A review of the current diphtheria outbreaks

Corynebacterium diphtheriae is responsible for both endemic and epidemic diphtheria. The predisposing factor for this disease is the failure to immunize during childhood. Humans are the only hosts of the organism and is present in the upper respiratory tract. The organism is transmitted via airborne route and can cause respiratory obstruction and heart failure because of the exotoxin it produces. There is presently a resurgence of diphtheria outbreaks in Nigeria. The Nigeria Center for Disease Control (NCDC) was notified of suspected diphtheria outbreaks in Lagos and Kano States, Nigeria, in December 2022 and has been issuing monthly reports since that time. This review of the diphtheria outbreaks following online database searches on PubMed and Google Scholar as well as the NCDC/WHO websites and grey literatures, describes the current trend of the outbreaks globally, elucidated the different strains of Corynebacterium responsible for the outbreaks, identified the recent vaccine formulation developed to tackle the outbreaks, and provide information on vaccine delivery and efficacy studies in the country and globally.

Tends of "Zero-dose" children aged 12-23 months in Togo from 2000 to 2017 and predictions for 2030

Guided by the principle of leaving no one behind by improving equitable access and use of new and existing vaccines, the Immunization Agenda 2030 aims, among other things, to halve the incidence of "zero-dose" at the national level. This study aimed at studying the tends of the prevalence of "zerodose" children from 2000 to 2017 and making predictions for 2030. The study consisted of secondary data analyses from the Multiple Indicator Cluster Surveys (MICS) conducted in Togo. The study population consisted of children aged 12-23 months surveyed during MICS2 in 2000, MICS3 in 2006, MICS4 in 2010 and MICS6 in 2017. The dependent variable was the "zero-dose" vaccination status (1=Yes vs 0=No). The explanatory variables were related to the child, mother, household and environment. The study generated the overall annual percentage changes (APC) and by the independent variables. As a result, the prevalence of children with "zero-dose" expected for 2030 was estimated using Excel 2013 and Stata 16.0 software. In total, 636, 864, 916 and 952 children aged 12-23 months were included for MICS2, MICS3, MICS4 and MICS7, respectively. The prevalence of "zerodose" children decreased from 37.15% in 2000 to 31.72% in 2006, then 30.10% in 2010 and 26.86% in 2017, with an overall APC= - 1.89%. The highest relative annual decrease was from 2000 to 2006. If the historical rate of decrease remains unchanged, we predict that percentage of "zero-dose" children aged 12-23 months will be 20.96% in 2030, with a decrease of 22% compared to 2017, against a target of 50%. We suggest that strengthening strategies to increase full immunization coverage of children will contribute to reducing the percentage of zero dose children. A prerequisite will be a better understanding of the predictors of the "zero-dose" phenomenon in children

Knowledge, attitude and perception of mothers of under-five towards vaccination during supplementary immunization activities in Ibadan North-West Local Government Area, Ibadan, Oyo State, Nigeria

Supplementary immunization activities campaigns provide children with an additional dose of vaccine and deliver other interventions. However, there is dearth of information on knowledge, attitude and perception of mothers of under-five towards vaccination during supplementary immunization activities. A descriptive cross-sectional study which employed multistage sampling technique was designed to fill this gap. Four wards were randomly selected from eleven wards in Ibadan North-West Local Government Area and houses were enumerated from the selected wards, systematic random sampling was used to select houses and then respondents. A semi-structured interviewer administered questionnaire was used to elicit information on three hundred and five respondents. Knowledge scores of ≤4, 5-8, and ≥ 9 were rated poor, fair and good, respectively. Attitude scores of ≤5 and >5 was rated negative and positive attitude, respectively while perception scores ≤4 and >4 were rated negative and positive perception, respectively. Data was analyzed with SPSS version 25 using descriptive statistics and Chi-square test at 5% level of significance. The mean age of respondents was 30.6±6.1years, the highest level of education for most (68.5%) was secondary school. Their mean parity and number of under-five were 2.5±1.4 and 1.2±0.4, respectively. Knowledge was generally poor, more than half (53.1%) had poor knowledge, majority (88.2%) have positive attitude while 84.6% have a positive perception. One-fourth (24.6%) and one-fifth are of the opinion that frequent vaccination will make the vaccine ineffective and overload immune system, respectively. There was generally poor knowledge of supplementary immunizations and mothers need to be educated on the importance.

