Routine vaccination coverage - worldwide, 2021

This article discusses the worldwide routine vaccination coverage in 2021, as part of the Immunisation Agenda 2030, a global immunisation strategy to reduce morbidity and mortality from vaccine-preventable diseases. The report presents global, regional, and national estimates and trends in vaccination coverage through 2021, based on reviews of country-specific data, including administrative and survey-based coverage. Global estimates show that coverage with 3 doses of diphtheria, tetanus and pertussis-containing vaccine (DTPcv3) and the first dose of measles-containing vaccine (MCV1) decreased to their lowest levels since 2008. In 2021, 25.0 million infants were not vaccinated with DTPcv3, 2.1 million more than in 2020, and 5.9 million more than in 2019. The number of zero-dose children was 37% higher than in 2019, with 18.2 million infants not receiving any DTPcv dose by the age of 12 months. The report highlights that the full recovery from disruptions to immunisation programmes due to the COVID-19 pandemic will require context-specific strategies to find missed children, prioritise essential health services, and strengthen immunisation programmes to prevent outbreaks.

Leaving no one behind: Defining and implementing an integrated life course approach to vaccination across the next decade as part of the immunization Agenda 2030.

Strategic Priority 4 (SP4) of the Immunization Agenda 2030 aims to ensure that all people benefit from recommended immunizations throughout the life-course, integrated with essential health services. Therefore, it is necessary for immunization programs to have coordination and collaboration across all health programs. Although there has been progress, immunization platforms in the second year of life and beyond need continued strengthening, including booster doses and catch-up vaccination, for all ages, and recommended vaccines for older age groups. We note gaps in current vaccination programs policies and achieved coverage, in the second year of life and beyond. In 2021, the second dose of measles-containing vaccine (MCV2), given in the second year of life, achieved 71% global coverage vs 81% for MCV1. For adolescents, 60% of all countries have adopted human papillomavirus vaccines in their vaccination schedule with a global coverage rate of only 12 percent in 2021. Approximately 65% of the countries recommend influenza vaccines for older adults, high-risk adults and pregnant women, and only 25% recommended pneumococcal vaccines for older adults. To achieve an integrated life course approach to vaccination, we reviewed the evidence, gaps, and strategies in four focus areas: generating evidence for disease burden and potential vaccine impact in older age groups; building awareness and shifting policy beyond early childhood; building integrated delivery approaches throughout the life course; and identifying missed opportunities for vaccination, implementing catch-up strategies, and monitoring vaccination throughout the life course. We identified needs, such as tailoring strategies to the local context, conducting research and advocacy to mobilize resources and build political will. Mustering sufficient financial support and demand for an integrated life course approach to vaccination, particularly in times of COVID-19, is both a challenge and an opportunity.

Australia

After having outlined its most relevant administrative features, the case of financial vulnerability of local governments (LGs) in Australia is presented and discussed applying the conceptual framework developed in Chapter 2. Although little change was observed in administrative structure and fiscal rules, as well as in the revenue structure in the aftermath of the COVID-19 pandemic, municipal expenditure structure was affected dramatically during the crisis. The chapter describes financial health of LGs at the onset of the crisis and presents some important measures taken by the Australian Government to assist LGs and local residents in the immediate aftermath of the pandemic. © 2022 selection and editorial matter, Emanuele Padovani, Eric Scorsone, Silvia Iacuzzi and Simone Valle de Souza;individual chapters, the contributors.

Patient Outcomes Following Salvage Lung Cancer Surgery Post Definitive Chemotherapy or Radiation

