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Bender RG, Shen J, Aravkin A, Bita Fouda AA, Bwaka AM, Galles NC, Haeuser E, Hay SI, Latt A, Mwenda JM, Rogowski EL, Sbarra AN, Sorensen RJ, Vongpradith A, Wright C, Zheng P, Mosser JF, Kyu HH. Meningococcal A conjugate vaccine coverage in the meningitis belt of Africa from 2010 to 2021: a modelling study. EClinicalMedicine 2023; 56:101797. [PMID: 36880052 PMCID: PMC9985031 DOI: 10.1016/j.eclinm.2022.101797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 12/02/2022] [Accepted: 12/05/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND As of the end of 2021, twenty-four countries in the African meningitis belt have rolled out mass campaigns of MenAfriVac®, a meningococcal A conjugate vaccine (MACV) first introduced in 2010. Twelve have completed introduction of MACV into routine immunisation (RI) schedules. Although select post-campaign coverage data are published, no study currently comprehensively estimates MACV coverage from both routine and campaign sources in the meningitis belt across age, country, and time. METHODS In this modelling study, we assembled campaign data from the twenty-four countries that had introduced any immunisation activity during or before the year 2021 (Benin, Burkina Faso, Burundi, Cameroon, Central African Republic, Chad, Côte d'Ivoire, Democratic Republic of the Congo, Ethiopia, Eritrea, the Gambia, Ghana, Guinea, Guinea Bissau, Kenya, Mali, Mauritania, Niger, Nigeria, Senegal, South Sudan, Sudan, Togo and Uganda) via WHO reports and RI data via systematic review. Next, we modelled RI coverage using Spatiotemporal Gaussian Process Regression. Then, we synthesized these estimates with campaign data into a cohort model, tracking coverage for each age cohort from age 1 to 29 years over time for each country. FINDINGS Coverage in high-risk locations amongst children aged 1-4 in 2021 was estimated to be highest in Togo with 96.0% (95% uncertainty interval [UI] 92.0-99.0), followed by Niger with 87.2% (95% UI 85.3-89.0) and Burkina Faso, with 86.4% (95% UI 85.1-87.6). These countries had high coverage values driven by an initial successful mass immunisation campaign, followed by a catch-up campaign, followed by introduction of RI. Due to the influence of older mass vaccination campaigns, coverage proportions skewed higher in the 1-29 age group than the 1-4 group, with a median coverage of 82.9% in 2021 in the broader age group compared to 45.6% in the narrower age group. INTERPRETATION These estimates highlight where gaps in immunisation remain and emphasise the need for broader efforts to strengthen RI systems. This methodological framework can be applied to estimate coverage for any vaccine that has been delivered in both routine and supplemental immunisation activities. FUNDING Bill and Melinda Gates Foundation.
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Affiliation(s)
- Rose G. Bender
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA
| | - Jasmine Shen
- School of Medicine, University of Washington, Seattle, WA, USA
| | - Aleksandr Aravkin
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Applied Mathematics, University of Washington, Seattle, WA, USA
| | | | - Ado M. Bwaka
- World Health Organization Regional Office for Africa, Inter-Country Support Team, Ouagadougou, Burkina Faso
| | - Natalie C. Galles
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Emily Haeuser
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Simon I. Hay
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA
| | - Anderson Latt
- World Health Organization Regional Office for Africa, Emergency Preparedness and Response Cluster, Dakar Emergency Hub, Dakar, Senegal
| | - Jason M. Mwenda
- World Health Organization Regional Office for Africa, Brazzaville, Republic of Congo
| | - Emma L.B. Rogowski
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Alyssa N. Sbarra
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Reed J.D. Sorensen
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Avina Vongpradith
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | | | - Peng Zheng
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA
| | - Jonathan F. Mosser
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA
- Corresponding author. Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave NE, Seattle, WA 98105, USA.