Tétanos de l'enfant au Centre Hospitalier Universitaire Mère­Enfant de Libreville, Gabon / Child tetanus at the Mother and Child University Hospital Center, Libreville, Gabon

L'objectif de cette étude était de déterminer les aspects épidémiologique, clinique, thérapeutique et évolutif du tétanos de l'enfant au service de réanimation du Centre Hospitalier Universitaire Mère-Enfant de Libreville, au Gabon. Méthodes : Etude rétrospective de type descriptif menée du 1er janvier 2019 au 31 décembre 2022. Les dossiers des enfants âgés de 0 à 16 ans, admis en réanimation pour tétanos, ont constitué la base des données. Les variables étudiées étaient épidémiologiques, cliniques, thérapeutiques et évolutives. Résultats : Parmi les 561 enfants hospitalisés en réanimation durant la période, il y'avait 12 cas de tétanos, soit une prévalence de 2,1%. Le sexe ratio était de 2. Les enfants âgés de 10 ans et plus représentaient la moitié de l'effectif (n=6). La porte d'entrée la plus retrouvée était une plaie du pied soit 50%, suivie d'une plaie céphalique dans 25% des cas. Tous les enfants avaient un état vaccinal incorrect, un trismus et des troubles d'alimentation. Le score pronostique de Dakar était à 2 chez six enfants (50%) et de 3 chez les 6 autres. Les molécules les plus utilisées étaient le Midazolam (92%), le Métronidazole (100%), le sérum et vaccin antitétanique (100%). Cinq patients (42%) ont bénéficié d'une ventilation assistée. La durée moyenne de séjour était de 13,6 jours ±9,9 et la létalité de 42%. Conclusion : le tétanos prédomine chez le grand enfant n'ayant pas de couverture vaccinale. Des mesures de sensibilisation des populations sur la vaccination antitétanique sont indispensables pour baisser la létalité.

Immunisation services in North-Eastern Nigeria: perspectives of critical stakeholders to improve uptake and service delivery

We investigated the perspectives of parents, health workers (HWs) and traditional medical practitioners (TMPs) on immunisation advocacy, knowledge, attitudes and immuni sation practice and ways of improving immunisation uptake in Borno State, North eastern Nigeria. A cross sectional study analysing quantitative data from the three stakeholders' categories. It was conducted across 18 local government areas of Borno State. A representative sample of 4288 stakeholders (n=1763 parents, n=1707 TMPs, and n=818 HWs aged 20 to 59years, had complete data. The sample has more males: 57.8% (Parents); 71.8% (TMPs) and 57.3% (HWs). The awareness of immunisation schedule among the stakeholders ranged from 87.2 to 93.4%. The study showed that 67.9% of the parent and 57.1% of the health workers had participated in immunisation except the TMPs (27.8%). Across the stake holders' categories, between 61.9 and 72.6% have children who had Adverse Event Following Immunisation (AEFI). The most common AEFI was fever. Safety concerns, preference for herbs and charm, culture and religions, and vaccination perception as a western culture were the major barriers to immunisation uptake. While 63.6 to 95.7% of respondents indicated that community leaders, religious and spiritual leaders and TMPs should be involved in immunisation advo cacy, 56.9 70.4% of them reported that community leaders should be involved in immunisation policy. Upscaling the critical stakeholders' involvement in advocacy, policy devel opment and implementation of immunization activities may improve acceptance, create demand and engender ownership in vulnerable communities of Borno State, Nigeria. AEFI could be detrimental to immunisation access and utilization. Consequently, health education by health workers needs strengthening to minimise vaccine hesitancy.

