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Diallo M, Dicko I, Dembélé S, Konaté B, Doumbia CO, Sanogo I, Togola OB, Konaté D, Sangaré M, Thiam H, Coulibaly YI, Diawara SI, Toloba Y, Coulibaly AB, Diakité M, Doumbia S. Comparing vaccination coverage before and during COVID-19 pandemic in children under one year in the health district of commune V in Bamako, Mali. BMC Pediatr 2023; 23:599. [PMID: 38012578 PMCID: PMC10680293 DOI: 10.1186/s12887-023-04416-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 11/10/2023] [Indexed: 11/29/2023] Open
Abstract
INTRODUCTION Although an essential frontline service in the prevention of child morbidity and mortality, there are indications that routine vaccinations have been disrupted during the COVID-19 pandemic. The present study aimed to compare vaccination coverage before COVID-19 in Mali in 2019 and during COVID-19 in 2020. OBJECTIVE To compare vaccination coverages before COVID-19 in Mali in 2019 and during COVID-19 in 2020. DESIGN Cross-sectional study. SETTING AND PARTICIPANTS We collected routine immunization data from 2019 to 2020 of children under one year in the health district of Commune V in Bamako which includes twelve community health centers (CSCom). RESULTS Considering all vaccines together, coverage in 2019 was higher than in 2020 (88.7% vs. 71,6%) (p < 10- 3, Fig. 1). In 2020, low proportions of children vaccinated were observed in May (51.1%) two months after the first COVID-19 case in Mali on March 25, 2020. For all vaccines, the mean number of children vaccinated was significantly higher in 2019 (before COVID-19) as compared to 2020 (during COVID-19) (p < 0.05). However, in September and October 2019 BCG vaccine coverage was lower in 2019 as compared to 2020 (p < 10- 3). CONCLUSION COVID-19 pandemic has affected routine childhood vaccine coverage in Commune V of Bamako, particularly in May 2020. Therefore, new strategies are needed to improve vaccine coverage in young children below 1.
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Affiliation(s)
- Mountaga Diallo
- University Clinical Research Center (UCRC), University of Sciences, Techniques and Technologies of Bamako (USTT-B), Bamako, Mali.
| | - Ilo Dicko
- University Clinical Research Center (UCRC), University of Sciences, Techniques and Technologies of Bamako (USTT-B), Bamako, Mali
| | - Samou Dembélé
- University Clinical Research Center (UCRC), University of Sciences, Techniques and Technologies of Bamako (USTT-B), Bamako, Mali
| | - Brahima Konaté
- University Clinical Research Center (UCRC), University of Sciences, Techniques and Technologies of Bamako (USTT-B), Bamako, Mali
| | - Cheick Oumar Doumbia
- University Clinical Research Center (UCRC), University of Sciences, Techniques and Technologies of Bamako (USTT-B), Bamako, Mali
| | - Ibrahim Sanogo
- University Clinical Research Center (UCRC), University of Sciences, Techniques and Technologies of Bamako (USTT-B), Bamako, Mali
| | | | - Drissa Konaté
- University Clinical Research Center (UCRC), University of Sciences, Techniques and Technologies of Bamako (USTT-B), Bamako, Mali
| | - Moussa Sangaré
- Neglected Tropical Diseases Research Unit, University of Sciences, Techniques and Technologies of Bamako (USTT-B), Bamako, Mali
| | - Hawa Thiam
- Centre de Santé de Référence de la Commune V du District Sanitaire de Bamako, Bamako, Mali
| | - Yaya Ibrahim Coulibaly
- Neglected Tropical Diseases Research Unit, University of Sciences, Techniques and Technologies of Bamako (USTT-B), Bamako, Mali
| | - Sory Ibrahim Diawara
- University Clinical Research Center (UCRC), University of Sciences, Techniques and Technologies of Bamako (USTT-B), Bamako, Mali
| | - Yacouba Toloba
- University Clinical Research Center (UCRC), University of Sciences, Techniques and Technologies of Bamako (USTT-B), Bamako, Mali
- Centre Hospitalier Universitaire du Point G, Bamako, Mali
| | | | - Mahamadou Diakité
- University Clinical Research Center (UCRC), University of Sciences, Techniques and Technologies of Bamako (USTT-B), Bamako, Mali
| | - Seydou Doumbia
- University Clinical Research Center (UCRC), University of Sciences, Techniques and Technologies of Bamako (USTT-B), Bamako, Mali
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Cooper S, Bicaba F, Tiendrebeogo CO, Bila A, Bicaba A, Druetz T. Vaccination coverage in rural Burkina Faso under the effects of COVID-19: evidence from a panel study in eight districts. BMC Health Serv Res 2023; 23:1016. [PMID: 37735414 PMCID: PMC10512531 DOI: 10.1186/s12913-023-10029-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/13/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Improving infant immunization completion and promoting equitable vaccination coverage are crucial to reducing global under-5 childhood mortality. Although there have been hypotheses that the impact of the COVID-19 pandemic would decrease the delivery of health services and immunization campaigns in low- and middle-income countries, the available evidence is still inconclusive. We