Africa Knowledge Hub for Children

Peer-reviewed articlePubMed (US National Library of Medicine)28 Jun 2026

Pre- vaccination seroprevalence of rubella IgM among women of child bearing age in southeast Nigeria: a five-year cross-sectional study.

Rubella is an acute, contagious viral illness that is generally mild, yet infection during early pregnancy can cause congenital rubella syndrome (CRS), a serious condition associated with deafness, blindness, congenital heart defects, and developmental disabilities. Although vaccination is the only effective preventive measure, rubella continues to circulate in regions with low immunization coverage. This study assessed the pre-vaccination seroprevalence of rubella IgM antibodies among women of reproductive age in Southeast Nigeria. A retrospective cross-sectional study was conducted from 2020 to 2024 among 405 women aged 15-49 years across five states in Southeast Nigeria. Serum samples were tested for rubella IgM antibodies using ELISA. Rubella IgM seroprevalence was 6.7% (27/405). Adolescents, 15-19 years had the highest positivity (11.7%), with prevalence declining steadily with age to 1.9% among women aged 30-34 years. Rubella positivity peaked in 2020 (16.0%) and 2024 (14.5%), with Imo State showing the highest prevalence (10.1%) and an incidence of 7.3 per 1,000,000 population. Rubella IgM positivity among women of childbearing age indicates ongoing transmission and susceptibility, particularly among adolescents. These findings provide baseline data for assessing vaccine impact and highlight the need for stronger surveillance and improved uptake to prevent CRS in Nigeria.

Chinedu Michael Chukwubike, Chioma Uju Benjamin-Puja, Constance Ugochi Azubuike et al.

Survival

Peer-reviewed articlePubMed (US National Library of Medicine)28 Jun 2026

Vaccine Hesitancy Among Caregivers in China: Associations of Misinterpreted AEFI, Compensation Awareness, and Institutional Trust.

BACKGROUND: Vaccine hesitancy remains a major global public health challenge despite high immunization coverage. While concerns about adverse events following immunization (AEFI) are widely recognized, limited attention has been paid to caregivers' ability to distinguish vaccine-related adverse reactions from coincidental illnesses, as well as to the associations of compensation awareness and institutional trust with vaccination decisions. METHODS: A cross-sectional survey was conducted between January and March 2025 among 3497 caregivers of children aged 0-6 years using multistage random sampling. Data were collected on AEFI knowledge (including understanding of coincidental illnesses), compensation mechanism awareness, institutional trust, and vaccination behaviors. Vaccine hesitancy was assessed using a self-reported measure and the WHO SAGE Vaccine Hesitancy Scale (VHS). Multivariable linear regression models were used to estimate factors associated with hesitancy scores. RESULTS: The prevalence of vaccine hesitancy was 8.6%, with a mean VHS score of 23.2 ± 4.2. Although general awareness of AEFI reached 90.0%, correct understanding of coincidental illnesses was only 25.7%. Higher AEFI knowledge and compensation awareness were associated with lower hesitancy scores, whereas distrust in compensation mechanisms and perceived vaccine unsafety were associated with higher hesitancy. Coverage of national immunization program (NIP) vaccines exceeded 90%, while uptake of self-paid vaccines varied from 46.7% to 89.7%. CONCLUSIONS: Vaccine hesitancy among caregivers was associated with cognitive understanding, economic considerations, and institutional trust. Limited understanding of coincidental illnesses may be associated with increased concerns about vaccine safety, while compensation awareness and institutional trust were associated with lower levels of vaccine hesitancy. Strengthening communication on AEFI causality and improving transparency of compensation policies may help reduce vaccine hesitancy and support immunization programs in settings with mixed public-private financing systems.

Binyue Xu, Qing Wang, Jiawei Xu et al.

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Peer-reviewed articlePubMed (US National Library of Medicine)28 Jun 2026

Immunization Status and Effectiveness Analysis of Hepatitis B Vaccine Among Preterm Infants in Fujian Province, 2022-2023.

