Effectiveness of interventions to increase healthcare workers' adherence to vaccination against vaccine-preventable diseases: a systematic review and meta-analysis, 1993 to 2022

BackgroundVaccination adherence among healthcare workers (HCWs) is fundamental for the prevention of vaccine-preventable diseases (VPDs) in healthcare. This safeguards HCWs' well-being, prevents transmission of infections to vulnerable patients and contributes to public health.AimThis systematic review and meta-analysis aimed to describe interventions meant to increase HCWs' adherence to vaccination and estimate the effectiveness of these interventions.MethodsWe searched literature in eight databases and performed manual searches in relevant journals and the reference lists of retrieved articles. The study population included any HCW with potential occupational exposure to VPDs. We included experimental and quasi-experimental studies presenting interventions aimed at increasing HCWs' adherence to vaccination against VPDs. The post-intervention vaccination adherence rate was set as the main outcome. We included the effect of interventions in the random-effects and subgroup meta-analyses.ResultsThe systematic review considered 48 studies on influenza and Tdap vaccination from database and manual searches, and 43 were meta-analysed. A statistically significant, positive effect was seen in multi-component interventions in randomised controlled trials (relative risk (RR) = 1.37; 95% CI: 1.13-1.66) and in observational studies (RR = 1.43; 95% CI: 1.29-1.58). Vaccination adherence rate was higher in community care facilities (RR = 1.58; 95% CI: 1.49-1.68) than in hospitals (RR = 1.24; 95% CI: 0.76-2.05).ConclusionInterventions aimed at increasing HCWs' adherence to vaccination against VPDs are effective, especially multi-component ones. Future research should determine the most effective framework of interventions for each setting, using appropriate study design for their evaluation, and should compare intervention components to understand their contribution to the effectiveness.

Measles, mumps, rubella and varicella antibodies among international and domestic university students

BACKGROUND

Vaccine-preventable infections are generally well controlled in Australia. However, gaps in immunity can lead to outbreaks and are important to identify. Young adults are a highly mobile population and a potential source of imported infections. We aimed to evaluate anti- measles, mumps, rubella and varicella (MMR&V) IgG seroprevalence and explore factors relating to antibody seropositivity.

METHODS

A cross-sectional online survey was conducted among students from a large Australian university to collect demographic, vaccination, infection and travel characteristics. Blood samples were collected to measure MMR&V seroprevalence. Logistic regression was used to identify factors associated with seropositivity.

RESULTS

Among 804 university students, seroprevalence (positive or equivocal) for measles was 82.3% (95% CI 79.6-84.8%), mumps 79.5% (95% CI 76.7-82.3%), rubella 91.5% (95% CI 89.6-93.5%) and varicella 86.2% (95% CI 84.1-88.8%), with 452 (56.2%, 95% CI 52.8-59.6) seropositive to all four viruses. Varicella seropositivity was highest in the older birth cohort (born 1988-1991). Measles seropositivity was higher for international students compared to domestic students. Among international students, mumps seroprevalence was significantly lower than measles and rubella seroprevalence. International travel in the previous 12 months was reported by 63.1% of students, but only 18.2% of travellers reported seeking pre-travel health advice prior to most recent international travel.

CONCLUSIONS

Overall, this study suggests immunity to MMR&V is sub-optimal. We found the university student population to be highly mobile and unlikely to seek pre-travel advice; thus, they are a potential source of infection importation. The implementation of university immunization policies could address the gaps identified and our findings can inform the development of targeted vaccination campaigns.

Systematic Mapping of Research on Vaccine-Preventable Diseases in Children in Sub-Saharan Africa: A Decennial Scientometric Analysis

Vaccine-preventable diseases (VPDs) remain a significant public health challenge, particularly in sub-Saharan Africa. The high burden of VPDs in this region necessitates the need for continued investigation and intervention. This paper presents a bibliometric analysis of research on VPDs in children in sub-Saharan Africa in the last 10 years to capture the current state of research in the field. This study used a systematic search for articles published between 2013 and 2022 in the Web of Science Core Collection database and, subsequently, scientometric techniques for data analyses and interpretation. Annual scientific production of publications on the research of VPDs in children in sub-Saharan Africa increased from 2013 to 2019 and then gradually declined. South Africa had the most VPD studies (n = 148; 16.2%), followed by Nigeria, Ghana, Kenya, The Gambia, Malawi, Ethiopia, and the Republic of Congo. The Vaccine journal published the most. The Pan African Medical Journal was the most frequent destination journal based in Africa. The commonly studied pathogens were Streptococcus pneumoniae and Haemophilus influenzae. Research productivity increased exponentially in the pre-COVID era and declined in the past two years, so more VPD research in this region is needed.

Safety of Monkeypox Vaccine Using Active Surveillance, Two-Center Observational Study in Italy

In August 2022, Italy launched a vaccination campaign to combat the spread of the monkeypox virus, which the WHO has designated as a public health emergency. Priority targets for the campaign included laboratory personnel and men who have sex with men with specific risk criteria. Primary immunization involved two doses of the Imvanex/Jynneos vaccine, followed by a single booster dose. We conducted a study in two Italian towns, Bologna and Forlì, in October and November 2022 to investigate adverse events following immunization (AEFIs) of the monkeypox vaccine through participant-based active surveillance. Participants who received the vaccine and were aged 18 and over were invited to complete an e-questionnaire by scanning a QR code during their second vaccine appointment or by email one month after the booster dose. A descriptive analysis of AEFI incidences was conducted, with the results stratified by type and severity of symptoms. A total of 135 first-dose, 50 second-dose, and 6 single-dose recipients were included, with a mean age of 36.4 ± 8.7 years. Systemic reactions after the first and second doses were reported by 39.3% and 26.0% of participants, respectively, with asthenia being the most common symptom. Local site reactions were reported by 97.0% and 100.0% of participants, respectively, with redness, swelling, and itching being the most common local AEFIs. Grade 3 or 4 AEFIs were reported for local AEFIs only by 16.8% and 14.0% of participants after the first and second doses, respectively. Our findings suggest that the monkeypox vaccine has a high tolerability profile in terms of short-term common systemic AEFIs. However, the high incidence and severity of local AEFIs highlight the need to monitor their persistence following intradermal administration of the vaccine.

Immunization during pregnancy: do healthcare workers recommend vaccination against influenza?

Background

A variety of circumstances can influence how widely vaccination during pregnancy is accepted. Healthcare workers (HCWs) are often seen as the main resource for recommending vaccination. The purpose of the current study was to determine whether Italian HCWs advise and recommend pregnant people to receive the influenza vaccinations, as well as what knowledge and attitudes affect their practices. A secondary aim of the study was to evaluate HCWs' knowledge and attitudes towards COVID-19 vaccination.

Methods

This cross-sectional study, took place between August 2021 and June 2022 in a randomly selected sample of HCWs in three Italian regions. The target population comprised obstetricians-gynecologists, midwives and primary care physicians, who provide medical care to pregnant people. The questionnaire consisted of 19 items divided into 5 parts gathered information about the participants' sociodemographic and professional characteristics, general knowledge about vaccinations during pregnancy, and vaccine-preventable diseases (VPDs), attitudes and practices towards immunization, and strategies to potentially increase vaccination uptake during pregnancy.

