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Background & objectives: There is a paucity of data regarding immunogenicity of recently introduced measles–rubella (MR) vaccine in Indian children, in which the first dose is administered below one year of age. This study was undertaken to assess the immunogenicity against rubella and measles 4-6 wk after one and two doses of MR vaccine administered under India’s Universal Immunization Programme (UIP). Methods: In this longitudinal study, 100 consecutive healthy infants (9-12 months) of either gender attending the immunization clinic of a tertiary care government hospital affiliated to a medical college of Delhi for the first dose of routine MR vaccination were enrolled. MR vaccine (0.5 ml, subcutaneous) was administered to the enrolled participants (1st dose at 9-12 months and 2nd dose at 15-24 months). On each follow up (4-6 wk post-vaccination), 2 ml of venous blood sample was collected to estimate the antibody titres against measles and rubella using quantitative ELISA kits. Seroprotection (>10 IU/ml for measles and >10 WHO U/ml for rubella) and antibody titres were evaluated after each dose. Results: The seroprotection rate against rubella was 97.5 and 100 per cent and against measles was 88.7 per cent and 100 per cent 4-6 wk after the first and second doses, respectively. The mean (standard deviation) titres against rubella and measles increased significantly (P<0.001) after the second dose in comparison to the levels after the first dose by about 100 per cent and 20 per cent, respectively. Interpretation & conclusions: MR vaccine administered below one year of age under the UIP resulted in seroprotection against rubella and measles in a large majority of children. Furthermore, its second dose resulted in seroprotection of all children. The current MR vaccination strategy of two doses, out of which the first is to be given to infants below one year of age, appears robust and justifiable among Indian children.
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Objectives To assess the gaps and trends in child immunization coverage among urban and rural areas in India, and compare the success of immunisation program in each. Methods PubMed, Scopus, and Crossref, and Google Scholar electronic databases were searched on October 9, 2019, and March 21, 2020, for studies that measured and reported immunization coverage indicators in India. Random-efects metaanalyses and meta-regressions were conducted. Results The authors' search identifed 545 studies, and 2 were obtained by expert suggestion. Among these 68 studies and 6 surveys were included. They found that full immunization coverage has grown yearly at 2.65% and 0.82% in rural and urban areas, respectively whereas partial immunization coverage declined by ?2.44% and ?0.69%, respectively. Percentage of nonimmunized children did not show a statistically signifcant trend in either. Conclusion While rural immunization coverage has seen a large increase over the past two decades, the progress in urban areas is weak and negligible. This was largely attributable to a focus on minimizing dropouts in rural areas. However, a lack of signifcant reduction in unimmunized children may indicate left-out children or pockets in both rural and urban areas. The poor performance of immunization programs in urban areas, coupled with a larger impact of COVID-19, warrants that India urgently adopts urban-sensitive and urban-focused policies and programs.
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Introducción: La industria nacional ha desarrollado un candidato vacunal contra neumococo. Ante su posible introducción en el sistema de salud debe valorarse el costo incremental que acarrearía. Objetivo: Estimar el incremento de los costos del Programa Nacional de Inmunización por la introducción del candidato vacunal contra neumococo. Métodos: Estudio de descripción de costos desde la perspectiva social para el año 2021. Se estudiaron ocho policlínicos de La Habana y se entrevistaron 38 familiares de lactantes. Se estimó el costo institucional, el gasto de bolsillo y el costo indirecto mediante microcosteo. Se estimó el costo incremental para un esquema de tres dosis (2p+1), concomitantes con otras vacunas. Resultados: El costo total para el Programa Nacional de Inmunización en estos policlínicos estuvo entre los 337 000,00 CUP y los 513 000,00 CUP, con un costo por dosis entre 33,11 CUP y 47,30 CUP. El 31,6 por ciento de las familias reportó gastos en transportación de entre 5,00 CUP y 40,00 CUP. La introducción de la vacuna representaría un incremento entre 8,43 por ciento y 18,99 por ciento del costo base del Programa Nacional de Inmunización en los policlínicos. El costo por dosis sería de entre 34,17 CUP y 47,82 CUP, para un incremento de entre 0,28 CUP y 1,33 CUP. Conclusiones: La mayor parte del costo del Programa Nacional de Inmunización lo asume el Estado. La aplicación de la vacuna cubana contra neumococo solo aumentaría muy levemente el costo por dosis(AU)
Introduction: The national industry has developed a vaccine candidate against pneumococcus. Given its possible introduction into the health system, the incremental cost that it would entail must be assessed. Objective: To estimate the increase in the costs of the National Immunization Program due to the introduction of the pneumococcal vaccine candidate. Methods: Study of cost description from the social perspective for the year 2021. Eight polyclinics in Havana were studied and 38 relatives of infants were interviewed. Institutional cost, out-of-pocket costs and indirect costs were estimated through microcost. The incremental cost was estimated for a three-dose schedule (2p+1), concomitant with other vaccines. Results: The total cost for the National Immunization Program in these polyclinics was between 337,000.00 CUP and 513,000.00 CUP, with a cost per dose between 33.11 CUP and 47.30 CUP. 31.6percent of families reported transportation expenses from 5.00 CUP to 40.00 CUP. The introduction of the vaccine would represent an increase between 8.43 percent and 18.99 percent of the base cost of the National Immunization Program in polyclinics. The cost per dose would be between 34.17 CUP and 47.82 CUP, for an increase of between 0.28 CUP and 1.33 CUP. Conclusions: Most of the cost of the National Immunization Program is borne by the State. The application of the Cuban pneumococcal vaccine would only slightly increase the cost per dose(AU)