| | - Hmwe H. Kyu
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA
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Goshu Muluneh A, Woldemariam Merid M, Tigabu B, Getie Ferede M, Molla Kassa G, Animut Y. Less than one-fifth of Ethiopian children were vaccinated for measles second dose; evidence from the Ethiopian mini demographic and health survey 2019. Vaccine X 2022; 12:100217. [PMID: 36148266 PMCID: PMC9486014 DOI: 10.1016/j.jvacx.2022.100217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 09/02/2022] [Accepted: 09/06/2022] [Indexed: 11/27/2022] Open
Abstract
Ethiopia introduced the measles second dose vaccine from the routine expanded immunization program in 2018. Shreds of evidence are scarce on the measles second dose vaccination coverage and its associated factors in Ethiopia. We aimed to assess the measles second dose vaccination coverage and associated factors in Ethiopia using the recent Ethiopian Mini Demographic and Health Survey (EMDHS) 2019 data. An in-depth secondary data analysis was conducted based on the Ethiopian mini demographic and health survey 2019 data; which was a cross-sectional survey targeted on key indicators of maternal and child health. A weighted sample of 965 children was included in the analysis. A multi-level mixed effect logistics regression model was fitted. Adjusted Odds Ratio (AOR) with 95 %CI was reported for statistically significant variables. The measles second dose coverage was 12.36 % (95 %CI = 10.89, 15.44). Not vaccinated for the third dose of pentavalent vaccine (Penta 3) (AOR = 0.60, 95 %CI: 0.37, 0.95), age of the child [13 to 23 months (AOR = 2.14, 95 %CI: 1.05, 4.36), 24 to 36 months (AOR = 2.58, 95 %CI: 1.32, 5.05)], household head educational status [no education (AOR = 0.51,95 %CI: 0.26, 0.99), primary (AOR = 0.44, 95 %CI: 0.23, 0.85)], and living in south nation, nationalities and peoples region (SNNPR) (AOR = 2.83,95 %CI: 1.12, 7.11) were significantly associated with measles second dose vaccination coverage. Measles second dose vaccination coverage was low in Ethiopia. Age of the child, being vaccinated for the Penta 3, educational status of the household head, and region of residence were significant determinants of measles second dose vaccination coverage.
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Aksnes BN, Walldorf JA, Nkwenkeu SF, Zoma RL, Mirza I, Tarbangdo F, Fall S, Hien S, Ky C, Kambou L, Diallo AO, Aké FH, Hatcher C, Patel JC, Novak RT, Hyde TB, Medah I, Soeters HM, Jalloh MF. Vaccination information, motivations, and barriers in the context of meningococcal serogroup A conjugate vaccine introduction: A qualitative assessment among caregivers in Burkina Faso, 2018. Vaccine 2021; 39:6370-6377. [PMID: 34579975 PMCID: PMC8519392 DOI: 10.1016/j.vaccine.2021.09.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 09/13/2021] [Accepted: 09/14/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND In March 2017, Burkina Faso introduced meningococcal serogroup A conjugate vaccine (MACV) into the Expanded Programme on Immunization. MACV is administered to children aged 15-18 months, concomitantly with the second dose of measles-containing vaccine (MCV2). One year after MACV introduction, we assessed the sources and content of immunization information available to caregivers and explored motivations and barriers that influence their decision to seek MACV for their children. METHODS Twenty-four focus group discussions (FGDs) were conducted with caregivers of children eligible for MACV and MCV2. Data collection occurred in February-March 2018 in four purposively selected districts, each from a separate geographic region; within each district, caregivers were stratified into groups based on whether their children were unvaccinated or vaccinated with MACV. FGDs were recorded and transcribed. Transcripts were coded and analyzed using qualitative content analysis. RESULTS We identified many different sources and content of information about MACV and MCV2 available to caregivers. Healthcare workers were most commonly cited as the main sources of information; caregivers also received information from other caregivers in the community. Caregivers' motivations to seek MACV for their children were driven by personal awareness, engagements with trusted messengers, and perceived protective benefits of MACV against meningitis. Barriers to MACV and MCV2 uptake were linked to the unavailability of vaccines, immunization personnel not providing doses, knowledge gaps about the 15-18 month visit, practical constraints, past negative experiences, sociocultural influences, and misinformation, including misunderstanding about the need for MCV2. CONCLUSIONS MACV and MCV2 uptake may be enhanced by addressing vaccination barriers and effectively communicating vaccination information and benefits through trusted messengers such as healthcare workers and other caregivers in the community. Educating healthcare workers to avoid withholding vaccines, likely due to fear of wastage, may help reduce missed opportunities for vaccination.