conducted a study in rural Burkina Faso to assess changes in vaccination coverage during the pandemic. A secondary objective was to examine long-term trends in vaccination coverage throughout 2010-2021. METHODS Using a quasi-experimental approach, we conducted three rounds of surveys (2019, 2020, 2021) in rural Burkina Faso that we pooled with two previous rounds of demographic and household surveys (2010, 2015) to assess trends in vaccination coverage. The study population comprised infants aged 0-13 months from a sample of 325 households randomly selected in eight districts (n = 736). We assessed vaccination coverage by directly observing the infants' vaccination booklet. Effects of the pandemic on infant vaccination completion were analyzed using multi-level logistic regression models with random intercepts at the household and district levels. RESULTS A total of 736 child-year observations were included in the analysis. The proportion of children with age-appropriate complete vaccination was 69.76% in 2010, 55.38% in 2015, 50.47% in 2019-2020, and 64.75% in 2021. Analyses assessing changes in age-appropriate full-vaccination coverage before and during the pandemic show a significant increase (OR: 1.8, 95% CI: 1.14-2.85). Our models also confirmed the presence of heterogeneity in full vaccination between health administrative districts. The pandemic could have increased inequities in infant vaccination completion between these districts. The analyses suggest no disruption in age-appropriate full vaccination due to COVID-19. Our findings from our sensitivity analyses to examine trends since 2010 did not show any steady trends. CONCLUSION Our findings in Burkina Faso do not support the predicted detrimental effects of COVID-19 on the immunization schedule for infants in low- and middle-income countries. Analyses comparing 2019 and 2021 show an improvement in age-appropriate full vaccination. Regardless of achieving and sustaining vaccination coverage levels in Burkina Faso, this should remain a priority for health systems and political agendas.
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Affiliation(s)
- Sarah Cooper
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, QC, Canada
- Centre de recherche en santé publique, Montreal, QC, Canada
| | - Frank Bicaba
- Société d'Études et de Recherches en Santé Publique, Ouagadougou, Burkina Faso
- Sciences de la Vie et de la Santé, University Aix-Marseille, Marseille, France
| | - Cheick Oumar Tiendrebeogo
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, QC, Canada
- Centre de recherche en santé publique, Montreal, QC, Canada
| | - Alice Bila
- Société d'Études et de Recherches en Santé Publique, Ouagadougou, Burkina Faso
| | - Abel Bicaba
- Société d'Études et de Recherches en Santé Publique, Ouagadougou, Burkina Faso
| | - Thomas Druetz
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, QC, Canada.
- Centre de recherche en santé publique, Montreal, QC, Canada.
- Department of Tropical Medicine, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA.
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Ghaznavi C, Eguchi A, Suu Lwin K, Yoneoka D, Tanoue Y, Kumar Rauniyar S, Horiuchi S, Hashizume M, Nomura S. Estimating global changes in routine childhood vaccination coverage during the COVID-19 pandemic, 2020-2021. Vaccine 2023:S0264-410X(23)00583-2. [PMID: 37246068 DOI: 10.1016/j.vaccine.2023.05.034] [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] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 05/13/2023] [Accepted: 05/13/2023] [Indexed: 05/30/2023]
Abstract
OBJECTIVES The COVID-19 pandemic has disrupted the distribution of routine immunizations globally. Multi-country studies assessing a wide spectrum of vaccines and their coverage rates are needed to determine global performance in achieving vaccination goals. METHODS Global vaccine coverage data for 16 antigens were obtained from WHO/UNICEF Estimates of National Immunization Coverage. Tobit regression was performed for all country-antigen pairs for which data were continuously available between 2015-2020 or 2015-2021 to predict vaccine coverage in 2020/2021. Vaccines for which multi-dose data were available were assessed to determine whether vaccine coverage for subsequent doses were lower than that of first doses. RESULTS Vaccine coverage was significantly lower-than-predicted for 13/16 antigens in 2020 and all assessed antigens in 2021. Lower-than-predicted vaccine coverage was typically observed in South America, Africa, Eastern Europe, and Southeast Asia. There was a statistically significant coverage drop for subsequent doses of the diphtheria-tetanus-pertussis, pneumococcus, and rotavirus vaccines compared to first doses in 2020 and 2021. CONCLUSION The COVID-19 pandemic exerted larger disruptions to routine vaccination services in 2021 than in 2020. Global efforts will be needed to recoup vaccine coverage losses sustained during the pandemic and broaden vaccine access in areas where coverage was previously inadequate.
