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1.
Vaccine ; 40(31): 4142-4149, 2022 Jul 29.
Article in English | MEDLINE | ID: covidwho-1867882

ABSTRACT

Over the past two decades, vaccination programmes for vaccine-preventable diseases (VPDs) have expanded across low- and middle-income countries (LMICs). However, the rise of COVID-19 resulted in global disruption to routine immunisation activities. Such disruptions could have a detrimental effect on public health, leading to more deaths from VPDs, particularly without mitigation efforts. Hence, as routine immunisation activities resume, it is important to estimate the effectiveness of different approaches for recovery. We apply an impact extrapolation method developed by the Vaccine Impact Modelling Consortium to estimate the impact of COVID-19-related disruptions with different recovery scenarios for ten VPDs across 112 LMICs. We focus on deaths averted due to routine immunisations occurring in the years 2020-2030 and investigate two recovery scenarios relative to a no-COVID-19 scenario. In the recovery scenarios, we assume a 10% COVID-19-related drop in routine immunisation coverage in the year 2020. We then linearly interpolate coverage to the year 2030 to investigate two routes to recovery, whereby the immunization agenda (IA2030) targets are reached by 2030 or fall short by 10%. We estimate that falling short of the IA2030 targets by 10% leads to 11.26% fewer fully vaccinated persons (FVPs) and 11.34% more deaths over the years 2020-2030 relative to the no-COVID-19 scenario, whereas, reaching the IA2030 targets reduces these proportions to 5% fewer FVPs and 5.22% more deaths. The impact of the disruption varies across the VPDs with diseases where coverage expands drastically in future years facing a smaller detrimental effect. Overall, our results show that drops in routine immunisation coverage could result in more deaths due to VPDs. As the impact of COVID-19-related disruptions is dependent on the vaccination coverage that is achieved over the coming years, the continued efforts of building up coverage and addressing gaps in immunity are vital in the road to recovery.


Subject(s)
COVID-19 , Vaccine-Preventable Diseases , COVID-19/prevention & control , Humans , Immunization , Immunization Programs , Vaccination/methods , Vaccine-Preventable Diseases/epidemiology , Vaccine-Preventable Diseases/prevention & control
2.
Commun Dis Intell (2018) ; 462022 May 19.
Article in English | MEDLINE | ID: covidwho-1856695

ABSTRACT

Background: In 2020, Victoria introduced multiple interventions aimed at containing the spread of coronavirus disease 2019 (COVID-19). We examine the effect of these restrictions on other vaccine preventable diseases (VPDs). Methods: We analysed the mandatory reporting data, notified to the Victorian Department of Health, for VPDs from January 2015 to December 2021. Results: Reductions in notifications were seen for most notifiable VPDs. A precipitous decline in influenza and measles notifications was recorded in April 2020, which was sustained for both diseases throughout 2020-2021. Notifications for chickenpox, invasive meningococcal disease, invasive pneumococcal disease, and pertussis were reduced by greater than 50% from the 2015-2019 average. No notified cases of diphtheria, poliomyelitis, or rubella were reported in 2020-2021. Conclusion: Restrictions placed to mitigate the effects of the COVID-19 pandemic were associated with significant reductions in other VPDs, which were sustained into 2021. Nevertheless, it is important that high levels of population vaccine coverage continue, to prevent a rebound increase in VPDs as restrictions are eased, and to maximise protection against VPDs for all Australians.


Subject(s)
COVID-19 , Vaccine-Preventable Diseases , COVID-19/epidemiology , COVID-19/prevention & control , Humans , Pandemics/prevention & control , Vaccination , Vaccine-Preventable Diseases/epidemiology , Vaccine-Preventable Diseases/prevention & control , Victoria/epidemiology
3.
Int J Infect Dis ; 119: 201-209, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1773375