A rapid increase in coverage of COVID-19 vaccination, Central African Republic

Problem In 2021, Central African Republic was facing multiple challenges in vaccinating its population against coronavirus disease 2019 (COVID-19), including inadequate infrastructure and funding, a shortage of health workers and vaccine hesitancy among the population. Approach To increase COVID-19 vaccination coverage, the health ministry used three main approaches: (i) task shifting to train and equip existing community health workers (CHWs) to deliver COVID-19 vaccination; (ii) evidence gathering to understand people's reluctance to be vaccinated; and (iii) bundling of COVID-19 vaccination with the polio vaccination programme. Local setting Central African Republic is a fragile country with almost two thirds of its population in need of humanitarian assistance. Despite conducting two major COVID-19 vaccination campaigns, by January 2022 only 9% (503 000 people) of the 5 570 659 general population were fully vaccinated. Relevant changes In the 6 months from February to July 2022, Central African Republic tripled its coverage of COVID-19 vaccination to 29% (1 615 492 out of 5 570 659 people) by August 2022. The integrated polio­COVID-19 campaign enabled an additional 136 040 and 218 978 people to be vaccinated in the first and second rounds respectively, at no extra cost. Evidence obtained through surveys and focus group discussions enabled the health ministry to develop communication strategies to dispel vaccine hesitancy and misconceptions. Lessons learnt Task shifting COVID-19 vaccination to CHWs can be an efficient solution for rapid scaling-up of vaccination campaigns. Building trust with the community is also important for addressing complex health issues such as vaccine hesitancy. Collaborative efforts are necessary to provide access to COVID-19 vaccines for high-risk and vulnerable populations.

Vaccination contre la Covid-19: droits des personnes et obligations du Gouvernement Congolais en période d'urgence sanitaire

Cette étude avait pour objectif de mettre en exergue le rapport entre le bénéfice de la couverture vaccinale contre la Covid-19 et les risques individuels et collectifs encourus par la population. A travers le monde, les études ont monté que les campagnes de vaccination ont insufflé une dynamique positive à la lutte contre la pandémie et la courbe de la maladie a fléchi dans les populations vaccinées. Face à ces résultats probants, le législateur congolais doit s'en inspirer pour proposer des instruments juridiques en faveur d'une vaccination obligatoire contre la Covid-19 soumise à tous les citoyens et citoyennes Congolais sans exception. Si tout le monde peut être contaminé, tout le monde peut également faire preuve d'un certain degré de citoyenneté responsable pour réduire les risques de contracter la maladie et ne pas la transmettre à son entourage. La couverture vaccinale contre la Covid-19 est une des mesures de l'incidence de la maladie dans la population et qui ne peut prendre la quasi-totalité de la population qu'en la rendant obligatoire.

Vaccination coverage and safety in Cameroon: descriptive assessment of COVID-19 infection in vaccinated individuals

Objective. Toassess national vaccination coverage, adverse events following immunization (AEFI) and evaluate the vaccination status in COVID infected patients. Methods. Sociodemographic data on vaccination and clinical characteristics of Covid-19 cases were extracted from the national COVID-19databases of the Public Health Emergency Center and the Expanded Program on Immunization. Result. A total number of 808229 out of 27 869965 (2.9%) were fully immunized on 13 February 2022 in the Cameroon. The most requested vaccine was Janssen with 48.24% of total doses administered. Women were less vaccinated than men and with a remarkable disparity in northern regions of the country. The Adamawa region presented the best performance 11.3% of adults fully immunized. Despite vaccinal coverage still insufficient among health care worker, they were the most vaccinated among priority groups (43.4%). Only 8% COVID-19 cases were vaccinated and 0.22 % of all vaccinated still developed COVID-19. Tolerability assessment identified 1.83 non-serious AEFI and 0.1 serious AEFI per 1000 doses administered. Only 7% of vaccinated individual still developed laboratory-confirmed COVID-19. Conclusion. COVID-19vaccination coverage is still low in Cameroon compared to the target of 60%. Although data completeness is still an issue, the protection against severe forms of the disease provided by the vaccines currently used is quite satisfactory. There is however a need to intensify all strategies to make people adhere to vaccination in order to protectthem against severe form of the disease.