Results

Among the participants, 78.3% knew that pregnant people are at increased risk of severe complications from influenza, 57.8% that the influenza vaccine is not provided only in the 2nd/3rd trimester of pregnancy and 60% that pregnancy is a risk factor for severe COVID-19 infection. Of the enrolled HCWs, 10.8% believed that the potential risks of vaccines administered during pregnancy are greater than the benefits. An even higher proportion of the participants was unsure (24.3%) or did not deem (15.9%) that vaccinating against influenza during pregnancy reduces the risk of preterm birth and abortion. Moreover, 11.8% of the sample did not believe or was uncertain that COVID-19 vaccine must be offered to all pregnant people. Among HCWs, 71.8% advised women about influenza vaccination during pregnancy, and 68.8% recommended getting vaccinated against influenza during pregnancy. Results showed that good knowledge and positive attitudes were the strongest factors positively associated with advising women about influenza vaccination during pregnancy.

Conclusion

The gathered data showed that a sizable portion of the HCWs lacks up-to-date knowledge, underestimates the risks of contracting a VPD, and overestimates the risks of vaccine side effects during pregnancy. The findings shed light on such attributes useful to promote adherence to evidence-based recommendations among HCWs.

Clinical profile and risk factors for mortality in children admitted with diphtheria: an observational study

BACKGROUND

There is an ongoing resurgence of diphtheria infection worldwide despite a vaccine being available to prevent it for more than four decades.

OBJECTIVES

To study the clinical characteristics and risk factors for mortality of diphtheria cases among children 1-12 years of age treated in our hospital from 1 April 2014 to 31 March 2021.

METHODOLOGY

The data of hospitalised cases of childhood diphtheria from 1 April 2014 to 31 March 2019 were retrospectively analysed from the medical records department of our hospital. All hospitalised children with diphtheria from 1 April 2019 to 31 March 2021, were prospectively studied. All categorical variables were expressed as proportion/percentage and all continuous variables were expressed as median with interquartile range (IQR). Risk factors for morbidity and mortality were analysed and tested for significance. Unadjusted odds ratio (OR) was calculated and significant variables were subjected to multivariate logistic regression.

RESULTS

Of the 58 children with diphtheria, 62% were lab-confirmed, most cases (45%) were between 5 and 9 years of age. Majority (57%) were completely immunised as per the national immunisation schedule. Fever (97%) was the most predominant clinical symptom. The classical diphtheria pseudo membrane was identified in all. Respiratory failure was the most predominant complication, followed by myocarditis and acute kidney injury. The case fatality rate was 8.6%.

CONCLUSION

Diphtheria cases were seen among children 5-9 years of age more commonly. Infection requiring hospitalisation was seen in vaccinated children too. No atypical manifestations were observed. Complications of the disease adversely affected the overall survival.

Protective Vaccination Used by Doctors for Prevention of Infections

Doctors, as with all healthcare workers, are a specific risk group due to a high probability of contact with contagious pathogens. An online survey was conducted among Polish doctors to establish their use of protective vaccination to decrease their personal risk of infection. The online survey was conducted using questions about medics' vaccination decisions and approaches. The results revealed that immunization against VPDs for most participants was not adequate based on recommendations or developments in vaccinology. To increase vaccination as a prophylactic method among doctors, especially those not involved in the immunization of patients, an educational campaign is demanded. As non-immunized medics are at risk themselves and are also a threat to the safety of patients, legal changes and the monitoring of vaccine acceptance and perception among medics are required.

Demographic and clinical characteristics of children and adolescents hospitalised with laboratory-confirmed COVID-19 in the Tel-Aviv District, Israel, 2020-2022

Our study population consisted of all children and adolescents, with laboratory-confirmed SARS-Co-V-2 infection, hospitalised from February 2020 through February 2022, among residents of the Tel Aviv (TA) District, Israel. There were 491 children and adolescents hospitalised with Sars-CoV-2 infection. Among them, 281 (57%) admitted with coronavirus disease 2019 (COVID-19) as the primary cause of admission (rate of 39 per 100 000). Among all children and adolescents in the TA District, the highest hospitalisation rates were observed among infants and children below the age of 4 years (rate of 311 per 100 000 population). Severe disease was observed mostly among children with multiple underlying medical conditions. Admission rates were also elevated among residents of the ultra-orthodox community (rate ratio (RR) compared to the rest of the district; 95% confidence interval (CI) 2.38-3.82). Admission rates with COVID-19 as primary cause of admission were higher during Omicron compared to Delta predominance period (RR 1.7; 95% CI 1.22-2.32). Targeted social and public health policies should be put in place when rates of disease start to increase, such as encouraging vaccine uptake for eligible children and social distancing when necessary, taking into account already existing social and learning gaps, in order to reduce the burden of disease.

The effectiveness of an extra-curricular lecture for STI prevention and sexual education

While the incidence of infections with the human immunodeficiency virus largely remained unchanged in Germany, an increase of other sexually transmitted infections (STIs) was observed. The aim was to analyse the effectiveness of our sexual education lecture for students in improving the awareness, knowledge and prevention of STIs. We conducted a cross-sectional survey after students had attended our extra-curricular lecture at the Department of Dermatology of the Ludwig-Maximilians-University of Munich, Germany (LMU). We compared the data with a previously performed study in which the same survey was carried out before the lecture had started. A total of 5866 questionnaires were included in the analysis. After attending the lecture significantly more students were aware of STIs (syphilis: 36.8% (before) vs. 63.5% (after); chlamydia: 30.5% vs. 49.3%; gonorrhoea: 22.4% vs. 38.2%; human papillomaviruses (HPV): 17.7% vs. 30.2%), the transmission pathways of STIs (oral: 36.6% vs. 82.6%; vaginal: 81.8% vs. 97.3%; anal: 42.8% vs. 94.0%; penile: 68.7% vs. 92.1%), knew that the HPV vaccination is directed against a virus (36.8% vs. 56.9%) and were interested in receiving a vaccination (57.7% vs. 78.8%). This study demonstrates the positive educative effects of our lecture for awareness and improved knowledge of STIs. To satisfy the need for a comprehensive sexual education, a combination of school and health facility-based programmes should be implemented as one single lecture cannot convey the entire information about STIs.

Social clustering of unvaccinated children in schools in the Netherlands

For the measles-mumps-rubella (MMR) vaccine, the World Health Organization-recommended coverage for herd protection is 95% for measles and 80% for rubella and mumps. However, a national vaccine coverage does not reflect social clustering of unvaccinated children, e.g. in schools of Orthodox Protestant or Anthroposophic identity in The Netherlands. To fully characterise this clustering, we estimated one-dose MMR vaccination coverages at all schools in the Netherlands. By combining postcode catchment areas of schools and school feeder data, each child in the Netherlands was characterised by residential postcode, primary and secondary school (referred to as school career). Postcode-level vaccination data were used to estimate vaccination coverages per school career. These were translated to coverages per school, stratified by school identity. Most schools had vaccine coverages over 99%, but major exceptions were Orthodox Protestant schools (63% in primary and 58% in secondary schools) and Anthroposophic schools (67% and 78%). School-level vaccine coverage estimates reveal strong clustering of unvaccinated children. The school feeder data reveal strongly connected Orthodox Protestant and Anthroposophic communities, but separated from one another. This suggests that even at a national one-dose MMR coverage of 97.5%, thousands of children per cohort are not protected by herd immunity.