Objective: This study evaluated hepatitis B vaccine (HepB) uptake, associated influencing factors, and post-vaccination immune responses among preterm infants residing in Fujian Province. The findings can support targeted improvements in hepatitis B prevention and control strategies tailored for this high-risk neonatal population. Methods: We conducted a multicenter cross-sectional study combined with short-term prospective serological follow-up across five counties, cities and districts of Fujian Province between 2022 and 2023. A total of 779 eligible preterm infants were enrolled in this study. We collected demographic information of participating mothers and infants, as well as complete HepB vaccination records throughout the study period. For 363 enrolled infants, we performed serological tests to detect hepatitis B surface antigen (HBsAg) and hepatitis B surface antibody (HBsAb) at 1-2 months after they completed the full HepB vaccination series. To explore factors linked to timely administration of the first HepB dose (HepB1), completion of the full vaccination course and HBsAb serostatus, we adopted a set of statistical approaches including descriptive statistics, the chi-square test (Fisher's exact test was used for groups with small sample sizes) and binary logistic regression. Results: The timely HepB1 vaccination rate among all preterm infants was 78.18%, while 63.80% completed the full vaccination schedule as required. In the serology cohort, the HBsAb positive rate was 90.91%, and 8.82% of infants showed double-negative HBsAg and HBsAb results, indicating susceptibility to HBV infection. Multivariate analysis identified multiple risk factors for delayed vaccination. Preterm infants were more likely to receive vaccinations late if their mothers tested HBsAg-negative (HepB1: OR = 25.231, 95%CI: 4.997-127.406; full-course HepB: OR = 2.440, 95%CI: 1.395-4.269), were delivered in county-level or lower-tier medical facilities (HepB1: OR = 3.724, 95%CI: 2.107-6.580), or were born via cesarean section (HepB1: OR = 3.460, 95%CI: 2.169-5.520; full-course HepB: OR = 1.954, 95%CI: 1.411-2.704). Additional risk factors included a gestational age below 34 weeks (HepB1: OR = 4.369, 95%CI: 1.894-10.081; full-course HepB: OR = 2.237, 95%CI: 1.148-4.359) and a birth weight less than 2500 g (HepB1: OR = 2.251, 95%CI: 1.397-3.629; full-course HepB: OR = 1.513, 95%CI: 1.065-2.150). Conclusions: Preterm infants enrolled from five regions in Fujian Province achieved robust immune protection following standard HepB vaccination. However, timely first-dose coverage and on-schedule full-course vaccination remain suboptimal in this cohort. Observed gaps in routine vaccination management at primary care settings highlight a key area for improvement in local hepatitis B prevention. Targeted standardized training for maternity care staff at county-level facilities, paired with a full-cycle follow-up system for preterm infant vaccination, may further strengthen hepatitis B mother-to-child transmission (MTCT) interruption in the study regions.

Hairong Zhang, Jie Zhang, Zhikun Cai et al.

SurvivalPre/postCNRead at source

Peer-reviewed articlePubMed (US National Library of Medicine)9 Feb 2026

Characteristics of Vaccine-Hesitant and Nonhesitant Parents in Italy: A Cross-Sectional Study.

BACKGROUND: Vaccine hesitancy remains a significant public health challenge, even in countries with high vaccination coverage, such as Italy. Understanding the sociodemographic, informational, and psychological characteristics associated with hesitancy is essential for designing effective, targeted interventions. OBJECTIVE: To describe and compare the sociodemographic, behavioral, informational, and psychological profiles of vaccine-hesitant and non-hesitant Italian parents. METHODS: A descriptive cross-sectional study was conducted between October 2024 and February 2025 using an anonymous online survey distributed through social media and parenting websites. Eligible participants were parents or legal guardians of children aged 0-18 years, residing in Italy. Vaccine hesitancy was assessed using the Parent Attitudes about Childhood Vaccines short form (PACV-5), alongside validated measures of health literacy (HLS-EU-Q6), vaccine literacy (HLVa-IT), adult vaccine hesitancy (aVHS), vaccine confidence (VCI), and parental health locus of control (PHLOC). Descriptive and bivariate analyses were performed to examine the differences between hesitant and nonhesitant parents. RESULTS: Of the 308 participants, 13% were classified as vaccine-hesitant. Hesitancy was significantly associated with lower educational attainment, absence of a health care background, reliance on television and health assistants for vaccine information, lower health and vaccine literacy, lower vaccine confidence, and higher scores in the Fate subscale of the Chance domain and the Child subscale of the Internal domain of the Health Locus. A total of 89.94% of parents reported full adherence to vaccination schedules, yet hesitant parents were more likely to partially vaccinate their children and express selective vaccination intentions. Discrepancies between past vaccination behavior and future intentions were observed, suggesting that hesitancy is dynamic and potentially unstable. DISCUSSION: Vaccine hesitancy among Italian parents is associated with low health literacy and confidence levels, distinct health beliefs, and specific information-seeking patterns. These findings suggest public health efforts should include trust-building approaches that address cognitive skills, fatalistic beliefs, and preferred communication channels. Longitudinal research is necessary to monitor changes in parental attitudes and to guide adaptive intervention strategies.