Couverture vaccinale et raisons de l'acceptation et de l'hésitation à la vaccination contre la COVID-19 chez les patients porteurs de pathologie cardiovasculaire à Ouahigouya / Vaccination coverage and reasons for accept ance orhesitation in vaccination against COVI D-19 in patients with cardiovascular disease in Ouahigouya

Objectif. La pandémie de COVID-19 a été cause d'une mortalité élevée chez les patients porteurs de comorbidités comme les pathologies cardiovasculaires. L'accélération de la mise sur marché des vaccins contre la pandémie a suscité une réticence envers ces derniers. L'étudié porte sur l'attitude des patients porteurs de pathologie cardiovasculaires vus en consultation cardiologique à Ouahigouya vis-à-vis de la vaccination contre la COVID-19. Population et méthodes. Une étude transversale a été menée du 1er au 25 avril 2022 dans trois cliniques privées de la ville de Ouahigouya. Nous avons inclus les patients consentants et porteurs de pathologie cardiovasculaire vus en consultation cardiologique. Le questionnaire était centré sur les connaissances, attitudes et pratiques de groupe vis-à-vis de la vaccination, notamment les raisons de 'l'acceptation ou du refus de se faire vacciner. Résultats. Cent-un patients ont été interviewés. Le sex-ratio était 1,46 avec un âge moyen de 48,26 ± 11,93 ans. Les plus représentés étaient les travailleurs indépendants, les urbains, les musulmans, les non-scolarisés et les mariés. L'HTA et ses complications étaient les atteintes cardiovasculaires les plus fréquentes (93,07%). La proportion de vaccinés était de 55,45%. Les raisons les plus évoquées par les vaccinés pour se vacciner étaient pour se protéger (100%) et le suivi des Recommandations gouvernementales et des agents respectivement 78,52% et 72,21%. Les raisons de l'hésitation vaccinale les plus citées étaient : la COVID-19 est une maladie banale (62,22%) et la peur des effets secondaires (44,44%). Conclusion. La vaccination contre la COVID-19 devrait se poursuivre, accompagnée d'une sensibilisation efficace afin d'améliorer le taux de couverture vaccinale parmi les patients porteurs de pathologies cardiovasculaires

Objective. COVID-19 pandemic has caused high mortality in patients with comorbidities such as cardiovascular pathologies. The acceleration of the marketing of vaccines against the pandemic has caused reluctance towards them. The study focuses on the attitude of patients with cardiovascular disease seen in cardiology consultation in Ouahigouya vis-à-vis COVID-19 vaccination. Population and methods. A cross-sectional study was conducted from April 1 to 25, 2022 in three private clinics of the city of Ouahigouya. We included consenting patients and carriers of cardiovascular pathology seen in cardiology consultation. Our main data of interest were the knowledge, attitude and practice of this population towards vaccination, especially thereasons for accepting or refusing vaccination. Results One hundred and one patients were interviewed. The sex ratio was 1.46 with an average age of 48.26 ± 11.93 years. The most represented were the self-employed, urban dwellers, Muslims, the uneducated and the married. Hypertension and its complications were the most common cardiovascular disorders (93.07%). The proportion of vaccinated was 55.45%. The reasons most mentioned by the vaccinated for getting vaccinated were to protect themselves (100%) and to follow government recommendations and agents, respectively 78.52% and 72.21%. The most cited reasons for vaccine hesitation were: COVID-19 is a common disease (62.22%) and fear of side effects (44.44%). Conclusion. Vaccination against COVID-19 must continue, accompanied by effective awareness-raising in order to improve the vaccination coverage rate among patients with cardiovascular pathologies

Emerging COVID-19 virus variants and low vaccination coverage in Ethiopia: The need for tailored vaccination strategy

The world has faced multiple waves of COVID-19 outbreaks, with more than 300 million cases and 5.5 million deaths officially reported globally as of Jan 8, 2022. Within the first year of the pandemic, there was hope that it would soon be under control, yet the pandemic sustains to be the world's priority health agenda. This brief communication provides emerging time-sensitive perspectives on the need for a tailored COVID-19 vaccination strategy in Ethiopia by reviewing studies and expert opinions. As of Jan 8, 2022, Ethiopia has reported 443,339 cases and 7,020 COVID-19-related deaths. Only 9,361,640 people (8%) of the Ethiopian population received at least one dose of the COVID-19 vaccine. While the short supply of vaccines is mentioned as a major bottleneck, the role of vaccine skepticism is largely overlooked, though the vaccine is the primary means to combat the emergence of new variants. Therefore, we recommend vaccine advocacy and awareness creation, planning for vaccine mandate for certain groups of the society, and targeted vaccination and economical use of the vaccines.