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Humans , Male , Female , Immunization Programs , Costs and Cost Analysis/economics , Pneumococcal Vaccines/therapeutic use , Epidemiology, DescriptiveABSTRACT
Background: India was one of the first countries to adopt the World Health Organization's Expanded Programme of Immunization (EPI). The program started globally in 1974 and was initiated in India in 1978. Immunization is considered to be one of the most important cost-effective and a powerful public health intervention. Achieving maximum coverage, however, has been a challenge due to many reasons, including high rates of defaulters from the program. The term 'defaulter' is used to refer a child who misses the scheduled vaccinations for any reason. The objective of this study was to explore the reasons behind defaulting from the routine immunization program.Methods: A study was conducted in Bowring and Lady Curzon Hospital, Bangalore between January 2012 and December 2012. A total of sixty six children's' details were gathered from mothers of defaulted children. Children below 5 years attending OPD were included in the study. Children above 5 years and inpatients were excluded. Observations and review of relevant documents was done.Results: Of the 66 children, in our study, males were more than females. Children in the age group of 2 years to 5 years were 17(25%) as compared to those between 1 to 2 years. Mothers were more literate than fathers. Muslim children had the best immunization coverage. The main determinant of defaulting was lack of knowledge and awareness regarding immunization by the mothers (21/31%) followed by sickness in children (11/16%), causing them to default immunization schedulesConclusions: The main reason for defaulting from the immunization program was lack of awareness, regarding immunization by mothers in the community.
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Background: India accounts for the highest number of under-five deaths in the world. Estimates claim that 89 lakh children in India receive fewer vaccines or no vaccine at all. One out of every three children in India does not receive all vaccines under the universal immunization programme. 5% children in urban and 8% children in rural areas remain unimmunized. According to NFHS-4 data complete vaccination coverage in India stands at 62%. The objectives of this study were to evaluate complete vaccination coverage, dropout rate and identify factors for failure of vaccination coverage in Doda district of Jammu and Kashmir, state of India.Methods: A cross-sectional quantitative study was conducted to evaluate the complete vaccination coverage by using an interview schedule devised as per WHO-UNICEF coverage cluster survey reference manual and National Immunization Schedule. A pre-determined sample size according to the WHO-UNICEF coverage cluster survey reference manual was adopted for the purpose of the study.Results: Of the total 207 children included in the study 66.2% (n=137) were fully immunized. 19.8% of the children had dropped out and did not receive the recommended dose of pentavalent vaccine. Among the reasons for low complete vaccination coverage, lack of awareness, mother too busy and vaccinator being absent were identified as the major reasons.Conclusions: Complete vaccination coverage has shown an increase with an increase in the coverage of the individual vaccines. But the coverage is still low and more efforts are needed to further improve the vaccination coverage.
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Background: Immunization remains an important public health intervention. On one side morbidity and mortality caused by vaccine-preventable diseases are still high in developing countries, on the other side immunization coverage is still low. Present study aims to assess immunization status of under-five children in relation to various demographic variables of their mothers.Methods: A total of 530 mothers with children under 5 years attending OPD, immunization clinic or admitted in paediatric ward were included in the study. Maternal demographic variables like age, religion, education, socio economic status, residence, parity and occupation were compared with immunization status of their children.Results: Most of mothers were housewives (73.77%), primary educated (33.58%), belonged to Hindu religion (47.54%), were of 21-30 years age group (52.64%), residing in urban areas (62.07%) and belonged to middle socio economic status (45.84%). Out of total 530 children 161 (30.37%) were completely immunized as compared to 21.32% who were unimmunized. Boys were marginally more unimmunized (37.32%) than girls (23.04%). Mothers' education, occupation, parity, religion, residence and socio-economic status significantly influenced immunization status of their children (p<0.05).Conclusions: Therefore, it is recommended that any strategy formulated to improve vaccination coverage in children of our country should focus to strengthen above mentioned weak links.