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Affiliation(s)
- Cyrus Ghaznavi
- Department of Health Policy and Management, School of Medicine, Keio University, Tokyo, Japan; Medical Education Program, Washington University School of Medicine in St Louis, Saint Louis, USA.
| | - Akifumi Eguchi
- Department of Health Policy and Management, School of Medicine, Keio University, Tokyo, Japan; Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Center for Preventive Medical Sciences, Chiba University, Chiba, Japan
| | - Kaung Suu Lwin
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Daisuke Yoneoka
- Department of Health Policy and Management, School of Medicine, Keio University, Tokyo, Japan; Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Tokyo Foundation for Policy Research, Tokyo, Japan; Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Yuta Tanoue
- Department of Health Policy and Management, School of Medicine, Keio University, Tokyo, Japan; Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Institute for Business and Finance, Waseda University, Tokyo, Japan
| | - Santosh Kumar Rauniyar
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Sayaka Horiuchi
- Center for Birth Cohort Studies, University of Yamanashi, Yamanashi, Japan
| | - Masahiro Hashizume
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shuhei Nomura
- Department of Health Policy and Management, School of Medicine, Keio University, Tokyo, Japan; Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Tokyo Foundation for Policy Research, Tokyo, Japan
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Lawlor R, Wilsdon T, Rémy-Blanc V, Nogal AÁ, Pana A. A review of the sustainability of vaccine funding across Europe and implications for post-COVID policymaking. Health Policy 2022; 126:956-969. [PMID: 36008177 PMCID: PMC9364713 DOI: 10.1016/j.healthpol.2022.08.004] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 08/01/2022] [Accepted: 08/02/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Approaches to routine vaccine funding and the underlying budget-setting process vary greatly across European countries. The ongoing COVID-19 pandemic has put enormous pressure on healthcare systems, affecting resilience of the overall vaccine ecosystem. METHODS This article reviews how vaccine budgets are structured across 8 European countries (England, Finland, France, Germany, Italy, Norway, Romania, and Spain). First a literature review of the landscape was undertaken, followed by expert interviews to review the findings and consider policy principles to secure prioritisation and sustainability of routine vaccination budgets post-COVID. RESULTS The organisation of budgets and vaccine spending varies greatly across Europe. In 2/8 countries (France and Germany) vaccine spending is subsumed into a wider healthcare budget. In 2/8 countries (Italy and Romania) the budget differentiates public health and prevention spending from other areas of healthcare, though there is no standalone vaccine budget. In 4/8 countries (England, Finland, Norway and Spain) there is a standalone vaccine budget, however this may not cover all elements needed for immunisation delivery and is not always transparent. CONCLUSION Ensuring adequate and dynamic country vaccine budgets, with horizon scanning approaches like in England and Finland, or flexible vaccines expenditures like Germany, would greatly help the timely availability of public funding for new vaccines and strengthen vaccines supply security in Europe through a more virtuous European vaccine ecosystem.
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Affiliation(s)
- Ryan Lawlor
- Life Sciences, Charles River Associates, London, UK.
| | - Tim Wilsdon
- Life Sciences, Charles River Associates, London, UK
| | | | | | - Adrian Pana
- Bucharest University of Economic Studies, Romania
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Maltezou HC, Medic S, Cassimos DC, Effraimidou E, Poland GA. Decreasing routine vaccination rates in children in the COVID-19 era. Vaccine 2022; 40:2525-2527. [PMID: 35341648 PMCID: PMC8938181 DOI: 10.1016/j.vaccine.2022.03.033] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 03/14/2022] [Indexed: 11/21/2022]
Affiliation(s)
- Helena C Maltezou
- Directorate of Research, Studies, and Documentation, National Public Health Organization, Athens, Greece.
| | - Snezana Medic
- Department of Epidemiology, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia; Center for Disease Control and Prevention, Institute of Public Health of Vojvodina, Novi Sad, Serbia
| | | | - Evgnosia Effraimidou
- Directorate of Research, Studies, and Documentation, National Public Health Organization, Athens, Greece
| | - Gregory A Poland
- Mayo Vaccine Research Group, Mayo Clinic and Foundation, Rochester, MN, United States
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van Heemskerken PG, Decouttere CJ, Broekhuizen H, Vandaele NJ. Understanding the complexity of demand-side determinants on vaccine uptake in sub-Saharan Africa. Health Policy Plan 2021; 37:281-291. [PMID: 34918093 DOI: 10.1093/heapol/czab139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 07/28/2021] [Accepted: 11/16/2021] [Indexed: 11/13/2022] Open
Abstract
Routine vaccination annually prevents millions of deaths worldwide but is underutilized in sub-Saharan Africa (SSA). The complexity of socio-cultural factors impacting vaccine uptake is not well understood. Hence, this paper aims to review the socio-cultural determinants of vaccine uptake and visualize their interrelationships. We conducted a literature search using Pubmed and Embase databases, including articles published from 2000 to 2019 describing socio-cultural demand-side determinants for vaccine uptake. Using the Andersen and Newman Framework of Health Services Utilization, demand-side determinants were categorized as predisposing, enabling or need factors. A qualitative system dynamics approach was employed to visualize how these factors and their dynamic interrelationships influence vaccine uptake. This visualization, by means of a causal-loop diagram (CLD), was mostly based on a qualitative input, with the majority being statements of the authors. These statements were abstracted from the papers found in the review. Quantification was done by counting direct (statistical) associations between each determinant and 'timely and full routine immunization coverage'. A total of 90 articles, primarily from Nigeria (n = 23), Ethiopia (n = 17) and Kenya (n = 11), met the inclusion criteria. We find that maternal autonomy and the perceived benefits caregivers attach to vaccination and exert their influences on many other factors through several feedback loops, thereby influencing timely and full routine immunization coverage. Utilization of health services (supply-related) and access to information (demand-related) were considered as high-potential leverage points. Quantification has shown that maternal autonomy and perceived benefit have an unclear evidence base. Future research should focus on these key players as they play a central role in multiple complex pathways, through which they could influence the uptake of vaccines in SSA.
