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Packham A, Taylor AE, Karangwa MP, Sherry E, Muvunyi C, Green CA. Measles Vaccine Coverage and Disease Outbreaks: A Systematic Review of the Early Impact of COVID-19 in Low and Lower-Middle Income Countries. Int J Public Health 2024; 69:1606997. [PMID: 38725903 PMCID: PMC11079172 DOI: 10.3389/ijph.2024.1606997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 03/27/2024] [Indexed: 05/12/2024] Open
Abstract
Objectives: We aimed to evaluate changes to measles-containing vaccine (MCV) provision and subsequent measles disease cases in low- and lower-middle income countries (LICs, LMICs) in relation to the COVID-19 pandemic. Methods: A systematic search was conducted of MEDLINE, OVID EMBASE and PubMed records. Primary quantitative and qualitative research studies published from January 2020 were included if they reported on COVID-19 impact on MCV provision and/or measles outbreak rates within LICs and LMICs. Results: 45 studies were included. The change in MCV1 vaccination coverage in national and international regions ranged -13% to +44.4% from pre-COVID time periods. In local regions, the median MCV1 and overall EPI rate changed by -23.3% and -28.5% respectively. Median MCV2 rate was disproportionally impacted in local areas during COVID-interruption time-periods (-48.2%) with ongoing disruption in early-recovery time-periods (-17.7%). 8.9% of studies reported on vaccination status of confirmed measles cases; from these, 71%-91% had received no MCV dose. Conclusion: MCV vaccination coverage experienced ongoing disruption during the recovery periods after initial COVID-19 disruption. Vaccination in local area datasets notably experienced longer-term disruption compared to nationally reported figures.
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Affiliation(s)
- Alice Packham
- School of Chemical Engineering, College of Engineering and Physical Sciences, University of Birmingham, Birmingham, England, United Kingdom
- Department of Infectious Diseases and Tropical Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Alice E. Taylor
- School of Chemical Engineering, College of Engineering and Physical Sciences, University of Birmingham, Birmingham, England, United Kingdom
- Department of Infectious Diseases and Tropical Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | | | - Emma Sherry
- School of Chemical Engineering, College of Engineering and Physical Sciences, University of Birmingham, Birmingham, England, United Kingdom
- Department of Infectious Diseases and Tropical Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | | | - Christopher A. Green
- School of Chemical Engineering, College of Engineering and Physical Sciences, University of Birmingham, Birmingham, England, United Kingdom
- Department of Infectious Diseases and Tropical Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
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Campbell JD, Pasetti MF, Oot L, Adam Z, Tefera M, Beyane B, Mulholland N, Steinglass R, Krey R, Chen WH, Blackwelder WC, Levine MM. Linked vaccination coverage surveys plus serosurveys among Ethiopian toddlers undertaken three years apart to compare coverage and serologic evidence of protection in districts implementing the RED-QI approach. Vaccine 2021; 39:5802-5813. [PMID: 34465472 PMCID: PMC8494116 DOI: 10.1016/j.vaccine.2021.08.071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 08/15/2021] [Accepted: 08/18/2021] [Indexed: 11/19/2022]
Abstract
A seroprotective tetanus titer indicates a toddler has received pentavalent vaccine. Serosurveys document increased seroprevalence post-measles vaccination campaigns. Vaccination coverage/serosurveys can assess interventions to improve immunizations.
