Vaccine Delivery Digest 201704 docxuwstartcenter.org/wp-content/uploads/2017/04/Vaccine... · · 2017-04-16vaccination among Pakistani mothers of reproductive ... Vaccination education

VaccineDeliveryResearchDigest,STARTCenter–March2017

VACCINEDELIVERYRESEARCHDIGEST

UNIVERSITY OF WASHINGTON STRATEGIC ANALYSIS , RESEARCH, & TRAINING (START)CENTER

REPORTTOTHEBILL&MELINDAGATESFOUNDATION

APRIL15, 2017PRODUCEDBY: KIDANE, L; SLYKER, J .

VaccineDeliveryResearchDigest,STARTCenter–March2017

TABLEOFCONTENTS

1. Prenatalvaccinationeducationinterventionimprovesboththemothers'knowledgeandchildren'svaccinationcoverage:EvidencefromrandomizedcontrolledtrialfromeasternChina.o ResultsfromanRCTassessingtheimpactofaprenatalvaccinationeducationinterventiontoimprove

maternalvaccinationknowledgeandvaccineuptake 3

2. Maternaleducation,empowerment,economicstatusandchildpoliovaccinationuptakeinPakistan:apopulationbasedcrosssectionalstudy.o Across-sectionalstudyexaminingthematernalcharacteristicassociatedwithchildhoodpolio

vaccinationamongPakistanimothersofreproductiveage. 4

3. SpreadofyellowfevervirusoutbreakinAngolaandtheDemocraticRepublicoftheCongo2015-16:amodelingstudy.o ModelpredictingthespatialdistributionofyellowfevervirusincentralAfricaandpotentialstrategies

tooptimizelimitedavailablevaccinestock. 5

4. RationaleandsupportforaOneHealthprogramforcaninevaccinationasthemostcost-effectivemeansofcontrollingzoonoticrabiesinendemicsettings.o Reviewofcasestudiesdemonstratingcosteffectivenessofcaninerabiesvaccinationcampaignsto

limitrabiestransmissioninendemic,resource-poorregions. 6

5. MeaslesepidemicinBrazilinthepost-eliminationperiod:Coordinatedresponseandcontainmentstrategies.o Strategiesandlessonslearnedfromcontrolmeasuresimplementedduringameaslesepidemicinthe

post-eliminationperiod. 7

6. Rotavirusimmunization:Globalcoverageandlocalbarriersforimplementation.o Nationalexpertsininfectiousdiseasesandhealth-careauthoritiessharelocalrecommendations,costs,

andperceptionofbarrierstouniversalrotavirusimmunization. 8

7. AnalysisoftheeffectsofindividualandcommunitylevelfactorsonchildhoodimmunizationinMalawi.o Across-sectionalstudyexaminingindividual-andcommunity-levelfactorsassociatedwithBCG,DPT3,

OPV3,andMCV1vaccineuptake. 9

8. HepatitisBvaccinationtiming:resultsfromdemographichealthsurveysin47countries.o AcrosssectionalstudyexaminingtheimpactofhepatitisBvaccinationschedulesandvaccinestypes

onchildhoodhepatitisBvaccinationstatus. 10

9. IsColombiareachingthegoalsoninfantimmunizationcoverage?Aquantitativesurveyfrom80municipalities.o Across-sectionalsurveyin80municipalitiesofColombiaevaluatingtimelinessofimmunizationto

assessthecoverageofnewlyintroducedvaccinesandtoidentifyfactorsassociatedwithvaccineuptake. 11

10. UtilizationofoutreachimmunizationservicesamongchildreninHoimaDistrict,Uganda:aclustersurvey.o ClusterSurveystudyexaminedthefactorsassociatedwithutilizationofoutreachimmunization

servicesamongchildrenaged10-23monthsinHoimaDistrict,Uganda. 12

Appendix:PubMedSearchTerms 13

VaccineDeliveryResearchDigest,STARTCenter-April2017

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1. Prenatalvaccinationeducationinterventionimprovesboththemothers'knowledgeandchildren'svaccinationcoverage:EvidencefromrandomizedcontrolledtrialfromeasternChina.HuY,ChenY,WangY,SongQ,LiQ.HumVaccinImmunother.2017Feb21:1-8PMID:28319453