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Affiliation(s)
- Phylisha G van Heemskerken
- Department of Health Evidence, Radboud University Medical Centre, Geert Grooteplein 21, Nijmegen 6525 EZ, The Netherlands
| | | | - Henk Broekhuizen
- Department of Health Evidence, Radboud University Medical Centre, Geert Grooteplein 21, Nijmegen 6525 EZ, The Netherlands.,Department of Health and Society, Wageningen University and Research, Hollandseweg 1, 6706 KN, Wageningen 3000, The Netherlands
| | - Nico J Vandaele
- Access-To-Medicines Research Center, KU Leuven, Naamsestraat 69, Leuven, Belgium
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Fu H, Abbas K, Klepac P, van Zandvoort K, Tanvir H, Portnoy A, Jit M. Effect of evidence updates on key determinants of measles vaccination impact: a DynaMICE modelling study in ten high-burden countries. BMC Med 2021; 19:281. [PMID: 34784922 PMCID: PMC8594955 DOI: 10.1186/s12916-021-02157-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 10/07/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Model-based estimates of measles burden and the impact of measles-containing vaccine (MCV) are crucial for global health priority setting. Recently, evidence from systematic reviews and database analyses have improved our understanding of key determinants of MCV impact. We explore how representations of these determinants affect model-based estimation of vaccination impact in ten countries with the highest measles burden. METHODS Using Dynamic Measles Immunisation Calculation Engine (DynaMICE), we modelled the effect of evidence updates for five determinants of MCV impact: case-fatality risk, contact patterns, age-dependent vaccine efficacy, the delivery of supplementary immunisation activities (SIAs) to zero-dose children, and the basic reproduction number. We assessed the incremental vaccination impact of the first (MCV1) and second (MCV2) doses of routine immunisation and SIAs, using metrics of total vaccine-averted cases, deaths, and disability-adjusted life years (DALYs) over 2000-2050. We also conducted a scenario capturing the effect of COVID-19 related disruptions on measles burden and vaccination impact. RESULTS Incorporated with the updated data sources, DynaMICE projected 253 million measles cases, 3.8 million deaths and 233 million DALYs incurred over 2000-2050 in the ten high-burden countries when MCV1, MCV2, and SIA doses were implemented. Compared to no vaccination, MCV1 contributed to 66% reduction in cumulative measles cases, while MCV2 and SIAs reduced this further to 90%. Among the updated determinants, shifting from fixed to linearly-varying vaccine efficacy by age and from static to time-varying case-fatality risks had the biggest effect on MCV impact. While varying the basic reproduction number showed a limited effect, updates on the other four determinants together resulted in an overall reduction of vaccination impact by 0.58%, 26.2%, and 26.7% for cases, deaths, and DALYs averted, respectively. COVID-19 related disruptions to measles vaccination are not likely to change the influence of these determinants on MCV impact, but may lead to a 3% increase in cases over 2000-2050. CONCLUSIONS Incorporating updated evidence particularly on vaccine efficacy and case-fatality risk reduces estimates of vaccination impact moderately, but its overall impact remains considerable. High MCV coverage through both routine immunisation and SIAs remains essential for achieving and maintaining low incidence in high measles burden settings.
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Affiliation(s)
- Han Fu
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.
| | - Kaja Abbas
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.,Public Health Foundation of India, New Delhi, India.,International Vaccine Institute, Seoul, South Korea
| | - Petra Klepac
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.,Department of Applied Mathematics and Theoretical Physics, University of Cambridge, Cambridge, UK
| | - Kevin van Zandvoort
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Hira Tanvir
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Allison Portnoy
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Mark Jit
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.,Modelling and Economics Unit, Public Health England, London, UK.,School of Public Health, University of Hong Kong, Hong Kong, SAR, China
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Larson A, Skolnik A, Bhatti A, Mitrovich R. Addressing an urgent global public health need: Strategies to recover routine vaccination during the COVID-19 pandemic. Hum Vaccin Immunother 2021; 18:1975453. [PMID: 34674605 PMCID: PMC8920227 DOI: 10.1080/21645515.2021.1975453] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Routine vaccination has been severely impacted by the COVID-19 pandemic, with 37% of countries reporting continuing disruptions to vaccination services into 2021. These programs have been faced with the challenges of achieving high vaccination coverage rates (VCRs), as well as identifying and vaccinating those who missed recommended doses since the pandemic began. Declines in VCRs, even for short periods, can lead to an increase in disease outbreaks, place additional pressure on health systems, and leave communities across the world at risk of death and disease from vaccine-preventable diseases.In the face of these disruptions, select governments are implementing promising approaches to address low VCRs, some of which represent innovative solutions to advance short-term, as well as longer-term program improvement. However, expanded action is urgently required to fully recover vaccination programs and strengthen vaccine system infrastructure. The COVID-19 pandemic provides a unique opportunity to modernize routine programs and corresponding infrastructure to meet today's and tomorrow's health challenges more effectively and efficiently. This can be achieved by prioritizing routine vaccination as an essential health service, improving access to vaccination across the life-course, strengthening data systems, ensuring sustainable immunization financing, and building confidence in vaccination.
