The rise in vaccine-preventable diphtheria diseases underscores the issue of vaccine hesitancy in Nigeria that undermines herd immunity and results in the re-emergence of diphtheria outbreaks. Knowledge and awareness of diphtheria resurgence among people of Plateau State, as well as signs and symptoms, is a challenge. This research examines the diphtheria vaccine hesitancy among individuals in Plateau State, Nigeria. The study employed a cross-sectional approach, utilizing questionnaires and interviews for data collection. A total sample size of 389 participants was involved through using Cochran’s William formula of 1963, and areas selected were LGAs that had recorded diphtheria infection previously (Wase, Jos-North, Kenam, Bokkos, Pankshin, Barkin-Ladi, Langtang, and Mikang LGAs). The study considered the inclusion of male and female, both infected victims and non-infected victims, where it excluded laboratory tests, children, and disabled people from the selected environment. The ethical considerations included contacting the Plateau State Ministry of Health and the Plateau State Hospital Management Board, as well as maintaining confidentiality. The study analyzed the data using simple statistics, including frequency/percentage, mean, and standard deviation, as well as factor analysis to determine the primary factors contributing to vaccine hesitancy in Plateau State. The findings reveal low knowledge and a lack of awareness about the re-emergence of the disease, as well as a limited understanding of its signs and symptoms. Others, unsure of the vaccine, lack confidence among health personnel due to fears of infertility and negative beliefs about vaccine safety. Poor awareness, self-negative assumptions, and parental decision-making regarding household vaccination are major factors identified. Thus, recommendations were made appropriately to encourage herd immunity.
Introduction In Papua New Guinea, acute lower respiratory infection (ALRI) is the most common reason for childhood hospitalisation and death. Recent changes in epidemiology, diagnostic approaches and vaccine policy warrant re-examination of the aetiology of ALRI. Methods A matched case-control study was performed using nasopharyngeal samples collected from a prospective study recruiting children < 5 years of age with moderate/severe pneumonia (cases) and community controls (2013–16). Respiratory viruses and Bordetella pertussis detection was undertaken using an in-house multiplex real-time reverse-transcriptase polymerase chain reaction (qRT-PCR) assay and the frequency of pathogen detection reported. Using multivariate logistic regression models, the population-attributable fraction was estimated. Results From the original sample cohort, 251 ALRI cases and 251 healthy matched controls were assessed. The median age was 12 months. One or more respiratory viruses were identified in 159 cases (63.3%) and 82 controls (32.7%). Rhinovirus was most frequently detected in both cases (23.1%) and controls (19.5%), followed by respiratory syncytial virus (HRSV; 21.8% and 2.0% respectively) and parainfluenza virus type 3 (HPIV3; 16.2% and 2.5% respectively). Co-infections were frequently detected. Significant differences in detection between cases and controls were observed for HRSV, influenza A, HPIV1, HPIV3, and seasonal human coronavirus types HCoV-NL63 and HCoV-229E. We estimated that respiratory viruses were responsible for at least 39.7% (95% CI: 28.2–49.4%) of ALRI. Discussion Respiratory viruses are a major contributor to ALRI in children < 5 years of age in this population, with HRSV representing a key pathogen. This underscores the need for targeted intervention strategies and ongoing surveillance of viral aetiology.
Vaccine hesitancy and immunization inequity remain major public health challenges in Nigeria, where limited access, uneven service delivery, and weak confidence in vaccines continue to constrain progress toward universal immunization coverage. This narrative review examined the public health determinants of vaccine hesitancy, the role of misinformation in shaping vaccine decisions, and the health system strategies that may improve equitable uptake. The literature search period spanned 2008 to 2026, drawing on evidence from biomedical, public health, behavioral, and policy studies to capture both routine childhood immunization and vaccine acceptance in the COVID 19 era. The reviewed evidence shows that vaccine hesitancy in Nigeria is not driven by a single factor, but by a combination of structural and social influences. Low coverage is closely linked to poverty, rural residence, distance to health facilities, insecurity, weak primary care, poor antenatal contact, and geographical inequities that leave many children zero dose or under immunized. Hesitancy is also shaped by low trust in health authorities, fear of side effects, doubts about vaccine effectiveness, religious interpretation, gendered decision making, and limited health literacy. In parallel, misinformation has become a powerful driver of resistance, especially through social media and video platforms where conspiracy narratives, fear-based content, and doubts about government intentions amplify uncertainty and reduce confidence. The review also indicates that uptake improves when interventions go beyond information sharing and address the realities of access and trust. Community engagement, trusted local communication, mobile reminders, stronger primaryhealth care delivery, women centered empowerment strategies, and culturally responsive outreach were repeatedly associated with better uptake and stronger acceptance. Overall, the evidence suggests that reducing vaccine hesitancy in Nigeria requires an integrated response that combines reliable service delivery, misinformation control, community partnership, and equity focused policy action. Such an approach is essential for improving immunization coverage, reducing the burden of zero dose children, and advancing the country’s broader public health goals.