ABSTRACTOBJECTIVES:Toverifytheeffectivenessofprenatalvaccinationeducationinterventiononimprovingmother'svaccinationknowledgeandchild'svaccinationstatusinZhejiangprovince,easternChina.METHODS:Pregnantwomenwith≥12gestationalweekswererecruitedandrandomlyassignedintotheinterventiongroupandthecontrolgroup.Theinterventiongroupweregivenavaccinationeducationsessionwhilethecontrolgroupwerenot.Tworoundsurveyswereperformedbeforeand3monthsaftertheintervention.Thevaccinationstatusofchildwasextractedat12monthsofagefromimmunizationinformationsystem.Thedifferencesofthevaccinationknowledge,thecoverage,thecompletenessandthetimelinessofvaccinationbetween2groupswereevaluated.Theeffectivenessofvaccinationeducationinterventionwasassessed,underthecontroloftheotherdemographicvariables.RESULTS:Amongthe1252participants,851subjectsrepliedtothepost-survey.Significantimprovementsofvaccinationknowledgebetweenthepre-andthepost-surveyintheinterventiongroupwereobserved(Mean±S.D:1.8±1.1vs.3.7±1.2forvaccinesscoreand2.7±1.5vs.4.8±1.0forvaccinepolicyscore,respectively).Thecoverageoffullvaccinationwassignificantlyhigherintheinterventiongroup(90.0%vs.82.9%,P<0.01).Thetimelinessoffullvaccinationwassignificantlyhigherintheinterventiongroup(51.9%vs.33.0%,P<0.01).Intheinterventiongroup,pregnantwomenweremorelikelytobewithhighscoreofknowledge(OR=5.2,95%CI:2.6-8.8),andchildrenweremorelikelytocompletethefullseriesofvaccination(OR=3.4,95%CI:2.1-4.8),andchildrenweremorelikelytocompletethefullseriesofvaccinationinatimelymanner(OR=2.3,95%CI:1.6-3.5).CONCLUSIONS:Vaccinationeducationinthepregnantwomencaneffectivelyimprovetheknowledgeregardingimmunizationandincreasethecoverage,thecompletenessandthetimelinessofchildhoodvaccination.StrongpartnershipneedstobeestablishedbetweentheobstetriciansandthevaccinationstafftoimprovetheperformanceofNIP.Web:https://dx.doi.org/10.1080/21645515.2017.1285476ImpactFactor:2.37Citedhalf-life:1.80UWEditorialComment:ThisworkcontributestoagrowingbodyofevidencedemonstratingthepotentialeffectivenessofmaternalvaccineeducationofferedinconjunctionwithprenatalcareservicestoimprovevaccinecoverageandisthefirstRCTofitskindinChina.Theprimaryoutcomewasthedifferenceinvaccinecoverageatscheduledperiodsbetweentheinterventionandcontrolarms.Secondaryoutcomeswerethetimelinessofvaccinationandchangesinmaternalknowledgeregardingvaccines.Thereisahighdegreeofmissingdata,whichcouldaffectvalidityoftheresults.Baselinedataondemographics,knowledge,andresourcesofvaccineinformationwerecollectedforallparticipants,howeverinvestigatorswereonlyabletocollectfollowupdatafromonly68%.Authorsassertedthatthestudyremainedadequatelypowereddespitethehighlevelofattrition,howeverparticipantsexitingearlyarelikelytobesystematicallydifferentfromthosethatcontinuedtostudyend.Theproportionofmissingresponsedatabetweeninterventionandcontrolarmswasnotstatisticallysignificant.Anotherlimitationofthestudywastheinabilityofinvestigatorstoaccountforexternalsourcesofinformationthatmayhaveimpactedmaternalknowledgebetweenadministrationofpreandpostsurveys.Followupforchildrenoccurredat12monthsbutthevaccinationcoveragemeasuredidnotconsidertheageinwhichchildrenreceivedthevaccine.Alongerfollowupperiodmayhaveenabledinvestigatorstoexploretrendsinvaccinecoverageasitrelatestotimeliness.


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2. Maternaleducation,empowerment,economicstatusandchildpoliovaccinationuptakeinPakistan:apopulationbasedcrosssectionalstudy.KhanMT,ZaheerS,ShafiqueK.BMJOpen.2017Mar10;7(3):e013853PMID:28283489

ABSTRACTOBJECTIVES:ToexploretheassociationofmaternaleducationandempowermentwithchildhoodpoliovaccinationusingnationallyrepresentativedataofPakistanimothersinareproductiveagegroup.DESIGN:Cross-sectional.SETTING:SecondaryanalysisofPakistanDemographicandHealthSurvey(PDHS),2012-2013datawasperformed.PARTICIPANTS:Ofthe13558mothersincludedinthesurveysample,6982motherswereabletoprovideinformationregardingpoliovaccinations.MAINOUTCOMEMEASURES:Poliovaccinationcoverageamongchildrenagedupto5yearswascategorisedascompletevaccination(allfouroralpoliovaccine(OPV)doses),incompletevaccination,andnovaccination(zeroOPVdosereceived).Mothers'empowermentstatuswasassessedusingstandard'MeasureDHS'questionsregardingtheirinvolvementindecision-makingrelatedtohealth,householdpossessionsandvisitsamongfamilyandfriends.Educationwascategorisedasnoeducation,primary,secondaryandhighereducation.ResultsofmultinomialregressionanalyseswerereportedasadjustedORwith95%CI.Weadjustedforage,wealthindex,urban/ruralresidence,placeofdelivery,andantenatalandpostnatalvisits.RESULTS:Only56.4%(n=3936)ofthechildrenreceivedcompletepoliovaccination.Womenwithnoeducationhadsignificantlyhigheroddsoftheirchildreceivingnopoliovaccination(OR2.34,95%CI1.05to5.18;p<0.01)andincompletevaccination(OR1.40,95%CI1.04to1.87;p<0.01).Further,unempoweredwomenalsohadsignificantlyhigheroddsofnottakingtheirchildforanypoliovaccination(OR1.58,95%CI1.17to2.12;p<0.01)andincompletevaccination(OR1.18,95%CI1.00to1.41;p=0.04).CONCLUSIONS:Illiteracy,socioeconomicstatusandempowermentofwomenremainedsignificantfactorslinkedtopooreruptakeofroutinepoliovaccination.Web:https://dx.doi.org/10.1136/bmjopen-2016-013853ImpactFactor:3.47Citedhalf-life:9.40UWEditorialComment:Vaccinationstatuswasdeterminedusingvaccinationcardandmaternalself-reportifcardswereunavailable.Maternalreportissubjecttorecallbiasandthetwoformsofdatacollectionforthesingleoutcomealsopresentopportunitiesformisclassificationofvaccinestatus.Theinvestigatorstakeparticularinterestintheeffectsofmaternalunempowermentonpoliovaccinationuptakedespitethemixedresultsseeninunvaccinatedandpartialvaccinationoutcomes.Investigatorsbelievethatempoweredmothersmayactasstrategicpartnersinvaccinecoverageinsettingswithlowvaccinecompliance.Theauthorsnoteempowermentcantakemanydefinitions.Inthisstudyamotherwasconsideredempoweredifshereportedbeingdirectlyinvolvedinanydecisionsregardingherhealthcare,householdpurchases,orvisitstoherfamilyorrelatives.Thisrenderingofempowermentassumesamother’sabilitytomakechoicesregardingthevaccinationofherchildisdeterminedbyandlimitedtoanyoppositionshemayfacefromherpartner.Figures1and2illustratedifferencesbetweenurbanandruralsettingsfornon-vaccinationwithrespecttowealthindexrankingsandmaternaleducation.Authorssuggestthismaybeduetointernalmigrationofpopulationfromruraltourbansettingsandgrowingurbanizationmaycounteractthepositiveeffectsofurbanenvironmentsonvaccineuptake.