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Harris RC, Chen Y, Côte P, Ardillon A, Nievera MC, Ong-Lim A, Aiyamperumal S, Chong CP, Kandasamy KV, Mahenthiran K, Yu TW, Huang C, El Guerche-Séblain C, Vargas-Zambrano JC, Chit A, Nageshwaran G. Impact of COVID-19 on routine immunisation in South-East Asia and Western Pacific: Disruptions and solutions. Lancet Reg Health West Pac 2021; 10:100140. [PMID: 33899040 PMCID: PMC8057868 DOI: 10.1016/j.lanwpc.2021.100140] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 03/08/2021] [Accepted: 03/18/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Data on COVID-19-induced disruption to routine vaccinations in the South-East Asia and Western Pacific regions (SEAR/WPR) have been sparse. This study aimed to quantify the impact of COVID-19 on routine vaccinations by country, antigen, and sector (public or private), up to 1 June 2020, and to identify the reasons for disruption and possible solutions. METHODS Sanofi Pasteur teams from 19 countries in SEAR/WPR completed a structured questionnaire reporting on COVID-19 disruptions for 13-19 routinely delivered antigens per country, based on sales data, government reports, and regular physician interactions. Data were analysed descriptively, disruption causes ranked, and solutions evaluated using a modified public health best practices framework. FINDINGS 95% (18/19) of countries reported vaccination disruption. When stratified by country, a median of 91% (interquartile range 77-94) of antigens were impacted. Infancy and school-entry age vaccinations were most impacted. Both public and private sector healthcare providers experienced disruptions. Vaccination rates had not recovered for 39% of impacted antigens by 1 June 2020. Fear of infection, movement/travel restrictions, and limited healthcare access were the highest-ranked reasons for disruption. Highest-scoring solutions were separating vaccination groups from unwell patients, non-traditional vaccination venues, virtual engagement, and social media campaigns. Many of these solutions were under-utilised. INTERPRETATION COVID-19-induced disruption of routine vaccination was more widespread than previously reported. Adaptable solutions were identified which could be implemented in SEAR/WPR and elsewhere. Governments and private providers need to act urgently to improve coverage rates and plan for future waves of the pandemic, to avoid a resurgence of vaccine-preventable diseases. FUNDING Sanofi Pasteur.
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Affiliation(s)
- Rebecca C. Harris
- Sanofi Pasteur, 38 Beach Road, #18-11 South Beach Tower, Singapore 189767, Singapore
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Yutao Chen
- Sanofi Pasteur China, 7F HP Plaza, 112 Jianguo Rd, ChaoYang District, Beijing 100022, China
| | - Pierre Côte
- Sanofi Pasteur, 14 Espace Henry Vallée, 69007 Lyon, France
| | - Antoine Ardillon
- Sanofi Pasteur, 14 Espace Henry Vallée, 69007 Lyon, France
- Current affiliation: Institute of Pharmaceutical and Biological Sciences, Claude Bernard Lyon University, 8 avenue Rockefeller, 69373 Lyon, France
| | - Maria Carmen Nievera
- Sanofi Pasteur, 38 Beach Road, #18-11 South Beach Tower, Singapore 189767, Singapore
| | - Anna Ong-Lim
- Division of Infectious and Tropical Disease, Department of Pediatrics, University of the Philippines – Philippine General Hospital, Manila 1000, Philippines
| | - Somasundaram Aiyamperumal
- Department of Developmental and Behavioural Pediatrics, D'Soul Child Development Centre and Kanchi Kamakoti Childs Trust Hospital, Chennai 600034, India
| | - Chan Poh Chong
- Division of General Ambulatory Paediatrics and Adolescent Medicine, Department of Paediatrics, National University Children's Medical Institute, National University Hospital, 1E Kent Ridge Road, NUHS Tower Block, Singapore 119228, Singapore
| | | | - Kuharaj Mahenthiran
- Sanofi Pasteur, 38 Beach Road, #18-11 South Beach Tower, Singapore 189767, Singapore
| | - Ta-Wen Yu
- Sanofi Pasteur, 38 Beach Road, #18-11 South Beach Tower, Singapore 189767, Singapore
| | - Changshu Huang
- Sanofi Pasteur, New World International Trade, No.568, Jianshe Avenue, Jianghan District, Wuhan City 430000, China
| | | | | | - Ayman Chit
- Sanofi Pasteur, Discovery Drive Swiftwater, PA 18370, USA
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON M5S 3M2, Canada
| | - Gopinath Nageshwaran
- Sanofi Pasteur, 38 Beach Road, #18-11 South Beach Tower, Singapore 189767, Singapore
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Schmid-Küpke NK, Matysiak-Klose D, Siedler A, Felgendreff L, Wieler L, Thaiss HM, Betsch C. Cancelled routine vaccination appointments due to COVID-19 pandemic in Germany. Vaccine X 2021; 8:100094. [PMID: 33821245 PMCID: PMC8012162 DOI: 10.1016/j.jvacx.2021.100094] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 03/24/2021] [Accepted: 03/29/2021] [Indexed: 11/28/2022] Open
Abstract
Pandemic measures to mitigate the outbreak of SARS-CoV-2 in Germany led to cancellations of routine vaccination appointments for both adults and children. Survey data indicate that, with easing pandemic restrictions, many cancelled appointments were rescheduled or caught up. Nevertheless, 40% of cancelled appointments were still not rescheduled and were primarily cancelled by patients. Therefore, doctors should regularly remind patients of vaccinations and use every visit to improve their vaccination statuses.