Invasive Pneumococcal Disease: Concerning Trends in Serotype 19A Notifications in New Zealand

New Zealand (NZ) is one of few countries to shift from PCV13 to PCV10. The number of serotype 19A cases in young children and the proportions of isolates that are penicillin-resistant have been steadily increasing since. It is time for NZ to reconsider its choice of pneumococcal vaccine.

Process Evaluation of the Universal Immunization Program in Imphal-East District of Manipur: A Cross-Sectional Study

BACKGROUND

Various strategies have been made to make vaccines universally available including to most hard-to-reach and vulnerable population. However, change in coverage level never reached upto expected level in spite of giving so much effort by the Govt. of India and World bodies. Therefore, there is the need to look beyond. Hence, the process evaluation of Universal Immunization Program (UIP) was conducted to evaluate the process of UIP using selected variables.

METHODS

A cross-sectional observation was done during the period from May 2017 to April 2020 among the 14 health-care facilities and 36 selected session sites, and interview was done to 48 health-care providers working at different levels, located in Imphal East district of Manipur. Both checklist and pretested semi-structured questioners were used for collection of data. Descriptive statistics such as frequency, proportion, and percentage were used.

RESULTS

Ice-lined refrigerator and Deep-freezer were found to be present in working condition in 11 (100%) centers. The use of vaccine carrier was found in all 36 (100%) centers. Way of vaccine administration was found to be correct in 26 (72.2%) centers. Availability of up-to-date microplan was found in 18 (78.3%) centers.

CONCLUSIONS

Barriers in the UIP were not uniform throughout the villages and districts. Hence, area-specific measures need to be taken up for overcoming the barriers and challenges.

Bilateral Thalamic Stroke: A Case of COVID-19 Vaccine-Induced Immune Thrombotic Thrombocytopenia (VITT) or a Coincidence Due to Underlying Risk Factors?

Vaccine-induced immune thrombotic thrombocytopenia (VITT) is a rare but potentially life-threatening side effect that has only been observed in adenovirus-based vaccines for coronavirus disease 2019 (COVID-19). VITT is an immune-mediated condition that generally presents within five to 10 days post-vaccination with thrombosis, thrombocytopenia, and coagulation abnormalities. A diagnosis of VITT is made clinically and through laboratory testing. Although VITT is an important differential to consider, it is believed that more emphasis should be placed on vaccination due to the safety and efficacy in overcoming COVID-19.

Barriers for vaccination of healthcare workers

Outbreaks of vaccine preventable diseases (VPDs) in hospital settings remain a challenge even in countries with established (childhood-) vaccination programs. Healthcare workers (HCWs) with an updated vaccination card play an important role in reducing the risk of nosocomial spread of VPDs. Yet, in many places, HCWs report their immunization status to be unknown or not updated. In times of a global pandemic, the debate on vaccination of HCWs is as hot as ever; do HCWs have an increased responsibility to get vaccinated against VPDs? If so, how do we increase vaccination uptake rates among HCWs? Mandatory vaccination against VPDs for HCWs has been introduced in some countries, but it may cause ethical dilemmas and not be culturally acceptable everywhere. We looked at vaccination policies and HCWs' attitudes toward immunization against VPDs. We found that missing vaccine policies and lack of knowledge of VPDs, vaccination benefits, as well as inadequate organization around HCWs' immunizations were important barriers to have a complete vaccination record. A systematic approach to employees providing information of VPDs and vaccinations, going through their vaccination cards and offering antibody testing where appropriate or a shot of a missing vaccine could support staff to adhere to vaccination schemes.

Outbreak of Acute Respiratory Illness Associated with Human Adenovirus Type 4 at the U.S. Coast Guard Academy, 2019

BACKGROUND

Although a human adenovirus (HAdV) vaccine is available for military use, officers-in-training are not routinely vaccinated. We describe an HAdV-associated respiratory outbreak among unvaccinated cadets at the U.S. Coast Guard Academy and its impact on cadet training.

METHODS

We defined a case as a cadet with new onset cough or sore throat during August 1-October 4, 2019. We reviewed medical records and distributed a questionnaire to identify cases and to estimate impact on cadet training. We performed real-time PCR testing on patient and environmental samples and whole genome sequencing on a subset of positive patient samples.

RESULTS

Among the 1,072 cadets, 378 (35%) cases were identified by medical records (n=230) or additionally by the questionnaire (n=148). Of the 230 cases identified from medical records, 138 (60%) were male and 226 (98%) had no underlying conditions. From questionnaire responses, 113/228 (50%) cases reported duty restrictions. Of cases with respiratory specimens, 36/50 (72%) were HAdV positive; all 14 sequenced specimens were HAdV-4a1. Sixteen (89%) of 18 environmental specimens from the cadet dormitory were HAdV-positive.

CONCLUSIONS

The HAdV-4-associated outbreak infected a substantial number of cadets and significantly impacted cadet training. Routine vaccination could prevent HAdV respiratory outbreaks in this population.

Immunisation of healthcare workers in the Nordic countries: Variation in recommendations and practices and a lack of assessment

Healthcare workers (HCWs) are at increased risk of both exposure and transmission of infectious disease. Two European Union (EU) directives state that health services are responsible for assessing their employees’ potential exposure to infectious diseases and offering immunisation free of charge. We assessed current policy for immunisation of HCWs and the availability of vaccine coverage data in the Nordic countries by surveying national vaccination experts in Denmark, Finland, Iceland, Norway and Sweden, as well as Swedish county medical officers (CMOs). All national experts and 17 of 21 Swedish CMOs responded. All EU countries had transposed the European directives into national law, while Norway and Iceland had similar national legislation. Recommendations or guidelines were issued in Denmark, Finland, Iceland, Norway and 15 of 17 responding Swedish counties. The range of diseases covered differed by countries and Swedish counties. HCW vaccine coverage data were not systematically collected; incomplete estimates were only available for Finland and two Swedish counties. In conclusion, recommendations or guidelines exist in the Nordic countries, but their impact cannot be assessed, as vaccine uptake among HCWs is not currently measured. Systematic collection of data is a necessary step towards improving HCW immunisation policy and practice in the Nordic countries.

Immunisation program reviews in East and Southern Africa (2012-2018): key lessons

Introduction

the World Health Organisation (WHO) recommends that countries conduct comprehensive national immunisation program reviews regularly to help them identify systems wide-barriers or gaps and monitor performance against the set targets.

Methods

we reviewed reports from the latest national immunisation program reviews conducted in the 20 countries in the sub-region in the course of 2012-2018. We generated descriptive analysis of the findings across the sub-region.

Results

the 20 program reviews included field observations to the subnational levels as well as interviews with program staff and stakeholders. At the time of the reviews, only 11 countries had functional National Immunisation Technical Advisory Groups. Operational funding was inadequate in half of the countries. The reviews documented the cancellation of outreach services, supportive supervision visits and maintenance of cold chain equipment due to the lack of fuel or operational funding. Immunisation programs in 10 countries had major human resource gaps. Vaccine stock management tools were not effectively used in 10 countries, and stock out of vaccines and supplies was documented in 9 countries during the review. The full components of the RED strategy were implemented in only 3 of the 20 countries. Twelve countries reported challenges with the availability and accuracy of target populations. Four countries had documented the presence of vaccine hesitant groups at the time of the reviews.

Conclusion

the reviews demonstrated challenges in various aspects of the programs in different countries. The implementation of the review recommendations should be built into the annual program plans, as well as into coasted multi-year plans, in order to address the gaps and helps the program to attain the set targets. With the rapid evolution of the scope and complexity of the immunisation programs in recent years, countries should invest their efforts in building the capacity of their human resources as well as updating their logistics and data systems.