Background: Nigeria introduced single-dose HPV vaccination for girls aged 9-14 in 2023, reaching approximately 60% aggregate coverage by 2025. While an important achievement, this remains short of the 90% coverage called for under the WHO's 90-70-90 cervical cancer elimination targets, and further scale-up depends on reaching out-of-school girls. In this study we used a model of HPV transmission in Nigeria to quantify the residual cervical cancer burden under continued adolescent delivery, assess how additional screening scale-up and equity assumptions modify it, and identify the effective coverage requirements for an infant HPV vaccination program to be non-inferior to the existing adolescent strategy. Methods: We used HPVsim, an agent-based microsimulation calibrated to Nigerian sexual behavior, HPV prevalence, and cervical cancer incidence, to project new cervical cancer cases and age-standardized incidence over 2025-2100 under scenarios which vary vaccination delivery mode (status-quo adolescent, WHO 90-70-90 adolescent scale-up, and 60/75/90% infant delivery), screening coverage (opportunistic 15% vs. scaled 70% aggregate), and the degree to which primary school completion correlated with vaccination (odds ratio 1 vs. 5) and with screening (odds ratio 1 vs. 3). Infant delivery scenarios were run at hypothetical effective-vaccine-efficacy-at-exposure values of 50%, 70%, and 95% - scenario inputs bracketing the plausible waning range, not evidence-based estimates of infant vaccine performance (no HPV vaccine trial has enrolled anyone below age 10). Each scenario was run at 50 replicates (10 calibration draws, 5 seeds); reported outcomes are the median across replicates and uncertainty ranges are interquartile (25th-75th percentile). Results: Continuation of Nigeria's current adolescent program is projected to avert 1.82 million cervical cancer cases (IQR 1.65-1.90 million; 95% UI 1.39-2.02 million) over 2025-2100 (a 53% reduction relative to no vaccination, IQR 51-55%; 95% UI 46-58%), with age-standardized incidence falling from 19.7 to 7.8 per 100,000 by 2100. However, 82% of the near-term (2025-2075) burden is projected to fall on the pre-2015 birth cohort, i.e. women already beyond the vaccination target age, leaving approximately 945,000 residual cases (IQR 905K-1.00M; 95% UI 835K-1.14M) in this cohort. Scaling up screening to WHO targets was estimated to avert a further ~387K cases (IQR 331-424K; 95% UI 269-515K), roughly 25% of the residual burden; results were about 6-8% better if the scale-up instead reached all women equitably regardless of education. Under a hypothetical scenario of infant vaccination at 90% coverage and 95% effective vaccine efficacy at exposure (matching adolescent-age performance), outcomes were comparable to full WHO adolescent scale-up (49% vs. 54% reduction in vaccine-targetable cohort cancers), but under a hypothetical 50% effective efficacy at Nigeria's DTP3-anchored 62% coverage the strategy averted only a fraction of these cancers. Conclusions: The near-term cervical cancer burden in Nigeria is dominated by cohorts vaccination cannot reach; scaling screening for them is the more consequential lever over the coming three decades and rests on established evidence. Findings on infant HPV delivery are exploratory and hypothesis-generating: they depend on three unverified empirical prerequisites - infant HPV vaccine immunogenicity in the first months of life, durability of protection across the ~15-25-year interval to peak HPV exposure, and coverage achievable through Nigeria's routine childhood immunization platform - and should not be read as a basis for any policy recommendation contingent on infant HPV delivery until those prerequisites are established.
Robyn Margaret Stuart, Ifeoma Umeh, Christopher Gill et al.
Background Ensuring high immunization coverage is essential to preventing vaccine-preventable diseases (VPDs). In Vietnam, routine childhood vaccination coverage has fluctuated due to administrative changes and COVID-19 related service disruptions, increasing vulnerability to VPDs. This study examined factors impacting full immunization coverage by age one among children born in 2020–2021 in Southern Vietnam. Methods A cross-sectional survey, using multi-stage cluster sampling, enrolled 960 children across four randomly selected provinces in Southern Vietnam. Vaccination histories were verified through personal records, commune logbooks, and the National Immunization Information System, and household and caregiver characteristics were assessed through interviews. Full immunization was defined as receiving all recommended vaccines by 12 months of age. All statistical analyses were adjusted for cluster sampling. Results Overall, 54.0% of children were fully immunized; 62.8% among children born in 2020 and 45.8% among those born in 2021. In multivariable analysis, having a caregiver with less than high school education (adjusted odds ratio [AOR] 0.60; 95% confidence interval [CI]: 0.41–0.88), and a delay in receiving at least one vaccination at the recommended month interval (AOR 0.43; 95% CI: 0.31–0.60), were associated with lower odds of full immunization by age 1. Children whose birth order was third or higher also had lower odds of full immunization (AOR 0.60; 95% CI: 0.41–0.90). Conclusion Findings indicate suboptimal routine vaccination coverage in these Southern provinces, lower than administrative estimates. Strengthening catch-up vaccination, minimizing service disruptions, and systematic approaches to improve access for families with multiple children or caregivers with lower education may help restore and sustain high coverage.