In low and middle-income countries, estimating the proportion of vaccinated toddlers in a population is important for controlling vaccine-preventable diseases by identifying districts where immunization services need strengthening. Estimates measured before and several years after specific interventions can assess program performance. However, employing different methods to derive vaccination coverage estimates often yield differing results. Methods Linked vaccination coverage surveys and seroprotection surveys performed among ~300 toddlers 12–23 months of age in districts (woredas), one per region, of Ethiopia (total, ~900 toddlers) in 2013 to estimate the proportion vaccinated with tetanus toxoid (a proxy for pentavalent vaccine) and measles vaccine. The surveys were followed by implementation of the Reaching Every District using Quality Improvement (RED-QI) approach to strengthen the immunization system. Linked coverage/serosurveys were repeated in 2016 to assess effects of the interventions on vaccination coverage. Indicators included “documented coverage” (vaccination card and/or health facility register records) and “crude coverage” (documented plus parent/caretaker recall for children without cards). Seroprotection thresholds were IgG-ELISA tetanus antitoxin ≥0.05 IU/ml and plaque reduction neutralization (PRN) measles titers ≥120 mIU/ml. Findings Improved markers in 2016 over 2013 include coverage of pentavalent vaccination, vaccination timeliness, and fewer missed opportunities to vaccinate. In parallel, tetanus seroprotection increased in the 3 woredas from 59.6% to 79.1%, 72.9% to 83.7%, and 94.3 to 99.3%. In 2015, the Ethiopian government conducted supplemental measles mass vaccination campaigns in several regions including one that involved a project woreda and the campaign overlapped with the RED-QI intervention timeframe; protective measles PRN titers there rose from 31.0% to 50.0%. Interpretation The prevalence of seroprotective titers of tetanus antitoxin (stimulated by tetanus toxoid components within pentavalent vaccine) provides a reliable biomarker to identify children who received pentavalent vaccine. In the three study woredas, the RED-QI intervention appeared to improve immunization service delivery, as documented by enhanced pentavalent vaccine coverage, vaccination timeliness, and fewer missed vaccination opportunities. A measles mass vaccination campaign was followed by a markedly increased prevalence of measles PRN antibodies. Collectively, these observations suggest that wider implementation of RED-QI can strengthen immunization, and periodic linked vaccination surveys/serosurveys can monitor changes.
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Affiliation(s)
- James D Campbell
- Center for Vaccine Development and Global Health, Baltimore, MD 21201, USA; Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Marcela F Pasetti
- Center for Vaccine Development and Global Health, Baltimore, MD 21201, USA; Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Lisa Oot
- JSI Research & Training Institute Inc., Arlington, VA, USA
| | - Zenaw Adam
- JSI Research & Training Institute Inc., Arlington, VA, USA
| | - Mesfin Tefera
- Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia
| | - Berhane Beyane
- Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia
| | - Nigisti Mulholland
- Family & Reproductive Rights Education Program (FARREP), The Royal Women's Hospital, Parkville, VIC 3052, Australia
| | | | - Rebecca Krey
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Wilbur H Chen
- Center for Vaccine Development and Global Health, Baltimore, MD 21201, USA; Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - William C Blackwelder
- Center for Vaccine Development and Global Health, Baltimore, MD 21201, USA; Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA; Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Myron M Levine
- Center for Vaccine Development and Global Health, Baltimore, MD 21201, USA; Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD 21201, USA; Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
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Procter SR, Abbas K, Flasche S, Griffiths U, Hagedorn B, O'Reilly KM, Jit M. SARS-CoV-2 infection risk during delivery of childhood vaccination campaigns: a modelling study. BMC Med 2021; 19:198. [PMID: 34384441 PMCID: PMC8359640 DOI: 10.1186/s12916-021-02072-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 07/26/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has disrupted the delivery of immunisation services globally. Many countries have postponed vaccination campaigns out of concern about infection risks to the staff delivering vaccination, the children being vaccinated, and their families. The World Health Organization recommends considering both the benefit of preventive campaigns and the risk of SARS-CoV-2 transmission when making decisions about campaigns during COVID-19 outbreaks, but there has been little quantification of the risks. METHODS We modelled excess SARS-CoV-2 infection risk to vaccinators, vaccinees, and their caregivers resulting from vaccination campaigns delivered during a COVID-19 epidemic. Our model used population age structure and contact patterns from three exemplar countries (Burkina Faso, Ethiopia, and Brazil). It combined an existing compartmental transmission model of an underlying COVID-19 epidemic with a Reed-Frost model of SARS-CoV-2 infection risk to vaccinators and vaccinees. We explored how excess risk depends on key parameters governing SARS-CoV-2 transmissibility, and aspects of campaign delivery such as campaign duration, number of vaccinations, and effectiveness of personal protective equipment (PPE) and symptomatic screening. RESULTS Infection risks differ considerably depending on the circumstances in which vaccination campaigns are conducted. A campaign conducted at the peak of a SARS-CoV-2 epidemic with high prevalence and without special infection mitigation measures could increase absolute infection risk by 32 to 45% for vaccinators and 0.3 to 0.5% for vaccinees and caregivers. However, these risks could be reduced to 3.6 to 5.3% and 0.1 to 0.2% respectively by use of PPE that reduces transmission by 90% (as might be achieved with N95 respirators or high-quality surgical masks) and symptomatic screening. CONCLUSIONS SARS-CoV-2 infection risks to vaccinators, vaccinees, and caregivers during vaccination campaigns can be greatly reduced by adequate PPE, symptomatic screening, and appropriate campaign timing. Our results support the use of adequate risk mitigation measures for vaccination campaigns held during SARS-CoV-2 epidemics, rather than cancelling them entirely.