ABSTRACT

BACKGROUND: The COVID-19 pandemic has contributed to the widespread disruption of immunization services, including the postponement of mass vaccination campaigns. METHODS: In May 2020, the World Health Organization and partners started monitoring COVID-19-related disruptions to mass vaccination campaigns against cholera, measles, meningitis A, polio, tetanus-diphtheria, typhoid, and yellow fever through the Immunization Repository Campaign Delay Tracker. The authors reviewed the number and target population of reported preventive and outbreak response vaccination campaigns scheduled, postponed, canceled, and reinstated at 4 time points: May 2020, December 2020, May 2021, and December 2021. FINDINGS: Mass vaccination campaigns across all vaccines were disrupted heavily by COVID-19. In May 2020, 105 of 183 (57%) campaigns were postponed or canceled in 57 countries because of COVID-19, with an estimated 796 million postponed or missed vaccine doses. Campaign resumption was observed beginning in July 2020. In December 2021, 77 of 472 (16%) campaigns in 54 countries, mainly in the African Region, were still postponed or canceled because of COVID-19, with about 382 million postponed or missed vaccine doses. INTERPRETATION: There is likely a high risk of vaccine-preventable disease outbreaks across all regions because of an increased number of susceptible persons resulting from the large-scale mass vaccination campaign postponement caused by COVID-19.


Subject(s)
COVID-19 , Vaccine-Preventable Diseases , Vaccines , COVID-19/epidemiology , COVID-19/prevention & control , Humans , Immunization Programs , Pandemics , SARS-CoV-2 , Vaccination , Vaccine-Preventable Diseases/epidemiology , Vaccine-Preventable Diseases/prevention & control
4.
Lancet Glob Health ; 10(2): e186-e194, 2022 02.
Article in English | MEDLINE | ID: covidwho-1721219

ABSTRACT

BACKGROUND: The SARS-CoV-2 pandemic has revealed the vulnerability of immunisation systems worldwide, although the scale of these disruptions has not been described at a global level. This study aims to assess the impact of COVID-19 on routine immunisation using triangulated data from global, country-based, and individual-reported sources obtained during the pandemic period. METHODS: This report synthesised data from 170 countries and territories. Data sources included administered vaccine-dose data from January to December, 2019, and January to December, 2020, WHO regional office reports, and a WHO-led pulse survey administered in April, 2020, and June, 2020. Results were expressed as frequencies and proportions of respondents or reporting countries. Data on vaccine doses administered were weighted by the population of surviving infants per country. FINDINGS: A decline in the number of administered doses of diphtheria-pertussis-tetanus-containing vaccine (DTP3) and first dose of measles-containing vaccine (MCV1) in the first half of 2020 was noted. The lowest number of vaccine doses administered was observed in April, 2020, when 33% fewer DTP3 doses were administered globally, ranging from 9% in the WHO African region to 57% in the South-East Asia region. Recovery of vaccinations began by June, 2020, and continued into late 2020. WHO regional offices reported substantial disruption to routine vaccination sessions in April, 2020, related to interrupted vaccination demand and supply, including reduced availability of the health workforce. Pulse survey analysis revealed that 45 (69%) of 65 countries showed disruption in outreach services compared with 27 (44%) of 62 countries with disrupted fixed-post immunisation services. INTERPRETATION: The marked magnitude and global scale of immunisation disruption evokes the dangers of vaccine-preventable disease outbreaks in the future. Trends indicating partial resumption of services highlight the urgent need for ongoing assessment of recovery, catch-up vaccination strategy implementation for vulnerable populations, and ensuring vaccine coverage equity and health system resilience. FUNDING: US Agency for International Development.


Subject(s)
COVID-19/epidemiology , Global Health , Immunization Programs/statistics & numerical data , Vaccination Coverage/statistics & numerical data , Vaccine-Preventable Diseases/prevention & control , Humans , Pandemics , SARS-CoV-2 , World Health Organization
6.
Pan Afr Med J ; 38: 313, 2021.
Article in English | MEDLINE | ID: covidwho-1547767

ABSTRACT

For 15 years, the Annual African Vaccinology Course (AAVC) hosted by the Vaccines for Africa Initiative, has been at the forefront of vaccinology training in Africa. The AAVC was developed in 2005 in response to the growing demand for vaccinology training in Africa. To date, 958 policy makers, immunization managers, public and private health practitioners, scientists, postgraduate and postdoctoral students have been trained. These participants are from 44 of the 54 African countries. The course content covers diverse topics such as considerations for new vaccine introduction, mathematical modelling, and emerging and re-emerging vaccine preventable diseases. As the landscape of vaccinology continues to evolve, the AAVC aims to expand the reach of vaccinology training using blended learning approaches which will incorporate online and face-to-face formats, while expanding access to this popular course. Ultimately, the AAVC endeavours to develop a big pool of vaccinology expertise in Africa and to strengthen regional ownership for immunization programmes.