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Affiliation(s)
| | - Jenny A Walldorf
- Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | | | - Robert L Zoma
- Institut National de Statistique et Démographie, Ouagadougou, Burkina Faso
| | | | | | | | | | - Cesaire Ky
- Ministère de la Santé, Ouagadougou, Burkina Faso
| | | | | | | | - Cynthia Hatcher
- Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - Jaymin C Patel
- Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - Ryan T Novak
- Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - Terri B Hyde
- Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - Isaïe Medah
- Ministère de la Santé, Ouagadougou, Burkina Faso
| | - Heidi M Soeters
- Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA.
| | - Mohamed F Jalloh
- Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
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Mbaeyi S, Sampo E, Dinanibè K, Yaméogo I, Congo-Ouédraogo M, Tamboura M, Sawadogo G, Ouattara K, Sanou M, Kiemtoré T, Dioma G, Sanon B, Somlaré H, Kyetega A, Ba AK, Aké F, Tarbangdo F, Aboua FA, Donnou Y, Kamaté I, Patel JC, Schmink S, Spiller MW, Topaz N, Novak R, Wang X, Bicaba B, Sangaré L, Ouédraogo-Traoré R, Kristiansen PA. Meningococcal carriage 7 years after introduction of a serogroup A meningococcal conjugate vaccine in Burkina Faso: results from four cross-sectional carriage surveys. Lancet Infect Dis 2020; 20:1418-1425. [PMID: 32653071 PMCID: PMC7689286 DOI: 10.1016/s1473-3099(20)30239-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 02/05/2020] [Accepted: 03/12/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND In the first 2 years after a nationwide mass vaccination campaign of 1-29-year-olds with a meningococcal serogroup A conjugate vaccine (MenAfriVac) in Burkina Faso, carriage and disease due to serogroup A Neisseria meningitidis were nearly eliminated. We aimed to assess the long-term effect of MenAfriVac vaccination on meningococcal carriage and herd immunity. METHODS We did four cross-sectional studies of meningococcal carriage in people aged 9 months to 36 years in two districts of Burkina Faso between May 2, 2016, and Nov 6, 2017. Demographic information and oropharyngeal swabs were collected. Meningococcal isolates were characterised using whole-genome sequencing. FINDINGS Of 14 295 eligible people, 13 758 consented and had specimens collected and laboratory results available, 1035 of whom were meningococcal carriers. Accounting for the complex survey design, prevalence of meningococcal carriage was 7·60% (95% CI 5·67-9·52), including 6·98% (4·86-9·11) non-groupable, 0·48% (0·01-0·95) serogroup W, 0·10% (0·01-0·18) serogroup C, 0·03% (0·00-0·80) serogroup E, and 0% serogroup A. Prevalence ranged from 5·44% (95% CI 4·18-6·69) to 9·14% (6·01-12·27) by district, from 4·67% (2·71-6·64) to 11·17% (6·75-15·59) by round, and from 3·39% (0·00-8·30) to 10·43% (8·08-12·79) by age group. By clonal complex, 822 (88%) of 934 non-groupable isolates were CC192, all 83 (100%) serogroup W isolates were CC11, and nine (69%) of 13 serogroup C isolates were CC10217. INTERPRETATION Our results show the continued effect of MenAfriVac on serogroup A meningococcal carriage, for at least 7 years, among vaccinated and unvaccinated cohorts. Carriage prevalence of epidemic-prone serogroup C CC10217 and serogroup W CC11 was low. Continued monitoring of N meningitidis carriage will be crucial to further assess the effect of MenAfriVac and inform the vaccination strategy for future multivalent meningococcal vaccines. FUNDING Bill & Melinda Gates Foundation and Gavi, the Vaccine Alliance.
