Impact of the COVID-19 pandemic on the vaccination of children 12 months of age and under: an ecological study. / Impacto da pandemia do COVID-19 na vacinação de crianças de até um ano de idade: um estudo ecológico.

This study aimed to evaluate the impact of the COVID-19 pandemic on the vaccination numbers for immunization geared toward individuals under 12 months of age in Brazil. This study analyzed the numbers of the nationwide vaccination coverage of ten vaccines present in the calendar from the National Immunization Program (NIP) over the past eight years (2013-2020). This is an ecological study, and all data were taken from the NIP. In comparison to the previous years, 2020 recorded the lowest figures of vaccination coverage (VC) of the average of the group of studied vaccines - 79.07% - while in 2019, this same index was 84.44%, resulting in a drop of 11.10% between these two periods. Moreover, during the year of the pandemic, of the ten analyzed vaccines, nine recorded their lowest historical VC figures, all of which were at least 14 percentage points below the goals set by the Brazilian Ministry of Health (MS, in Portuguese). Although there had already been a tendency toward a decline in VC, for various reasons, the present study illustrates that the numbers recorded in 2020 were significantly lower, a phenomenon also reported in other countries. Therefore, although it is impossible to affirm that the COVID-19 pandemic and its distancing measures are the causes for the drop in the immunization numbers, it can be inferred that there is indeed an association.

O objetivo do estudo foi avaliar o impacto da pandemia de COVID-19 nos valores de vacinação para as imunizações voltadas a indivíduos com menos de um ano de vida no Brasil. Analisou-se os valores de cobertura vacinal, em território nacional, de dez vacinas presentes no calendário do Programa Nacional de Imunizações (PNI) durante os últimos oito anos (2013-2020). Esse é um estudo ecológico e todos os dados foram extraídos do PNI. Comparativamente aos anos prévios, em 2020 registrou-se o menor valor de cobertura vacinal da média do conjunto das vacinas estudadas, 75,07%, enquanto em 2019 esse mesmo índice ficou em 84,44%, resultando em uma queda de 11,10% entre esses dois períodos. Além disso, no ano da pandemia, das dez vacinas analisadas, nove registraram o seu menor valor histórico de cobertura, todas estando a no mínimo 14 pontos percentuais abaixo da meta do Ministério da Saúde. Embora já houvesse uma tendência de queda na cobertura vacinal, por diversos motivos, o presente estudo demonstra que os valores registrados em 2020 foram significativamente menores, fenômeno também registrado em outros países. Portanto, mesmo não conseguindo afirmar que a pandemia de COVID-19 e as medidas de distanciamento sejam as causas da queda dos valores de imunização, podemos inferir que há uma associação.

COVID-19 Bivalent Booster Vaccination Coverage and Intent to Receive Booster Vaccination Among Adolescents and Adults - United States, November-December 2022.

COVID-19 vaccine booster doses are safe and maintain protection after receipt of a primary vaccination series and reduce the risk for serious COVID-19-related outcomes, including emergency department visits, hospitalization, and death (1,2). CDC recommended an updated (bivalent) booster for adolescents aged 12-17 years and adults aged ≥18 years on September 1, 2022 (3). The bivalent booster is formulated to protect against the Omicron BA.4 and BA.5 subvariants of SARS-CoV-2 as well as the original (ancestral) strain (3). Based on data collected during October 30-December 31, 2022, from the National Immunization Survey-Child COVID Module (NIS-CCM) (4), among all adolescents aged 12-17 years who completed a primary series, 18.5% had received a bivalent booster dose, 52.0% had not yet received a bivalent booster but had parents open to booster vaccination for their child, 15.1% had not received a bivalent booster and had parents who were unsure about getting a booster vaccination for their child, and 14.4% had parents who were reluctant to seek booster vaccination for their child. Based on data collected during October 30-December 31, 2022, from the National Immunization Survey-Adult COVID Module (NIS-ACM) (4), 27.1% of adults who had completed a COVID-19 primary series had received a bivalent booster, 39.4% had not yet received a bivalent booster but were open to receiving booster vaccination, 12.4% had not yet received a bivalent booster and were unsure about getting a booster vaccination, and 21.1% were reluctant to receive a booster. Adolescents and adults in rural areas had a much lower primary series completion rate and up-to-date vaccination coverage. Bivalent booster coverage was lower among non-Hispanic Black or African American (Black) and Hispanic or Latino (Hispanic) adolescents and adults compared with non-Hispanic White (White) adolescents and adults. Among adults who were open to receiving booster vaccination, 58.9% reported not having received a provider recommendation for booster vaccination, 16.9% had safety concerns, and 4.4% reported difficulty getting a booster vaccine. Among adolescents with parents who were open to getting a booster vaccination for their child, 32.4% had not received a provider recommendation for any COVID-19 vaccination, and 11.8% had parents who reported safety concerns. Although bivalent booster vaccination coverage among adults differed by factors such as income, health insurance status, and social vulnerability index (SVI), these factors were not associated with differences in reluctance to seek booster vaccination. Health care provider recommendations for COVID-19 vaccination; dissemination of information by trusted messengers about the continued risk for COVID-19-related illness and the benefits and safety of bivalent booster vaccination; and reducing barriers to vaccination could improve COVID-19 bivalent booster coverage among adolescents and adults.