Subject(s)
Vaccination/methods , Vaccines/administration & dosage , Vaccinology/education , Africa , Humans , Immunization Programs/organization & administration , Vaccine-Preventable Diseases/prevention & control
7.
Lancet Infect Dis ; 21(12): e387-e398, 2021 12.
Article in English | MEDLINE | ID: covidwho-1458583

ABSTRACT

Migrant populations are one of several underimmunised groups in the EU or European Economic Area (EU/EEA), yet little is known about their involvement in outbreaks of vaccine-preventable diseases. This information is vital to develop targeted strategies to improve the health of diverse migrant communities. We did a systematic review (PROSPERO CRD42019157473; Jan 1, 2000, to May 22, 2020) adhering to PRISMA guidelines, to identify studies on vaccine-preventable disease outbreaks (measles, mumps, rubella, diphtheria, pertussis, polio, hepatitis A, varicella, Neisseria meningitidis, and Haemophilus influenzae) involving migrants residing in the EU/EEA and Switzerland. We identified 45 studies, reporting on 47 distinct vaccine-preventable disease outbreaks across 13 countries. Most reported outbreaks involving migrants were of measles (n=24; 6496 cases), followed by varicella (n=11; 505 cases), hepatitis A (n=7; 1356 cases), rubella (n=3; 487 cases), and mumps (n=2; 293 cases). 19 (40%) outbreaks, predominantly varicella and measles, were reported in temporary refugee camps or shelters. Of 11 varicella outbreaks, nine (82%) were associated with adult migrants. Half of measles outbreaks (n=11) were associated with migrants from eastern European countries. In conclusion, migrants are involved in vaccine-preventable disease outbreaks in Europe, with adult and child refugees residing in shelters or temporary camps at particular risk, alongside specific nationality groups. Vulnerability varies by disease, setting, and demographics, highlighting the importance of tailoring catch-up vaccination interventions to specific groups in order to meet regional and global vaccination targets as recommended by the new Immunisation Agenda 2030 framework for action. A better understanding of vaccine access and intent in migrant groups and a greater focus on co-designing interventions is urgently needed, with direct implications for COVID-19 vaccine delivery.


Subject(s)
Disease Outbreaks , Transients and Migrants , Vaccine-Preventable Diseases/epidemiology , Adult , Child , Disease Outbreaks/prevention & control , Europe/epidemiology , Humans , Immunization Programs , Refugee Camps , Refugees , Vaccination , Vaccine-Preventable Diseases/prevention & control
10.
Allergy Asthma Proc ; 42(5): 378-385, 2021 09 01.
Article in English | MEDLINE | ID: covidwho-1394714

ABSTRACT

Background: Infectious diseases are a leading cause of morbidity and mortality worldwide. As of 2018, the total world population of children < 5 years of age was roughly estimated at 679 million. Of these children, an estimated 5.3 million died of all causes in 2018, with an estimated 700,000 who died of vaccine-preventable infectious diseases; 99% of the children who died had lived in low- and middle-income countries. The infectious diseases that remain major causes of mortality for which vaccines have been shown to provide proven preventive success include, in order of prevalence, are those caused by Streptococcus pneumoniae, Rotavirus, Bordetella pertussis, measles virus, Haemophilus influenzae type b and influenza virus. Objective: The purpose of the present report was to address the global burden of these six vaccine-preventable infectious diseases in children < 5 years of age, together with implications for the prevention of coronavirus disease 2019 (COVID-19) infection in children. Methods: The current immunization strategies for the prevention of the six vaccine-preventable infectious diseases in children are reviewed as a framework for new strategies of vaccine prevention of COVID-19 in children. Results: The burden of addressing vaccine prevention of future infectious disease in children can be effectively pursued through knowledge gained from past experiences with vaccine usage in these six vaccine-preventable childhood infectious diseases. Conclusion: Issues with regard to the burden of disease mortality, disease transmission, and available vaccines as well as vaccine successes and shortcomings for specific pathogens can serve as important landmarks for effective use of future vaccines. Although much success has been made globally in preventing these childhood deaths, much remains to be done.