COVID-19 herd immunity v. learning to live with the virus

Mutations of SARS-CoV-2 have been associated with increased transmissibility and occasionally reduced sensitivity to neutralising antibody activity induced by past ancestry virus infection or current COVID-19 vaccines. Nevertheless, COVID-19 vaccines have consistently demonstrated high efficacy and effectiveness against COVID-19 severe disease, hospitalisation and death, including disease caused by designated variants of concern. In contrast, COVID-19 vaccines are more heterogeneous in reducing the risk of infection and mild COVID19, and are modestly effective in interrupting virus transmission. Ongoing mutations of SARS-CoV-2 resulting in increased transmissibility and relative evasion of neutralising antibody activity induced by past virus infection or COVID-19 vaccines are likely. The duration of protection induced by COVID-19 vaccines is modelled to be relatively short in protecting against infection and mild COVID-19, but is likely to be 2 - 3 years against severe disease. Current experience from the UK and Israel demonstrates that even with high levels of COVID19 vaccine coverage (>85% of the adult population), resurgences with new variants of concern remain a strong probability. Nevertheless, such resurgences are not mirrored by high rates of hospitalisation and death compared with what was experienced in relatively COVID-19 vaccine-naive populations. Even though COVID-19 vaccines are unlikely to result in a herd immunity state, their ability to protect against severe COVID-19 and death could allow for a return to normalcy once a large enough proportion of the adult population in a country has been vaccinated

Insights into vaccine hesitancy from systems thinking, Rwanda

Objective To investigate vaccine hesitancy leading to underimmunization and a measles outbreak in Rwanda and to develop a conceptual, community-level model of behavioural factors. Methods Local immunization systems in two Rwandan communities (one recently experienced a measles outbreak) were explored using systems thinking, human-centred design and behavioural frameworks. Data were collected between 2018 and 2020 from: discussions with 11 vaccination service providers (i.e. hospital and health centre staff ); interviews with 161 children's caregivers at health centres; and nine validation interviews with health centre staff. Factors influencing vaccine hesitancy were categorized using the 3Cs framework: confidence, complacency and convenience. A conceptual model of vaccine hesitancy mechanisms with feedback loops was developed. Findings/ A comparison of service providers' and caregivers' perspectives in both rural and peri-urban settings showed that similar factors strengthened vaccine uptake: (i) high trust in vaccines and service providers based on personal relationships with health centre staff; (ii) the connecting role of community health workers; and (iii) a strong sense of community. Factors identified as increasing vaccine hesitancy (e.g. service accessibility and inadequate follow-up) differed between service providers and caregivers and between settings. The conceptual model could be used to explain drivers of the recent measles outbreak and to guide interventions designed to increase vaccine uptake. Conclusion The application of behavioural frameworks and systems thinking revealed vaccine hesitancy mechanisms in Rwandan communities that demonstrate the interrelationship between immunization services and caregivers' vaccination behaviour. Confidencebuilding social structures and context-dependent challenges that affect vaccine uptake were also identified.

Child vaccination coverage and dropout rates in pastoral and semi-pastoral regions in Ethiopia: CORE Group Polio Project implementation areas

Background: Vaccination programs are one of the priority health interventions, and all children in every country should be vaccinated. The World Health Organization (WHO) aims for 90% coverage of the Expanded Program on Immunization (EPI) by the age of 12 months. The CORE Group Polio Project (CGPP) Ethiopia implemented interventions in pastoral and semi-pastoral regions to increase routine immunization coverage and support supplemental immunization campaigns. Objective: Assess vaccination coverage, estimate dropout rates and identify associated factors. Methods: A cross-sectional study using the modified WHO EPI cluster survey method was conducted as part of the mid-term evaluation in 2015 in six pastoral and semi-pastoral zones in Ethiopia. A sample of 600 children age 12 to 23 months was selected, and mothers/caregivers were interviewed at home using face-to-face interviews, supported by mobile data collection using the Open Data Kit (ODK)system. Data were exported from the server, cleaned, and analysed using STATA 12.0.Both descriptive analytical methods were used and p-values less than 0.05 were used to declare statistical significance. Results: Of the estimated sample, 577 (96.6%) children were included in the analysis. The overall rate of full vaccination was estimated to be 44.0% (21.2%in pastoral areas and 71.6% in semi-pastoral areas). With vaccine specific coverage of 53.7% for Bacillus Calmette-Guérin(BCG);58.8% for oral polio vaccine 3 (OPV 3);58.8% for pentavalent 3;56.3% for OCV 3 and 53.6% for measles.Mothers'/caregivers' residence, age and education were found to be significant predictors for children not being fully vaccinated, i.e.children of mothers living in pastoralist communities, young age, and with no education were at a significantly higher risk of being not fully vaccinated. Among those children who had at least one vaccine, 20.5% failed to take at least one of the next higher doses. Specifically, among those who took BCG and pentavalent 1, 10.1% and 14.1%, respectively,failed to take the measles vaccination. Conclusions and recommendations: The proportion of children who were fully vaccinated in pastoral and semi-pastoral zones was low. Dropout rates for measles, BCG and pentavalent 1 immunization were above the acceptable rate of less than 10%.Therefore, efforts should focus on mobilizing the community to complete all child vaccinations, and community-based approaches with the integration of community volunteers, health extension workers and health center staff should be strengthened so that dropout children can be traced so that they can complete their vaccinations. More information is also required on why mothers/caregivers fail to ensure that their children take all available vaccinations

