Improved population coverage of the human papillomavirus vaccine after implementation of a school-based vaccination programme: the Singapore experience

INTRODUCTION@#Cervical cancer has a high disease burden in Singapore, and it is strongly associated with human papillomavirus (HPV) infections. Despite constant efforts to encourage vaccination, local HPV vaccine uptake remains low. Universal mass vaccination is a proven cost-effective method to reduce the cervical cancer disease burden. This paper reviews the newly implemented school-based HPV vaccination programme in Singapore and the factors that led to its success.@*METHODS@#Fully subsidised HPV vaccinations were offered to all Secondary 1 female students on an opt-in basis, starting as a rollout dose in 2019. One-time catchup vaccination was also offered to female students in Secondary 2-5. Eligible recipients were identified using enrolment data provided by Ministry of Education schools. A total of 19,144 students across 139 schools were offered the rollout dose, and 20,854 students across 140 schools were offered the catchup doses.@*RESULTS@#High vaccine uptake rates of 80.6%-87.3% were noted with the introduction of the school-based programme, translating to high vaccine coverage of 90.3%-93.4%. Only a small proportion of students (1.5%-1.9% per cohort) opted out. The rate of reported side effects, which were commonly known effects, was low at one in 1000. Among the students who reported side effects, those who received the second vaccine dose did so uneventfully.@*CONCLUSION@#High HPV vaccine coverage was achieved after implementation of the school-based immunisation programme. Timely assessment of knowledge lapses and targeted intervention, strong partnerships with stakeholders, constant on-site adaptation and positive social influence contributed to its success. This model can be applied to future school health programmes.

Restricted participation: Drivers, experiences and implications of disability stigma in Ethiopia

Background: Community-based inclusive development (CBID) acknowledges society's critical role in supporting the active participation of persons with disabilities. However, research on how this approach relates to the context-sensitive socially situated barriers of disability stigma is underexplored. Objectives: This study aimed to understand the drivers and experiences of disability stigma in Ethiopia, from the perspective of persons with disabilities engaged in CBID programmes, and to establish how disability stigma acts as a barrier to participation. Methods: An inductive methodological approach guided the research design. Mixed methods were used including a narrative review of disabilities studies literature, 16 semi-structured interviews with persons with disabilities, and a quantitative survey of 970 persons with disabilities across three communities in Ethiopia. Results: Informed by theories of epistemic justice, this study identified specific indicators of meaningful participation and examined how these relate to experiences of disability stigma. The study found that the participation of adults with disabilities in society is restricted across different areas of life. Misconceptions about the causes of disability and social perceptions regarding the capacities of persons with disabilities are found to exacerbate stigma and act as a barrier to participation. Conclusion: Targeted efforts to challenge internalised norms and harmful beliefs within CBID approaches are required to address disadvantages arising from embedded disability stigma. Contribution: This study makes conceptual, empirical and practical contributions that advance insights into the relationship between disability stigma and participation in Ethiopia and the dimensions of epistemic justice relevant to understanding the nature and drivers of disability stigma.

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.

Knowledge, Attitudes, and Beliefs Among Dental Students and Faculty Members Regarding COVID-19 Vaccines in Dental Colleges of Haryana, India - A Cross-Sectional Study

Aim: To assess knowledge, attitudes, and beliefs among dental students and faculty members regarding COVID?19 vaccines in dental colleges in Haryana, India. Objectives: To assess knowledge level, attitudes, and beliefs differences among BDS, MDS students and faculty members and find association between knowledge and COVID?19 vaccine inoculation among study participants. Materials and Methods: A cross?sectional study was carried out among students and faculty members of dental colleges in Haryana, India. Data collection was done via an online questionnaire based on questions to assess the knowledge, attitude and beliefs regarding COVID?19 vaccines. Results: The present study comprised of 270 study participants, where majority, i.e., 81.5% have reported COVID?19 vaccine inoculation. The mean knowledge score of the participants was reported to be 5.54 ± 2.19. A significant difference was found in the mean knowledge score of faculty members (7.81 ± 1.69), MDS (6.72 ± 1.49), and BDS (4.39 ± 1.68) students. COVID?19 vaccine inoculation was found to be significantly associated with average knowledge score of participants (OR = 6.1, P < 0.01). Conclusion: Dental professionals have an adequate degree of knowledge and attitude level regarding COVID?19 vaccines and are generally optimistic about resolving the pandemic situation with the immunization.