Camilla Elena Magi, Andrea Poliani, Alessia Campoli et al.

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Peer-reviewed articlePubMed (US National Library of Medicine)2 Apr 2026

High Coverage, Hidden Inequities: Factors Associated With Incomplete Vaccination Among Orang Asli Children in Peninsular Malaysia.

Childhood vaccination is a vital public health measure to prevent infectious diseases and reduce mortality among children under five. This study aimed to determine the prevalence of primary vaccination and identify factors associated with incomplete vaccination among Orang Asli children aged 12 to 59 months in Peninsular Malaysia. Data were derived from the 2022 Orang Asli Health Survey, a cross-sectional study using a complex multistage sampling design with structured questionnaires and verified immunization records. The overall prevalence of complete vaccination was 87.7%, with incomplete vaccination more common among younger children, those from the Negrito tribe, and those residing in urban and remote areas. Multivariable logistic regression showed that Negrito tribal affiliation (aOR = 3.31; 95% CI: [1.80, 6.09]) was associated with higher odds of incomplete vaccination, while older age was protective, reducing the odds with each additional month (aOR = 0.87; 95% CI: [0.84, 0.90]). The presence of respiratory symptoms was also protective, likely reflecting increased health care contact facilitating vaccination review (aOR = 0.02; 95% CI: [0.00, 0.28]). Targeted, culturally appropriate strategies, including engagement with tribal leaders and outreach, are essential to improve vaccination equity in these populations.

S Maria Awaluddin, Nor'Ain Abd Wahab, Norliza Shamsuddin et al.

SurvivalPractitionerMYRead at source

Peer-reviewed articlePubMed (US National Library of Medicine)15 Apr 2026

Parental vaccination status and other socioeconomic determinants shaping COVID-19 vaccine uptake in children and adolescents in Singapore.

OBJECTIVES: During the pandemic, achieving high and equitable COVID-19 vaccination coverage in children and adolescents was essential for reducing transmission, protecting vulnerable household members, and limiting disruption to schools. We examined real-world uptake of COVID-19 vaccine doses among children and adolescents in Singapore, where vaccinations for those aged 12-17 years and 5-11 years were introduced during the Delta and Omicron waves, respectively. METHODS: We conducted a retrospective cohort study using national-level data for all children and adolescents aged 5-17 years eligible for vaccination between June 1, 2021, and April 30, 2022. Time-to-vaccination for each dose was analyzed, stratified by age group. RESULTS: Among 442,399 children and adolescents, uptake declined progressively with each additional vaccination dose. Among adolescents aged 12-17 years, 95.8% completed primary vaccination, 92.5% received a first booster, and 18.6% received a second booster. Corresponding uptake among children aged 5-11 years was 75.8%, 46.1%, and 20.2%, respectively. Parental COVID-19 vaccination status was the strongest predictor of uptake. Regular influenza re-vaccination was consistently associated with shorter time-to-vaccination and showed stronger association with booster vaccination. CONCLUSION: Vaccination uptake was shaped by socioeconomic status, household structure, and parental vaccination. Tailored, family-centered strategies may help support rollout of vaccination programs.

Jinghao Nicholas Ngiam, Alex J W Yap, Liang En Wee et al.

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Peer-reviewed articlePubMed (US National Library of Medicine)14 May 2026

Decomposition of Wealth-Related Inequalities in Childhood Zero-Dose Vaccination: Analysis of the 2016 Ethiopian Demographic and Health Survey.