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3. SpreadofyellowfevervirusoutbreakinAngolaandtheDemocraticRepublicoftheCongo2015-16:amodelingstudy.KraemerMU,FariaNR,ReinerRCJr,GoldingN,NikolayB,StasseS,JohanssonMA,SaljeH,FayeO,WintGR,NiedrigM,ShearerFM,HillSC,ThompsonRN,BisanzioD,TaveiraN,NaxHH,PradelskiBS,NsoesieEO,MurphyNR,BogochII,KhanK,etal.TheLancetInfectiousDiseases.2017Mar31;17(3):330-8.PMID:28017559

ABSTRACTBACKGROUND:Sincelate2015,anepidemicofyellowfeverhascausedmorethan7334suspectedcasesinAngolaandtheDemocraticRepublicoftheCongo,including393deaths.Wesoughttounderstandthespatialspreadofthisoutbreaktooptimisetheuseofthelimitedavailablevaccinestock.METHODS:Wejointlyanalyseddatasetsdescribingtheepidemicofyellowfever,vectorsuitability,humandemography,andmobilityincentralAfricatounderstandandpredictthespreadofyellowfevervirus.Weusedastandardlogisticmodeltoinferthedistrict-specificyellowfevervirusinfectionriskduringthecourseoftheepidemicintheregion.FINDINGS:Theearlyspreadofyellowfeverviruswascharacterisedbyfastexponentialgrowth(doublingtimeof5–7days)andfastspatialexpansion(49districtsreportedcasesafteronly3months)fromLuanda,thecapitalofAngola.Earlyinvasionwaspositivelycorrelatedwithhighpopulationdensity(Pearson'sr0·52,95%CI0·34–0·66).ThefurtherawaylocationswerefromLuanda,thelaterthedateofinvasion(Pearson'sr0·60,95%CI0·52–0·66).InaCoxmodel,wenotedthatdistrictswithhigherpopulationdensitiesalsohadhigherrisksofsustainedtransmission(thehazardratioforcasesceasingwas0·74,95%CI0·13–0·92perlog-unitincreaseinthepopulationsizeofadistrict).Amodelthatcapturedhumanmobilityandvectorsuitabilitysuccessfullydiscriminateddistrictswithhighriskofinvasionfromotherswithalowerrisk(areaunderthecurve0·94,95%CI0·92–0·97).Ifatthestartoftheepidemic,sufficientvaccineshadbeenavailabletotarget50outof313districtsinthearea,ourmodelwouldhavecorrectlyidentified27(84%)ofthe32districtsthatwereeventuallyaffected.INTERPRETATION:Ourfindingsshowthecontributionsofecologicalanddemographicfactorstotheongoingspreadoftheyellowfeveroutbreakandprovideestimatesoftheareasthatcouldbeprioritisedforvaccination,althoughotherconstraintssuchasvaccinesupplyanddeliveryneedtobeaccountedforbeforesuchinsightscanbetranslatedintopolicy.Web:https://dx.doi.org/10.1016/S1473-3099(16)30513-8ImpactFactor:5.82Citedhalf-life:4.70UWEditorialComment:DataweresourcedfromAngolaandDRCyellowfever(YF)outbreaksandWHOsituationreports.AuthorsidentifiedkeyecologicalanddemographicdeterminantsofYFtransmissionanddevelopedananalyticalframeworktoprioritizedistricts(Angola)andcommunes(DRC)forinterventions.ThemodelperformedwellinestimatingthegeographicspreadofYFusingexistingdata,andindicatedspatialexpansionoftheYFviruswaspredictedbyhumanmobilitycapturedusingde-identifiedmobilephonedata.Authorssuggestincreasedreportingduringinitialstagesoftheoutbreakaretypicalandmayinflatethereproductionnumber(R0)andestimatesforcriticalvaccinationcoverage.Therewasastrongneighborhoodeffectatthesubnationalunitlevels,henceusingnationaldatatoestimatereproductionnumbermaylimitaccuracy,andestimatesoftransmissiondynamicsmaybemoreaccurateatsmallerunitsofgeography.Theratioofmosquitostohumansinisnotwellestablishedatdistrictandcommunelevels,sothemodelwasunabletocharacterizeheterogeneityinvectorspatialdistribution,andsuitability(theeffectofenvironmentalfactorsinlimitingvectorpersistenceandtransmissibility)remainedapproximatelyconstantthroughouttheregions.Theabsenceofvaccinationandcountdataatthesubnationalunitprohibitsestimatingimpactofvaccinationcampaignonoutbreakdurationandspread.