Implementation of integrated supportive supervision in the context of coronavirus 19 pandemic: its effects on routine immunization and vaccine preventable surveillance diseases indicators in the East and Southern African countries

Introduction

the coronavirus disease (COVID-19) global pandemic has caused serious disruption to almost all aspect of human endeavor forcing countries to implement unprecedented public health measures aimed at mitigating its effects, such as total lockdown (inter and intra), travel bans, quarantine, social distancing in an effort to contain the spread of the virus. Supportive supervision is a functional component of the immunization systems that allows identification of existing gaps, provides an opportunity for onsite training, and document real-time findings for improvement of the program. The control measures of COVID-19 pandemic have also resulted in limitation of operations of the immunization system including supportive supervision. This has limited many aspects of supportive supervision for surveillance and routine immunization monitoring system in the East and Southern African countries. The aim of this study is to identify the effects of COVID-19 on Integrated Supportive Supervision visits for expanded programme on immunization (EPI) and how it influences the immunization and vaccine preventable disease (VPD) surveillance indicators, and its short-term effect towards notification of increase or decrease morbidity and mortality.

Methods

we reviewed the integrated supportive supervision (ISS) data and the routine administrative coverage from 19 countries in the East and Southern Africa (ESA) for the period January to August 2019 to analyze the trends in the number of visits, vaccine-preventable diseases (VPD), and routine immunization (RI) indicators using t-test, and compare with the period January to August 2020 during the months of the COVID-19 pandemic.

Results

thirteen countries out of the 19 considered, had shown a decline in the number of integrated supportive supervision (ISS) visits, with 10 (77%) having more than 59% decrease during the January-August 2020 as compared to the same period 2019. Eleven (57%) of the countries have shown a decrease (p-value < 0.05). Ethiopia and Kenya had the highest drop (p-value < 0.000). Six (32%) had an increase in the number of visits, with Madagascar, Zambia, and Zimbabwe having >100% increase in the number of visits. Sixty-seven percent (67%) of the countries that have decreased in the number of ISS visits have equally witnessed a drop in DPT3 administrative coverage. Countries with a low proportion of outreach sessions conducted in the period of January - August 2020, have all had sessions interruption, with more than 40% of the reasons associated with the lockdown.

Conclusion

countries have experienced a decrease in the number of supportive supervision visits conducted, during the period of the COVID-19 pandemic and, this has influenced the routine immunization and vaccine-preventable diseases surveillance (VPD) process indicators monitored through the conduct of the visits. Continuous decrease in these performance indicators pose a great threat to the performance sustained and the functionality of the surveillance and immunization system, and consequently on increased surveillance sensitivity to promptly detect outbreaks and aiming to reducing morbidity and mortality in the sub-region.

The World Health Organization African regional training course for mid-level immunization managers: lessons and future directions

The World Health Organization (WHO) African regional training course for mid-level managers (MLM) of immunization programs launched in 2004, has undergone revisions across the years, to accommodate new developments in the field. In 2016, the WHO African regional office conducted a thorough review of the course materials and delivery methods to document lessons to help improve the course. Some of the gaps included inappropriate selection of trainees, inadequate focus on skills development, heavy reliance on text and presentations, as well as resource limitations to reach a critical mass of learners. The regional office worked with Bull City Learning to redesign the course materials along carefully crafted course objectives and curricula, and to assist facilitators to better deliver the course. In addition, the materials were converted into online learning tools. Within 10 months, a total of 3011 learners were enrolled in the online MLM training platform and earned a total of 9209 certificates. The MLM course will continue to be highly relevant as the immunization area of work expands significantly, with the addition of new vaccines, introduction of new technologies, and expanding opportunities for online learning.

Immunisation program reviews in East and Southern Africa: 2012-2018; key lessons

Introduction

World Health Organisation (WHO) recommends that countries conduct comprehensive national immunisation programme reviews regularly to help them identify systems wide-barriers or gaps and monitor performance against the set targets.

Methods

we reviewed reports from the latest national immunisation program reviews conducted in the 20 countries in the subregion in the course of 2012-2018. We generated descriptive analysis of the findings across the subregion.

Results

the 20 program reviews included field observations to the subnational levels as well as interviews with program staff and stakeholders. At the time of the reviews, only 11 countries had functional National Immunisation Technical Advisory Groups. Operational funding was inadequate in half of the countries. The reviews documented the cancellation of outreach services, supportive supervision visits and maintenance of cold chain equipment due to the lack of fuel or operational funding. Immunisation programs in 10 countries had major human resource gaps. Vaccine stock management tools were not effectively used in 10 countries, and stockout of vaccines and supplies was documented in 9 countries during the review. The full components of the Reaching Every District (RED) Strategy were implemented in only 3 of the 20 countries. Twelve countries reported challenges with the availability and accuracy of target populations. Four countries had documented the presence of vaccine hesitant groups at the time of the reviews.

Conclusion

the reviews demonstrated challenges in various aspects of the programs in different countries. The implementation of the review recommendations should be built into the annual program plans, as well as into costed multi-year plans, in order to address the gaps and helps the program to attain the set targets. With the rapid evolution of the scope and complexity of the immunisation programs in recent years, countries should invest their efforts in building the capacity of their human resources as well as updating their logistics and data systems.

Knowledge, attitudes and beliefs about vaccination in primary healthcare workers involved in the administration of systematic childhood vaccines, Barcelona, 2016/17

BackgroundHealthcare professionals are a reliable and impactful source of information on vaccination for parents and children.ObjectivesWe aimed to describe the knowledge, attitudes and beliefs primary care professionals involved in administration of childhood vaccines in Barcelona have about vaccines and vaccination.MethodsIn 2016/17, surveys were administered in person to every public primary care centre (PCC) with a paediatrics department (n = 41). Paediatricians and paediatric nurses responded to questions about disease susceptibility, severity, vaccine effectiveness, vaccine safety, confidence in organisations, key immunisation beliefs, and how they vaccinate or would vaccinate their own children. We used standard descriptive analysis to examine the distribution of key outcome and predictor variables and performed bivariate and multivariate analysis.ResultsCompleted surveys were returned by 277 (81%) of 342 eligible participants. A quarter of the respondents reported doubts about at least one vaccine in the recommended childhood vaccination calendar. Those with vaccine doubts chose the response option 'vaccine-hesitant' for every single key vaccine belief, knowledge and social norm. Specific vaccine knowledge was lacking in up to 40% of respondents and responses regarding the human papilloma virus vaccine were associated with the highest degree of doubt. Being a nurse a risk factor for having vaccine doubts (adjusted odds ratio (ORa) = 2.0; 95% confidence interval (95% CI): 1.1-3.7) and having children was a predictor of lower risk (ORa = 0.5; 95% CI: 0.2-0.9).ConclusionsDespite high reported childhood immunisation rates in Barcelona, paediatricians and paediatric nurses in PCC had vaccine doubts, especially regarding the HPV vaccine.

Current regional consensus recommendations on infant vaccination of the Latin American pediatric infectious diseases society (SLIPE)

INTRODUCTION

The 1st Regional Experts on Infant Vaccination (REIV) meeting generated updated consensus recommendations to improve the control of various major vaccine preventable diseases (VPD) in Latin America.