Vaccination prevents 3.5-5 million deaths annually, yet inequities persist within low- and middle-income countries, including Ethiopia. Zero-dose children, those who have not received any routine vaccines, are often found in the poorest and most marginalized communities. In 2019, 16.3% of Ethiopian children aged 12-35 months were zero-dose, highlighting persistent wealth-related disparities. The aim for the present study was to examine wealth-related inequalities in zero-dose status among Ethiopian children aged 12-23 months and identify key contributing factors. A secondary analysis of the 2016 Ethiopian Demographic and Health Survey was conducted, including 1,890 children aged 12-23 months. Zero-dose status was defined as not receiving the first dose of a diphtheria-, tetanus-, and pertussis-containing vaccine. Wealth-related inequality was measured using the Erreygers corrected concentration index (CnI), and contributing factors were assessed using Wagstaff decomposition analysis. Overall, 25.7% of children were zero-dose, with the highest prevalence among those whose mothers had no education, received no antenatal care (ANC), delivered at home, or lived in rural or pastoralist areas. The CnI (-0.15; P <0.001) indicated that zero-dose children were disproportionately concentrated among poorer households. Low household wealth (36.5%) and a lack of ANC (33%) were the main contributors to inequality, followed by religion (22.3%), place of childbirth (10.2%), and maternal education (5.9%). Substantial wealth-based inequalities in zero-dose vaccination persist in Ethiopia. Expanding ANC coverage, prioritizing the poorest and most underserved populations through targeted outreach, and strengthening maternal education are essential to advancing immunization equity and achieving national and global immunization goals.

Fisseha Shiferie, Anteneh Asefa, Samson Gebremedhin et al.

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Peer-reviewed articlePubMed (US National Library of Medicine)1 Jul 2026

Rotavirus Vaccine Coverage and Potential Barriers Among US Children Born From 2007 to 2024.

BACKGROUND/OBJECTIVES: The Advisory Committee on Immunization Practices recommends the first dose of rotavirus vaccine (RVV) be delivered by a maximum age of 14 weeks, 6 days and that the vaccine not be delivered until time of discharge from the neonatal intensive care unit (NICU). We hypothesized that these guidelines limit the number of children who can be vaccinated with RVV. METHODS: Children born on or after January 1, 2007, enrolled in the New Vaccine Surveillance Network from December 2014 to August 2024 aged at least 15 weeks with rotavirus-negative acute gastroenteritis or as a healthy control, and with known vaccination status were included. We identified factors associated with not initiating or completing the RVV series and missed opportunities for vaccination. Odds ratios (ORs) and 95% CIs were calculated using univariate logistic regression. RESULTS: A total of 24 755 children met the inclusion criteria. The risk factors most strongly associated with not initiating RVV were receiving the diphtheria, tetanus, and pertussis vaccine at greater than or equal to age 15 weeks (OR, 30.0; 95% CI, 26.8-33.7), extremely preterm birth (OR, 14.6; 95% CI, 11.2-20.0), being born soon after RVV introduction (2007-2009) (OR, 3.3; 95% CI, 2.9-3.8), and having no health insurance (OR, 2.2; 95% CI, 1.8-2.7). More than 50% of extremely preterm infants in the NICU were not discharged until greater than or equal to age 15 weeks. CONCLUSIONS: Re-evaluation of the vaccine guidelines to allow RVV administration in the NICU may remove barriers to vaccination and help improve RVV coverage.

Mary C Moran, Mary E Wikswo, Leila C Sahni et al.

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Peer-reviewed articlePubMed (US National Library of Medicine)3 Jun 2026

Incidence of acute diarrhoea among children (0-59 months old) in Thailand after introduction of rotavirus vaccine: a retrospective national database analysis (2014-2024).