Estimating global changes in routine childhood vaccination coverage during the COVID-19 pandemic, 2020-2021.

OBJECTIVES: The COVID-19 pandemic has disrupted the distribution of routine immunizations globally. Multi-country studies assessing a wide spectrum of vaccines and their coverage rates are needed to determine global performance in achieving vaccination goals. METHODS: Global vaccine coverage data for 16 antigens were obtained from WHO/UNICEF Estimates of National Immunization Coverage. Tobit regression was performed for all country-antigen pairs for which data were continuously available between 2015-2020 or 2015-2021 to predict vaccine coverage in 2020/2021. Vaccines for which multi-dose data were available were assessed to determine whether vaccine coverage for subsequent doses were lower than that of first doses. RESULTS: Vaccine coverage was significantly lower-than-predicted for 13/16 antigens in 2020 and all assessed antigens in 2021. Lower-than-predicted vaccine coverage was typically observed in South America, Africa, Eastern Europe, and Southeast Asia. There was a statistically significant coverage drop for subsequent doses of the diphtheria-tetanus-pertussis, pneumococcus, and rotavirus vaccines compared to first doses in 2020 and 2021. CONCLUSION: The COVID-19 pandemic exerted larger disruptions to routine vaccination services in 2021 than in 2020. Global efforts will be needed to recoup vaccine coverage losses sustained during the pandemic and broaden vaccine access in areas where coverage was previously inadequate.

Changes in vaccine administration trends across the life-course during the COVID-19 pandemic in the United States: a claims database study.

BACKGROUND: This study provides an updated and expanded analysis of the impact of the COVID-19 pandemic on routine vaccinations across the life-course in the United States. RESEARCH DESIGN AND METHODS: Routine wellness visits and vaccination rates were calculated using structured claims data for each month during the impact period (January 2020 to August 2022) and compared to the respective baseline period (January 2018 to December 2019). Monthly rates were aggregated as annual accumulated and cumulative percent changes. RESULTS: The complete monthly rate interactive dataset can be viewed at https://vaccinationtrends.com. The greatest decrease in annual accumulated administration rates in the 0-2 and 4-6 years age groups was for the measles, mumps, and rubella vaccine; for adolescents and older adults, it was for human papillomavirus and pneumococcal vaccines, respectively. Routine in-person wellness visit rates recovered faster and more completely than vaccination rates in all age groups, indicating potential missed opportunities to administer vaccines during visits. CONCLUSIONS: This updated analysis reveals that the negative impact of the COVID-19 pandemic on routine vaccination continued through 2021 and into 2022. Proactive efforts to reverse this decline are needed to increase individual- and population-level vaccination coverage and avoid the associated preventable morbidity, mortality, and health care costs.

Surveillance and high vaccination coverage: how Portugal overcame the collapse and regained control of the pandemic. / Vigilância e elevada cobertura vacinal: como Portugal superou o colapso e retomou o controle da pandemia.

The uncertainties about COVID-19 require evaluating national responses to identify successes and failures in the pandemic control. This article analyzes Portugal´s response, particularly the contribution of its health and surveillance systems in dealing with the pandemic. An integrative literature review was conducted, including consultations of observatories, documents, and institutional websites. Portugal´s response was agile and showed unified technical and political coordination, including surveillance structure using telemedicine. The reopening was supported by high testing and low positivity rates and strict rules. However, the relaxation of measures as of November/2020 resulted in an increase in cases, collapsing the health system. The response involved a consistent surveillance strategy with innovative monitoring tools, which, combined with high population adherence to vaccination, led to overcoming that moment and kept hospitalization and death rates at new disease waves at low levels. Thus, the Portuguese case discloses the risks of disease resurgence with the flexibility of measures and the population´s exhaustion in the face of restrictive measures and new variants, but also the importance of articulation between technical coordination, the political sphere, and the scientific committee.