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Affiliation(s)
- Sarah Mbaeyi
- National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | | | - Kambiré Dinanibè
- Centre Hospitalier Universitaire Pédiatrique Charles de Gaulle, Ouagadougou, Burkina Faso
| | - Issaka Yaméogo
- Direction de la Protection de la Santé de la Population, Burkina Faso Ministry of Health, Ouagadougou, Burkina Faso
| | | | - Mamadou Tamboura
- Centre Hospitalier Universitaire Pédiatrique Charles de Gaulle, Ouagadougou, Burkina Faso
| | - Guetawendé Sawadogo
- Direction de la Protection de la Santé de la Population, Burkina Faso Ministry of Health, Ouagadougou, Burkina Faso
| | - Kalifa Ouattara
- Centre Hospitalier Universitaire de Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - Mahamadou Sanou
- Centre Hospitalier Universitaire Pédiatrique Charles de Gaulle, Ouagadougou, Burkina Faso
| | - Tanga Kiemtoré
- Direction de la Protection de la Santé de la Population, Burkina Faso Ministry of Health, Ouagadougou, Burkina Faso
| | - Gerard Dioma
- Centre Hospitalier Universitaire de Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - Barnabé Sanon
- Centre Hospitalier Régional de Kaya, Kaya, Burkina Faso
| | - Hermann Somlaré
- Centre Hospitalier Universitaire de Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - Augustin Kyetega
- Centre Hospitalier Universitaire Pédiatrique Charles de Gaulle, Ouagadougou, Burkina Faso
| | - Absatou Ky Ba
- Centre Hospitalier Universitaire du Bogodogo, Ouagadougou, Burkina Faso
| | - Flavien Aké
- Davycas International, Gounghin Petit-Paris, Ouagadougou, Burkina Faso
| | - Félix Tarbangdo
- Davycas International, Gounghin Petit-Paris, Ouagadougou, Burkina Faso
| | | | - Yvette Donnou
- Davycas International, Gounghin Petit-Paris, Ouagadougou, Burkina Faso
| | - Idrissa Kamaté
- World Health Organization, Intercountry Support Team, Ouagadougou, Burkina Faso
| | - Jaymin C Patel
- National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Susanna Schmink
- National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Michael W Spiller
- National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Nadav Topaz
- National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ryan Novak
- National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Xin Wang
- National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Brice Bicaba
- Direction de la Protection de la Santé de la Population, Burkina Faso Ministry of Health, Ouagadougou, Burkina Faso
| | - Lassana Sangaré
- Centre Hospitalier Universitaire de Yalgado Ouédraogo, Ouagadougou, Burkina Faso
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Kaboré L, Meda B, Médah I, Shendale S, Nic Lochlainn L, Sanderson C, Ouattara M, Kaboré WMF, Betsem E, Ogbuanu IU. Assessment of missed opportunities for vaccination (MOV) in Burkina Faso using the World Health Organization's revised MOV strategy: Findings and strategic considerations to improve routine childhood immunization coverage. Vaccine 2020; 38:7603-7611. [PMID: 33077298 PMCID: PMC7604568 DOI: 10.1016/j.vaccine.2020.10.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/04/2020] [Accepted: 10/07/2020] [Indexed: 11/30/2022]
Abstract
We assessed reasons for missed opportunities for vaccination (MOV) in Burkina Faso. We found the prevalence of MOV was 76% among all eligible children. The prevalence of MOV was 97% among children attending for a non-vaccination visit. Health workers’ knowledge, attitude and practices were insufficient to minimize MOV. Reducing MOV can result in increases to both vaccine coverage and equity.