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Background: Immunization is an important cost effective tool for preventing the morbidities and mortalities caused by vaccine preventable diseases. The objectives of this study were to assess the universal immunization programme coverage of children of 12–23 months of age in Kozhikode district and to study the factors associated with immunization coverage.Methods: A cross sectional study was conducted in 30 randomly selected electoral wards of Kozhikode district which were selected using multi stage cluster sampling technique during April 2013 to May 2014.Results: 469 children were studied from 30 clusters. 75.5% was fully immunized while 1.5% was unimmunized. Dropout rate for DPT 3 to Measles was the highest accounting to 20.2%. Most common reason for failure of immunization among unimmunized was that the parents didn’t feel the need (57.1%) and for partially immunized was the illness of the child (27.8%) followed by lack of awareness of the time of immunization (22.2%). Religion, early age of the mother at marriage and first delivery and high birth order were significantly associated with a higher proportion of partially immunized while higher education of the parents (>12th standard), health worker’s home visit in the first year of the child and presence of immunization card were significantly associated with a high full immunization coverage (p<0.05).Conclusions: Immunization coverage of 75.5% is far behind the target to be achieved. 1.5% of the children didn’t get any of the vaccinations. It is very important to increases the coverage to prevent the re-emergence of vaccine preventable diseases.
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Background: Acute Lower Respiratory Tract Infections (ALRTI) remains the major cause of increased morbidity and mortality in under-five children. Vitamin A has a protective role against infections in children. Vitamin A supplementation is given to under-five children as part of the National Immunization Programme in India. The aim of this study was to find out the effectiveness of vitamin A supplementation in preventing the recurrent ALRTI (?3 episodes per year) in under-five children.Methods: A cross-sectional analytical study was conducted to find out the role of vitamin A supplementation in reducing recurrent ALRTI in under-five children who were enrolled in Anganwadi centers (AWC's) in Villupuram district, Tamil Nadu, India. Two hundred children of 1-5 years of age were selected by random systematic sampling. History was elicited and documents about vitamin A supplementation and previous episodes of ALRTI were verified. The association between recurrence of ALRTI and vitamin A supplementation was analyzed using chi-square test.Results: The mean age of the children in this study is 24'8 months. The median number of episodes of ALRTI per year is 2 (1-3). Among 200 children enrolled in the study, 127 (63.5%) children received vitamin A supplementation and 73 (36.5%) did not receive it. There is a significant decrease in the number of ALRTI episodes (less than 3 episodes per year) in the children who received vitamin A supplementation (p <0.001).Conclusions: Vitamin A supplementation along with the National Immunization Programme had shown reduced' ALRTI episodes. Since, the number of ALTRI episodes are directly proportional to mortality due to pneumonia, reduction in number of episodes can decrease the Under-five mortality. Vitamin A supplementation is an important programme in this regard and needs to be scrupulously carried out.
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Prophylactic HPV vaccine was a milestone in the prevention and control of HPV-related diseases, especially cervical cancer. The first HPV vaccine has been marketed in the world for more than 10 years. The follow-up study of HPV vaccine clinical trials further confirms the effectiveness and safety. Since HPV vaccine had been introduced into more and more national immunization programs, the population-level effectiveness of HPV vaccine was increasingly proved: Reduced the incidence of HPV infection, genital warts and high-grade precancerous lesions, and improved the herd immunity effect among non-vaccinated populations. However, improvement of the coverage of HPV vaccine, especially in low-and-middle income countries, is the major challenge in putting the HPV vaccine into practice.
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More than 100 countries have added hepatitis B vaccination to their routine immunization programmes.Hepatitis B vaccines progressed from blood vaccines to recombinant vaccines,then to peptide vaccines and DNA vaccines,to their functions extended from prophylactic to therapeutic.This article analyzes the relationship between hepatitis B vaccine R&D and the immunization programmes in different countries,to summarizes the R&D of both prophylactic and therapeutic vaccines,and points out the direction for futare vaccine development.