Subject(s)
COVID-19 Vaccines , COVID-19/prevention & control , Global Health/statistics & numerical data , Mass Vaccination , Vaccine-Preventable Diseases/epidemiology , COVID-19/epidemiology , Child Mortality , Child, Preschool , Cost of Illness , Developing Countries , Female , Health Services Accessibility , Humans , Infant , Infant Mortality , Infant, Newborn , Male , Prevalence , Vaccination Refusal , Vaccine-Preventable Diseases/prevention & control
11.
Arch Dis Child ; 107(3): e4, 2022 03.
Article in English | MEDLINE | ID: covidwho-1319389

ABSTRACT

OBJECTIVE: To assess the impact of the COVID-19 pandemic on routine childhood vaccination coverage in Colombia by age group, rural/urban residence, state and vaccine type. DESIGN: Ecological study of official monthly vaccination records. SETTING: Vaccination records from the Colombian Ministry of Health (March-October 2019 and 2020). PARTICIPANTS: Aggregated data for Colombian children (<12 months, n=676 153; 12-23 months, n=700 319; and 5 years, n=734 295) participating in the Expanded Program on Immunization. MAIN OUTCOME MEASURES: Proportion of eligible population receiving vaccination. RESULTS: Vaccination coverage showed an overall decline of approximately 14.4% from 2019 to 2020 (2019 coverage=76.0, 2020 coverage=61.6%). The greatest reduction in proportion vaccinated was observed in children <12 months of age for pneumococcal vaccine (second dose) (2019 coverage=81.4%; 2020 coverage=62.2%; 2019-2020 absolute difference, 19.2%; 95% CI 14.8% to 23.7%). For children aged 12-23 months, the proportion vaccinated for yellow fever declined by 16.4% (12.4% to 20.9%) from 78.3% in 2019 to 61.8% in 2020. Among children 5 years of age, the biggest decrease occurred for the oral polio vaccine (second dose), with a difference of 11.4% (7.1% to 15.7%) between 2019 and 2020 (73.1% and 61.7% for 2019 and 2020). We observed a statistically significant effect on vaccine coverage in rural versus urban areas for children <12 months and 5 years of age. CONCLUSIONS: Reduced uptake of immunisations during the COVID-19 pandemic poses a serious risk of vaccine-preventable disease outbreaks. Colombia and other middle-income countries need to continue to monitor immunisation programme coverage and disease outbreaks at the national and subnational levels and undertake catch-up vaccination activities.


Subject(s)
COVID-19/epidemiology , Immunization Programs , Pandemics , Vaccination Coverage , Vaccine-Preventable Diseases/prevention & control , Child, Preschool , Colombia/epidemiology , Health Services Accessibility , Humans , Infant , Patient Acceptance of Health Care , Rural Population , SARS-CoV-2 , Urban Population
12.
Hum Vaccin Immunother ; 18(1): 1939620, 2022 12 31.
Article in English | MEDLINE | ID: covidwho-1291289

ABSTRACT

The discovery and development of vaccines remain one of the major successes of global health with millions of lives saved every year through routine vaccination. Although vaccines provide a safe and cost-effective solution to vaccine-preventable diseases (VPDs), VPDs are still a serious public health problem in most parts of the world, especially in sub-Saharan Africa (SSA) and Asia. In this review, we discuss the burden of VPDs and vaccine coverage several decades after the introduction of the Expanded Program on Immunization (EPI) in Cameroon. We also discuss how different factors affect the implementation of the EPI, highlighting context-specific factors such as the ongoing civil conflict in Cameroon, and the presence of other infectious diseases like COVID-19.


Subject(s)
COVID-19 , Vaccine-Preventable Diseases , Vaccines , Cameroon/epidemiology , Humans , Immunization Programs , Vaccination , Vaccine-Preventable Diseases/epidemiology , Vaccine-Preventable Diseases/prevention & control
13.
J Med Virol ; 93(3): 1814-1816, 2021 03.
Article in English | MEDLINE | ID: covidwho-1206821

ABSTRACT

While vaccination remains the cornerstone of controlling vaccine-preventive diseases (VPD), little is known about the effect of social distancing on incidence of VPDs. We investigated the impact of social distancing practiced during the coronavirus disease 2019 (COVID-19) pandemic on the incidence of selected VPDs in South Korea. National surveillance data on monthly incidence of hepatitis A, hepatitis B, varicella, mumps, invasive pneumococcal disease (IPD), and pertussis were retrieved and compared the VPD incidences in 2020 to the average of the last 4 years (2015-2019) of the corresponding months. In 2020, there were 44% decline for mumps, 44% decline for varicella, 28% decline for pertussis, 22% decline for IPD, 14% decline in incidence of hepatitis A, and no change for hepatitis B incidences, compared to baseline years (2015-2019). The largest decline of total VPDs was in April (65%) and in May (67%), during the intensified social distancing measures. In the setting of sustained vaccination coverage, social distancing may provide additional public health benefit in controlling the VPDs.