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4. RationaleandsupportforaOneHealthprogramforcaninevaccinationasthemostcost-effectivemeansofcontrollingzoonoticrabiesinendemicsettings.LavanRP,KingAI,SuttonDJ,TunceliK.Vaccine.2017Mar23;35(13):1668-1674.PMID:28216188

ABSTRACTAlthoughdogvaccinationhasbeendemonstratedtoreduceandeliminaterabiesinhumans,duringmeetingsthereareoftencallsforfurtherpilotstudies.Theassembleddataprovesthatawidespreadapproachisnowrequired.Whilezoonoticrabieshasaminimalpresenceindevelopednations,itisendemicthroughoutmostofAsiaandAfrica,whereitisconsideredtobeaneglectedtropicaldisease.Intheseareas,rabiescausesanestimatedannualmortalityofatleast55,000humandeaths.Worldwiderabiddogsarethesourceofthevastmajorityofhumanrabiesexposures.TheWorldHealthOrganization(WHO),theFoodandAgricultureOrganization(FAO)oftheUnitedNationsandtheWorldOrganizationforAnimalHealth(OIE)advocateacollaborativeOneHealthapproachinvolvinghumanpublichealthandveterinaryagencies,withmasscaninevaccinationprogramsinendemicareasbeingthemainstayofstrategiestoeliminatedog-mediatedhumanrabies.Whilepost-exposureprophylaxis(PEP)iseffectiveinpreventingdeathsinpeopleexposedtorabies,itiscomparativelyexpensiveandhaslittleimpactonthecaninereservoirthatistheprimarysourceofzoonoticrabies.Indiscriminatecullingofthedogpopulationisexpensiveandthereislittleevidencethatitiseffectiveincontrollingrabiesinnon-islandlocations.MasscaninevaccinationprogramsusingaOneHealthframeworkthatachievesaminimum70%vaccinationcoverageduringannualcampaignshaveproventobecost-effectiveincontrollingzoonoticrabiesinendemic,resource-poorregions.Casestudies,suchasinTanzaniaandBhutan,illustratehowanapproachbasedonmasscaninerabiesvaccinationhaseffectivelyreducedbothcanineandhumanrabiestominimallevels.Themultiplebenefitsofmasscaninerabiesvaccinationinthesecasesincludedeliminatingrabiesinthedomesticdogreservoirs,eliminatinghumanrabiescases,anddecreasingtherabieseconomicburdenbyreducingexpendituresonPEP.Web:https://dx.doi.org/10.1016/j.vaccine.2017.02.014ImpactFactor:3.62Citedhalf-life:5.50UWEditorialComment:PassivereportingsystemsandsporadicsurveillanceinAfricaandAsiaarelikelytounderestimatethetrueincidenceofhumanrabiesdeaths.Humanrabiesvaccineshave~100%efficacyforbothpreventionandpost-exposureprophylaxis(PEP),butaretoocostlyforwidespreaduseinmostLMIC.CaninesrepresentthelargestsourceforrabiestransmissiontohumansinAsiaandAfrica,andthecommentaryassertsthatcaninevaccinationisthemostcosteffectivecontrolmeasureinendemicsettings.TherelativelylowtransmissibilityofRabies(R0:1.05–1.72)suggestssuccessfulcontrolofcaninerabiesmaybeachievedwithvaccinecoverageratesbelowtheminimum70%threshold.AcasestudyinBhutanfoundamasscaninevaccinationandsterilizationprogramoverthecourseof6yearsbecamecosteffectivein3yearsandresultedinanultimatesavingsof$40,000.Thecostperdogofwasestimatedtobe$1.20forvaccinationand$6.36forsterilization,butassertsterilizationisnotanessentialcomponentofcaninerabiescontrol.Theauthorsdonotprovideestimatesofthechangeinincidenceofhumanrabiescasesachievedbeforeandaftertheintervention.ThepriceperdoseofcaninerabiesvaccinesingovernmentandNGOledcampaignsisunknownbutestimatesforvaccinesinthedevelopingworldrangebetween$0.20-$1.00/dose,withthemajorityofcampaigncostscoveringpersonnelandlogistics.Theauthorsalsodiscussthepotentialvalueaddedindevelopingathermostablecaninerabiesvaccine.Thearticledoesnotdiscussthecosteffectivenessofalternativeinterventionstrategiesorcombinedinterventions.


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5. MeaslesepidemicinBrazilinthepost-eliminationperiod:Coordinatedresponseandcontainmentstrategies.LemosDR,FrancoAR,deSáRorizML,CarneiroAK,deOliveiraGarciaMH,deSouzaFL,DuronAndinoR,deGóesCavalcantiLPVaccine.2017Mar23;35(13):1721-1728.PMID:28256359

ABSTRACTThemeaslesviruscirculationwashaltedinBrazilin2001andthecountryhasaroutinevaccinationcoverageagainstmeasles,mumpsandrubellahigherthan95%.InCeará,thelastconfirmedcasewasin1999.Thisarticledescribesthestrategiesadoptedandtheeffectivenessofsurveillanceandcontrolmeasuresimplementedduringameaslesepidemicinthepost-eliminationperiod.TheepidemicstartedinDecember2013andlasted20months,reaching38citiesand1,052confirmedcases.TheD8genotypewasidentified.Morethan50,000samplesweretestedformeaslesand86.4%oftheconfirmedcaseshadalaboratorydiagnosis.Thebeginningofancampaignvaccinationwasdelayedinpartbytheavailabilityofvaccine.Theclassiccontrolmeasureswerenotenoughtocontroltheepidemic.Thecreationofacommitteeofexperts,theagreementsignedbetweenmanagersofthethreespheresofgovernment,theconductingofaninstitutionalactivesearchofsuspectedcases,vaccinationdoortodooratalternativetimes,theuseofmicroplanning,abroadadvertisingcampaignatlocalmediaandtechnicaloperativesupportcontributedtocontainingtheepidemic.Itisimportanttorecognizethepossibilityofepidemicsatthisstageofpost-eliminationandprepareasensitivesurveillancesystemfortimelyresponse.Web:https://dx.doi.org/10.1016/j.vaccine.2017.02.023ImpactFactor:3.62Citedhalf-life:5.50UWEditorialComment:Authorssuspectthemeaslesvirusislikelytocirculatefasterthanconventionaloutbreakvaccinationprogramscanrespond,andlimitingcontroleffortstovaccinatingdirectcontactsofmeaslescases,ratherthanmorebroadlyvaccinatingallsusceptibleindividuals,wasacriticalmisstepattheonsetoftheepidemic.Theslowandfragmentedoutbreakresponsemayhaveextendedthedurationandgeographicspreadoftheepidemic.ThehighinfectivepotentialofthevirusmayprovidesomeaccountastohowthemeaslesepidemicinCearátookplacedespitethehighrateofroutinevaccinationcoverageforthemeaslesvirusinthearea.PocketsofsusceptiblepopulationsinCearádemonstratetheneedforrapidmonitoringofroutinevaccinecoverageandthecontinuedcollectionandanalysisofdataespeciallyasitpertainstohigh-riskgroups.Followingtheimplementationofimmunizationefforts,scanningvaccinationhelpedtoidentifyandtreatsusceptibleindividualsandactivecasesforallindividualsage6months-49years.AuthorshighlightedscanningvaccinationmethodsareintegraltothesuccessandsustainabilityofmeaslesandrubellaeradicationprogramsintheAmericas.