BACKGROUND: Rotavirus vaccination has reduced incidence of childhood diarrhoea, but evidence from low- and middle-income countries remains limited. We evaluated diarrhoea incidence and hospitalisation rates among children aged 0-59 months after introduction of rotavirus vaccination in Thailand's national immunisation programme (February 2020-December 2024). METHODS: We analysed aggregated national surveillance data (ICD-10-TM: A00-A09, K56.1) from Thailand's Health Data Centre (covering ≈90% of public health facilities), including inpatient, outpatient, and death records. Diarrhoea incidence and hospitalisation rates were assessed using Poisson regression to estimate incidence rate ratios (IRRs) among children 0-59 months of age with acute diarrhoea and among 0-11 months with intussusception. Vaccine impact was assessed by comparing pre-vaccination (2014-2019) and post-vaccination (2021-2024) periods, excluding the year 2020. Analyses were age-stratified as proxies for differential vaccine exposure across birth cohorts under the immunisation program. FINDINGS: Individual-level demographic characteristics were not available. All-cause and rotavirus-associated diarrhoea incidence declined by 50.0% (IRR 0.50; 95% CI 0.39-0.63) and 52.0% (IRR 0.48; 95%CI 0.39-0.59), respectively, following rotavirus vaccine introduction. Hospitalisation for all-cause and rotavirus-associated diarrhoea decreased by 58.2% (IRR 0.42; 95% CI 0.30-0.58) and 49.0% (IRR 0.51; 95%CI 0.30-0.88), respectively, at 1-4 years post-vaccination. All-cause acute diarrhoea mortality did not differ significantly during pre- and post-vaccination periods (IRR 0.94; 95% CI 0.50-1.77); rotavirus-specific mortalities were too few to analyse. Following vaccine introduction, seasonal peaks between December and February became less pronounced. Intussusception rates remained stable during the post-vaccination period (IRR 1.03; 95% CI 0.82-1.29). INTERPRETATION: This study demonstrated a significant decline in incidence and hospitalisation of all-cause and rotavirus-associated diarrhoea among children (0-59 months). Sustaining high coverage is essential to maximise public health benefits from vaccination. FUNDING: None.

Thanate Sailuenarm, Wanatpreeya Phongsamart, Wichan Bhunyakitikorn et al.

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Peer-reviewed articlePubMed (US National Library of Medicine)26 Jun 2026

Knowledge of maternity caregivers on vaccination BCG recommendations and circuits.

INTRODUCTION: In France, 4866 cases of tuberculosis were reported in 2023, of which 5.3% involved children. The pediatric population is at higher risk of developing severe forms (miliary or meningeal tuberculosis). The BCG vaccine is effective in protecting young children against these severe forms. It is recommended for a targeted pediatric population, but vaccine coverage remains insufficient. Early prevention through identifying eligible newborns in maternity care could help improve vaccination coverage among high-risk populations. OBJECTIVE: This study assessed caregivers' knowledge of BCG vaccination indications and circuits in two maternity wards in the city of Toulouse (France), using a questionnaire. A second evaluation was conducted after a training session and the distribution of practical tools, to measure their impact on caregivers' knowledge and involvement. RESULTS: Caregivers' knowledge of BCG vaccination indications was insufficient (2.2 ± 0.33 correct indications out of 6). The development and implementation of training and prevention tools for caregivers helped improve their understanding of vaccination indications (2.6 ± 0.14 correct indications), identification (22.6 vs 45%), and prevention (17.7 vs 30%) CONCLUSION: Targeted vaccination requires greater caregiver training efforts than generalized and/or mandatory vaccination to improve implementation. For BCG vaccination, such training should ideally be provided to maternity staff.

Adrien Lequenne, Géraldine Gascoin, Camille Brehin et al.

SurvivalPractitionerFRRead at source

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Pre- vaccination seroprevalence of rubella IgM among women of child bearing age in southeast Nigeria: a five-year cross-sectional study.

Vaccine Hesitancy Among Caregivers in China: Associations of Misinterpreted AEFI, Compensation Awareness, and Institutional Trust.

Immunization Status and Effectiveness Analysis of Hepatitis B Vaccine Among Preterm Infants in Fujian Province, 2022-2023.

Characteristics of Vaccine-Hesitant and Nonhesitant Parents in Italy: A Cross-Sectional Study.

High Coverage, Hidden Inequities: Factors Associated With Incomplete Vaccination Among Orang Asli Children in Peninsular Malaysia.

Parental vaccination status and other socioeconomic determinants shaping COVID-19 vaccine uptake in children and adolescents in Singapore.

Decomposition of Wealth-Related Inequalities in Childhood Zero-Dose Vaccination: Analysis of the 2016 Ethiopian Demographic and Health Survey.

Rotavirus Vaccine Coverage and Potential Barriers Among US Children Born From 2007 to 2024.

Incidence of acute diarrhoea among children (0-59 months old) in Thailand after introduction of rotavirus vaccine: a retrospective national database analysis (2014-2024).

Knowledge of maternity caregivers on vaccination BCG recommendations and circuits.

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