A Study of Adverse Effects Following Administration of Anti-Rabies Vaccination - A Hospital Based Study

Rabies is an acute viral zoonotic disease that affects all warm-blooded animals including mammals and occurs in more than 150 countries and territories. Although rabies is a 100% fatal disease, it can be pre-vented by the use of potent anti-rabies vaccines (ARV). The present study was a hospital based descrip-tive longitudinal study conducted during February 2019 to July 2020 amongst the animal bite patients attending the Anti -Rabies clinic (ARC) of Vardhman Mahavir Medical College and Safdarjung Hospital (VMMC & SJH), New Delhi, to study the adverse events (vaccine reactions) if any following administra-tion of the ARV. The age of the study participants ranged from 2 to 65 years and the mean age was (29.315.2) years. No severe or serious adverse events were reported. Of the minor reactions, the most commonly reported symptom was pain at the injection site (34; 9.4%) followed by occurrence of tingling sensation (29; 8.1%), headache (22; 6.1%) and itching at the injection site (19; 5.3%). These findings corroborate with those found in previous studies in the literature. It was concluded that although there are possible local or mild or systemic adverse reactions to rabies vaccination, but once initiated, rabies prophylaxis should not be interrupted or discontinued.

Study of immunogenicity, safety and efficacy of covishield vaccine among health care workers in a tertiary cardiac care centre

Purpose: The pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) might be curtailed by vaccination. We assessed the safety, and immunogenicity of Covishield vaccine among Health care workers (HCWs) in a tertiary cardiac care centre. Methods: It's a prospective analytical study, conducted at Sri Jayadeva Institute of cardiovascular science and research centre, Mysore, between January 2021 to May 2021. Pre and Post vaccination SARS CoV2 IgG antibodies were assessed among 122 HCWs. Interval between two doses in this study were 4 and 6 weeks. Adverse events following immunisation b(AEFI) and efficacy were assessed and followed up for two month post vaccination. Results: Post vaccination seropositivity was 69.67% in overall study participants. Seropositivity and P/N ratio median value in uninfected and infected group were 60.43% (n ¼ 55),3.47 (IQR: 2.56–5.22) and 96.77% (n ¼ 30),9.49 (IQR: 7.57–12.30) respectively (P < 0.001). Seropositivity and P/N ratio after 4 and 6 weeks were 48.3% (n ¼ 60), 2.95 (IQR: 1.91–4.24), and 83.8% (n ¼ 31), 4.88, (IQR: 3.39–6.43) respectively (P < 0.001). AEFI after first and second dose was 72.9% and 27.8% (p < 0.05) respectively. The most common symptoms after both doses of vaccination were local pain (73% & 88.2%), followed by fever (38.2% & 26.5%). The average duration of symptoms in both doses was 1.75 days. Of 122 participants only 10 (8.19%) had breakthrough infection after two doses of vaccination with mild severity. Conclusion: Covishield vaccine has showed seropositivity of 69.67%.It has acceptable level of safety profile. Seropositivity and P/N ratio has increased with increase in interval between two doses. Though it has not prevented breakthrough infection it has certainly reduced the severity of infection.

Adéquation des soins de santé maternelle, néonatale et infantile: de la grossesse au programme d'immunisation de l'enfant dans la Zone de Santé Kenya à Lubumbashi / NA

Introduction. Le continuum des soins pour la santé maternelle, néonatale et infantile reconnait une interrelation étroite entre la santé de la mère, du nouveau-né et de l'enfant à différents niveaux. L'objectif était de vérifier l'adéquation d'utilisation des services essentiels dans le continuum des soins de santé maternelle, néonatale et infantile. Méthodologie. Il s'agit d'une étude descriptive transversale sur interview semi-dirigée auprès des femmes ayant un enfant de 9 mois à une année pendant la période allant de mars à juin 2022. L'échantillonnage a été arrêté à 422 femmes. Résultats. La moyenne d'âge maternel était de 28,37 ± 6,41 ans dont les extrêmes étaient de 17 ans et 47 ans. Le taux de suivi de CPN était de 88,86%, la fréquence moyenne des CPN était de 2,5 ± 1,3. Pendant les CPN, 82,93% des femmes avaient bénéficié d'un contrôle de la pression artérielle (PA), 80,27% de la mesure du poids, 78,40% de dépistage du VIH, 77,33% de la vaccination contre le tétanos, 76% de la prophylaxie contre le paludisme et 73,33% d'une supplémentation martiale. Le taux de césarienne était de 18,48% et 62,56% des femmes avaient accouché à l'hôpital ; 33,18% au centre de santé ; 3,32% à domicile et 0,95% en cours de route. Ainsi, 97,15% des enfants avaient été vaccinés et avaient reçu les vaccins anti polio, VPI, BCG et 95,97% avaient reçu DTC, pneumonie et le vaccin contre l'hépatite B, 95,02% des enfants avaient reçu le VAR. Conclusion. Les soins pour la santé maternelle, néonatale et infantile pose encore des problèmes à Lubumbashi. Ainsi la compréhension de la façon dont les femmes utilisent les soins aidera à mettre en œuvre et prioriser les interventions visant à améliorer la santé maternelle, néonatale et infantile.

