization in adjusted models (both concurrent and lagged). GBS hospitalizations demonstrated a seasonal pattern with winter months having higher rates compared to the month of June. P&I hospitalization rates were significantly correlated with hospitalization rates for GBS. Vaccine coverage did not significantly affect the rates of GBS hospitalization at the population level. Published by Elsevier Ltd.

Estimates of the timing of reductions in genital warts and high grade cervical intraepithelial neoplasia after onset of human papillomavirus (HPV) vaccination in the United States.

PubMed

Chesson, Harrell W; Ekwueme, Donatus U; Saraiya, Mona; Dunne, Eileen F; Markowitz, Lauri E

2013-08-20

The objective of this study was to estimate the number of years after onset of a quadrivalent HPV vaccination program before notable reductions in genital warts and cervical intraepithelial neoplasia (CIN) will occur in teenagers and young adults in the United States. We applied a previously published model of HPV vaccination in the United States and focused on the timing of reductions in genital warts among both sexes and reductions in CIN 2/3 among females. Using different coverage scenarios, the lowest being consistent with current 3-dose coverage in the United States, we estimated the number of years before reductions of 10%, 25%, and 50% would be observed after onset of an HPV vaccination program for ages 12-26 years. The model suggested female-only HPV vaccination in the intermediate coverage scenario will result in a 10% reduction in genital warts within 2-4 years for females aged 15-19 years and a 10% reduction in CIN 2/3 among females aged 20-29 years within 7-11 years. Coverage had a major impact on when reductions would be observed. For example, in the higher coverage scenario a 25% reduction in CIN2/3 would be observed with 8 years compared with 15 years in the lower coverage scenario. Our model provides estimates of the potential timing and magnitude of the impact of HPV vaccination on genital warts and CIN 2/3 at the population level in the United States. Notable, population-level impacts of HPV vaccination on genital warts and CIN 2/3 can occur within a few years after onset of vaccination, particularly among younger age groups. Our results are generally consistent with early reports of declines in genital warts among youth. Published by Elsevier Ltd.

Nudges or mandates? The ethics of mandatory flu vaccination.

PubMed

Dubov, Alex; Phung, Connie

2015-05-21

According to the CDC report for the 2012-2013 influenza season, there was a modest increase in the vaccination coverage rate among healthcare workers from 67% in 2011-2012, to 72% in 2012-2013 to the current 75% coverage. This is still far from reaching the US National Healthy People 2020 goal of 90% hospitals vaccination rates. The reported increase in coverage is attributed to the growing number of healthcare facilities with vaccination requirements with average rates of 96.5%. However, a few other public health interventions stir so much controversy and debate as vaccination mandates. The opposition stems from the belief that a mandatory flu shot policy violates an individual right to refuse unwanted treatment. This article outlines the historic push to achieve higher vaccination rates among healthcare professionals and a number of ethical issues arising from attempts to implement vaccination mandates. It then turns to a review of cognitive biases relevant in the context of decisions about influenza vaccination (omission bias, ambiguity aversion, present bias etc.) The article suggests that a successful strategy for policy-makers and others hoping to increase vaccination rates is to design a "choice architecture" that influences behavior of healthcare professionals without foreclosing other options. Nudges incentivize vaccinations and help better align vaccination intentions with near-term actions. Copyright © 2015 Elsevier Ltd. All rights reserved.

Clustered lot quality assurance sampling: a pragmatic tool for timely assessment of vaccination coverage.

PubMed

Greenland, K; Rondy, M; Chevez, A; Sadozai, N; Gasasira, A; Abanida, E A; Pate, M A; Ronveaux, O; Okayasu, H; Pedalino, B; Pezzoli, L

2011-07-01

To evaluate oral poliovirus vaccine (OPV) coverage of the November 2009 round in five Northern Nigeria states with ongoing wild poliovirus transmission using clustered lot quality assurance sampling (CLQAS). We selected four local government areas in each pre-selected state and sampled six clusters of 10 children in each Local Government Area, defined as the lot area. We used three decision thresholds to classify OPV coverage: 75-90%, 55-70% and 35-50%. A full lot was completed, but we also assessed in retrospect the potential time-saving benefits of stopping sampling when a lot had been classified. We accepted two local government areas (LGAs) with vaccination coverage above 75%. Of the remaining 18 rejected LGAs, 11 also failed to reach 70% coverage, of which four also failed to reach 50%. The average time taken to complete a lot was 10 h. By stopping sampling when a decision was reached, we could have classified lots in 5.3, 7.7 and 7.3 h on average at the 90%, 70% and 50% coverage targets, respectively. Clustered lot quality assurance sampling was feasible and useful to estimate OPV coverage in Northern Nigeria. The multi-threshold approach provided useful information on the variation of IPD vaccination coverage. CLQAS is a very timely tool, allowing corrective actions to be directly taken in insufficiently covered areas. © 2011 Blackwell Publishing Ltd.

Humoral immune response in dogs and cats vaccinated against rabies in southeastern Brazil

PubMed Central

2013-01-01

Background Brazil holds annual nationwide public campaigns to vaccinate dogs and cats against rabies. The presence of rabies antibodies in these animals, which are among the main transmitters of rabies to humans, is a good indicator that they are immunized and protected. Methods In the present study we analyzed 834 serum samples from dogs and cats from the Southeast of Brazil (Presidente Prudente and Dracena cities), 12 months after the 2009 vaccination campaign. We used the technique known as rapid fluorescent focus inhibition test (RFFIT) and considered reactant those sera with values higher 0.5 IU/mL. Results and discussion Reactant sample results in Presidente Prudente were 153 (51.0%) for dogs and 59 (32.6%) for cats, and in Dracena 110 (52.1%) for dogs and 71 (50.0%) for cats. We discussed vaccine coverage of animals involved in this experiment, and observed low titers < 0.5 IU/mL, especially in cats from Presidente Prudente. Conclusion According to the results presented in our experiment, we suggest that titers below 0.5 IU/mL are worrisome and that, for multiple reasons, animals should be immunized against rabies in the period between public vaccination campaigns. Hence, the desired vaccine coverage was not accomplished, especially among cats from Presidente Prudente. PMID:23899101