AREAS COVERED

Workshops highlighted recent changes in immunization schedules within the region, experience of countries incorporating combined acellular pertussis vaccines schedules and parenteral inactivated polio vaccine (IPV). The need to definitively replace oral polio vaccine (OPV) by IPV, and potential benefits of introducing new combined vaccines, were extensively discussed.

EXPERT OPINION

REIV strongly advised immediate adoption of either complete IPV schedules for all Latin America or schedules including at least two initial doses of IPV. Use of fractional doses of intradermally administered IPV (fIPV ID) was not recommended due to lower immunogenicity, lack of evidence on long-term protection, and technical difficulty to implement. Routine pertussis vaccination of pregnant women in addition to health workers of neonatology units and any previously unimmunized parent was encouraged. Administration of HBV vaccine to newborns within the first 24 hours of life, and then at 2, 4, and 6 months, and of a booster dose of conjugate Hib vaccine at age 12 through 15 months, was also recommended. Incorporation of combined vaccines (CV) was considered potentially advantageous.

High number of hospitalisations and non-classical presentations: lessons learned from a measles outbreak in 2017, Belgium

We describe and analyse an outbreak of measles that affected Belgium early 2017. In total, 289 cases were reported, mostly (53%) in people 15 years or older. For 133 (46%) vaccination status was unknown and a further 117 (41%) were not vaccinated. According to national guidelines, 83 of the unvaccinated cases (29% of total cases) should have received minimum one dose of vaccine, but did not. One in five cases (21%) did not present with the classical triad of fever, rash and any of coryza, conjunctivitis or cough. Rash was the most sensitive symptom, being absent in only six cases. A large proportion of cases (125/289, 43%) required hospitalisation. In hospitalised patients, the most commonly observed complications were hepatic disorders (present in 58/125 hospitalised patients, 46%). Thirty-six of the cases (12%) were in healthcare workers and nosocomial spread contributed importantly to the outbreak. Older age at presentation, altered clinical presentations and presence of complications like hepatitis can delay the correct diagnosis of measles. Clinicians should maintain a high index of suspicion in any individual presenting with rash. If the elimination target is to be reached, catch-up vaccination campaigns should be intensified and target young adults and health care workers.

Are men who have sex with men in Europe protected from hepatitis B?

Hepatitis B vaccination is recommended for men who have sex with men (MSM) in many countries, but information on vaccine coverage is scarce. We studied hepatitis B vaccination programmes and coverage among MSM in Europe to guide prevention. From a large (N = 174 209) pan-European MSM survey (EMIS-2010), we used data on self-reported hepatitis B vaccination, age, education, settlement size and disclosure of the same-sex sexual orientation ('outness'). We excluded participants with a history of hepatitis B. In multilevel (participants, countries) logistic regression models, we calculated adjusted odds ratios (aOR) with 95% confidence intervals (95% CI). We analysed data of 163 987 MSM in 38 European countries: 38.3% were 'out' to all or almost all, 56.4% reported vaccination against hepatitis B and 65.5% lived in countries with free recommended hepatitis B vaccination for MSM. In the final model the odds for being vaccinated increased with outness ('out to all or almost all': aOR 1.76, 95% CI 1.70-1.83 vs. 'out to no one') and with living in countries, where hepatitis B vaccination was recommended and free-of-charge for MSM (aOR 2.21, 95% CI 1.47-3.32 vs. 'no or unclear recommendation'). To increase hepatitis B vaccination coverage among MSM, implementation of MSM-specific recommendations and improvement of the societal climate for MSM is needed.

Assessment of the Clinical and Economic Impact of Different Immunization Protocols of Measles, Mumps, Rubella and Varicella in Internationally Adopted Children

The appropriate immunization of internationally adopted children (IAC) is currently under debate and different approaches have been suggested. The aim of this study is to evaluate the clinical and economic impact of different strategies of measles, mumps, rubella, and varicella (MMRV) immunization in IAC in Italy. A decision analysis model was developed to compare three strategies: presumptive immunization, pre-vaccination serotesting and vaccination based on documentation of previous immunization. Main outcomes were the cost of strategy, number of protected IAC, and cost per child protected against MMRV. Moreover, the incremental cost-effectiveness ratio (ICER) was calculated. The strategy currently recommended in Italy (immunize based on documentation) is less expensive. On the other hand, the pre-vaccination serotesting strategy against MMRV together, improves outcomes with a minimum cost increase, compared with the presumptive immunization strategy and compared with the comparator strategy. From a cost-effectiveness point of view, vaccination based on serotesting results in being the most advantageous strategy compared to presumptive vaccination. By applying a chemiluminescent immunoassay test, the serology strategy resulted to be clinically and economically advantageous. Similar results were obtained excluding children aged <1 year for both serology methods. In conclusion, based on our analyses, considering MMRV vaccine, serotesting strategy appears to be the preferred option in IAC.

Strengthening Routine Immunization Services in an Angolan Comuna: The Fight against the Burden of Unvaccinated Children in the Sustainable Development Goals Era

In May 2018, the non-governmental organization (NGO) Doctors with Africa CUAMM began to implement an intervention to strengthen Chiulo Hospital’s public health section to deliver immunization services in Mucope Comuna, Ombadja District. We aimed to evaluate the effect of this intervention. During the intervention period, actions such as staff training, improvement in the monitoring of vaccine stockpile, and the involvement of Community Health Workers were performed. The effects of the intervention on the number of vaccine doses administered were examined using negative binomial regression. Doses administered were 14,221 during the intervention period and 11,276 in the pre-intervention one. The number of administered doses was 26% higher (95% CI 9%–45%) in the intervention period than in the pre-intervention period. This was driven by vaccine doses administered during outreach sessions, where a statistically significant increase of 62% (95% CI 28%–107%) was observed. Regarding individual vaccines, statistically significant increases in the number of doses were observed for OPV2 (76%), OPV3 (100%), Penta3 (53%), PCV3 (53%), and Rota2 (43%). The NGO interventions led to improved delivery of immunization services in the study area. Greater increases were observed for vaccine doses that are more likely to be missed by children.

The state of adolescent immunization in Nigeria: a wake up call for all stakeholders

The number of children who survive to adolescence is increasing in Nigeria, significantly due to the success of child survival programs, with immunization as a major theme. However, the national immunization schedule in Nigeria is presently restricted to early childhood with no attention paid to immunization in adolescence. Presently, the vaccines that are readily available for adolescents include tetanus toxoid which is normally administered to pregnant women, so necessarily includes adolescent mothers; and a few research programs which offers hepatitis B vaccines. Also, there are few Nigerian adolescents who access immunization as a requirement for travelling outside the country or as a result of parental effort. Knowledge and awareness about adolescent immunization is generally poor. Nigerian adolescents have been shown to be poorly protected from tetanus, rubella and hepatitis B which are vaccine preventable. Neonatal, childhood and adult tetanus, congenital rubella syndrome, cervical cancer and hepatocellular carcinoma are just few of the diseases whose incidence can be reduced with an effective adolescent immunization program. This will also ensure that the gains of childhood immunization is concretized and socio-economic losses as a result of vaccine preventable diseases are eliminated to create a healthy and vibrant workforce. There is an urgent need to build a viable adolescent immunization program in Nigeria as adolescents represent a window of opportunity to prevent diseases which affect both the younger and older age group. This can be extended to other developing countries as well.