As incertezas sobre a COVID-19 requerem avaliação das respostas nacionais, visando identificar sucessos e fracassos no seu controle. Este artigo analisou a resposta portuguesa, particularmente a contribuição dos seus sistemas de saúde e de vigilância no enfrentamento à pandemia. Foi realizada uma revisão integrativa da literatura, sendo incluídas consultas a observatórios, documentos e sites institucionais. A resposta portuguesa foi ágil e revelou uma coordenação técnica e política unificada. Contou com estrutura de vigilância e uso de telemedicina. A reabertura foi amparada na alta testagem, baixa positividade e regras rígidas. Contudo, o relaxamento das medidas a partir de novembro/2020 resultou em aumento de casos com colapso do sistema de saúde. A resposta a esta situação envolveu estratégia de vigilância consistente, com instrumentos de monitoramento inovadores, que, aliados à alta adesão da população à vacinação, levaram à superação daquele momento e mantiveram baixos índices de hospitalizações e óbitos em novas ondas. Nesse sentido, o caso português evidenciou os riscos de recrudescimento com a flexibilização, a exaustão da população em relação a medidas restritivas e novas variantes, mas também a importância da articulação entre a coordenação técnica, a esfera política e o comitê científico.

[Expert opinion on strategies to improve vaccination coverage against seasonal influenza]. / Documento de opinión de expertos para la mejora de la cobertura vacunal frente a la gripe estacional.

Seasonal flu continues to be a major public health concern, and the influenza vaccine remains the most effective preventive measure. In Spain, vaccination coverage data from previous seasons show vaccination rates well below official targets; however, these figures improved significantly after the COVID-19 pandemic. Given the importance of achieving and maintaining high vaccination rates in order to avoid the clinical and economic impact of influenza, our multidisciplinary group of experts on vaccines analyzed the impact of low vaccination rates in Spain and drafted a series of measures to boost influenza vaccination coverage, particularly among priority groups.

COVID-19 excess deaths in Eastern European countries associated with weaker regulation implementation and lower vaccination coverage

Background: Since winter 2020, excess deaths due to COVID-19 have been higher in Eastern Europe than most of Western Europe, partly because regulatory enforcement was poor. Methods: This paper analysed data from 50 countries in the WHO European Region, in addition to data from USA and Canada. Excess mMortality and vaccination data were retrieved from “Our World In Data” and regulation implementation was assessed using standard methods. Multiple linear regression was used to assess the association between mortality and each covariate. Results: Excess mortality increased by 4.1 per 100 000 (P = 0.038) for every percentage decrease in vaccination rate and with 6/100 000 (p=0.011) for every decreased unit in the regulatory implementation score a country achieved in the Rule of Law Index. Conclusion: Degree of regulation enforcement, likely including public health measure enforcement, may be an important factor in controlling COVID-19’s deleterious health impacts.

COVID-19 Booster Dose Vaccination Coverage and Factors Associated with Booster Vaccination among Adults, United States, March 2022.

The Centers for Disease Control and Prevention recommends a COVID-19 vaccine booster dose for all persons >18 years of age. We analyzed data from the National Immunization Survey-Adult COVID Module collected during February 27-March 26, 2022 to assess COVID-19 booster dose vaccination coverage among adults. We used multivariable logistic regression analysis to assess factors associated with vaccination. COVID-19 booster dose coverage among fully vaccinated adults increased from 25.7% in November 2021 to 63.4% in March 2022. Coverage was lower among non-Hispanic Black (52.7%), and Hispanic (55.5%) than non-Hispanic White adults (67.7%). Coverage was 67.4% among essential healthcare personnel, 62.2% among adults who had a disability, and 69.9% among adults who had medical conditions. Booster dose coverage was not optimal, and disparities by race/ethnicity and other factors are apparent in coverage uptake. Tailored strategies are needed to educate the public and reduce disparities in COVID-19 vaccination coverage.

Why school is crucial to increase vaccination coverage for children: Evaluation of school vaccination check program in South Korea 2021-2022.

