Under the National Immunisation Programme (NIP), 1,520,301 children and pregnant women were vaccinated in the Netherlands in 2019. Together, they received a total of 2,929,264 vaccinations. National immunisation coverage rose slightly for the first time in five years. In 2019, there were no notifications for diphtheria, tetanus, rubella, and polio. As in previous years, the number of notifications was low for Haemophilus influenzae type b (Hib; 39). The number of measles notifications was relatively high (84). The number of mumps cases (131) was double the number reported in the previous year. The number of notifications of hepatitis B (1205) remained stable. The number of notifications of meningococcal W disease (62) decreased after introduction of MenACWY-vaccination into the NIP (for 14-month-olds and 14-year-olds). This ended the rise in notifications from 2015 to 2018 (from 9 to 103). The number of pertussis notifications (6383) increased compared with 2018. Since the end of 2019, pregnant women are vaccinated against pertussis to prevent severe pertussis in infants. From March 2020 to June, during the Dutch COVID-19 response measures, including social distancing and school closure, the reported incidence of pertussis, invasive pneumococcal disease, meningococcal disease and mumps dropped. The Ministry of Health, Welfare and Sport has decided in April 2020 to cancel the implementation of rotavirus vaccination for children with an high risk for severe disease in the NIP. A new study showed lower vaccine-effectiveness estimates for high-risk infants than expected. The ministry asked for a new advise of the Health Council, which is expected in 2021. In 2020, the intention was to offer pneumococcal vaccination to elderly 60, 65, 70 and 75 years of age. Due to the COVID-19 pandemic, however, priority in this year has been given to the oldest age groups (73- to 79-year-olds).
BACKGROUND: Based on 2021 data, Nigeria had the second largest number of zero-dose children globally estimated at over 2.25 million, concentrated in the northern part of the country due to factors some of which are sociocultural. This study analysed the impact of the COVID-19 pandemic and response on childhood vaccination in Northern Nigeria. METHODS: Using a mixed methods sequential study design in the most populous northern states of Kaduna and Kano, quantitative routine immunisation data for the period 2018-2021 and qualitative data collected through 16 focus group discussions and 40 key informant interviews were used. An adaptation of the socioecological model was used as a conceptual framework. Mean vaccination coverages and test of statistical difference in childhood vaccination data were computed. Qualitative data were coded and analysed thematically. RESULTS: Mean Penta 1 coverage declined in Kaduna from 69.88% (SD=21.02) in 2018 to 59.54% (SD=19.14%) by 2021, contrasting with Kano where mean Penta 1 coverage increased from 51.87% (SD=12.61) to 56.32% (SD=17.62%) over the same period. Outreaches and vaccination in urban areas declined for Kaduna state by 10% over the pandemic period in contrast to Kano state where it showed a marginal increase. The two states combined had an estimated 25% of the country's zero-dose burden in 2021. Lockdowns, lack of transport and no outreaches which varied across the states were some of the factors mentioned by participants to have negatively impacted childhood vaccination. Special vaccination outreaches were among the recommendations for ensuring continued vaccination through a future pandemic. CONCLUSION: While further interrogating the accuracy of denominator estimates for the urban population, incorporating findings into pandemic preparedness and response will ensure uninterrupted childhood vaccination during emergencies. Addressing the identified issues will be critical to achieving and sustaining universal childhood vaccination in Nigeria.
Ibrahim Dadari, Alyssa Sharkey, Ismael Hoare et al.
Low vaccination coverage is highlighted as a challenge in Ukraine and among Ukrainian refugees, however there is limited knowledge on coverage among Ukrainian refugees living in European countries. Individual-level data from the National Population Register for children (<20 years) with at least one parent from Ukraine were linked to the Norwegian Immunisation Registry (SYSVAK). We estimated vaccination coverage according to Norwegian Childhood Immunisation Program recommendations among 1) Ukrainian refugee children (i.e. immigrated after 01.02.2022) (N = 8,804) and 2) children born in Norway to Ukrainian refugee parent(s) (N = 224), compared to national coverage. National coverage rates were 95.8% to 96.5% (2-year-olds), 94.5% to 96.7% (9-year-olds), and 90.0% to 94.0% (16-year-olds). Corresponding rates among Ukrainian refugee children were 39.5% to 60.5%, 27.3% to 58.6%, and 9.2% to 34.3%, respectively. Coverage among Norwegian-born children of Ukrainian refugees was >91%. In all, 31% of Ukrainian refugee children had no vaccinations registered in SYSVAK. Coverage for Human Papilloma Virus (HPV) catch-up vaccination among Ukrainian refugee boys was lowest (9%), however, routine HPV vaccination coverage was 63%. Ukrainian children with a refugee background showed lower vaccination coverage than the national coverage. We found large differences between routine versus catch-up vaccination. Our findings suggest that access to catch-up vaccination, routines for retrospective registration of vaccines given outside of Norway and surveillance reporting, as well as vaccine hesitancy should all be considered when assessing childhood vaccination coverage among Ukrainian refugees. These factors should be addressed to improve vaccine uptake and surveillance in this population.