Background Despite the remarkable achievements of the Expanded Programme on Immunization (EPI) in Burkina Faso, numerous challenges remain, including missed opportunities for vaccination (MOV) which occur when people visit a health facility with at least one vaccine due according to the national immunization schedule, are free of contraindications, and leave without receiving all due vaccine doses. In 2016, we used the revised World Health Organization’s (WHO) MOV strategy to assess the extent of and reasons for MOV in Burkina Faso. Methods We purposively selected 27 primary health facilities (PHFs) from the eight health districts with the highest absolute numbers of children who missed the first dose of measles-rubella (MR1) in 2015. We conducted exit interviews with caregivers of children aged 0–23 months, and requested health workers to complete a self-administered knowledge, attitudes and practices (KAP) questionnaire. Results A total of 489 caregivers were interviewed, of which 411 were eligible for inclusion in our analysis. Medical consultation (35%) and vaccination (24.5%) were the most frequent reasons for visiting PHFs. Among the 73% of children eligible for vaccination, 76% of vaccination opportunities were missed. Among eligible children, the percentage with MOV was significantly higher in those aged ≥12 months and also in those attending for a reason other than vaccination. A total of 248 health workers completed the KAP questionnaire. Of these, 70% (n = 168/239) considered their knowledge on immunization to be insufficient or outdated; 83% failed to correctly identify valid contraindications to vaccination. Conclusion Addressing MOV offers the potential for substantial increases in vaccine coverage and equity, and ultimately reducing the burden of vaccine-preventable diseases (VPDs). This will require the implementation of a series of interventions aimed at improving community knowledge and practices, raising health workers’ awareness, and fostering the integration of immunization with other health services.
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Affiliation(s)
- Lassané Kaboré
- Agence de Médecine Préventive (AMP), Ouagadougou, Burkina Faso.
| | - Bertrand Meda
- Agence de Médecine Préventive (AMP), Ouagadougou, Burkina Faso
| | - Isaie Médah
- Ministry of Health, Direction de la Prévention par les Vaccinations (DPV), Ouagadougou, Burkina Faso
| | - Stephanie Shendale
- Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization, Geneva, Switzerland
| | - Laura Nic Lochlainn
- Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization, Geneva, Switzerland
| | - Colin Sanderson
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Mâ Ouattara
- World Health Organization, Country Office, Ouagadougou, Burkina Faso
| | - William M F Kaboré
- Ministry of Health, Direction de la Prévention par les Vaccinations (DPV), Ouagadougou, Burkina Faso
| | - Edouard Betsem
- Agence de Médecine Préventive (AMP), Ouagadougou, Burkina Faso; Laboratoire Mixte International de Vaccinologie (LAMIVAC), Bobo-Dioulasso, Burkina Faso
| | - Ikechukwu U Ogbuanu
- Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization, Geneva, Switzerland
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6
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Patel JC, Soeters HM, Diallo AO, Bicaba BW, Kadadé G, Dembélé AY, Acyl MA, Nikiema C, Lingani C, Hatcher C, Acosta AM, Thomas JD, Diomande F, Martin S, Clark TA, Mihigo R, Hajjeh RA, Zilber CH, Aké F, Mbaeyi SA, Wang X, Moisi JC, Ronveaux O, Mwenda JM, Novak RT. MenAfriNet: A Network Supporting Case-Based Meningitis Surveillance and Vaccine Evaluation in the Meningitis Belt of Africa. J Infect Dis 2020; 220:S148-S154. [PMID: 31671453 DOI: 10.1093/infdis/jiz308] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Meningococcal meningitis remains a significant public health threat, especially in the African meningitis belt where Neisseria meningitidis serogroup A historically caused large-scale epidemics. With the rollout of a novel meningococcal serogroup A conjugate vaccine (MACV) in the belt, the World Health Organization recommended case-based meningitis surveillance to monitor MACV impact and meningitis epidemiology. In 2014, the MenAfriNet consortium was established to support strategic implementation of case-based meningitis surveillance in 5 key countries: Burkina Faso, Chad, Mali, Niger, and Togo. MenAfriNet aimed to develop a high-quality surveillance network using standardized laboratory and data collection protocols, develop sustainable systems for data management and analysis to monitor MACV impact, and leverage the surveillance platform to perform special studies. We describe the MenAfriNet consortium, its history, strategy, implementation, accomplishments, and challenges.