A survey of infectious diseases and vaccination uptake in long-term hematopoietic stem cell transplant survivors in Australia

BACKGROUND

This cross-sectional survey aimed to establish the prevalence of infectious diseases and vaccination uptake in long-term allogeneic hematopoietic stem cell transplants (HSCT) survivors in New South Wales, in order to reduce long-term post-HSCT morbidity and mortality and enhance long-term care.

PATIENTS AND METHODS

Hematopoietic stem cell transplants survivors aged over 18 years and transplanted between 2000-2012 in New South Wales (NSW) were eligible to participate. Survivors self-completed the Sydney Post BMT Study survey, FACT-BMT (V4), Chronic Graft versus Host Disease (cGVHD) Activity Assessment Self Report, Lee Chronic GvHD Symptom Scale, DASS21, Post Traumatic Growth Inventory, and the Fear of Recurrence Scale.

RESULTS

Of the 583 HSCT survivors contacted, 441 (78%) completed the survey. Respondents included 250 (57%) males and median age was 54 years (range 19-79 years). The median age at the time of transplant was 49 years (Range: 17-71), the median time since HSCT was 5 years (Range: 1-14) and 69% had cGVHD. Collectively, 41.7% of survivors reported a vaccine preventable disease (VPD) with the most common being influenza-like-illness (38.4%), varicella zoster/shingles (27.9%), pap smear abnormalities (9.8%), pneumococcal disease (5.1%), and varicella zoster (chicken pox) (4.6%). Only 31.8% had received the full post-HSCT vaccination schedule, and the majority (69.8%) of these had received the vaccines via their General Practitioner. cGVHD was not found to be a significant factor on multivariate analysis for those who were vaccinated. There was a trend toward lower vaccination rates in patients in a lower income strata.

CONCLUSIONS

Vaccinating post-HSCT survivors to prevent infections and their consequences have an established role in post-HSCT care. Improving rates of post-HSCT vaccination should be a major priority for BMT units.

Assessing the severity of influenza: a role for longitudinal telephone surveys?

During the 2009 influenza pandemic, a rapid assessment of disease severity was a challenge as a significant proportion of cases did not seek medical care; care-seeking behaviour changed and the proportion asymptomatic was unknown. A random-digit-dialling telephone survey was undertaken during the 2011/12 winter season in England and Wales to address the feasibility of answering these questions. A proportional quota sampling strategy was employed based on gender, age group, geographical location, employment status and level of education. Households were recruited pre-season and re-contacted immediately following peak seasonal influenza activity. The pre-peak survey was undertaken in October 2011 with 1061 individuals recruited and the post-peak telephone survey in March 2012. Eight hundred and thirty-four of the 1061 (78.6%) participants were successfully re-contacted. Their demographic characteristics compared well to national census data. In total, 8.4% of participants self-reported an influenza-like illness (ILI) in the previous 2 weeks, with 3.2% conforming to the World Health Organization (WHO) ILI case definition. In total, 29.6% of the cases reported consulting their general practitioner. 54.1% of the 1061 participants agreed to be re-contacted about providing biological samples. A population-based cohort was successfully recruited and followed up. Longitudinal survey methodology provides a practical tool to assess disease severity during future pandemics.

Socioeconomic Status Is Associated With Antibody Levels Against Vaccine Preventable Diseases in the Netherlands

Background: We investigated whether low socioeconomic status (SES), which is associated with reduced health and life expectancy, might play a role in increased risk for infectious diseases. Therefore, we explored the association between SES and immunoglobulin G (IgG) levels against various pathogens.

Methods: We analyzed the association between SES [educational level and net household income (NHI)] and serum IgG concentration against measles, mumps, rubella, varicella, Haemophilus influenzae type B (HiB), pneumococcus, meningococcus serogroup C (MenC), and cytomegalovirus (CMV) collected within a national cross-sectional serosurvey (2006/2007) using linear regression analyses among non-vaccinated individuals.

Results: Higher educational level was associated with higher IgG concentrations against measles (GMC ratio 1.34, 95% CI 1.18–1.53) and rubella (1.13, 1.02–1.25) compared to low education level. In contrast, higher education level was associated with lower IgG concentrations against pneumococcus (0.78, 0.70–0.88), MenC (0.54, 0.44–0.68), and CMV (0.23, 0.18–0.31) compared to low education level. This pattern was also evident when NHI was used as SES indicator.

Conclusion: Our study suggests that socioeconomic status is associated with antibody levels in a pathogen-dependent manner. The results suggest that differences in serological response upon infection or differences in exposure might be involved in the variation in IgG levels between SES groups.

Resurgence of Diphtheria in North Kerala, India, 2016: Laboratory Supported Case-Based Surveillance Outcomes

Introduction

As part of national program, laboratory supported vaccine preventable diseases surveillance was initiated in Kerala in 2015. Mechanisms have been strengthened for case investigation, reporting, and data management. Specimens collected and sent to state and reference laboratories for confirmation and molecular surveillance. The major objective of this study is to understand the epidemiological information generated through surveillance system and its utilization for action.

Methods

Surveillance data captured from reporting register, case investigation forms, and laboratory reports was analyzed. Cases were allotted unique ID and no personal identifying information was used for analysis. Throat swabs were collected from investigated cases as part of surveillance system. All Corynebacterium diphtheriae isolates were confirmed with standard biochemical tests, ELEK’s test, and real-time PCR. Isolates were characterized using whole genome-based multi locus sequence typing method. Case investigation forms and laboratory results were recorded electronically. Public health response by government was also reviewed.

Results

A total of 533 cases were identified in 11 districts of Kerala in 2016, of which 92% occurred in 3 districts of north Kerala; Malappuram, Kozhikode, and Kannur. Almost 79% cases occurred in >10 years age group. In <18 years age group, 62% were male while in ≥18 years, 69% were females. In <10 years age group, 31% children had received three doses of diphtheria vaccine, whereas in ≥10 years, 3% cases had received all doses. Fifteen toxigenic C. diphtheriae isolates represented 6 novel sequence types (STs) (ST-405, ST-408, ST-466, ST-468, ST-469, and ST-470). Other STs observed are ST-50, ST-295, and ST-377.

Conclusion

Diphtheria being an emerging pathogen, establishing quality surveillance for providing real-time information on disease occurrence and mortality is imperative. The epidemiological data thus generated was used for targeted interventions and to formulate vaccine policies. The data on molecular surveillance have given an insight on strain variation and transmission patterns.

The epidemiology of invasive pneumococcal disease in older adults in the post-PCV era. Has there been a herd effect?

The 7 and 13-valent pneumococcal conjugate vaccines (PCVs) have reduced the incidence of invasive pneumococcal disease (IPD) in children in many countries. The objective of this work was to assess the impact of PCVs and potential herd-protection in older adults in Ireland. IPD notification and typing data from adults ⩾65 years of age from July 2007 to June 2016 was assessed using national surveillance data. There was a 94% reduction in PCV7 serotypes from 2007-2008 to 2015-2016, incidence rate ratio (IRR 0·05, P < 0·0001). However, there was no decline in the additional PCV13 (PCV13-7) serotypes over the same period (IRR 0·90) nor in comparison with the pre-PCV13 period 2009-2010 (IRR 0·92). The incidence of serotypes in the 23-valent pneumococcal polysaccharide vaccine only (PPV23-PCV13) and non-vaccine types (NVTs) increased significantly (IRR 2·17, P = 0·0002 and IRR 3·43, P = 0·0001 respectively). Consequently, the overall IPD incidence rate in adults has remained relatively unchanged (from 28·66/100 000 to 28·88/100 000, IRR 1·01, P = 0·9477). Serotype 19A and NVTs were mainly responsible for penicillin resistance in recent years. The decline of PCV7 serotypes indicate that the introduction of PCV7 resulted in herd-protection for adults. However, increases in PPV23-PCV13 and NVTs suggest that changes in vaccination strategy amongst older adults are needed to build on the success of PCVs in children.