Maternal vaccination: A narrative review

Background: Vaccinations in general are considered to be one of the greatest achievements in medicine, saving millions of lives globally. Aim: This narrative review highlights issues related to vaccination in pregnancy and provides information on those vaccines registered for use in pregnancy. Method: Published articles on vaccinations in pregnancy are included in this review. The search engines used included PubMed, Medline, Google Scholar, and ScienceDirect. Results: Vaccinations during pregnancy are more likely to be administered in high income countries (HICs) compared to low-income countries (LICs) due to easier access to healthcare services and better communicable disease awareness. Maternal and perinatal morbidity and mortality rates associated with infectious diseases are higher in LICs with access to maternal care services, infrastructure and hospital equipment lacking in these settings. Conclusion: Suitable vaccinations are recommended for use in pregnancy to prevent harm to women, their foetuses and newborns from some communicable diseases, and they have resulted in declines in maternal and infant morbidity and mortality. Furthermore, this review has shown that vaccination during pregnancy is not only safe for both the woman and her foetus but also effective. Therefore, health professionals and national governments should strongly consider approved vaccinations prior to or during pregnancy.

Qualitative Analysis of One Primary Health Care per Ward in Ekiti State, Nigeria

The "One Primary Health Care (PHC) per Ward" policy is an important health care component for achieving health for all. This study assesses the functionality, successes and challenges in the implementation of 'one PHC per ward' policy in Ekiti State, Nigeria. In-depth and key informant interview guides serve as qualitative research instruments for data collection. Relevant information was sourced from different stakeholders, including the Executives of the State Primary Health Care Development Agency (SPHCDA), the Local Government Chairmen, the Heads of Departments in PHCs, Staff of PHCs and patients who visited PHC facilities, amounting to twenty-five in-depth and seven key informant interviews. Although all the wards assessed had at least one PHC facility, none of the PHC facilities visited met the minimum standards recommended by the National Primary Health Care Development Agency (NPHCDA). PHC facilities located in the rural areas had fewer infrastructural and human resources than those in the urban areas. Routine immunization exercises were improved across the PHC facilities as the Universal Drug Revolving Scheme adopted by the PHCs was successful, largely because of the re-investment of both principal and profit into the purchase of drugs. Results suggest that while routine immunization as an aspect of PHC services had received remarkable successes, the PHC facilities suffered from inadequate equipment and personnel. There is need for a political will and concerted actions that are designed to improve PHC facilities if PHCs are to realize the objectives for setting them up.

Implementation Of An Immunisation Project For The Refugees Using The Logic Model

@#Refugees worldwide have been a challenge to many countries. Threats of preventable immunisable diseases amongst children that disrupt the herd immunity have been a concern as many countries lack a structured national policy to administer full vaccines to these refugees. Full immunisation coverage not only protected the refugees but also safeguarded the children of the home country. We designed a collaborative university-based community service partnership with UNHCR and International-Organisation-for-Migration, implemented a practice-integrated immunisation service initiative with the local community. This paper described the implementation process of an immunisation project for the refugees using the evaluative Logic Model. This model diagrammatically shows the relationships between the program's objectives, program activities, process indicators, outcomes, and resources used. It applies to program planning, operation, evaluation and address questions for decision making. The aim was to provide refugees' children below 18-years the complete doses of the national scheduled immunisation. The immunisation was given in six refugees-learning-centres in a total of 31 visits. The workflow includes administering the immunisation, health education, triaging, data collection, and monitoring the children immunised. A total of 1116 children received full immunisation within a period of eighteen months. Vaccines given were Pentavalent, Hepatitis B, Tetanus-Diphtheria, and Mumps-Measles-Rubella. This project has achieved more than 80% immunisation coverage for all the vaccines except Pentavalent (<50%). The Logic Model is useful for developing, implementing, and evaluating knowledge co-production partnerships in the context of a community delivery system in this project.