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6. Rotavirusimmunization:Globalcoverageandlocalbarriersforimplementation.LoVecchioA,LiguoroI,DiasJA,BerkleyJA,BoeyC,CohenMB,CruchetS,Salazar-LindoE,PodderS,SandhuB,ShermanPM,ShimizuT,Vaccine.2017Mar14;35(12):1637-1644.PMID:28216189

ABSTRACTBACKGROUND:Rotavirus(RV)isamajoragentofgastroenteritisandanimportantcauseofchilddeathworldwide.Immunization(RVI)hasbeenavailablesince2006,andtheFederationofInternationalSocietiesofGastroenterologyHepatologyandNutrition(FISPGHAN)identifiedRVIasatoppriorityforthecontrolofdiarrhealillness.AFISPGHANworkinggrouponacutediarrheaaimedatestimatingthecurrentRVIcoverageworldwideandidentifyingbarrierstoimplementationatlocallevel.METHODS:Asurveywasdistributedtonationalexpertsininfectiousdiseasesandhealth-careauthorities(March2015-April2016),collectinginformationonlocalrecommendations,costsandperceptionofbarriersforimplementation.RESULTS:Forty-nineofthe79contactedcountries(62%responserate)providedacompleteanalyzabledata.RVIwasrecommendedin27/49countries(55%).AlthoughfivecountrieshaverecommendedRVIsince2006,alargenumber(16,33%)includedRVIinaNationalImmunizationSchedulebetween2012and2014.Thecostsofvaccinationarecoveredbythegovernment(39%),bytheGAVIAlliance(10%)orpublicandprivateinsurance(8%)insomecountries.However,inmostcases,immunizationispaidbyfamilies(43%).Elevatedcostofvaccine(49%)isthemainbarrierforimplementationofRVI.Highcostsofvaccination(rs=-0.39,p=0.02)andcoverageofexpensesbyfamilies(rs=0.5,p=0.002)significantlycorrelatewithalowerimmunizationrate.LimitedperceptionofRVillnessseveritybythefamilies(47%),public-healthauthorities(37%)orphysicians(24%)andthetimingofadministration(16%)arefurthermajorbarrierstolarge-scaleRVIprograms.CONCLUSIONS:After10yearssinceitsintroduction,theimplementationofRVIisstillunacceptablylowandshouldremainamajortargetforglobalpublichealth.Barrierstoimplementationvaryaccordingtosetting.Nevertheless,publichealthauthoritiesshouldpromoteeducationforcaregiversandhealth-careprovidersandinteractwithlocalhealthauthoritiesinordertoimplementRVI.Web:https://dx.doi.org/10.1016/j.vaccine.2017.01.082ImpactFactor:3.62Citedhalf-life:5.50UWEditorialComment:Seventy-twocountriescomprise95%ofallrotavirus-relatedmortality.In2016,80countriesincludedRVIintheirNationalImmunizationProgram.BarrierstoRVIdisseminationvariedbothbetweenandwithinnations.Costandperceptionsoftheburdenofrotaviruswerethemostfrequentlyreportedbarrierstoimplementinguniversalimmunization.Althoughrare,safetyconcernscenteredaroundtheriskofintussusceptionasasideeffect.SurveyswereadministeredtoparticipantsdrawnfromaconveniencesampleofmembersoftheFISPGHANworkinggroup,limitinggeneralizability.FortypercentofsurveyresponsescamefromEuropeancountrieswhererotavirusrelatedmortalityisrare.Responsesfromhigh-incomeEuropeancountriesmayreflectlessinterestinRVI,whichwouldbiasthesampletowardsalowerperceivedseverityofrotavirus.


