Predictors of COVID-19 vaccine acceptance among Nigerian medical doctors

Background: Since its discovery in late 2019, COVID-19 has claimed approximately three million lives worldwide, causing a significant economic burden and strain on health care delivery and services. Therefore, the COVID-19 vaccine may offer the potential to promote global recovery. Objective: To determine the acceptability of the COVID-19 vaccine among Nigerian doctors and the factors influencing the acceptance. Methods: Using a cross-sectional design, an anonymous online survey was administered to medical doctors across the six geopolitical zones in Nigeria between 13 January and 31 January 2021, using the health belief model (HBM). Results: Out of 830 respondents, 38.8% were willing to take the COVID-19 vaccine, 36.0% were unsure, while the remaining 26.5% refused to take the vaccine. Following adjustments, males were more likely to take the vaccine (OR = 3.357; 95% CI 2.009-5.610; p = 0.0001), whereas increasing age, higher perceived viral virulence and perceived viral infectivity were observed to be significantly associated with less likelihood of accepting the vaccine. Respondents who believed in the efficacy of ivermectin were much less likely to receive the vaccine (OR = 0.217; 95% CI 0.108-0.436; p=0.001). Concerns on vaccination safety were the main barriers to vaccine acceptability. Hypothetically addressing these concerns increased vaccine acceptance rates by approximately a third (34.6%) (p < 0.001). Conclusion: The proposed nationwide distribution of the COVID-19 vaccine may be met with poor vaccine acceptability among Nigerian medical practitioners. Measures specifically addressing vaccine safety concerns should be provided to allay fears and enhance the acceptability of the vaccine.

Prioritization of operational research questions on COVID vaccination in the African Region

Introduction: a year after the start of COVID-19 vaccination, coverage remains very low in the African Region. Different challenges and operational barriers have been documented, but countries will need to supplement the available information with operational research in order to adequately respond to practical questions regarding how best to scale up COVID-19 vaccination. We conducted a survey among immunisation program staff working in the African Region, in order to identify the high priority operational research questions relevant to COVID-19 vaccination. Methods: proposed operational research questions categorized into six topic areas were sent to resource persons, asking them to rate according to the relevance, urgency, feasibility, and potential impact of the research questions on the progress of COVID vaccination. Results: a total of 25 research questions have been given an average weighted rating of 75% or more by the respondents. Nine of these top priority research questions were in the area of demand generation, risk communication and community engagement while 8 questions covered the area of service delivery. Conclusion: countries should plan for and coordinate stakeholders to ensure that relevant operational research is done to respond to the top priority research questions, with a view to influence policies and implementation of strategies.

Lessons learned from detecting and responding to recurrent measles outbreak in Liberia post Ebola-Epidemic 2016-2017

Introduction: measles is an acute viral disease that remains endemic in much of sub-Sahara Africa, including Liberia. The 2014 Ebola epidemic disrupted an already fragile health system contributing to low uptake of immunization services, population immunity remained low thus facilitating recurrent outbreaks of measles in Liberia. We describe lessons learnt from detecting and responding to recurrent outbreaks of measles two years post the 2014 Ebola epidemic in Liberia.Methods: we conducted a descriptive study using the findings from Integrated Diseases Surveillance and Response (IDSR) 15 counties, National Public Health Institute of Liberia (NPHIL), National Public Health Reference Laboratory (NPHRL) and District Health Information Software (DIHS2) data conducted from October to December, 2017. We perused the outbreaks line lists and other key documents submitted by the counties to the national level from January 2016 to December 2017.Results: from January 2016 to December 2017, 2,954 suspected cases of measles were reported through IDSR. Four hundred sixty-seven (467) were laboratory confirmed (IgM-positive), 776 epidemiologically linked, 574 clinically confirmed, and 1,137 discarded (IgM-negative). Nine deaths out of 1817 cases were reported, a case fatality rate of 0.5%; 49% were children below the age of 5 years. Twenty-two percent (405/1817) of the confirmed cases were vaccinated while the vaccination status of 55% (994/1817) was unknown.Conclusion: revitalization of IDSR contributed to increased detection and reporting of suspected cases of measles thus facilitating early identification and response to outbreaks. Priority needs to be given to increasing the uptake of routine immunization services, introducing a second dose of measles vaccine in the routine immunization program and conducting a high-quality supplementary measles immunization campaign for age group 1 to 10 years to provide protection for a huge cohort of susceptible

Implementation research: reactive mass vaccination with single-dose oral cholera vaccine, Zambia