Quang Duy Pham, Nguyen Thuy Ly, Sasha Mital et al.
ABSTRACT Objective This study theorizes how and empirically analyzes the extent linkages to illiberal world culture shape child mortality. Methods I test these arguments using fixed‐effects panel regression models of worldwide country‐year data from 1960 to 2024. Results Affiliations with illiberal intergovernmental organizations and the global density of these organizations are associated with declines in child mortality. In contrast, a higher global proportion of autocracies is associated with increased child mortality. Conclusion Illiberal world‐cultural structures have heterogeneous consequences for child health. These findings offer a new explanation for cross‐national and longitudinal variation in child mortality and explore the boundaries of the emerging literature on the post‐liberal turn in world society.
Abstract Background Measles has resurged globally in the post-pandemic period as routine immunisation recovery remains below the two-dose threshold required to interrupt transmission. Bangladesh, previously nearing measles–rubella elimination, entered 2026 with widening coverage gaps, depleted vaccine stocks, and increasing numbers of missed children. We conducted a situation analysis to assess the scale, concentration, and programmatic implications of the outbreak. Methods We performed a rapid mixed-evidence review from 11–15 April 2026 using data from WHO, UNICEF, DGHS bulletins, PubMed/MEDLINE, ReliefWeb, SEARO updates, and Bangla-language media. Of 46 records screened, 19 were included. Analysis was based on aggregated, publicly available surveillance and programme data. Findings The DGHS measles press release dated 15 April 2026 reported cumulative totals since 15 March of 19,161 suspected cases, 2,973 confirmed cases, 166 suspected deaths, and 32 confirmed deaths; a WHO update dated 15 April reported 58 affected districts. The cumulative suspected-case burden was spatially concentrated: Dhaka and Rajshahi together accounted for 62.7% of suspected cases, and the division-level HHI was 0.255. Children under five comprised 81% of cases, including 34% infants under nine months. Vaccination status showed 72% zero-dose and 16% partially vaccinated cases. Valid MR1 coverage declined from 88.6% in 2019 to 86.1% in 2023, while valid MR2 coverage declined from 89.1% to 80.7%, indicating a widening immunity gap. Interpretation The resurgence reflects accumulated immunity gaps rather than vaccine failure, driven by subnational inequities and programme disruption. Urgent priorities include targeted vaccination campaigns, restoration of vitamin A supplementation, strengthening paediatric care capacity, and integrating real-time surveillance into outbreak response.
Md. Kamrujjaman, Faizunnesa Khondaker, Alvi Ahmed Sarker et al.
Background: Persistently low and inequitable childhood immunization coverage remains an important public health concern, particularly among socially and economically disadvantaged populations.Fieldpractice-level data that align with the national surveys are needed to understand local drivers of immunization inequity.Objectives: This study aimed to determine the association between selected sociodemographic factors and full immunization status, to assess the extent and pattern of socioeconomic inequality in full immunization coverage, and to describe disparities by gender, geographic location, and urban-rural residence among children aged 12-23 months.Methods: A community-based cross-sectional study was conducted from August to October 2023 among 400 children aged 12-23 months (200 urban, 200 rural), selected by multistage random sampling from the fieldpractice areas of Osmania Medical College, Hyderabad, Telangana, India.Full immunization status was verified against Mother and Child Protection Cards and Anganwadi Centre records.Associations were assessed using the chi-squared test; socioeconomic inequality was quantified using the Erreygers Concentration Index, and Fairlie decomposition was used to identify contributors to the socioeconomic gap.Results: Among 400 children, 228 (57.0%) were fully immunized and 172 (43.0%) were non-fully immunized.Full immunization was significantly associated with socioeconomic status (SES), place of residence, sex, and birth order.Coverage was higher among children from the upper socioeconomic class (152/224, 67.86%) than the lower socioeconomic class (76/176, 43.18%; p<0.001), among urban (130/200, 65.0%) than rural children (98/200, 49.0%; p=0.002), and among males (140/226, 61.95%) than females (88/174, 50.57%; p=0.030).Maternal age, maternal education, and religion were not significantly associated with immunization status.A pro-rich distribution was evident (Concentration Index +0.1067; Erreygers Index +0.2432; Wagstaff Index +0.2481), with an absolute SES gap of 24.68 percentage points.Fairlie decomposition explained 1.96 percentage points (7.9%) of the observed gap; urban residence (+136.9%)and Hindu religion (+60.1%)widened the gap, whereas first birth order (-53.1%),male sex (-25.4%), and maternal literacy (-24.8%)narrowed it.The SES equity gap was wider among females (+34.15 percentage points) than males (+18.57) and among urban (+52.74)than rural children (-5.11).Closing the SES gap could increase overall coverage by 10.86 percentage points, corresponding to a population attributable fraction of 16.0%.Conclusion: Full immunization coverage in this population remains below global targets and shows a pattern by SES, residence, and gender, with disadvantage compounding among lower-SES girls and lower-SES urban households.Because measured sociodemographic factors explained less than one-tenth of the observed inequality, closing this gap will likely require health system and supply-side interventions alongside household-targeted approaches.