A pilot study of routine immunization data quality in Bunza Local Government area: causes and possible remedies

Introduction

As a result of poor quality administrative data for routine immunisation (RI) in Nigeria, the real coverage of RI remains unknown, constituting a setback in curtailing vaccine preventable diseases (VPDs). Consequently, the purpose of this pilot study is to identify source(s) and evaluate the magnitude of poor data quality as well as propose recommendations to address the problem.

Methods

The authors conducted a cross-sectional study in which 5 out of the 22 health facilities providing routine immunization services in Bunza Local Government Area (LGA), Kebbi State, Nigeria, were selected for data quality assessment. The reported coverage of RI in August and September, 2016 was the primary element of evaluation in the selected Health Facilities (HFs). Administered questionnaires were adapted from WHO Data Quality Assurance and RI monitoring tools to generate data from the HFs, as well as standardised community survey tool for household surveys.

Results

Data inconsistency was detected in 100% of the selected HFs. Maximum difference between HF monthly summary and RI registration book for penta 3 data quality report analysis was 820% and 767% in MCH Bunza and PHC Balu respectively. However, a minimum difference of 3% was observed at Loko Dispensary. Maximum difference between HF summary and RI registration for measles was 614% at MCH Bunza and 43% minimum difference at Loko. In contrast to the administrative coverage, 60-80% of the children sampled from households were either not immunised or partially immunised. Further, the main sources of poor data quality include heavy workload on RI providers, over-reliance on administrative coverage report, and lack of understanding of the significance of high data quality by RI providers.

Conclusion

Substantial data discrepancies were observed in RI reports from all the Health Facilities which is indicative of poor data quality at the LGA level. Community surveys also revealed an over-reporting from administrative coverage data. Consequently, efforts should be geared towards achieving good data quality by immunisation stakeholders as it has implication on disease prevention and control efforts.

Impact of State Public Health Spending on Disease Incidence in the United States from 1980 to 2009

OBJECTIVE

To understand the relationship between state-level spending by public health departments and the incidence of three vaccine preventable diseases (VPDs): mumps, pertussis, and rubella in the United States from 1980 to 2009.

DATA SOURCES

This study uses state-level public health spending data from The Census Bureau and annual mumps, pertussis, and rubella incidence counts from the University of Pittsburgh's project Tycho.

STUDY DESIGN

Ordinary least squares (OLS), fixed effects, and random effects regression models were tested, with results indicating that a fixed effects model would be most appropriate model for this analysis.

PRINCIPAL FINDINGS

Model output suggests a statistically significant, negative relationship between public health spending and mumps and rubella incidence. Lagging outcome variables indicate that public health spending actually has the greatest impact on VPD incidence in subsequent years, rather than the year in which the spending occurred. Results were robust to models with lagged spending variables, national time trends, and state time trends, as well as models with and without Medicaid and hospital spending.

CONCLUSION

Our analysis indicates that there is evidence of a significant, negative relationship between a state's public health spending and the incidence of two VPDs, mumps and rubella, in the United States.

Attitudinal variables and a possible mediating mechanism for vaccination practice in health care workers of a local hospital in L'Aquila (Italy)

Active immunization is an important concern for health care workers (HCWs) susceptible subjects and potential sources of infection for patients. However, the vaccine coverage for vaccine preventable diseases (VPDs) is below recommended standards. The aims of the study were to estimate the hospitals' HCWs' susceptibility and vaccination coverage rates for VPDs and to analyze the role of HCWs' attitudes and knowledge as determinants of the immunization practices. A cross-sectional study enrolled 334 HCWs (physicians, nurses, others) at local hospital in L'Aquila (Italy). By means of an anonymous questionnaire, self-report data about history of disease and active vaccination for seasonal influenza, chickenpox, measles-mumps-rubella and hepatitis B were collected, as well as attitudes and knowledge about vaccination in HCWs. The employees showed high levels of susceptibility and insufficient vaccination coverage rates, particularly for influenza. Specific trends were detected for different VPDs across age strata and professional categories, not always consistent with literature. Overall, the level of knowledge about recommended vaccination for HCWs was low, in all categories. The active immunization status against influenza was found the most clearly associated with difference levels in 3 psychometric variables: personal responsibility, beliefs on usefulness and beliefs on risk of vaccination. A mediation mechanism was analyzed between these constructs, and an interesting indirect effect was highlighted for beliefs that could enhance the advantage of increased responsibility for HCWs. Further effort in research is needed to evaluate the black-box of longitudinal intervention studies (education, environmental changes, policies), to improve HCWs immunization.

Risk factors for delay in age-appropriate vaccinations among Gambian children

BACKGROUND

Vaccination has been shown to reduce mortality and morbidity due to vaccine-preventable diseases. However, these diseases are still responsible for majority of childhood deaths worldwide especially in the developing countries. This may be due to low vaccine coverage or delay in receipt of age-appropriate vaccines. We studied the timeliness of routine vaccinations among children aged 12-59 months attending infant welfare clinics in semi-urban areas of The Gambia, a country with high vaccine coverage.

METHODS

A cross-sectional survey was conducted in four health centres in the Western Region of the Gambia. Vaccination dates were obtained from health cards and timeliness assessed based on the recommended age ranges for BCG (birth-8 weeks), Diphtheria-Pertussis-Tetanus (6 weeks-4 months; 10 weeks-5 months; 14 weeks-6 months) and measles vaccines (38 weeks-12 months). Risk factors for delay in age-appropriate vaccinations were determined using logistic regression. Analysis was limited to BCG, third dose of Diphtheria-Pertussis -Tetanus (DPT3) and measles vaccines.

RESULTS

Vaccination records of 1154 children were studied. Overall, 63.3% (95 % CI 60.6-66.1%) of the children had a delay in the recommended time to receiving at least one of the studied vaccines. The proportion of children with delayed vaccinations increased from BCG [5.8% (95 % CI 4.5-7.0%)] to DPT3 [60.4% (95 % CI 57.9%-63.0%)] but was comparatively low for the measles vaccine [10.8% (95 % CI 9.1%-12.5%)]. Mothers of affected children gave reasons for the delay, and their profile correlated with type of occupation, place of birth and mode of transportation to the health facilities.

CONCLUSION

Despite high vaccination coverage reported in The Gambia, a significant proportion of the children's vaccines were delayed for reasons related to health services as well as profile of mothers. These findings are likely to obtain in several countries and should be addressed by programme managers in order to improve and optimize the impact of the immunization coverage rates.

Effectiveness of interventions that apply new media to improve vaccine uptake and vaccine coverage

BACKGROUND

Vaccine-preventable diseases (VPD) are still a major cause of morbidity and mortality worldwide. In high and middle-income settings, immunization coverage is relatively high. However, in many countries coverage rates of routinely recommended vaccines are still below the targets established by international and national advisory committees. Progress in the field of communication technology might provide useful tools to enhance immunization strategies.

OBJECTIVE

To systematically collect and summarize the available evidence on the effectiveness of interventions that apply new media to promote vaccination uptake and increase vaccination coverage.