Evy Therese Dvergsdal, Suzanne Campbell, Nora Dotterud Lerstad et al.
This study aimed to investigate prevalence and associated factors of influenza vaccination (IV) among children aged 12-23 months. Our cross-sectional survey interviewed 489 parents of children aged 12-23 months anonymously at twelve maternal and child health centers in Hong Kong. Results showed that only 11.5% of the children had ever received IV (64.3% being subsidized). Adjusted for the child's age, significant factors of the children's IV included parental knowledge about governmental policy/recommendation (Adjusted odds ratio [AOR] = 2.64, 95%CI = 1.09,6.40), knowledge about annual IV requirement (AOR = 2.30, 95%CI = 1.21,4.38), perceived safety-related barrier (AOR≥0.14, 95%CI = 0.06,0.33), cue to action (AOR = 7.79, 95%CI = 3.45,17.58), and subjective norm (AOR = 4.59, 95%CI = 2.34,9.00). IV prevalence of children aged 12-23 months remained low despite a subsidization scheme. The higher IV prevalence of older children reported by other studies suggested that parents postponed action. Promotion campaigns should shift emphases from cost reduction and mass media approaches to dissemination of knowledge about IV policy and safety, enhancement of health professionals' advice, and creation of supportive subjective norm.
Joseph T. F. Lau, Catalina Sau Man Ng, Anise M. S. Wu et al.
Background: National Family Health Survey-4 (NFHS-4) revealed a significant improvement in the percentage of complete immunization attained in India. Even though determinants of immunization coverage in India are addressed by some studies, the impact of missing data in such large-scale surveys has not been accounted earlier. The present study aimed to identify the potential factors associated with immunization coverage in India using the complete case analysis (CCA) and multiple imputation by chained equations (MICE) analysis. Materials and methods: We created a dichotomous immunization variable based on the status of all the vaccines given to the child. All relevant variables were summarized using appropriate descriptive statistics along with the proportion of missingness. Further, MICE procedure was performed to impute the missing values after assessing the missing data mechanism. Multiple logistic regression after accounting for the sampling weights were used to report the estimates of odds-ratio (OR) and 95% confidence intervals (CI) for both CCA and MICE analysis and compared. Results: The percentage of children under five years of age who had total immunization was 69%. Further, we observed that female sex and rural habitation had higher odds of getting immunized in both CCA and MICE. Moreover, wealth index, number of antenatal visits, checkup after delivery and place of birth played an important role in the immunization coverage. Conclusion: MICE provided more precise risk estimates on potential factors associated with vaccination coverage compared to CCA, even if the major findings did not alter due to large sample size. Key words: Immunization, Health surveys, missing data, Logistic regression, complete case analysis, MICE.