The School Vaccination Check Program (SVCP) is a public health measure that aims to achieve high levels of National Immunization Program (NIP) vaccination coverage for children by checking the completion of the vaccination schedule for students when they enter elementary or middle school. Due to the COVID-19 pandemic, the SVCP was stopped in 2020 and 2021, and restarted in June-August 2022. In this study, we examined and quantified the relationship with SVCP and the vaccination uptake by comparing the vaccination coverage of 2021 and 2022. Based on the standard schedule, the vaccination records of DTaP5, IPV4, MMR2 and IJEV4 were evaluated for elementary school students. The Tdap6, IJEV5 and HPV1 were evaluated for the students from middle school. Using a difference-in-difference study design and national level big data, the study compared vaccination coverage as of August 2021 and 2022. The study found that the SVCP was effective in increasing vaccination coverage for targeted vaccinations such as DTaP5, IPV4, MMR2 and IJEV4 for elementary school students, and Tdap6, IJEV5 for middle school students. However, the SVCP did not show a statistically significant effect on increasing vaccination coverage on HPV1 for middle school students. School can play an important role to improve vaccination coverage. Therefore, close collaboration with health and education authority is crucial to accomplish successful vaccination program reducing vaccine preventable disease outbreaks in schools.

Chicago's Citywide COVID-19 Vaccine Equity Program: Protect Chicago Plus.

Vaccination is one of the most effective strategies to control the spread of COVID-19 and reduce morbidity and mortality; however, rapid and equitable vaccine distribution is required to achieve such outcomes. We conducted a basic interrupted time-series analysis to examine the short-term impacts of a citywide vaccine equity plan, the Protect Chicago Plus (PCP) plan. We compared vaccine coverage in zip codes in Chicago with high COVID-19 vulnerability, as identified from the Chicago COVID-19 Community Vulnerability Index, with coverage in all other zip codes in Chicago. From our analysis, we observed that implementation of PCP coincided with reduced vaccination disparities between Chicago communities with low and high vulnerability indexes over time. In our analysis of vaccination coverage before program implementation, vaccination coverage climbed nearly twice as fast among non-PCP zip codes (0.19% per day) than among PCP zip codes (0.10% per day) or by 0.09 percentage points (P < .001). In model analysis after program implementation, zip codes prioritized for the program had 0.42% additional coverage per day as compared with 0.27% per day for non-PCP zip codes. Our findings suggest that such programs may improve vaccine equity, but additional research is needed to better understand the longer-term effects of citywide vaccination strategies on vaccine uptake.

Increasing COVID-19 Vaccination Coverage for Newcomer Communities: The Importance of Disaggregation by Language.

The COVID-19 pandemic has disproportionately affected refugee, immigrant, and migrant populations. Vaccines are essential for decreasing transmission and severity of COVID-19 infection. Understanding differences in vaccination coverage based on preferred language is crucial for focusing efforts to decrease COVID-19-related disparities. Four sites in the Minnesota Center of Excellence in Newcomer Health collaboratively evaluated completion of primary COVID-19 vaccination series on or before December 31, 2021, for patients who were 12 years or older on June 30, 2021, by preferred language. The non-English/non-Spanish speaking population included 46,714 patients who spoke 174 languages; COVID-19 vaccination coverage by language ranged from 26.2% to 88.0%. Stratifying vaccination coverage by specific language is a critical first step toward dismantling disparities and shaping interventions that best meet the needs of communities served.

Accelerating the development of vaccine microarray patches for epidemic response and equitable immunization coverage requires investment in microarray patch manufacturing facilities.

INTRODUCTION: There is a need for investment in manufacturing for vaccine microarray patches (vMAPs) to accelerate vMAP development and access. vMAPs could transform vaccines deployment and reach to everyone, everywhere. AREAS COVERED: We outline vMAPs' potential benefits for epidemic preparedness and for outreach in low- and lower-middle-income countries (LMICs), share lessons learned from pandemic response, and highlight that investment in manufacturing-at-risk could accelerate vMAP development. EXPERT OPINION: Pilot manufacturing capabilities are needed to produce clinical trial material and enable emergency response. Funding vMAP manufacturing scale-up in parallel to clinical proof-of-concept studies could accelerate vMAP approval and availability. Incentives could mitigate the risks of establishing multi-vMAP manufacturing facilities early.

Vaccine co-administration in adults: An effective way to improve vaccination coverage.