Objective:To describe the implementation and feasibility of an innovative mass vaccination strategy ­ based on single-dose oral cholera vaccine ­ to curb a cholera epidemic in a large urban setting.Method:In April 2016, in the early stages of a cholera outbreak in Lusaka, Zambia, the health ministry collaborated with Médecins Sans Frontières and the World Health Organization in organizing a mass vaccination campaign, based on single-dose oral cholera vaccine. Over a period of 17 days, partners mobilized 1700 health ministry staff and community volunteers for community sensitization, social mobilization and vaccination activities in 10 townships. On each day, doses of vaccine were delivered to vaccination sites and administrative coverage was estimated.Findings:Overall, vaccination teams administered 424 100 doses of vaccine to an estimated target population of 578 043, resulting in an estimated administrative coverage of 73.4%. After the campaign, few cholera cases were reported and there was no evidence of the disease spreading within the vaccinated areas. The total cost of the campaign ­ 2.31 United States dollars (US$) per dose ­ included the relatively low cost of local delivery ­ US$ 0.41 per dose.Conclusion:We found that an early and large-scale targeted reactive campaign using a single-dose oral vaccine, organized in response to a cholera epidemic within a large city, to be feasible and appeared effective. While cholera vaccines remain in short supply, the maximization of the number of vaccines in response to a cholera epidemic, by the use of just one dose per member of an at-risk community, should be considered

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

Inactivated Poliovirus Vaccine Campaign in Kenya: Lessons Learned

Despite being free of polio since 2006 Kenya has suffered a number of wild poliovirus outbreaks in the subsequent years. In December 2013; in response to one such outbreak in Dadaab; inactivated poliovirus vaccine (IPV) was co-administered with oral poliovirus vaccine as a more effective measure in closing immunity gaps. A five-day vaccination campaign was staged followed by a vaccination coverage survey in the refugee camps of Dadaab and the surrounding host communities. A variety of operational challenges were faced - the number of health facilities; outreach sessions; human resources and cold chain logistics were suboptimal in the campaign area with its scattered population and nomadic living pattern. However; despite the challenges; the survey showed that excellent coverage was achieved. Lessons learned evidence that IPV can be administered in similar geographical settings; and that systematically tailored training; timely and capacity-based operational/micro-planning; and evidence-based communication and social mobilization can make for successful outcomes

African vaccination week: platform for effective partnership to deliver multiple interventions in the African Region

African Vaccination Week (AVW) is an initiative of the countries in the World Health Organization African Region promoting equity and access to vaccination. The initiative focuses on reaching populations with limited access to regular health services. Available data from 2014 showed that countries took advantage of the initiative to conduct integrated delivery of multiple interventions; targeting those with limited access to regular health services. A majority of the countries integrated between five and six interventions and very few delivered single interventions. The most common integrated intervention was vitamin A supplementation; followed by de-worming. Other interventions included educational activities; supplementation minerals and provision of health services. Data on coverage of integrated interventions are shown in the article

Media and Interpersonal Persuasions in the Polio Eradication Campaign in Northern Nigeria

This study is premised on the increasing global concerns over the widespread resistance to polio eradication campaign in northern Nigeria. It aims to determine the level of campaign acceptance and compare the influences of mass media and interpersonal communication sources in Zaria local government area; being one of the high-risk (WPV-endemic) areas in northern Nigeria; where campaign resistance is known to be high. By way of quantitative survey; the study utilized 10sample of the populations of eight out of the thirteen Wards in Zaria local government area; with a response rate of 78.6. Findings reveal close ranks between campaign acceptance and resistance in the local government area; thus further confirming the difficulties still faced in polio eradication campaign in the region. This study also indicates higher performance of Interpersonal than Mass Media sources in influencing campaign acceptance and resistance in the local communities. Contact with friends and relations was rated the most influential interpersonal sources in the acceptance and resistance decision of individuals; while newspapers and magazines were rated most influential media sources that influenced campaign resistance in the local communities. The study concludes that a polio eradication campaign; backed with competent and sufficient communication expertise that utilizes knowledge- based indigenous interpersonal communication strategies will likely result in greater community acceptance in northern Nigeria

Current Concept in the Management of Acute Bacterial Meningitis

"Though largely considered a disease of the so called dry and hot ""African meningitis belt;"" meningitis is assuming a global public health problem. Recent emergence of resistant strains of bacteria has resulted in increased morbidity of and mortality attributable to meningitis. This review addresses recent developments in the pathogenesis and diagnosis of this largely neglected disease as well as their implications for its management. A preventive strategy; particularly mass vaccination is advocated. The possible impact of climate change in the epidemiology of meningitis is highlighted."