Shadan Butool, Rafath Unnisa Begum, Prafful K Butti et al.
Uganda ranks third with the highest malaria cases globally, highlighting limitations in existing prevention efforts. Malaria vaccination is a key promising strategy to reduce both morbidity and severity among children under 5 (U5) years. In April 2025, Uganda introduced a four-dose R21 malaria vaccine for U5s. We assessed willingness to vaccinate with the malaria vaccine and associated factors among caregivers of U5s to support vaccine rollout in the targeted population. In March 2025, we conducted a cross-sectional study at the Maternal and Child Health unit of Masaka Regional Referral Hospital among 292 caretakers. We generated caretaker attendance lists daily to serve as sampling frames and developed a sampling interval. We used systematic sampling to obtain the total sample size. We administered a questionnaire assessing caregivers’ willingness to vaccinate, and identified associated factors using modified Poisson regression. We interviewed 292 caretakers, 250(86%) were female and 249(85%) indicated willingness to vaccinate their children. Prior experience with adverse events following immunization (AEFIs) (adjusted prevalence ratio [aPR]=0.2,95%Confidence Interval [CI]0.05-0.5), having other relatives than biological parents as main decision makers (aPR 0.2, 95%CI0.04-0.9) and having tertiary education (aPR 0.14, 95%CI0.04-0.6) were associated with reduced willingness to vaccinate, while receipt of malaria Intermittent Preventive Treatment in pregnancy (IPTp) (aPR 6.2, 95%CI1.6-23) and trust in vaccine safety (aPR 13, 95%CI4.0-43) were associated with increased willingness to vaccinate. Majority of the caretakers were not aware of the malaria vaccine butwere willing to vaccinate their children when oriented. AEFI history, household decision-making roles, and education level were associated with reduced willingness, while having received malaria IPTp and trust in vaccine safety were associated with increased willingness to vaccinate. We recommended providing malaria vaccine information through antenatal care, preparing health workers to address the AEFI history and vaccine-safety concerns and prioritizing safety-focused messaging over general awareness messaging.
Annet Mary Namusisi, Richard Migisha, Dominic Kizza et al.
Background & Objective: Tetanus toxoid vaccination is a recommended preventive measure during pregnancy; however, coverage remains low in several developing countries, including Indonesia. No studies have specifically examined the effect of tetanus vaccine doses on Immunoglobulin G (IgG) levels in Indonesian pregnant women. Therefore, the present study was conducted with aim to determine tetanus-specific IgG antibody levels in this population.Materials & Methods: This analytical descriptive study with a case-control design was conducted at Sitti Khadijah 1 Women's and Children's Hospital in Makassar, Indonesia. Pregnant women were divided into two groups based on whether they had or neither received tetanus-diphtheria vaccinations during pregnancy. Serum levels of tetanus-specific IgG antibodies were measured using an Enzyme-Linked Immunosorbent Assay (ELISA) kit. Data analysis was performed using SPSS (version 27.0). P<0.05 was considered statistically significant.Results: A total of 112 pregnant women were enrolled. A significant association was found between tetanus toxoid vaccination and IgG levels, with vaccinated women exhibiting higher IgG concentrations (P<0.001). Furthermore, women who received two vaccine doses had significantly higher IgG levels compared to those receiving only one dose (P=0.003). Age, body mass index, gravidity, and educational level did not significantly influence IgG levels (P>0.05).Conclusion: Two doses of tetanus toxoid vaccination during pregnancy significantly increase IgG antibody levels in pregnant women. These findings reinforce the importance of expanding tetanus immunization coverage among pregnant women, particularly in Indonesia, to include the second dose through effective health policies and programs.
Ikhmah Sulistyowati, St. Maisuri T. Chalid, Irnawati Bahar et al.