Estimation of coverage of pulse polio immunization round on 28th January 2018

Background: India accounted for more than 50% of polio cases globally. India therefore started the intensive pulse polio immunization (IPPI) in 1995. The national immunization days (NID) were on 28th January and 11th March 2018. The objectives of this study were to determine the completeness of pulse polio immunization round on 28th January 2018, to evaluate the reasons for non-compliance of the community towards the vaccination round, to assess the demographic profile amongst the unvaccinated children.Methods: A cross-sectional descriptive study was conducted among 570 children of zero-five years were checked in major areas of Pune that is Katraj Zoo, Swargate, Saras baug and a school in Dhankawadi. The data was collected after the first round of PPI by viewing the ink mark on the left little finger nail of the child or by interviewing the parents. SIA monitoring chart was used to assess the completeness of immunization campaign. Statistical analysis: Microsoft Excel were used to calculate percentages.Results: Out of 570, 69 (12.1%) were unvaccinated with the highest number seen in nursery that is 28 (40.6%). Amongst the unvaccinated (n=69), 40 (57.9%) were males. In the unvaccinated children (n=69), 13 (18.84%) and 56 (81.15%) belonged to age group of 'zero-two years and two-five years respectively. Reasons for being unvaccinated were 29(42%) parents were unaware of time and place of PPI, 21 (30.4%) were outside Pune and 19 (27.5%) were unwilling due to false beliefs..Conclusions: Awareness should be increased about benefits of PPI through mass media, local leaders and teachers to enhance community participation. The authorities' in charge of the PPI should be informed regarding areas lacking significant coverage so that they can be concentrated upon during subsequent PPI rounds ultimately contributing to eradicate poliomyelitis.

Knowledge and awareness of breastfeeding, weaning practices and newborn care in pregnant women in urban areas

Background: Breastfeeding, proper weaning practices, and newborn care play a crucial role in the health of a child. The objective of the study is to determine the availability of information regarding breastfeeding, newborn care and immunization and to find out about the attitude of women towards newborn care practices.Methods: A cross-sectional observational study was conducted in a tertiary health care centre in an urban area in Navi Mumbai, on primigravidae in their third trimester of pregnancy. The data was collected by a questionnaire, results were analysed by EpiInfo7.Results: 93% women knew the benefits of breastfeeding, 92% knew of exclusive breastfeeding. 90% would initiate breastfeeding immediately after delivery, 83% would not give prelacteal feeds. 75% would practise skin-to-skin contact and 95% would practise rooming-in technique. 44% would delay bathing the newborn. 95% women received TT immunisation. All agreed to vaccinate their child. 19% believed traditional practices like applying kajal to eyes, prelacteal feeds etc. to be hazardous.Conclusions: The knowledge pregnant women have about breastfeeding and newborn care is inadequate. There is a need for intervention measures such as behavior-change-communication and better health services, to equip mothers so they may provide optimal care to their babies.

Empowering the Role of Family Practice in Vaccine-Preventable Diseases Through HALO

@#Vaccination has reduced the disease burden of infectious disease since it was invented. Each person has his or her own unique vaccination needs during the various stages of one’s life. What each one needs is determined by one’s health, age, lifestyle and occupation at that time. Strategically, the Centre for Disease Control (CDC) Advisory Committee on Immunization Practices (ACIP) introduced a simple HALO2 approach to help physicians customise vaccinations for the public with the circumstances and needs of the public in mind. With the HALO approach, the public is able to discuss with their personal family physician or general practitioner and receive the relevant vaccines to prevent diseases and maintain health.