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Affiliation(s)
- Simon R Procter
- Centre for Mathematical Modelling of Infectious Disease, London School of Hygiene and Tropical Medicine, WC1E 7HT, London, UK.
| | - Kaja Abbas
- Centre for Mathematical Modelling of Infectious Disease, London School of Hygiene and Tropical Medicine, WC1E 7HT, London, UK
| | - Stefan Flasche
- Centre for Mathematical Modelling of Infectious Disease, London School of Hygiene and Tropical Medicine, WC1E 7HT, London, UK
| | | | | | - Kathleen M O'Reilly
- Centre for Mathematical Modelling of Infectious Disease, London School of Hygiene and Tropical Medicine, WC1E 7HT, London, UK
| | - Mark Jit
- Centre for Mathematical Modelling of Infectious Disease, London School of Hygiene and Tropical Medicine, WC1E 7HT, London, UK
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Amani A, Fouda AAB, Nangmo AJ, Bama SN, Tatang CA, Mbang MA, Douba ECE, Noula AGM, Dia M, Bouhenia M. Reactive mass vaccination campaign against cholera in the COVID-19 context in Cameroon: challenges, best practices and lessons learned. Pan Afr Med J 2021; 38:392. [PMID: 34381536 PMCID: PMC8325454 DOI: 10.11604/pamj.2021.38.392.27754] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 04/05/2021] [Indexed: 11/11/2022] Open
Abstract
Introduction since 1971, Cameroon is facing a growing series of cholera epidemics despite all the efforts made by the government to address this huge public health threat. In 2020, in addition to the COVID-19 pandemic, Cameroon recorded a high cholera case fatality rate of 4.3% following epidemics noted in the South, Littoral and South-West regions. The Cameroon Ministry of Public Health, has thus organized a reactive vaccination campaign against cholera to address the high mortality rate in the affected health districts of those regions. The objective of this study was to describe the challenges, best practices and lessons learned drawing from daily experiences from this reactive vaccination campaign against cholera. Methods we conducted a cross-sectional study drawn from the results of the campaign. We had a target population of 631,109 participants aged 1 year and above resident of the targeted health areas. Results the overall vaccination coverage was 64.4% with a refusal rate ranging from 0-10% according to health districts. Vaccination coverage was the lowest among people aged 20 years and above. The main challenge was difficulty maintaining physical distanciation, the main best practice was the screening of all actors taking part at the vaccination against COVID-19 and we found that emphasizing on thorough population sensitization through quarter heads and social mobilizers and adequately programming the campaign during a good climate season is crucial to achieving good vaccination coverage. Conclusion lessons learned from this study could serve to inform various agencies in the event of planning rapid mass vaccination programs during pandemics.
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Affiliation(s)
- Adidja Amani
- Sub-Directorate of Vaccination, Directorate of Family Health, Ministry of Public Health, Yaoundé, Cameroon
| | - André Arsène Bita Fouda
- World Health Organization, Regional Office for Africa, Vaccine-Preventable Disease Unit, Brazzaville, Republic of Congo
| | | | | | - Collins Asaah Tatang
- Sub-Directorate of Vaccination, Directorate of Family Health, Ministry of Public Health, Yaoundé, Cameroon
| | - Marie Angèle Mbang
- Sub-Directorate of Vaccination, Directorate of Family Health, Ministry of Public Health, Yaoundé, Cameroon
| | - Emmanuel Christian Epee Douba
- National Operating Office, Disease Prevention and Control Office, Emergency Preparedness and Control Office, World Health Organization Country Office, Yaoundé, Cameroon
| | - Aimé Gilbert Mbonda Noula
- Community Epidemic and Pandemic Preparedness, International Federation of Red Cross and Red Crescent Societies Cluster Support Team, Central Africa Region, Yaoundé, Cameroon
| | - Mariette Dia
- World Health Organization Africa Office, Brazzaville, Republic of Congo
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