Subject(s)
Physical Distancing , Vaccine-Preventable Diseases/prevention & control , COVID-19/immunology , COVID-19/prevention & control , Humans , Immunization Programs/methods , Incidence , Pandemics/prevention & control , Republic of Korea , SARS-CoV-2/immunology , Vaccination/methods , Vaccine-Preventable Diseases/immunology , Vaccines/immunology
14.
Pan Afr Med J ; 38: 164, 2021.
Article in English | MEDLINE | ID: covidwho-1206453

ABSTRACT

INTRODUCTION: the coronavirus disease (COVID-19) global pandemic has caused serious disruption to almost all aspect of human endeavor forcing countries to implement unprecedented public health measures aimed at mitigating its effects, such as total lockdown (inter and intra), travel bans, quarantine, social distancing in an effort to contain the spread of the virus. Supportive supervision is a functional component of the immunization systems that allows identification of existing gaps, provides an opportunity for onsite training, and document real-time findings for improvement of the program. The control measures of COVID-19 pandemic have also resulted in limitation of operations of the immunization system including supportive supervision. This has limited many aspects of supportive supervision for surveillance and routine immunization monitoring system in the East and Southern African countries. The aim of this study is to identify the effects of COVID-19 on Integrated Supportive Supervision visits for expanded programme on immunization (EPI) and how it influences the immunization and vaccine preventable disease (VPD) surveillance indicators, and its short-term effect towards notification of increase or decrease morbidity and mortality. METHODS: we reviewed the integrated supportive supervision (ISS) data and the routine administrative coverage from 19 countries in the East and Southern Africa (ESA) for the period January to August 2019 to analyze the trends in the number of visits, vaccine-preventable diseases (VPD), and routine immunization (RI) indicators using t-test, and compare with the period January to August 2020 during the months of the COVID-19 pandemic. RESULTS: thirteen countries out of the 19 considered, had shown a decline in the number of integrated supportive supervision (ISS) visits, with 10 (77%) having more than 59% decrease during the January-August 2020 as compared to the same period 2019. Eleven (57%) of the countries have shown a decrease (p-value < 0.05). Ethiopia and Kenya had the highest drop (p-value < 0.000). Six (32%) had an increase in the number of visits, with Madagascar, Zambia, and Zimbabwe having >100% increase in the number of visits. Sixty-seven percent (67%) of the countries that have decreased in the number of ISS visits have equally witnessed a drop in DPT3 administrative coverage. Countries with a low proportion of outreach sessions conducted in the period of January - August 2020, have all had sessions interruption, with more than 40% of the reasons associated with the lockdown. CONCLUSION: countries have experienced a decrease in the number of supportive supervision visits conducted, during the period of the COVID-19 pandemic and, this has influenced the routine immunization and vaccine-preventable diseases surveillance (VPD) process indicators monitored through the conduct of the visits. Continuous decrease in these performance indicators pose a great threat to the performance sustained and the functionality of the surveillance and immunization system, and consequently on increased surveillance sensitivity to promptly detect outbreaks and aiming to reducing morbidity and mortality in the sub-region.


Subject(s)
COVID-19/prevention & control , Immunization Programs , Vaccination/statistics & numerical data , Vaccine-Preventable Diseases/prevention & control , Africa, Eastern , Africa, Southern , Disease Outbreaks/prevention & control , Humans , Population Surveillance , Public Health , Vaccination Coverage , Vaccines/administration & dosage
15.
Expert Rev Vaccines ; 20(3): 231-234, 2021 03.
Article in English | MEDLINE | ID: covidwho-1069175

ABSTRACT

Introduction: The Latin American Society of Pediatric Infectology (SLIPE for its acronym in Spanish) is working hard to contribute with strategic actions to prevent the recurrence of Vaccine-Preventable Diseases and to prevent the reduction of vaccine coverage in the region of the Americas.Areas covered: On Friday, September 25th, a Latin American forum of experts on immunization services during the COVID-19 pandemic was held through Webex platform. Issues such as: the imminent risk of occurrence and outbreaks of vaccine-preventable diseases, the importance of epidemiological surveillance and the vaccination campaign challenges, in the context of a pandemic were discussed.Expert opinion: Vaccination campaigns should no longer be postponed or delayed; instead, they must be reactivated; governments, scientific societies, and physicians must promote vaccination programs to avoid outbreaks of vaccine-preventable diseases. On the eve of a SARS-CoV-2 vaccine, it is necessary to insist on the availability of sufficient doses to avoid dose shortages in disadvantaged areas of the region.