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Affiliation(s)
- Jaymin C Patel
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Heidi M Soeters
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alpha Oumar Diallo
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | - Mahamat A Acyl
- Ministère de la Santé Publique du Tchad, N'Djamena, Tchad
| | | | - Clement Lingani
- World Health Organization, AFRO Intercountry Support Team for West Africa, Ouagadougou, Burkina Faso
| | - Cynthia Hatcher
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Anna M Acosta
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jennifer D Thomas
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Fabien Diomande
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Stacey Martin
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Thomas A Clark
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Richard Mihigo
- World Health Organization Regional Office for Africa, Brazzaville, Republic of the Congo
| | - Rana A Hajjeh
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Flavien Aké
- Davycas International, Ouagadougou, Burkina Faso
| | - Sarah A Mbaeyi
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Xin Wang
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jennifer C Moisi
- Agence de Médecine Préventive, Paris, France, Geneva, Switzerland
| | | | - Jason M Mwenda
- World Health Organization Regional Office for Africa, Brazzaville, Republic of the Congo
| | - Ryan T Novak
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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Abstract
The recent setbacks in efforts to achieve measles elimination goals are alarming. To reverse the current trends, it is imperative that the global health community urgently intensify efforts and make resource commitments to implement evidence-based elimination strategies fully, including supporting research and innovations. The Immunization Agenda 2030: A Global Strategy to Leave No One Behind (IA2030) is the new global guidance document that builds on lessons learned and progress made toward the GVAP goals, includes research and innovation as a core strategic priority, and identifies measles as a “tracer” for improving immunisation services and strengthening primary health care systems. To achieve vaccination coverage and equity targets that leave no one behind, and accelerate progress toward disease eradication and elimination goals, sustained and predictable investments are needed for the identified research and innovations priorities for the new decade.
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Affiliation(s)
- James L Goodson
- Accelerated Disease Control and Surveillance Branch, Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Nkwenkeu SF, Jalloh MF, Walldorf JA, Zoma RL, Tarbangdo F, Fall S, Hien S, Combassere R, Ky C, Kambou L, Diallo AO, Krishnaswamy A, Aké FH, Hatcher C, Patel JC, Medah I, Novak RT, Hyde TB, Soeters HM, Mirza I. Health workers' perceptions and challenges in implementing meningococcal serogroup a conjugate vaccine in the routine childhood immunization schedule in Burkina Faso. BMC Public Health 2020; 20:254. [PMID: 32075630 PMCID: PMC7031928 DOI: 10.1186/s12889-020-8347-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 02/12/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Meningococcal serogroup A conjugate vaccine (MACV) was introduced in 2017 into the routine childhood immunization schedule (at 15-18 months of age) in Burkina Faso to help reduce meningococcal meningitis burden. MACV was scheduled to be co-administered with the second dose of measles-containing vaccine (MCV2), a vaccine already in the national schedule. One year following the introduction of MACV, an assessment was conducted to qualitatively examine health workers' perceptions of MACV introduction, identify barriers to uptake, and explore opportunities to improve coverage. METHODS Twelve in-depth interviews were conducted with different cadres of health workers in four purposively selected districts in Burkina Faso. Districts were selected to include urban and rural areas as well as high and low MCV2 coverage areas. Respondents included health workers at the following levels: regional health managers (n = 4), district health managers (n = 4), and frontline healthcare providers (n = 4). All interviews were recorded, transcribed, and thematically analyzed using qualitative content analysis. RESULTS Four themes emerged around supply and health systems barriers, demand-related barriers, specific challenges related to MACV and MCV2 co-administration, and motivations and efforts to improve vaccination coverage. Supply and health systems barriers included aging cold chain equipment, staff shortages, overworked and poorly trained staff, insufficient supplies and financial resources, and challenges with implementing community outreach activities. Health workers largely viewed MACV introduction as a source of motivation for caregivers to bring their children for the 15- to 18-month visit. However, they also pointed to demand barriers, including cultural practices that sometimes discourage vaccination, misconceptions about vaccines, and religious beliefs. Challenges in co-administering MACV and MCV2 were mainly related to reluctance among health workers to open multi-dose vials unless enough children were present to avoid wastage. CONCLUSIONS To improve effective administration of vaccines in the second-year of life, adequate operational and programmatic planning, training, communication, and monitoring are necessary. Moreover, clear policy communication is needed to help ensure that health workers do not refrain from opening multi-dose vials for small numbers of children.