Immunization coverage of 12 to 23 months old children in Ethiopia

Vaccine preventable diseases are the major global health problem which contributes to morbidity and mortality of less than 5 years child population. But, the immunization coverage worldwide is below the target. Therefore, the study was aimed at immunization coverage of 12 to 23 months old children in Areka Town, Sothern Ethiopia. A community based cross-sectional study conducted from 10th March to 19th June 19, 2016 in Areka Town, Sothern Ethiopia. Data on 173 children aged 12 to 23 months from 173 households selected using a systematic random sampling. Analysis was conducted using SPSS version 20. The result presented in the all tables and figures. The study showed that, 130(75.4%) fully vaccinated and 93(53.6%) vaccinated during immunization campaigns. The sources of information for 39(22.5%) were radio and television. 22(12.9%) missed vaccine appointment day and 13(7.7%) interrupted vaccine program. Of the vaccinated children, 166(96.2%) vaccinated for Bacillus Calmette­Guérin (BCG), 138(80%) vaccinated for oral polio vaccine (OPV) 0, 172 (99.2%) OPV1, Penta1 and PCV1, 165(95.4%) vaccinated for OPV2, Penta2 and PCV2, 161(92.9%) vaccinated for OPV3, Penta3 and PCV3, and 158(91.5%) vaccinated for measles. The dropout rate from BCG to measles was 4.7%.Therefore, continuous support and health education at the community level is recommended

Comparing static and outreach immunization strategies and associated factors in Uganda, Nov-Dec 2016

Introduction: the government of Uganda aims at reducing childhood morbidity through provision of immunization services. We compared the proportion of children 12-33 months reached using either static or outreach immunization strategies and factors affecting utilization of routine vaccination services in order to inform policy updates.Methods: we adopted the 2015 vaccination coverage cluster survey technique. The sample selection was based on a stratified three-stage sample design. Using the Fleiss formula, a sample of 50 enumeration areas was sufficient to generate immunization coverages at each region. A total of 200 enumeration areas were selected for the survey. Thirty households were selected per enumeration area. Epi-Info software was used to calculate weighted coverage estimates.Results: among the 2231 vaccinated children aged 12-23 months who participated in the survey, 68.1% received immunization services from a health unit and 10.6% from outreaches. The factors that affected utilization of routine vaccination services were; accessibility, where 78.2% resided within 5km from a health facility. 29.7% missed vaccination due to lack of vaccines at the health facility. Other reasons were lack of supplies at 39.2% and because the caretaker had other things to do, 26.4%. The survey showed 1.8% (40/2271) respondents had not vaccinated their children. Among these, 70% said they had not vaccinated their child because they were busy doing other things and 27.5% had not done so because of lack of motivation.Conclusion: almost 7 in 10 children aged 12-23 months access vaccination at health facilities. There is evidence of parental apathy as well as misconceptions about vaccination