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Affiliation(s)
| | - Dorothea Matysiak-Klose
- Department for Infectious Disease Epidemiology, Immunization Unit, Robert Koch Institute, Berlin, Germany
| | - Anette Siedler
- Department for Infectious Disease Epidemiology, Immunization Unit, Robert Koch Institute, Berlin, Germany
| | - Lisa Felgendreff
- Media and Communication Science, University of Erfurt, Nordhäuser Straße 63, 99089 Erfurt, Germany.,Center for Empirical Research in Economics and Behavioral Sciences, University of Erfurt, Nordhäuser Straße 63, 99089 Erfurt, Germany
| | | | | | - Cornelia Betsch
- Media and Communication Science, University of Erfurt, Nordhäuser Straße 63, 99089 Erfurt, Germany.,Center for Empirical Research in Economics and Behavioral Sciences, University of Erfurt, Nordhäuser Straße 63, 99089 Erfurt, Germany
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11
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Liu S, Wang J, Liu Y, Xu Y, Che X, Gu W, Du J, Zhang X, Xu E. Survey of contraindications in children's routine vaccination in Hangzhou, China. Hum Vaccin Immunother 2017; 13:1539-1543. [PMID: 28406739 PMCID: PMC5512785 DOI: 10.1080/21645515.2017.1304868] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 02/26/2017] [Accepted: 03/07/2017] [Indexed: 10/19/2022] Open
Abstract
Objective To describe the epidemiological characteristics of contraindications in children routine vaccination, to evaluate vaccination doctors' ability to determine contraindications. Method Using cross-section study, 34 urban and 15 suburb units were selected from 206 Community Health Center (CHC) in Hangzhou, China. Subjects were all children coming to CHCs for routine vaccination. All situations considered to be unsuitable for vaccination were recorded as contraindications. 3 experts were used to classify these abnormal records as true or false contraindications. Then, the multi-analysis was used to find factors related with the rate of false contraindications. Results There were 2801 children with 2969 contraindications in the present study. The prevalence of contraindications was 3.03‰ by dose of vaccines. Cough (24.78%), fever (21.86%) and medication (19.54%) were the most common contraindications in children routine vaccination. Measles-rubella vaccine (MR) (6.78‰), measles-mumps-rubella vaccine (MMR) (5.87‰) and hepatitis B vaccine (Hep B) (5.25‰) had higher prevalence of contraindications than other vaccines. According to the evaluation of 3 experts, about 13.53% of contraindications were misdiagnosed by vaccination doctor. The rate of misdiagnosed contraindications was correlated with the sex, age and educational background of vaccination doctor, total dose of vaccination of CHC. Conclusion A portion of children might miss the routine vaccination because of misdiagnosed contraindications. More investigations are needed to report the epidemiological distribution of contraindication in routine vaccination of children.