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Affiliation(s)
| | - Mohamed F. Jalloh
- U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329 USA
| | - Jenny A. Walldorf
- U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329 USA
| | - Robert L. Zoma
- Institut National de Statistique et Démographie, Ouagadougou, Burkina Faso
| | | | - Soukeynatou Fall
- UNICEF Ouagadougou, 01 PO Box 3420, Ouagadougou 01, Burkina Faso
| | - Sansan Hien
- UNICEF Ouagadougou, 01 PO Box 3420, Ouagadougou 01, Burkina Faso
| | | | - Cesaire Ky
- Ministère de la Santé, Ouagadougou, Burkina Faso
| | | | | | | | | | - Cynthia Hatcher
- U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329 USA
| | - Jaymin C. Patel
- U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329 USA
| | - Isaïe Medah
- Ministère de la Santé, Ouagadougou, Burkina Faso
| | - Ryan T. Novak
- U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329 USA
| | - Terri B. Hyde
- U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329 USA
| | - Heidi M. Soeters
- U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329 USA
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Novak RT, Ronveaux O, Bita AF, Aké HF, Lessa FC, Wang X, Bwaka AM, Fox LM. Future Directions for Meningitis Surveillance and Vaccine Evaluation in the Meningitis Belt of Sub-Saharan Africa. J Infect Dis 2019; 220:S279-S285. [PMID: 31671452 PMCID: PMC6822967 DOI: 10.1093/infdis/jiz421] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
In sub-Saharan Africa, bacterial meningitis remains a significant public health problem, especially in the countries of the meningitis belt, where Neisseria meningitidis serogroup A historically caused large-scale epidemics. In 2014, MenAfriNet was established as a consortium of partners supporting strategic implementation of case-based meningitis surveillance to monitor meningitis epidemiology and impact of meningococcal serogroup A conjugate vaccine (MACV). MenAfriNet improved data quality through use of standardized tools, procedures, and laboratory diagnostics. MenAfriNet surveillance and study data provided evidence of ongoing MACV impact, characterized the burden of non-serogroup A meningococcal disease (including the emergence of a new epidemic clone of serogroup C), and documented the impact of pneumococcal conjugate vaccine. New vaccines and schedules have been proposed for future implementation to address the remaining burden of meningitis. To support the goals of "Defeating Meningitis by 2030," MenAfriNet will continue to strengthen surveillance and support research and modeling to monitor the impact of these programs on meningitis burden in sub-Saharan Africa.
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Affiliation(s)
- Ryan T Novak
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - André F Bita
- WHO Regional Office for Africa, Brazzaville, Congo
| | | | - Fernanda C Lessa
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Xin Wang
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ado M Bwaka
- WHO Inter-Country Support Team West Africa, Ouagadougou, Burkina Faso
| | - LeAnne M Fox
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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10
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Novak RT, Moïsi JC, Tall H, Preziosi MP, Hadler SC, Messonnier NE, Mihigo R. Country Data for Action: The MenAfriNet Experience in Strengthening Meningitis Surveillance in Africa. J Infect Dis 2019; 220:S137-S139. [PMID: 31671440 DOI: 10.1093/infdis/jiz347] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ryan T Novak
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Haoua Tall
- Agence de Médecine Préventive, Ouagadougou, Burkina Faso
| | | | - Stephen C Hadler
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Nancy E Messonnier
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Richard Mihigo
- World Health Organization Regional Office for Africa, Brazzaville, Republic of the Congo
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