Subject(s)
COVID-19 , Vaccine-Preventable Diseases/prevention & control , Vaccines/administration & dosage , COVID-19 Vaccines/administration & dosage , Humans , Immunization Programs/organization & administration , Latin America , Vaccination/statistics & numerical data , Vaccination Coverage
16.
Muscle Nerve ; 63(3): 294-303, 2021 03.
Article in English | MEDLINE | ID: covidwho-1037922

ABSTRACT

The clinical course of neuromuscular disorders (NMDs) can be affected by infections, both in immunocompetent individuals, and in those with reduced immunocompetence due to immunosuppressive/immunomodulating therapies. Infections and immunizations may also trigger NMDs. There is a potential for reduced efficacy of immunizations in patients with reduced immunocompetence. The recent vaccination program for coronavirus disease-2019 (COVID-19) raises several questions regarding the safety and efficacy of this vaccine in individuals with NMDs. In this Practice Topic article, we address the role of vaccine-preventable infections in NMDs and the safety and efficacy of immunization in individuals with NMDs, with emphasis on vaccination against COVID-19.


Subject(s)
COVID-19 Vaccines/therapeutic use , COVID-19/prevention & control , Immunosuppressive Agents/adverse effects , Neuromuscular Diseases/therapy , Vaccine-Preventable Diseases/prevention & control , COVID-19/complications , COVID-19/epidemiology , COVID-19/immunology , Guillain-Barre Syndrome/epidemiology , Guillain-Barre Syndrome/etiology , Humans , Immunocompetence/immunology , Immunocompromised Host/immunology , Immunologic Factors/adverse effects , Neuromuscular Diseases/epidemiology , Neuromuscular Diseases/immunology , SARS-CoV-2 , Vaccines, Attenuated/therapeutic use , Vaccines, Inactivated/therapeutic use
17.
Vaccine ; 39(7): 1039-1043, 2021 02 12.
Article in English | MEDLINE | ID: covidwho-1009912

ABSTRACT

We aimed to assess the impact of the COVID-19 pandemic on the incidence of vaccine-preventable diseases (VPDs) and participation in the routine infant vaccination programme in the Netherlands. The incidence of various VPDs initially decreased by 75-97% after the implementation of the Dutch COVID-19 response measures. The participation in the first measles-mumps-rubella vaccination among children scheduled for vaccination in March-September 2020 initially dropped by 6-14% compared with the previous year. After catch-up vaccination, a difference in MMR1 participation of -1% to -2% still remained. Thus, the pandemic has reduced the incidence of several VPDs and has had a limited impact on the routine infant vaccination programme.


Subject(s)
COVID-19 , Pandemics , Vaccination/statistics & numerical data , Vaccine-Preventable Diseases/epidemiology , Child , Humans , Immunization Programs , Incidence , Infant , Measles-Mumps-Rubella Vaccine/administration & dosage , Netherlands/epidemiology , Vaccine-Preventable Diseases/prevention & control
20.
Tex Med ; 116(9): 47, 2020 Sep 01.
Article in English | MEDLINE | ID: covidwho-891844

ABSTRACT

Regardless of whether education takes place virtually or in-person, Texas school vaccination rules remain in effect for the 2020-21 school year, according to the Texas Department of State Health Services. All Texas public schools (and most private schools) and colleges require students to have certain shots before they can attend classes at the beginning of a school year.


Subject(s)
Community Health Services/legislation & jurisprudence , Patient Education as Topic , Schools , Vaccination/legislation & jurisprudence , Vaccination/statistics & numerical data , Vaccine-Preventable Diseases/prevention & control , Vaccines , COVID-19 , Child , Coronavirus Infections , Humans , Office Visits/statistics & numerical data , Pandemics , Pneumonia, Viral , Texas
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