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7.AnalysisoftheeffectsofindividualandcommunitylevelfactorsonchildhoodimmunizationinMalawi.NtendaPA,ChuangKY,TirunehFN,ChuangYC.Vaccine.2017Apr4;35(15):1907-1917.PMID:28284678

ABSTRACTBACKGROUND:Empiricalevidenceregardingtherelationshipbetweenchildhoodimmunizationandindividual-andcommunity-levelfactorsinlow-incomecountrieshasreceivedlittleattention.Wecomparedthetrendsandtheeffectsofawiderangeofindividual-andcommunity-levelsocioeconomicfactorsonthelikelihoodofachildbeingimmunizedbetween2004and2010inMalawi.METHODS:Weuseddatafromthe2004and2010MalawiDemographicandHealthSurveyandappliedgeneralizedestimatinglogisticregressionequationtoanalyzedatarespectivelyon2042and3496childrenaged12-23months.Wecomparedtherelationshipbetweenindividual-andcommunity-levelsocioeconomicfactorsandachild'svaccinationstatusforfourbasicvaccinesrecommendedbytheWorldHealthOrganization:bacillusCalmette-Guérin(BCG)vaccine,diphtheria-tetanus-pertussis(DPT3)vaccine,oralpoliovaccine(OPV3),andmeasles-containingvaccine1(MCV1).RESULTS:Thetrendsofvaccinationhadasimilarpatternin2004and2010.ThecoverageofthefourvaccinationswashighestforBCGandlowestforOPV3andcompleteimmunizationwashigherin2010.Themultivariateanalysesshowthatmother'sloweducation,havingoneornoneantenatalvisits,havingnoimmunizationcard,havingimmunizationcardbutnotseen,residinginpoorhouseholds,andlivingincentralregionwerethemostsignificantfactorsassociatedwithdecreasedoddsofachievingvaccinationcoverageandcompletevaccinationinboth2004and2010.However,maternaleducationwasmorelikelytobeassociatedwithchildren'simmunizationin2010,whilethegeographicalregionwasmorelikelytobeassociatedwithchildren'simmunizationin2004.CONCLUSIONS:Thereweremarkedimprovementsinthenationalimmunizationcoveragefrom2004to2010.Inordertoachievecompleteimmunization,tofurtherenhancethenationalimmunizationcoverageaswellastolessenthegapsanddisparitiesinchildhoodvaccinationinMalawi,policymakersshoulddesigninterventionsbasedonthefactorsaddressedinthisstudy.Web:https://dx.doi.org/10.1016/j.vaccine.2017.02.036ImpactFactor:3.62Citedhalf-life:5.50UWEditorialComment:TheauthorsreportthisisthefirststudyexaminingtherelativeimpactsofcommunityandindividualleveldriversofvaccineuptakeinMalawi.Strengthsofthestudyincludethemultilevelanalysis,useofthenationallyrepresentativeDHSdata,andrestrictionoftheanalysistotherelevantdemographic.Malawi’sEPIrecommendschildrenreceivethecompletevaccinationscheduleby12months.Investigatorsexaminedoutcomesofchildrenages12-23monthstocapturevaccinesadministeredwithinthefirst12monthsandcatch-upvaccinesadministeredafter12months.Studylimitationsincludepotentialrecallbiasbecausevaccineuptakewasassessedbymaternalreport.Investigatorscomparetheeffectsof11individualandsevencommunitylevelcategoricalvariableswithrespecttofivedifferentoutcomes;becausethelargenumbersofstatisticaltestsdonotaccountformultiplecomparisonssignificantpvaluesshouldbeinterpretedwithcaution.Figure1isalinegraphpresentingchangesinfivevaccinationoutcomesforasingletimeinterval;theuseoflinegraphsandpresentationofcategoricalvariablesonthex-axismakesthegraphsubjecttomisinterpretationandgivestheimpressionofillustratinglongitudinaldata.


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8.HepatitisBvaccinationtiming:resultsfromdemographichealthsurveysin47countries.SchweitzerA,AkmatovMK,KrauseG.BullWorldHealthOrgan.2017Mar1;95(3):199-209G.PMID:28250533

ABSTRACTOBJECTIVE:ToexaminetheimpactofhepatitisBvaccinationschedulesandtypesofvaccinesonhepatitisBvaccinationtiming.METHODS:Weuseddatafor211643childrenfromdemographicandhealthsurveysin47low-andmiddle-incomecountries(medianstudyyear2012).Datawerefromvaccinationcardsandmaternalinterviews.Wegroupedcountriesaccordingtothevaccinationscheduleandtypeofvaccineused(monovalentorcombination).Foreachcountry,wecalculatedhepatitisBvaccinationcoverageandtimelyreceiptofvaccinedoses.Weusedmultivariablelogisticregressionmodelstostudytheeffectofvaccinationschedulesandtypesonvaccinationdelay.FINDINGS:Substantialdelaysinvaccinationwereobservedevenincountrieswithfairlyhighcoverageofalldoses.Mediandelaywas1.0week(interquartilerange,IQR:0.3to3.6)forthefirstdose(n = 108626children)and3.7weeks(IQR:1.4to9.3)forthethirddose(n = 101 542).Weobservedatendencyofloweroddsofdelaysinvaccinationschedulesstartingat6andat9weeksofage.Forthefirstvaccinedose,werecordedloweroddsofdelaysforcombinationvaccinesthanformonovalentvaccines(adjustedoddsratio,aOR:0.76,95%confidenceinterval,CI:0.71to0.81).CONCLUSION:WidevariationsinhepatitisBvaccinationcoverageandadherencetovaccinationschedulesacrosscountriesunderscorethecontinuedneedtostrengthennationalimmunizationsystems.Timelyinitiationofthevaccinationprocessmightleadtotimelyreceiptofsuccessivedosesandimprovedoverallcoverage.Wesuggestincorporatingvaccinationtimingasaperformanceindicatorofvaccinationprogrammestocomplementcoveragemetrics.Web:https://dx.doi.org/10.2471/BLT.16.178822ImpactFactor:5.30Citedhalf-life:>10UWEditorialComment:TheauthorsdefinevaccinecoverageasthereceiptofthefullcourseofHBVvaccine.Vaccinationcardswereonlyavailablefor58%ofthechildrenincludedinthestudy.Figure1illustratesthepooleddistributionofagesinwhichchildrenwereindicatedtohavereceivedtheirfirstandthirddosesusingdataextractedfromvaccinationcards.Variedimmunizationschedulesacrosscountriesmayexplainsomeofthevariationinageatdose.Vaccinecoverageratesdemonstratedconsiderablevariationacrosscountriesevenwhencountriesutilizedthesamevaccinesandsharedidenticalvaccineschedules.Incomparingcoverageratesforthefirstandthirddosesinvestigatorsnotedadeclineincoverageandtimelydeliveryindependentofvaccinescheduleandtype.However,vaccinecoverageandtimingwereonlyweaklycorrelatedinthedata(Spearmanrho=0.28;P=0.05),whichmaysuggestlengthyperiodsofincompleteprotection.Only13countriesinthestudyreportcompliancewithWHOrecommendationofadministeringvaccineatbirth.InvestigatorsassertthatadministeringbirthdosesinAfricatosuppressperinatalandearlyhorizontalinfectionswarrantsadditionalconsiderationgiventhepotentiallyhighriskoftransmissionfromHBeAg-positivemothers.Investigators note barriers to immunization stemming from the range of inequities in healthcare delivery andaccessacrossthe47LMICrepresentedinthestudyare likelytoaccountfortheconsiderablevariationobservedbetween countries. The use of DHS data prohibits comparisons across counties as surveys are conducted at indifferentyears(medianyear=2012).