DESIGN

We conducted a systematic literature review. Studies published from January 1999 to September 2013 were identified by searching electronic resources (Pubmed, Embase), manual searches of references and expert consultation. Study setting We focused on interventions that targeted recommended vaccinations for children, adolescents and adults and: (1) aimed at increasing community demand for immunizations, or (2) were provider-based interventions. We limited the study setting to countries that are members of the Organisation for Economic Co-operation and Development (OECD).

MAIN OUTCOME MEASURES

The primary outcome was a measure of vaccination (vaccine uptake or vaccine coverage). Considered secondary outcomes included willingness to receive immunization, attitudes and perceptions toward vaccination, and perceived helpfulness of the intervention.

RESULTS

Nineteen studies were included in the systematic review. The majority of the studies were conducted in the US (74%, n = 14); 68% (n = 13) of the studies were experimental, the rest having an observational study design. Eleven (58%) reported results on the primary outcome. Retrieved studies explored the role of: text messaging (n.7, 37%), smartphone applications (n.1, 5%), Youtube videos (n.1, 5%), Facebook (n.1, 5%), targeted websites and portals (n.4, 21%), software for physicians and health professionals (n.4, 21%), and email communication (n.1, 5%). There is some evidence that text messaging, accessing immunization campaign websites, using patient-held web-based portals and computerized reminders increase immunization coverage rates. Insufficient evidence is available on the use of social networks, email communication and smartphone applications.

CONCLUSION

Although there is great potential for improving vaccine uptake and vaccine coverage by implementing programs and interventions that apply new media, scant data are available and further rigorous research - including cost-effectiveness assessments - is needed.

Attitude toward immunization and risk perception of measles, rubella, mumps, varicella, and pertussis in health care workers working in 6 hospitals of Florence, Italy 2011

BACKGROUND

Health care workers (HCWs) are at risk of infection and transmission of vaccine-preventable infectious diseases. In recent years cases of measles or varicella in health care workers were observed with increasing frequency. The aim of our study was to investigate attitude toward immunization and risk perception of measles, rubella, mumps, varicella, and pertussis in HCWs working in 6 hospitals of Florence (Italy).

METHODS

A cross-sectional survey among the physicians, nurses, midwives, and nursing assistants working in selected departments was performed trough a self-administered, anonymous questionnaire. Overall, 600 questionnaires were sent and 436 HCWs' completed forms were included into the study (Participation rate: 72.7%). Data were analyzed with STATA 11.0® and odds ratio (OR) were calculated in a multivariate analysis.

RESULTS

Among all respondents 74.9% were females. The average age was nearly 43-years-old (42.9-SD 8.95). The majority of participants (58.6%) were nurses, 21.3% physicians, 12.9% nursing assistants, and 7.2% were midwives. Among those HCWs reporting no history of disease, 52.8% (95% CI: 42.0-63.3%) declared to have been immunized for measles, 46.9% for rubella (95% CI: 39.0-54.9%), 21.6% for mumps (95% CI: 15.1-29.4%), 14.9% for varicella (95% CI: 7.4-25.7%), and 14.5% for pertussis (95% CI: 10.0-20.0%). When considering potentially susceptible HCWs (without history of disease or vaccination and without serological confirmation), less than a half of them feel at risk for the concerned diseases and only less than 30% would undergo immunization. One of the main reasons of the relatively low coverage was indeed lack of active offer of vaccines.

CONCLUSION

Attitudes toward immunization observed in this study are generally positive for preventing some infectious diseases (i.e., measles and rubella), but relatively poor for others (i.e., varicella). More information should be made available to HCWs on the benefits of vaccination and efforts to encourage vaccination uptake should be performed. Educational program on the risk of being infected working in a hospital should be implemented in order to increase the risk perception toward infectious diseases among HCWs.

When knowledge is not enough: changing behavior to change vaccination results

Why don't health care workers universally embrace vaccination to prevent vaccine preventable diseases and protect themselves and their patients? To address this problem most vaccination campaigns focus on providing education and information to health care workers. While knowledge is a necessary first step, it is likely not sufficient to increase health care worker vaccine uptake. We discuss a novel approach to applying behavior change theories and principles as a framework to plan, guide, and evaluate vaccine promotion interventions, with the goal of enhancing vaccine coverage among health care workers.

How parents make decisions about their children's vaccinations

BACKGROUND

Continued parental acceptance of childhood vaccination is essential for the maintenance of herd immunity and disease prevention. As such, understanding parents' decision-making in relation to their children's vaccinations is vitally important.

OBJECTIVE

This qualitative study sought to develop an understanding of the general process parents go through when making decisions about their children's vaccinations.

METHODS

Interviews were conducted with U.S.-born parents living in King County, Washington who had children ≤18 months of age. These interviews were recorded and transcribed verbatim.

RESULTS

Through the application of grounded theory, a general decision-making process was identified. Stages in this process included: awareness, assessing and choosing, followed by either stasis or ongoing assessment. The greatest variation occurred during the assessing stage, which involved parents examining vaccination-related issues to make subsequent decisions. This research suggests that three general assessment groups exist: acceptors, who rely primarily on general social norms to make their vaccination decisions; reliers, who rely primarily on other people for information and advice; and searchers, who seek for information on their own, primarily from published sources.

CONCLUSIONS

These results imply that one-size-fits-all approaches to vaccination interventions are inappropriate. Instead, this research suggests that interventions must be targeted to parents based on how they assess vaccination.

Immunization coverage and its determinants among children aged 12 - 23 months in a peri-urban area of Kenya

INTRODUCTION

The institutionalization of strong immunization services over recent years has ensured that today more than 70% of the worlds' targeted population is reached. In Kenya, approximately 77% of children aged 12-23 months are fully vaccinated with some districts reporting even lower levels of coverage. However, low immunization coverage remains a challenge in low income and high population settings such as Kaptembwo Location, Nakuru district.

METHODS

A cross sectional community based survey was undertaken between January and March 2011. Cluster sampling method was employed. Data was collected using pretested interviewer guided structured questionnaires through house to house visits. Data was analyzed in SPSS using descriptive, bivariate and multivariate logistic regression to identify independent predictors of full immunization.

RESULTS

Complete immunization coverage was 76.6%. Coverage for specific antigens was; BCG (99.5%), OPV0 (97.6%), OPV 1(98.7%), OPV2 (96.6%), OPV3 (90.5%), Penta 1(98.9), Penta 2 (96.6%), Penta 3 (90.0%), Measles (77.4%). The drop-out rate between the first and third pentavalent vaccine coverage was 8.9%. Predictors of full immunization included number of children within the family, place of birth of the child, advice on date of next visit for growth monitoring and opinion on the health immunization services offered.

CONCLUSION

Complete immunization coverage among children aged 12-23 months is still below target. Efforts to improve vaccination coverage must take into account the immunization determinants found in this study. There is need to focus on strengthening of awareness strategies.

Health status of visitors and temporary residents, United States

Human mobility has always been associated with the spread of infection, and mobility of nonimmigrant visitors and temporary residents to the United States is increasing, from approximately 12 million in 1987 to approximately 37 million in 2007. Lack of information about the health status of these populations upon arrival and their need for and use of medical services in the United States hinders development of public health policy, education, and provision of adequate clinical care. After these issues and needs are clarified, intervention programs should be developed to increase access and decrease the disparities of care experienced by these populations.