Introduction: Definitive chemoradiaotherapy (dCRT) is an option for patients with lung cancer who are medically inoperable or have unresectable locally advanced disease. The local recurrence rate after dCRT is 30% and the prognosis is poor. Salvage surgery, or surgical resection of recurrent disease following dCRT, is one therapeutic option, however, optimal therapy for locoregional recurrences or residual disease is controversial. The purpose of this study was to determine the efficacy of salvage lung resection. Methods: This is a single centre retrospective database review. Patients eligible for the study received definitive chemotherapy, radiation therapy or both followed by salvage pulmonary resection for local recurrence or residual disease. Patient characteristics and outcomes were examined. Results: Sixteen patients (11 male, 5 female) out of 201 that met the inclusion criteria treated between January 2017 and August 2020 were identified with a median follow-up time of 21 months (Q1, Q3 8-37.5). The median patient age was 68. All 16 patients received radiation, 7 of whom received less than 59 Gy and 9 received greater than 59 Gy. The rationale for dCRT varied as 6 patients had disease considered to be unresectable, 5 patients were originally considered to be medically inoperable, 4 patients had a preference for non-surgical management initially, and 1 patient pursued dCRT due to uncertainty of surgical options due to the COVID-19 pandemic. The median time from radiotherapy to surgery was 22 months (Q1, Q3 14.25-27.5). The extent of salvage resections differed as 5 patients had wedge resections, 4 had lobectomies, and 5 patients had more than one lobe resected. No pneumonectomies were preformed. Two resections were aborted in the operating room due to upstaging at the time of resection. The final pathology was 9 adenocarcinomas, 5 squamous cell carcinomas, 1 adenosquamous carcinoma and 1 non-malignant (nodular fibroblastic scarring with surrounding focal organizing pneumonia). Median procedure time was 3h10.5m. Adhesions were noted in 12 cases (75%). Ninety-day mortality was 0%. Overall survival at most recent follow-up was 75% (12 patients). Conclusions: Salvage pulmonary resection after dCRT can be performed with low morbidity and mortality rates and is a good option for treatment of recurrent or residual disease after dCRT. Keywords: Early stage lung cancer treatment, Salvage pulmonary resection, Definitive chemoradiaotherapy

Routine vaccination coverage - worldwide, 2020

This report, which updates previous reports, presents estimates of global, regional, and national vaccination coverage and trends as of 2020. It describes the changes in vaccination coverage and the numbers of unvaccinated and undervaccinated children as measured by receipt of the first and third doses of diphtheria, tetanus, and pertussis-containing vaccine (DTP)in 2020, when the COVID-19 pandemic began, compared with 2019. Global coverage estimates with the third dose of DTP (DTP3) and a polio vaccine (Pol3) fell from 86% in 2019 to 83% in 2020. Similarly, MCV1 coverage fell from 86% in 2019 to 84% in 2020. The last year the coverage estimates were at 2020 levels was 2009 for DTP3 and 2014 for both MCV1 and the third dose of Pol (Pol3). Worldwide, 22.7 million children(17% of the target population) did not receive DTP in 2020, compared with 19.0 million (14%) in 2019. Children who did not receive the first DTP dose (DTP1) by age 12 months (zero-dose children) accounted for 95%of the increased number. Among those who did not receive DTP3 in 2020, approximately 17.1 million (75%)were zero-dose children. Global coverage decreased in 2020 compared with 2019 estimates for the completion of Haemophilus influenzae type b (Hib), hepatitis B vaccine (HepB), human papillomavirus vaccine (HPV),and rubella-containing vaccine (RCV). To reach full coverage with all recommended vaccines, tailored strategies will be needed, especially to reach communities with a lot of children who haven't had any or enough vaccines.

Systematic Review of Caregivers and Palliative Intent Radiation Therapy: Barriers, Facilitators, Decision Making Needs

To determine the facilitators, barriers, and decision making needs of caregivers of patients receiving palliative intent radiation therapy Systematic review of articles utilizing PRISMA guidelines was performed. Inclusion criteria included studies published from 2007 to 2018 focusing on caregivers of patients receiving palliative intent radiation therapy (PRT) for advanced cancers. Pediatric and non-English articles were excluded. Rayyan QCRI was utilized to screen abstracts, and Covidence organized the review of full text articles by 2 reviewers. Of 6079 articles identified, 36 were selected for full text review, and 6 met inclusion. Limited literature was found. Caregivers experience anxiety, fatigue, and hopelessness. Caregivers need more information and their emotions impact both the receipt of radiation therapy and satisfaction with services. While limited, literature focusing on caregivers of patients undergoing palliative intent radiation therapy consistently find unmet caregiver education and emotional distress which impact patient receipt of and satisfaction with PRT services. More research is needed to better understand needs of caregivers of patients with advanced cancers undergoing PRT. [ABSTRACT FROM AUTHOR] Copyright of International Journal of Radiation Oncology, Biology, Physics is the property of Pergamon Press - An Imprint of Elsevier Science and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Satisfaction and Regret With Decision Making in Older Women With Breast Cancer