RISK PERCEPTION OF CHILDHOOD IMMUNISATION AMONG THE PUBLIC IN KOTA KINABALU, SABAH

@#Objective: The study was designed to determine the risk perception of the public population in Kota Kinabalu towards childhood immunisation. Methodology: This was a cross-sectional study where self-administered questionnaires were distributed to the public in Kota Kinabalu. The respondents who consented were 18 years old and older. The illiterate persons and the foreigners were excluded. The calculated sample size was 400. Only 313 samples collected were suitable for analysis using SPSS21.0. Results: Fever, pain swelling and allergic reaction were correctly identified as risks of immunisation. Autism, mental retardation and even death could also result from vaccination. Of the total respondents, 76.7% agreed with the practice of childhood vaccination, 70.0% thought that childhood vaccinations were safe and effective and 58.1% felt that its benefit outweighed the risk. Other than that, 32.0% refused childhood vaccination from fear of its risks, and this fear was the main reason for the refusal of childhood vaccination. Age, marital status, race and income were the factors which influenced parental willingness to vaccinate their children (p<0.05). Conclusions: Most participants understood the risks of childhood vaccination, but few agreed to the practice of childhood immunisation for herd immunity. Public health campaigns are needed, to increase the understanding and acceptance of childhood vaccination especially in the rural community.

High agreement between the new Mongolian electronic immunization register and written immunization records: a health centre based audit

Introduction: Monitoring of vaccination coverage is vital for the prevention and control of vaccine-preventable diseases. Electronic immunization registers have been increasingly adopted to assist with the monitoring of vaccine coverage; however, there is limited literature about the use of electronic registers in low- and middle-income countries such as Mongolia. We aimed to determine the accuracy and completeness of the newly introduced electronic immunization register for calculating vaccination coverage and determining vaccine effectiveness within two districts in Mongolia in comparison to written health provider records. Methods: We conducted a cross-sectional record review among children 2–23 months of age vaccinated at immunization clinics within the two districts. We linked data from written records with the electronic immunization register using the national identification number to determine the completeness and accuracy of the electronic register. Results: Both completeness (90.9%; 95% CI: 88.4–93.4) and accuracy (93.3%; 95% CI: 84.1–97.4) of the electronic immunization register were high when compared to written records. The increase in completeness over time indicated a delay in data entry. Conclusion: Through this audit, we have demonstrated concordance between a newly introduced electronic register and health provider records in a middle-income country setting. Based on this experience, we recommend that electronic registers be accompanied by routine quality assurance procedures for the monitoring of vaccination programmes in such settings.

A recombinant plasmid of composite cysteine proteinase inhibitor/ glyceraldehyde‑3‑phosphate dehydrogenase gene of periodic Brugia malayi functions on DNA immunity in the host.

Objectives: Both cysteine proteinase inhibitors (CPIs) and glyceraldehyde‑3‑phosphate dehydrogenase (GAPDH) play important roles in the pathogenesis of parasites and their relationship with the hosts. We constructed a new eukaryotic recombinant expression plasmid pcDNA3.1(+)‑BmCPI/BmGAPDH of periodic Brugia malayi for investigation of the DNA vaccine‑elicited immune responses. Materials and Methods: We cloned a gene encoding the CPIs and GAPDH from periodic B. malayi into vector pcDNA3.1. The composited plasmid or the control was injected into the tibialis anterior muscle of the hind leg in BALB/c mice, respectively. The target genes were detected by reverse transcription‑polymerase chain reaction in muscle tissues. The stimulation index (SI) of T‑lymphocyte proliferation and the levels of interferon‑gamma (INF‑γ) and interleukin‑4 (IL‑4) in serum were detected by thiazolyl blue tetrazolium blue and enzyme‑linked immunosorbent assays. Results: The pcDNA3.1(+)‑BmCPI/ BmGAPDH was amplified from muscle tissues of the mice after immunisation. The SI of the immunised group was significantly higher than that of the two control groups (P < 0.05). The levels of INF‑γ and IL‑4 of pcDNA3.1(+)‑BmCPI/BmGAPDH group were both higher than those of the two control groups (P < 0.05). The level of INF‑γ of pcDNA3.1(+)‑BmCPI/BmGAPDH group was significantly higher than that of pcDNA3.1(+)‑BmCPI/CpG group (P < 0.05). Conclusions: We conclude that the recombinant plasmid pcDNA3.1(+)‑BmCPI/BmGAPDH could elicit specific humoural and cellular immune responses in mice.