A post-conflict vaccination campaign, Central African Republic

Objective : To rapidly increase childhood immunization through a preventive, multi-antigen, vaccination campaign in Mambéré-Kadéï prefecture, Central African Republic, where a conflict from 2012 to 2015 reduced vaccination coverage. Methods:The three-round campaign took place between December 2015 and June 2016 using: (i) oral poliomyelitis vaccine (OPV); (ii) combined diphtheria, tetanus and pertussis (DTP) vaccine, Haemophilus influenza type B (Hib) and hepatitis B (DTP­Hib­hepatitis B) vaccine; (iii) pneumococcal conjugate vaccine (PCV); (iv) measles vaccine; and (v) yellow fever vaccine. Administrative data were collected on vaccines administered by age group and vaccination coverage surveys were carried out before and after the campaign.Findings:Overall, 294 054 vaccine doses were administered. Vaccination coverage for children aged 6 weeks to 59 months increased to over 85% for the first doses of OPV, DTP­Hib­hepatitis B vaccine and PCV and, in children aged 9 weeks to 59 months, to over 70% for the first measles vaccine dose. In children aged 6 weeks to 23 months, coverage of the second doses of OPV, DTP­Hib­hepatitis B vaccine and PCV was over 58% and coverage of the third doses of OPV and DTP­Hib­hepatitis B vaccine was over 20%. Moreover, 61% (5804/9589) of children aged 12 to 23 months had received two PCV doses and 90% (25933/28764) aged 24 to 59 months had received one dose.Conclusion:A preventive, multi-antigen, vaccination campaign was effective in rapidly increasing immunization coverage in a post-conflict setting. To sustain high coverage, routine immunization must be reinforced

Oral cholera vaccination in hard-to-reach communities, Lake Chilwa, Malawi

Objective To evaluate vaccination coverage, identify reasons for non-vaccination and assess satisfaction with two innovative strategies for distributing second doses in an oral cholera vaccine campaign in 2016 in Lake Chilwa, Malawi, in response to a cholera outbreak. Methods We performed a two-stage cluster survey. The population interviewed was divided in three strata according to the second-dose vaccine distribution strategy: (i) a standard strategy in 1477 individuals (68 clusters of 5 households) on the lake shores; (ii) a simplifiedcold-chain strategy in 1153 individuals (59 clusters of 5 households) on islands in the lake; and (iii) an out-of-cold-chain strategy in 295 fishermen (46 clusters of 5 to 15 fishermen) in floating homes, called zimboweras. Finding Vaccination coverage with at least one dose was 79.5% (1153/1451) on the lake shores, 99.3% (1098/1106) on the islands and 84.7% (200/236) on zimboweras. Coverage with two doses was 53.0% (769/1451), 91.1% (1010/1106) and 78.8% (186/236), in the three strata, respectively. The most common reason for non-vaccination was absence from home during the campaign. Most interviewees liked the novel distribution strategies. Conclusion Vaccination coverage on the shores of Lake Chilwa was moderately high and the innovative distribution strategies tailored to people living on the lake provided adequate coverage, even among hard-to-reach communities. Community engagement and simplified delivery procedures were critical for success. Off-label, out-of-cold-chain administration of oral cholera vaccine should be considered as an effective strategy for achieving high coverage in hard-to-reach communities. Nevertheless, coverage and effectiveness must be monitored over the short and long term

Factors and misperceptions of routine childhood immunization service uptake in Ethiopia: findings from a nationwide qualitative study

Introduction: while the routine childhood immunization program might be affected by several factors, its identification using qualitative evidence of caretakers is generally minimal. This article explores the various factors and misperceptions of routine childhood immunization service uptake in Ethiopia and provides possible recommendations to mitigate them.Methods: in this study, we used a qualitative multiple case study design collecting primary data from 63 focus group discussions (FGDs) conducted with a purposefully selected sample of children's caretakers (n = 630).Results: according to the results of this study, the use of routine childhood immunization is dependent on four major factors: caretakers' behavior, family characteristics, information and communication and immunization service system. In addition, the participants had some misperceptions about routine childhood immunization. For example, immunization should be taken when the child gets sick and a single dose vaccine is enough for a child. These factors and misperceptions are complex and sometimes context-specific and vary between categories of caretakers.Conclusion: our interpretations suggest that no single factor affects immunization service uptake alone in a unique way. Rather, it is the synergy among the factors that has a collective influence on the childhood immunization system. Therefore, intervention efforts should target these multiple factors simultaneously. Importantly, this study recommends improving the quality of existing childhood immunization services and building awareness among caretakers as crucial components