Purpose/Objective(s): Shared decision making is a fundamental component of the conversation between physicians and older women with early-stage breast cancer making decisions to omit radiation therapy. The purpose of this study is to report patient comfort and satisfaction levels with decision making. Materials/Methods: Women with pre-invasive or early-stage breast cancer who had been given the option to omit radiation therapy were identified. Two validated instruments (decisional regret and satisfaction with decision) were provided to all women with 5 choices (strongly agree, agree, neither agree nor disagree, disagree, strongly disagree). All women then underwent a qualitative interview about their decision making process, and were given option of $50.00 gift card after completion. Interviews were transcribed, and common themes were coded using qualitative data analysis software by two members of the research team. Results: Thirty-six women diagnosed with early stage or pre-invasive breast cancer from 2013-2020 were consented. Median age at diagnosis was 72. Twenty (55%) chose to omit RT. Majority of women (92%) agreed or strongly agreed that it was the right decision, and that they were satisfied about being adequately informed about the issues that were important to the decision making process. In women who had chosen radiation therapy, one woman expressed regret regarding side effects of radiation therapy: “So with the surgery and the shrinking, then I think I would have been better off if I had gone with a mastectomy and probably a double and then had reconstruction.” Other women expressed regret with radiation in the context of coordinating the complexities of treatment: “I might have decided to just have a double mastectomy. I wouldn't had to have the cancer drug. I wouldn't have had the radiation. It was just much more complicated than I thought in my mind,” and “then again, in my head, there's something about putting radiation into my body when there's another option where one is putting something in and the pill is taking something out.” While no women expressed regret regarding omission of radiation (pre- and post-COVID-19 pandemic), some women expressed knowledge deficit or poor expectation of the side effects of hormonal blockade: “We really didn't talk about the side effects. I've gotten more information from my friends that are on the pill than I have from the doctor. Doctor's attitude was you need to take this, and you're going to take it, and we're going to monitor you,” [the medical oncologist] said I shouldn't have any problem.” Conclusion: Older women with early-stage breast cancer offered options for omission of radiation therapy did not express regret regarding their decision to omit radiation, but sometimes felt that they were not informed about the expectations and side effects of hormonal blockade. Additional educational tools to assist in adjuvant therapy decision making regarding radiation therapy and endocrine therapy options are warranted.

Courts in Victoria, Australia, During COVID: Will Digital Innovation Stick?

We present a case-study of the swift digital response to COVID-19 restrictions by the courts in the State of Victoria, Australia’s second-largest jurisdiction. We analyse the extent to which the management of this crisis (Step 1 in John Kotter’s model of innovation) can serve as the catalyst for digital innovation in these courts. We contend that the history of innovation in Australia is of quick, pragmatic fixes which do not translate into systematic change. For example, although Australian courts are often credited with being pioneers in court technology, recourse to apparent ‘virtual courts’ before and during COVID is probably not truly innovative. Applying Boschma’s theory about the 5 ‘proximities’ which promote innovation — geographical, social, cognitive, institutional and organisational — we maintain that for these courts, those factors have, paradoxically, worked in the opposite direction to undermine technological innovation. However COVID has seen critical changes in a number of these elements, supported by ideological and practical concerns for courts. Taken together, we are cautiously optimistic that post-COVID, Kotter’s final stage of “Making it Stick” through a technologically friendly legal culture which supports systematic and sustained court innovation, might just be possible if government is willing to fund a grander innovation agenda and has confidence in the courts’ ability to carry it through. © 2021 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC-BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See http://creativecommons.org/licenses/by/4.0/.