Infant and young child feeding practices of mothers attending immunisation clinic at a tertiary care hospital of Lucknow

Background: Adequate infant and young child feeding (IYCF) practices are essential to ensure optimal survival, health, growth, development and overall nutritional status of children. Objective: The objective of the present study was to assess the IYCF practices among mothers with children aged 0-23 months attending immunisation clinic at a tertiary care hospital of Lucknow, capital of Uttar Pradesh. Materials and methods: A hospital based cross-sectional study was conducted at immunisation clinic, King George’s Medical University from January 2015 to September 2015. Systematic random sampling was used and a total of 240 mothers with children 0-23 months old attending immunisation clinic were interviewed with the help of pre-designed, pre-tested and semi-structured questionnaire. Results: Breastfeeding (BF) was initiated within one hour of birth in 18.3% of children. Early initiation of BF was significantly associated with educational and socioeconomic status of mother and type of delivery. Pre-lacteal feeds were given to 23.4% of the children, children born at government health facility and with birth order ≤2 received pre-lacteal feeds more often. Colostrum was given by 67.9% of the mothers. Children born at private institutions or home were more likely to receive colostrum (p< 0.05). The prevalence of exclusive breastfeeding for at least 6 months was 53.8%. It was higher in children belonging to low socioeconomic group (p< 0.05). Complementary feeding was initiated at 6 months in 32.8% of children. Children of mothers belonging to upper socioeconomic Shukla M, Tyagi S, Agarwal M. Infant and young child feeding practices of mothers attending immunisation clinic at a tertiary care hospital of Lucknow. IAIM, 2016; 3(1): 58-66. Page 59 class, nuclear family and delivered at government institution through normal delivery were more likely to be started on timely complementary feeding (p<0.05). Conclusion: The study revealed that inadequate IYCF practices are still quite prevalent in the community and therefore emphasis should be given to IYCF education sessions.

Measles prevention in adolescents: lessons learnt from implementing a high school catch-up vaccination programme in New South Wales, Australia, 2014-2015

Introduction: In response to a significant increase of measles cases and a high percentage of unvaccinated adolescents in New South Wales, Australia, a measles high school catch-up vaccination programme was implemented between August and December 2014. This study aimed to explore the factors affecting school-based supplementary immunization activities (SIAs) and to inform future SIA and routine school-based vaccination programme implementation and service provision. Methods: Focus group analysis was conducted among public health unit (PHU) staff responsible for implementing the SIA catch-up programme. Key areas discussed were pre-programme planning, implementation, resources, consent materials, media activity and future directions for school vaccination programme delivery. Sessions were audio recorded, transcribed verbatim and reviewed. Thematic analysis was conducted to identify the major themes. Results: Two independent focus groups with 32 participants were conducted in January 2015. Barriers to the SIA implementation included lead time, consent processes, interagency collaboration, access to the targeted cohort and the impact of introducing a SIA to an already demanding curriculum and school programme immunization schedule. A positive PHU school coordinator rapport and experience of PHU staff facilitated the implementation. Consideration of different approaches for pre-clinic vaccination status checks, student involvement in the vaccination decision, online consent, workforce sharing between health districts and effective programme planning time were identified for improving future SIA implementation. Conclusion: Although many barriers to school programme implementation have been identified in this study, with adequate resourcing and lead time, SIAs implemented via a routine school vaccination programme are an appropriate model to target adolescents.

Public health activism: success story of overcoming barriers to health care faced by a migrant family.

This is a case study from a village in Haryana. A migrant family from another state was working in poultry farm. Family had six children. Youngest was girl infant with grade IV malnutrition and unimmunised. This family was denied immunisation, registration to Anganwari centre, and there were issues of child labour. With public health activism, all these problems were solved. This case study demonstrates that if there is strong commitment and confidence among public health practitioners, they can overcome most of the barriers. Such Public Health Activism should be promoted.

Travel Medicine in Primary Care

International travel is growing despite economic and geographical challenges. Travellers should seek pretravel advice 4 to 6 weeks before departure. Required immunisations include yellow fever and meningococcal vaccines. The common recommended immunisations are based on risk assessment. These include typhoid, cholera, hepatitis A, Japanese encephalitis and rabies vaccine. Common illnesses in returned travellers are mainly due to gastrointestinal diseases, febrile diseases and dermatologic diseases. Evaluation of the travel-related illness requires an understanding of geographical distribution of infections, risk factors for transmission of infection, incubation periods of common infections, clinical presentation and appropriate laboratory investigations. Syndromic approach to the evaluation of illness in a returned traveller is important for post-travel diagnosis.