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9.IsColombiareachingthegoalsoninfantimmunizationcoverage?Aquantitativesurveyfrom80municipalities.NarváezJ,OsorioMB,Castañeda-OrjuelaC,ZakzukNA,CedielN,Chocontá-PiraquiveLÁ,deLaHoz-RestrepoF.Vaccine.2017Mar13;35(11):1501-8.PMID:28209436

ABSTRACTOBJECTIVES:ThisstudyaimedtoevaluatethecoverageoftheColombianExpandedProgramonImmunizationamongchildrenlessthan6yearsold,toevaluatethetimelinessofimmunization,toassessthecoverageofnewlyintroducedvaccines,andtoidentifyfactorsassociatedwithlackofimmunization.METHODS:Weconductedacross-sectionalsurveyin80municipalitiesofColombia,usingatwo-stageclusterrandomsampling.Weattemptedtocontactallchildrenlessthan6yearsoldlivinginthesampledblocks,andaskedtheircaregiverstoprovideimmunizationrecordcards.Wealsocollectedbasicsociodemographicinformation.RESULTS:Wereached81%oftheattemptedhouseholdcontacts,identifying18,232children;ofthem,14,805(83%)hadanimmunizationrecordcard.Coveragefortraditionalvaccineswasabove90%:BCG(tuberculosis)95.7%(95%CI:95.1-96.4),pentavalentvaccine93.3%(92.4-94.3),MMR(measles,mumps,rubella)initialdose94.5%(93.5-95.6);butitwaslowerforrecentlyintroducedvaccines:rotavirus80%(77.8-82.1),influenza48.4%(45.9-50.8).Resultsfortimelyvaccinationwerenotequallysuccessful:pentavalentvaccine44.2%(41.4-47.1),MMRinitialdose71.2%(68.9-73.4).Mother'seducationwassignificantlyassociatedwithhigherimmunizationodds.Olderage,agreaternumberofsiblings,lowsocioeconomicstatus,andnothavinghealthinsuranceweresignificantlyassociatedwithlowerimmunizationodds.Therewassignificantheterogeneityinimmunizationratesbymunicipalityacrossthecountry.CONCLUSIONS:Althoughabsoluteimmunizationcoveragefortraditionalvaccinesmetthegoalof90%forthe80municipalitiescombined,disparitiesincoverageacrossmunicipalities,delayedimmunization,anddeclineofcoveragewithage,arecommonproblemsinColombiathatmayresultinreducedprotection.Newlyintroducedvaccinesrequireadditionaleffortstoreachthegoal.Theseresultshighlighttheassociationofhealthinequitieswithlowimmunizationcoverageanddelayedimmunization.Identificationofvulnerablepopulationsandtheirmissedopportunitiesforvaccinationmayhelptoimprovethereachofimmunizationprograms.Web:https://dx.doi.org/10.1016/j.vaccine.2017.01.073ImpactFactor:3.62Citedhalf-life:5.50STARTEditorialComment:Theprimarylimitationofthestudyisthedegreeofmissingoutcomedatausedtocalculateabsoluteandtimelycoverage.AbsolutecoverageisdefineastheproportionofchildrenhavingreceivedfullseriesofvaccinesrecommendedfortheirageregardlessofwhetherornotthosevaccineswereadministeredaccordingtotheEPIschedule.Timelycoverageisdefinedastheproportionofchildrenreceivingeverysingledoseattherecommendedagesandisamorestringentindicatorofvaccinecompliancethanabsolutecoverage.Investigatorsassertmedicalrecordsmaintainedbyrobusthealthinformationsystemsaremorelikelytodocumentcomprehensivevaccinationhistorythanimmunizationrecordcards.Immunizationcardstendtounderestimatethetruenumberofvaccinesreceivedbychildren.Investigatorsrelyingonimmunizationcardsastheprimarysourceofoutcomedatawouldbeatriskofunderreportingabsolutecoverage.However,theauthorsasserttheabsolutecoveragewasabove90%formanyofthevaccinesevaluatedinthisstudysoitisunlikelythatthedegreeofmissingoutcomesdataarelargeenoughtobiasORestimatestoalargedegree.Similarly,theproportionoftimelycoveragemaybegreaterthanorequaltoORestimatesprovidedintable5.