Incinerateur de dechets medicaux a base de materiaux locaux : experience de la campagne 2002 de vaccination anti-rougeole a Douala; Cameroun

Methode de choix pour detruire les dechets biomedicaux; l'incineration consiste a les reduire en cendres par une combustion a 800oC; detruisant les micro-organismes;supprimant les risques de blessure. L'incinerateur presente; de type modulaire double chambre preconise en pays en developpement; repond aux principes de : fabrication artisanale peu couteuse; combustion en exces d'air; reduction des risques d'accident ou de contamination; postcombustion des fumees; economie d'energie; manipulation et entretien faciles; securite d'utilisation. L'incinerateur; en briques d'argile de fabrication locale; solidarise par des cornieres d'acier; comporte deux chambres pour la combustion et la post-combustion. Un reservoir de carburant et un ventilateur permettent d'activer la combustion. Lemodele fonctionne par fournees en cycles de 2 heures. La campagne de vaccination anti-rougeole (decembre 2002) devait produire pour 5 districts deDouala 800000 seringues autobloquantes avec aiguilles. Immediatement jetes dans des boites de securite de carton (contenance 5 litres; 1 Kg); ces dechets etaient achemines jusqu'a l'incinerateur puis incineres en 2 fournees quotidiennes. Resultats. La construction de l'incinerateur a coute 3500000FCFA (5300 _). 5816 boites ont ete incinerees; soit 29080 litres; 872 400 seringues; 6 281 Kg de dechets. Leur incineration a necessite 126 fournees realisees en 11 semaines. Les cendres (240 litres; soit 0;8du volume incinere) ne contenaient pratiquement aucun residu solide. La consommation de gazole a ete negligeable. Les fumees n'ont jamais ete abondantes; opaques; ou malodorantes. Les temperatures mesurees lors d'essais prealables depassaient toujours 800oC. Selon l'OMS; les emissions toxiques sont negligeables au-dela de 700oC si l'incinerateur fonctionnemoins de 2 heures quotidiennes. L'experience devra etre completee par des travaux sur le controle des temperatures; la determination de la composition des cendres et fumees; des essais en differentes conditions climatiques et d'utilisation

National EPI coverage survey report in Ethiopia, 2006

Background: Routine EPI reports have shown an upward trend in immunization coverage in recent years in Ethiopia; however; regional disparities exist. Objective: To determine regional coverage of child and TT immunization and assess reasons for not utilizing immunization services. Methods: The revised 2005 WHO-EPI regional coverage cluster survey method was used to determine the sample size for the study. Regional immunization status of 12-23 months of children and mothers with 0-11 months of infants forchild immunization and TT immunization respectively were taken as the unit of analysis. A sample of 6;903 children between 12-23 months and 6;952 mothers with infants between 0-11 months from 468 clusters in 11 regions of the country were surveyed in June 2006. Results: The weighted national immunization coverage assessed by card plus history for children aged 12-23 months vaccinated before the age of one year was BCG 83.4; DPT1 84.3; DPT3 66.0; measles 54.3; and fully immunized children 49.9. The weighted national TT2+ coverage and rate of Protection at Birth (PAB) assessed by card plus history was 75.6and 63.0respectively. Conclusion: The survey showed a 10 percentage point of increment in DPT3 coverage compared to 2001 survey coverage. However; progress was not uniform in all regions of the country. Despite the improve-ment in the access to immunization in the country; DPT3 coverage was less than 30and dropout rate remained very high in three emerging regions. Effective behavioral change communication (BCC) strategies need to be designed and implemented to tackle high dropout rate in the program. Besides; health workers training program on interpersonal communication and Reaching Every District (RED) approach should be fully implemented to increase and sustain high level of immunization coverage in Ethiopia

Introduction of the Pneumococcal Conjugate Vaccine into the South African Public Immunisation Programme: Dawn of a New Era?

Streptococcus pneumoniae is a leading vaccine-preventable cause of childhood death with an estimated 716;000 deaths occurring annually. Recent advances have seen the development of vaccines targeted against S. pneumoniae that are immunogenic and efficacious in very young children. These pneumococcal conjugate vaccines have now been evaluated in developed and industrialising countries with consistent efficacy against invasive pneumococcal disease at least due to the serotypes included in the vaccine. The vaccine has also been efficacious in preventing radiographically confirmed pneumonia; but has had less effect on pneumococcal acute otitis media. The introduction of the vaccine into the USA has been greatly successful and exceeds its expectations based upon the vaccine efficacy trials. In addition to preventing a greater than expected burden of invasive disease and pneumonia than anticipated in vaccinated children; the vaccine has also been associated with marked reduction in pneumococcal disease among unvaccinated members of the population; referred to as `indirect protection'. The introduction of the vaccine into the immunisation programme of industrialising countries; such as in South Africa; require robust surveillance to evaluate the effectiveness of the vaccine in such settings where the epidemiology of pneumococcal diseases differs to that in developed countries