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Affiliation(s)
- Shijun Liu
- Hangzhou Center for Disease Control and Prevention, Hangzhou, China
| | - Jun Wang
- Hangzhou Center for Disease Control and Prevention, Hangzhou, China
| | - Yan Liu
- Hangzhou Center for Disease Control and Prevention, Hangzhou, China
| | - Yuyang Xu
- Hangzhou Center for Disease Control and Prevention, Hangzhou, China
| | - Xinren Che
- Hangzhou Center for Disease Control and Prevention, Hangzhou, China
| | - Wenwen Gu
- Hangzhou Center for Disease Control and Prevention, Hangzhou, China
| | - Jian Du
- Hangzhou Center for Disease Control and Prevention, Hangzhou, China
| | - Xiaoping Zhang
- Hangzhou Center for Disease Control and Prevention, Hangzhou, China
| | - Erping Xu
- Hangzhou Center for Disease Control and Prevention, Hangzhou, China
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12
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Abstract
The possibility of periodic routine vaccination campaigns (PRVCs) is introduced in the context of a search for optimal oral poliovirus vaccine (OPV) administration strategies. Like the usual continuous routine vaccination campaign (CRVC), PRVCs target only newborns. However, they are not necessarily implemented continuously in time. Using a dynamic and compartmental polio transmission model in a stochastic context, it is shown that some PRVCs can achieve much greater efficiency than CRVC in terms of probability of wild poliovirus (WPV) eradication, even though they never outperform CRVC in terms of total number of paralytic infections. Moreover, these PRVCs results can be obtained at a lower price than CRVC. It is also shown that, even though PRVCs do not perform better than pulse vaccination campaigns (PVCs) when only epidemiological outputs are valued, they can do so when a cost-benefit analysis is preferred.
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Affiliation(s)
- Nicolas Houy
- Université de Lyon, Lyon F-69007, France; CNRS, GATE Lyon Saint-Etienne, Ecully F-69130, France.
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13
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Suarez-Castaneda E, Burnett E, Elas M, Baltrons R, Pezzoli L, Flannery B, Kleinbaum D, de Oliveira LH, Danovaro-Holliday MC. Catching-up with pentavalent vaccine: Exploring reasons behind lower rotavirus vaccine coverage in El Salvador. Vaccine 2015; 33:6865-70. [PMID: 26263200 DOI: 10.1016/j.vaccine.2015.07.092] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 07/06/2015] [Accepted: 07/27/2015] [Indexed: 02/05/2023]
Abstract
Rotavirus vaccine was introduced in El Salvador in 2006 and is recommended to be given concomitantly with DTP–HepB–Haemophilus influenzae type b (pentavalent) vaccine at ages 2 months (upper age limit 15 weeks) and 4 months (upper age limit 8 months) of age. However, rotavirus vaccination coverage continues to lag behind that of pentavalent vaccine, even in years when national rotavirus vaccine stock-outs have not occurred. We analyzed factors associated with receipt of oral rotavirus vaccine among children who received at least 2 doses of pentavalent vaccine in a stratified cluster survey of children aged 24–59 months conducted in El Salvador in 2011. Vaccine doses included were documented on vaccination cards (94.4%) or in health facility records (5.6%). Logistic regression and survival analysis were used to assess factors associated with vaccination status and age at vaccination. Receipt of pentavalent vaccine by age 15 weeks was associated with rotavirus vaccination (OR: 5.1; 95% CI 2.7, 9.4), and receipt of the second pentavalent dose by age 32 weeks was associated with receipt of two rotavirus vaccine doses (OR: 5.0; 95% CI 2.1–12.3). Timely coverage with the first pentavalent vaccine dose was 88.2% in the 2007 cohort and 91.1% in the 2008 cohort (p = 0.04). Children born in 2009, when a four-month national rotavirus vaccine stock-out occurred, had an older median age of receipt of rotavirus vaccine and were less likely to receive rotavirus on the same date as the same dose of pentavalent vaccine than children born in 2007 and 2008. Upper age limit recommendations for rotavirus vaccine administration contributed to suboptimal vaccination coverage. Survey data suggest that late rotavirus vaccination and co-administration with later doses of pentavalent vaccine among children born in 2009 helped increase rotavirus vaccine coverage following shortages.
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14
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Abstract
Typhoid vaccination is an important component of typhoid fever prevention and control, and is recommended for public health programmatic use in both endemic and outbreak settings. We reviewed experiences with various vaccination strategies using the currently available typhoid vaccines (injectable Vi polysaccharide vaccine [ViPS], oral Ty21a vaccine, and injectable typhoid conjugate vaccine [TCV]). We assessed the rationale, acceptability, effectiveness, impact and implementation lessons of these strategies to inform effective typhoid vaccination strategies for the future. Vaccination strategies were categorized by vaccine disease control strategy (preemptive use for endemic disease or to prevent an outbreak, and reactive use for outbreak control) and vaccine delivery strategy (community-based routine, community-based campaign and school-based). Almost all public health typhoid vaccination programs used ViPS vaccine and have been in countries of Asia, with one example in the Pacific and one experience using the Ty21a vaccine in South America. All vaccination strategies were found to be acceptable, feasible and effective in the settings evaluated; evidence of impact, where available, was strongest in endemic settings and in the short- to medium-term. Vaccination was cost-effective in high-incidence but not low-incidence settings. Experience in disaster and outbreak settings remains limited. TCVs have recently become available and none are WHO-prequalified yet; no program experience with TCVs was found in published literature. Despite the demonstrated success of several typhoid vaccination strategies, typhoid vaccines remain underused. Implementation lessons should be applied to design optimal vaccination strategies using TCVs which have several anticipated advantages, such as potential for use in infant immunization programs and longer duration of protection, over the ViPS and Ty21a vaccines for typhoid prevention and control.