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10.UtilizationofoutreachimmunizationservicesamongchildreninHoimaDistrict,Uganda:aclustersurvey.OryemaP,BabiryeJN,BagumaC,WasswaP,GuwatuddeD.BMCResNotes.2017Feb27;10(1):111.PMID:28241865

ABSTRACTBACKGROUND:Theglobalvaccineactionplan2011–2020wasendorsedby194statestoequitablyextendthebenefitsofimmunizationtoallpeople.However,gapsinvaccinationcoverageremainindevelopingcountriessuchasUganda.Oneofthestrategiesusedtotackleexistinginequitiesisimplementationofoutreachimmunizationservicestodeliverservicestothosewithpoorgeographicalaccess.However,reportsofinconsistentuseoftheseservicesprevail;thereforeunderstandingthefactorsassociatedwithuseoftheseservicesiscriticalforimprovingservicedelivery.Thisstudyexaminedthefactorsassociatedwithutilizationofoutreachimmunizationservicesamongchildrenaged10–23monthsinHoimaDistrict,Uganda.RESULTS:Overall,87.4%(416/476)ofthechildrenhadeverutilizedoutreachimmunizationservices.Ofthese,3.6%(15/416)hadcompletedtheirentireimmunizationschedulesfromoutreachimmunizationsessions.Useofoutreachserviceswasassociatedwithreportsthatthetimeofoutreachsessionswasconvenient[adjustedoddsratio(AOR)2.9,95%confidenceinterval(CI)1.32–6.51],communitymobilizationwasdonepriortooutreachsessions(AOR4.9,95%CI1.94–12.61),thecaretakerknewthebenefitsofchildhoodimmunizations(AOR2.1,95%CI1.30–4.42),andthecaretakerwasabletonameatleastfourvaccinepreventablediseases(AOR3.0,95%CI1.13–7.88).CONCLUSIONS:UtilizationofoutreachimmunizationservicesinHoimaDistrictwashighbutreducedwithsubsequentvaccinedoses.Therefore,strategiestargetedatretainingserviceusersfortheentireimmunizationscheduleneedtobedevelopedandimplemented.Suchstrategiescouldincludehealtheducationemphasizingthebenefitsofchildhoodimmunization.Web:https://dx.doi.org/10.1186/s13104-017-2431-1ImpactFactor:1.6Citedhalf-life:0STARTEditorialComment:Investigatorsimplementedathree-stageclustersamplingtechnique.Inthefirststageinvestigatorsselected6subcountydistrictsusingsimplerandomsampling,inthe2ndstage68villageclusterswereselectedwithoutreplacementusingcomputergeneratedrandomnumbers.Inthefinalstage,investigatorsidentifiedarandomjunctioninthevillageandthenmovedtowardsthecenterofthevillage,astheyproceededtoidentifyhouseholdswitheligibleparticipants.Investigatorsusedprobabilityproportionatetosizemethodtodeterminethenumberofrespondentsrequiredpercluster.Selectedforinclusioninthestudyiftheyhadlivedinthestudyareaforatleast10months.Investigatorschosetheyoungestchildinhouseholdswithmorethanonechildandinhouseholdswithmultiplebirthsasinglechildwaselectedusingatableofrandomnumbers.

Investigatorsdichotomizedanddefineutilizationsuchthathighuserssoughtoutreachimmunizationservicesfor≥3ofthe5recommendimmunizationschedules,andlowuserssoughtservicesfor<3ofthe5recommendimmunizationschedules.Datawerecollectedonsocialdemographicvariablesforchildandcaretakersandfactorssuchasconvenienceoftimeofoutreachsessions,communitymobilization,caretakers’maritalstatus,educationalattainment,knowledgeofimmunization,religionandoccupation,thefrequencyofoutreachsessions,andhealthworkers’behaviors.QuestionnairesweretranslatedfromEnglishtoRunyoro,themostcommonlyspokenlocallanguage.ResponseswerethenbacktranslatedtoEnglishtocheckforconsistencyandinterpretability.Investigatorssuspectnoncompliantrespondentsmayhavefeltsocialpressuretoover-reportvaccineuptakethismayresultinspuriouslyinflatedriskestimates.Thecrosssectionalstudydesignalsoprohibitsdatacollectionofoutreachservicesutilizedbeforeandafterthesurveyperiod.


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Appendix:PubMedSearchTerms(((((vaccine[tiab]ORvaccines[tiab]ORvaccination[tiab]ORimmunization[tiab]ORimmunisation[tiab]ORvaccine[mesh]ORimmunization[mesh])AND(logistics[tiab]ORsupply[tiab]OR"supplychain"[tiab]ORimplementation[tiab]ORexpenditures[tiab]ORfinancing[tiab]OReconomics[tiab]OR"Costeffectiveness"[tiab]ORcoverage[tiab]ORattitudes[tiab]ORbelief[tiab]ORbeliefs[tiab]ORrefusal[tiab]OR"Procurement"[tiab]ORtimeliness[tiab]ORsystems[tiab]))OR("vaccinedelivery"[tiab]))NOT("invitro"[tiab]OR"immuneresponse"[tiab]ORgene[tiab]ORchemistry[tiab]ORgenotox*[tiab]ORsequencing[tiab]ORnanoparticle*[tiab]ORbacteriophage[tiab]ORexome[tiab]ORexogenous[tiab]ORelectropor*[tiab]OR"systemsbiology"[tiab]OR"animalmodel"[tiab]ORcattle[tiab]ORsheep[tiab]ORgoat[tiab]ORrat[tiab]ORpig[tiab]ORmice[tiab]ORmouse[tiab]ORmurine[tiab]ORporcine[tiab]ORovine[tiab]ORrodent[tiab]ORfish[tiab]))AND(English[LA])("2017/2/15"[PDAT]:"2017/3/14"[PDAT]))

*OnApril5,2017,thissearchofEnglishlanguagearticlespublishedbetweenFebruary15th,2017andMarch14th,2017andindexedbytheUSNationalLibraryofMedicineresultedin206uniquemanuscripts.

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