BACKGROUND: Inability to track children's vaccination history coupled with parents' lack of awareness of vaccination due dates compounds the problem of low immunization coverage and timeliness in developing countries. We evaluated the impact of two types of silicone immunization reminder bracelets for children in improving immunization coverage and timeliness of Pentavalent-3 and the Measles-1 vaccines. METHODS: Children < 3 months were enrolled in either of the 2 intervention groups (Alma Sana Bracelet Group and Star Bracelet Group) or the Control group. Children in the intervention groups were provided the two different bracelets at the time of recruitment. Each time the child visited the immunization center, a hole was perforated in the silicone bracelet to denote vaccine administration. Each child was followed up till administration of Measles-1 vaccine or till 12 months of age (if they did not come to the center for vaccination). Data was analyzed using the intention-to-treat population between groups. The unadjusted and adjusted Risk Ratios (RR) and 95% confidence interval (CI) for Pentavalent-3 and Measles-1 coverage at 12 months of age were estimated through bivariate and multivariate analysis. Time-to-Pentavalent-3 and Measles-1 immunization curves were calculated using the Kaplan-Meier method. RESULTS: A total of 1,445 children were enrolled in the study between July 19, 2017 and October 10, 2017. Baseline characteristics among the three groups were similar. Up-to-date coverage for the Pentavalent-3 /Measles-1 vaccine at 12 months of age was 84.6%/72.0%, 85.4%/70.5% and 83.0%/68.5% in Alma Sana Bracelet group, Star Bracelet group and Control group respectively but the differences were not statistically significant. In the multivariate analysis, neither the Alma Sana bracelet (adjusted RR = 1.01; 95% CI: 0.96-1.06), (adjusted RR: 1.05; 95% CI: 0.97-1.13) nor the Star bracelet (adjusted RR = 1.01; 95% CI: 0.96-1.06) (adjusted RR: 1.03; 95% CI: 0.95-1.11) was significantly associated with Pentavalent-3 vaccination or Measles-1 vaccination. CONCLUSION: Although we did not observe any significant impact of the bracelets on improved immunization coverage and timeliness, our findings add to the existing literature on innovative, low cost reminders for health and make several suggestions for enhancing practical implementation of these tools. TRIAL REGISTRATION: ClinicalTrials.gov NCT03310762 . Retrospectively Registered on October 16, 2017.
Danya Arif Siddiqi, Mehr Munir, Mubarak Taighoon Shah et al.
Vaccines are one of the greatest public health interventions to date and an effective means of reducing the spread of vaccine-preventable diseases in the community.1 Vaccines are Schedule 4 (prescription only) medications,2 yet little is known about the quality of vaccine prescribing in a hospital setting. The aim of this study was to investigate the quality and adherence of inpatient immunisation prescribing, as well as timeliness and recording of immunisations onto the national immunisation register, within a tertiary paediatric hospital setting. We conducted an observational, retrospective review of inpatient immunisations at Perth Children’s Hospital from July 2018 to February 2019. Inpatient vaccine prescriptions for children aged 16 years or less were obtained from hospital medical records, prescription charts and pharmacy dispensing databases. Vaccine prescription dose, route, documentation, timeliness and recording onto the electronic national immunisation registry were assessed against the state-funded immunisation schedule, the National Safety and Quality Health Service Standards (NHSQHSS) for Medication Safety,3 and national guidelines, the Australian Immunisation Handbook.4 Overall, 130 vaccine prescriptions were identified; 20 were excluded due to unavailability of medication charts. Of the 110 vaccine prescriptions included, 10% (n = 11) contained one prescription drug error. Of these, seven prescriptions (64%) had the incorrect dose prescribed and all of these were related to the influenza vaccine, aged-based dosing. This included identification of three episodes of under-dosing for age and four instances of over-dosing for age for the influenza vaccine. Two prescription errors were corrected by ward-based pharmacists and subsequently correct vaccine administration was performed. The remaining prescription errors were not detected by the ward pharmacist due to pharmacy resource constraints and were recommended for reporting through the hospital clinical incidence management system. Three prescriptions (3%) had incorrect route of administration (relating to inadvertent SC administration of IM preparations and vice versa) and one had duplicate vaccine administration. Seventeen prescriptions (13%) had abbreviations considered unacceptable for use by NHSQHSS (most frequently, Ṫ), and one prescription was deemed illegible. Nineteen patients (17%) were overdue vaccinations by one month or more, according to the child’s age and the state-funded immunisation schedule. Recording of the vaccine administrated onto the electronic registry was complete in just under half (46/96, 48%) of children immunised as inpatients. This preliminary research conducted at a single hospital site identified that the majority of prescriptions were adherent to prescribing guidelines. A lower proportion of inpatients were up to date with routine immunisations (83%), compared with the overall state immunisation rate of more than 91%.4 Reasons for this are likely multifactorial5 and education around false contraindications to vaccination, as well as promoting timeliness with immunisations, could assist. The value of hospital-based pharmacists was demonstrated, with correction of two prescription drug errors. Age-based dosing for vaccines, as highlighted from this cohort, is a significant risk factor for vaccine prescribing errors, and supports the move to non-aged-based influenza dosing for children nationally in 2020.2 With almost one out of every two children administrated a vaccine as an inpatient not recorded onto the electronic registry, further targeted education strategies are required, and a dedicated immunisation service can assist.5 Easily accessible prescribing information for vaccines in immunisation resources could also support prescribers.4 Ethics approval was obtained from the Child and Adolescent Health Service Ethics Committee (GEKO approval 31454). The authors declare that they have no conflicts of interest. The data are not publicly available due to privacy or ethical restrictions.