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Affiliation(s)
- Kashmira A Date
- Global Immunization Division, Centers for Disease Control and Prevention (CDC), Atlanta, GA 30329-4027, USA.
| | - Adwoa Bentsi-Enchill
- Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization (WHO), Geneva, Switzerland
| | - Florian Marks
- International Vaccine Institute, Kwanak PO Box 14, Seoul 151-600, Republic of Korea
| | - Kimberley Fox
- World Health Organization Regional Office for the Western Pacific, United Nations Avenue, 1000 Manila, Philippines
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15
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Cai C, Li H, Edwards J, Hawkins C, Robertson ID. Meta-analysis on the efficacy of routine vaccination against foot and mouth disease (FMD) in China. Prev Vet Med 2014; 115:94-100. [PMID: 24768436 DOI: 10.1016/j.prevetmed.2014.03.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 03/08/2014] [Accepted: 03/22/2014] [Indexed: 11/19/2022]
Abstract
Foot and mouth disease (FMD) outbreaks have been reported in China for many years. Recently, due to the rapid economic development, the price of meat and its demand have grown quickly. This trend has resulted in an increase in the number of livestock moving from south-east Asian countries into China. Foot and mouth disease is becoming one of the most important trans-boundary animal diseases affecting the livelihood of livestock owners in China. To contribute to the long term goal to control and eradicate FMD from China, the Chinese government has adopted a series of control measures which includes compulsory routine vaccination against the disease. In this paper, the surveillance results of the routine vaccination programme were systemically reviewed. The results from 28 published papers were combined and analysed through a meta-analysis approach. The results of the meta-analysis indicated that the vaccination programme has been very successful in China with more than 70% of animals protected against serotypes Asia-1 and O.
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Affiliation(s)
- Chang Cai
- College of Veterinary Medicine, Murdoch University, Western Australia 6150, Australia.
| | - Huachun Li
- Yunnan Animal Science and Veterinary Institute, Kunming City, Yunnan Province 650224, China
| | - John Edwards
- College of Veterinary Medicine, Murdoch University, Western Australia 6150, Australia; Food and Agriculture Organisation, ECTAD Office, Beijing 100600, China
| | - Chris Hawkins
- Department of Agriculture and Food Western Australia, Moora 6510, Western Australia, Australia
| | - Ian D Robertson
- College of Veterinary Medicine, Murdoch University, Western Australia 6150, Australia
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16
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Suárez-Castaneda E, Pezzoli L, Elas M, Baltrons R, Crespin-Elías EO, Pleitez OAR, de Campos MIQ, Danovaro-Holliday MC. Routine childhood vaccination programme coverage, El Salvador, 2011-In search of timeliness. Vaccine 2013; 32:437-44. [PMID: 24315884 DOI: 10.1016/j.vaccine.2013.11.072] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Revised: 10/09/2013] [Accepted: 11/21/2013] [Indexed: 11/28/2022]
Abstract
While assessing immunization programmes, not only vaccination coverage is important, but also timely receipt of vaccines. We estimated both vaccination coverage and timeliness, as well as reasons for non-vaccination, and identified predictors of delayed or missed vaccination, for vaccines of the first two years of age, in El Salvador. We conducted a cluster survey among children aged 23-59 months. Caregivers were interviewed about the child immunization status and their attitudes towards immunization. Vaccination dates were obtained from children immunization cards at home or at health facilities. We referred to the 2006 vaccination schedule for children below two years: one dose of BCG (Bacillus Calmette-Guérin) at birth; rotavirus at two and four months; three doses of pentavalent - DTP (diphtheria-tetanus-pertussis), hepatitis B, and Haemophilus influenzae type b (Hib) - and of oral poliomyelitis vaccine (polio) at two, four, and six months; first MMR (measles-mumps-rubella) at 12 months; and first boosters of DTP and OPV at 18 months. Timeliness was assessed with Kaplan-Meier analysis; Cox and logistic regression were used to identify predictors of vaccination. We surveyed 2550 children. Coverage was highest for BCG (991%; 95% CI: 98.8-99.5) and lowest for rotavirus, especially second dose (86.3%; 95% CI: 84.2-88.4). The first doses of MMR and DTP had 991% (95% CI: 98.5-99.6) and 977% (95% CI: 970-985), respectively. Overall coverage was 837% (95% CI: 81.4-86.0); 96.4% (95% CI: 95.4-97.5), excluding rotavirus. However, only 26.7% (95% CI: 24.7-28.8) were vaccinated within the age interval recommended by the Expanded Programme on Immunization. Being employed and using the bus for transport to the health facility were associated with age-inappropriate vaccinations; while living in households with only two residents and in the "Paracentral", "Occidental", and "Oriental" regions was associated with age-appropriate vaccinations. Vaccination coverage was high in El Salvador, but general timeliness and rotavirus uptake could be improved.
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Affiliation(s)
| | - Lorenzo Pezzoli
- Consultant for the Pan American Health Organization, London, UK.
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