The ongoing COVID-19 pandemic highlights that complications and mortality associated with infectious diseases increase with age. Various vaccines are recommended for adults, but coverage rates remain suboptimal. Although co-administration would improve vaccine uptake and timely immunization, this is not routine practice in adults. We review key data on co-administration of vaccines in children and adults to reassure healthcare providers about its safety and advantages. In European countries and the United States, combined tetanus, diphtheria, and acellular pertussis boosters as well as meningococcal and human papillomavirus vaccines are recommended for healthy adolescents and adults of certain ages. Vaccination against influenza (annually), pneumococcal disease, and herpes zoster is recommended for older adults and specific risk groups. While co-administration is well established in children, it is less common in adults. Travelers can also receive multiple co-administered vaccines. Pediatric and travel vaccine co-administration has a well-established positive benefit-risk profile and is an efficient and cost-saving strategy to improve coverage. Healthcare providers could more often recommend and practice vaccine co-administration; this would not risk patient safety and health, would improve protection against vaccine-preventable diseases, and would help comply with national vaccination calendars. Recommending bodies may consider revising vaccination schedules to reduce the number of visits.

Influenza vaccination in older adults in the context of the COVID-19 pandemic: current situation and future perspectives / Vacinação contra influenza em idosos no contexto da pandemia da COVID-19: situação atual e perspectivas futuras / Vacunación antigripal en ancianos en el contexto de la pandemia COVID-19: situación actual y perspectivas de futuro

A vacinação anual contra influenza em idosos tem sido exitosa desde a sua implementação no Brasil, atingindo as metas de cobertura vacinal. Com o surgimento da COVID-19, observaram-se dois cenários. Em 2020, a cobertura vacinal contra influenza nos idosos atingiu 120,7%; e em 2021, com o advento da vacina contra a COVID-19 e a vacinação no mesmo período da campanha de influenza, a cobertura foi de 70,9% em idosos. Em 2022, a campanha contra esta doença também foi concomitante com a aplicação das doses de reforço contra a COVID-19. Até agosto de 2022, a cobertura vacinal da influenza foi 70,2% em idosos, apesar da sua relevância para a proteção contra o subtipo A (H3N2). O texto discute estratégias para o aumento da cobertura vacinal contra influenza em idosos nos próximos anos, visando ao fortalecimento da Atenção Primária à Saúde para a sensibilização dos idosos e a adoção de estratégias de vacinação extramuros.

Annual influenza vaccination in older adults has been successful since its implementation in Brazil, reaching vaccination coverage targets. With the emergence of COVID-19, two scenarios were observed. In 2020, influenza vaccination coverage in older adults reached 120.7%; and in 2021, with the advent of the vaccine against COVID-19 and vaccination in the same period of the influenza campaign, coverage was 70.9% in the older group. In 2022, the influenza campaign was also concomitant with the application of booster doses against COVID-19. Until August 2022, influenza vaccination coverage was 70.2% in older adults, despite its relevance for protection against subtype A (H3N2). The text discusses some strategies to increase influenza vaccination coverage in older adults in the next years, aiming to strengthen Primary Health Care to raise awareness among the older adults and adopt extramural vaccination strategies.

La vacunación anual contra la influenza en ancianos ha sido existosa desde su implementación en Brasil, alcanzando las metas de cobertura de vacunación. Con la aparición del COVID-19, fue posible observar dos escenarios. En 2020, la cobertura de vacunación contra la influenza en adultos mayores alcanzó el 120,7%; y en 2021, con el advenimiento de la vacuna contra la COVID-19 y la vacunación en el mismo período de la campaña de influenza, la cobertura fue del 70,9% en los adultos mayores. En 2022, la campaña de influenza también fue concomitante con la aplicación de dosis de refuerzo contra el COVID-19. Hasta agosto de 2022, la cobertura de vacunación contra la influenza era del 70,2% en adultos mayores, a pesar de su relevancia para la protección contra el subtipo A (H3N2). El texto discute algunas estrategias para aumentar la cobertura de vacunación antigripal en ancianos en los próximos años, con el objetivo de fortalecer la Atención Primaria de Salud para sensibilizar a los ancianos y adoptar estrategias de vacunación extramuros.

[The scourge of vaccine tampering]. / Le fléau de la falsification des vaccins.

Fake vaccine trafficking is a recent but growing phenomenon, which represents a severe threat to public health. During the Covid-19 pandemic, Covid vaccines have been a prime target for traffickers, but all types of vaccines are falsified by profit-hungry criminals.The consequences of falsification on global health are serious: decline in vaccination coverage, loss of control of epidemics claiming yet more victims, resurgence of diseases that been under control. Fake vaccines also fuel the mistrust of populations towards science and towards the authorities.In order to tackle this scourge, a general and coordinated mobilization of all actors concerned is urgently needed: health professionals, political decision-makers, police and customs forces, judges and prosecutors, without forgetting the crucial awareness-raising of public opinion.