Background: The coverage of complete basic immunisation in Indonesia from 2020 to 2022 never reached the target of the 2020-2024 National Medium-Term Development Plan despite various efforts made by the government. As a result, there are many cases of infectious diseases in children. Therefore, this study aims to determine the overview of the coverage of complete basic immunisation in Indonesia in 2022 and the effect of antenatal care visits, doctor ratio, and ownership of immunisation documents on the coverage of complete basic immunisation in Indonesia in 2022. Methods: This study uses data from the Central Bureau of Statistics publication and the Ministry of Health publication. The analysis method used in this study is multiple linear regression analysis. Results: Antenatal care visits and the ratio of doctors have a positive and insignificant effect on the coverage of complete basic immunisation in Indonesia in 2022 while ownership of immunisation documents has a significant positive effect. Conclusion: The variable of ownership of immunisation documents is the most influential variable on the coverage of complete basic immunisation. This variable will increase the coverage of complete basic immunisation by 1.377 percent every 1 percent increase in the percentage of ownership of immunisation documents.
In the Central Coast Local Health District of New South Wales, Australia, childhood immunisation (CI) rates are around 95%, but pockets of underimmunisation exist. Using the World Health Organization's Tailoring Immunization Programmes, we identified areas of potential low vaccine coverage using Australian Immunisation Register (AIR) data (2016-18) and investigated factors that influence CI. Individual and group interviews with carers, community members and service providers (n=52 participants) were conducted. Data were analysed thematically and the themes presented to stakeholders for feedback before finalisation. During 2018, Umina had 218 children at least 1 month overdue for at least one vaccination. Five themes emerged: (1) broader socioeconomic factors may apply pressures that influence CI; (2) parents largely supported immunisation and knew of its benefits to their children and the community; (3) immunisation service providers are committed, experienced and collaborate with community partners; (4) there is potential to increase access to free immunisation services in Umina; and (5) AIR data and reminder systems could be better used to inform service delivery and prompt parents before immunisations are due. This study identified opportunities to improve CI coverage in Umina and new information useful in developing a tailored immunisation strategy. Awareness of the pressures socioeconomic factors may have on families could help plan and deliver supportive primary health care that includes equitable access to immunisation.
Katarzyna T. Bolsewicz, Susan L Thomas, Donna Moore et al.
Scientific relevance. Rotavirus disease and its consequences remain a leading vaccine-preventable cause of mortality in young children. Russia has not yet included rotavirus immunisation in the national vaccination schedule, but paediatric rotavirus vaccines are provided under several regional immunisation programmes. Aim. The authors aimed to review literature covering Russian clinical evidence of the safety and effectiveness of rotavirus vaccines and to analyse the prospects for the development of the national immunisation programme for young children using the available rotavirus vaccines and considering promising pipeline ones. Discussion. Local epidemiological studies on a range of pathogens suggest that rotaviruses are the most common cause of acute intestinal infections, especially in children under 3 years of age. Since Russia’s first rotavirus vaccine approval in 2012, the healthcare system has acquired sufficient experience with rotavirus vaccines to evaluate the safety and effectiveness of rotavirus immunisation. Long-term monitoring of the rotavirus A genotypes circulating in the country shows that currently available rotavirus vaccines cover the majority of identified rotavirus isolates. Local observational studies confirm the favourable safety profile of rotavirus vaccines and demonstrate notable effectiveness of vaccination. In the regions with high immunisation coverage, the overall morbidity has declined dramatically in vaccinated children compared to unvaccinated children; some of these regions have reported only individual hospital visits or admissions for acute intestinal infections. Conclusion. This review demonstrates that rotavirus immunisation should be included in the Russian National Immunisation Schedule.
