ABSTRACT
BackgroundRemarkable scientific progress has enabled expeditious development of effective vaccines against COVID-19. While healthcare workers (HCWs) have been at the frontlines for the pandemic response, vaccine acceptance amongst them needs further study. MethodsA web-based survey to assess vaccine acceptance and preparedness in India was disseminated to HCWs working in various settings between January and February 2021, shortly after the launch of Indias vaccination campaign. Descriptive statistics were used to examine respondent demographics and Likert scale responses. Binomial logistic regression analyses were used to identify factors associated with vaccine acceptance. ResultsThe survey yielded 624 respondents from 25 states and five union territories in India; 53.5% were male, and median age was 37 years (IQR 32-46). Amongst all respondents, 84.1% (525/624) supported COVID-19 vaccines, and 63.2% (141/223) of those unvaccinated at the time of survey administration were willing to accept a vaccine. Reliability on government sources, healthcare providers or scientific journal articles for COVID-19 related information was reported by 66.8%, while confidence in social media for this information was reported by only 4.5%. Factors independently associated with vaccine acceptance included advancing age (aOR 3.50 [95% CI, 1.04-11.76] for those above 45 years), evidence of vaccine effectiveness and safety (aOR 3.78 [95% CI 1.15-12.38]), and provision of free/no-cost vaccine (aOR 2.63 [95% CI, 1.06-6.50]). Most respondents (80%) were confident about their hospital being equipped to efficiently rollout COVID-19 vaccines to the general population. ConclusionsOverall attitudes towards COVID-19 vaccination and preparedness were positive among HCWs in India, although acceptance was lower among healthier and younger HCWs. Data availability on vaccine safety and effectiveness, and cost considerations were important for acceptance. Targeted interventions are needed to improve vaccine acceptance amongst HCWs, since they are critical in promoting vaccine acceptance amongst the general population.
ABSTRACT
BackgroundThe remarkable progress seen in maternal and child health (MCH) in India over the past two decades has been impacted by setbacks from the COVID-19 pandemic. We aimed to undertake a rapid assessment to identify key priorities for public health research in MCH in India within the context and aftermath of the COVID-19 pandemic. MethodsA web-based survey was developed to identify top research priorities in MCH. It consisted of 26 questions on six broad domains: vaccine preventable diseases, outbreak preparedness, primary healthcare integration, maternal health, neonatal health, and infectious diseases. Key stakeholders were invited to participate between September and November 2020. Participants assigned importance on a 5-point Likert scale, and assigned overall ranks to each sub-domain research priority. Descriptive statistics were used to examine Likert scale responses, and a ranking analysis was done to obtain an "average ranking score" and identify the top research priority under each domain. ResultsAmongst the 84 respondents, 37% were public-health researchers, 25% healthcare providers, 20% academic faculty and 13% were policy makers. Across the six domains, most respondents considered conducting research on systems strengthening as extremely important. The highest ranked research priorities were strengthening the public sector workforce (vaccine preventable diseases), enhancing public-health surveillance networks (outbreak preparedness), nutrition support through community workers (primary care integration), encouraging at least 4-8 antenatal visits (maternal health), neonatal resuscitation to reduce birth asphyxia (neonatal health) and pediatric and maternal screening and treatment of tuberculosis (infectious diseases). Common themes identified through open-ended questions were also systems strengthening priorities across domains. ConclusionsThe overall focus for research priorities in MCH in India during the COVID-19 pandemic is on strengthening existing services and service delivery, rather than novel research. Our results highlight pivotal steps within the roadmap for advancing and sustaining maternal and child health gains during the ongoing COVID-19 pandemic and beyond.
ABSTRACT
Background and ObjectiveThe COVID-19 pandemic has led to disruptions to routine immunization programs in India and around the world, setting the stage for potentially serious outbreaks of vaccine-preventable diseases. MethodsWe surveyed pediatric healthcare providers in India in 2 rounds in April-June and September 2020 to understand how COVID-19 control measures may have impacted routine vaccination. ResultsRespondents were predominantly pediatricians working in primary, secondary or tertiary healthcare centers, across 21 Indian states and two union territories. Among the 424 (survey 1) and 141 (survey 2) respondents, 33.4% and 7.8%, respectively, reported near complete suspension of vaccination services due to COVID-19. A 50% or greater drop in vaccination services was reported by 83.1% of respondents in June, followed by 32.6% four months later, indicating slow recovery of services. By September 2020, 83.6% were aware of updated guidelines on safe provision of immunization services, although awareness of specific catch-up vaccination plans was low, and 76.6% expressed concern about a vaccine coverage gap that could potentially lead to increased non-COVID-19 illnesses and deaths. ConclusionsPandemic-related disruptions to vaccination services were reported by pediatricians across India. Concerted efforts are needed from governing and academic groups to ensure that routine immunization and catch-up programs are implemented during this pandemic, which can sustain gains in vaccination coverage and provide a robust blueprint for the national roll-out of the COVID-19 vaccine.
ABSTRACT
BackgroundThe development and widespread use of an effective SARS-CoV-2 vaccine could help prevent substantial morbidity and mortality associated with COVID-19 infection and mitigate many of the secondary effects associated with non-pharmaceutical interventions. The limited availability of an effective and licensed vaccine will task policymakers around the world, including in India, with decisions regarding optimal vaccine allocation strategies. Using mathematical modelling we aimed to assess the impact of different age-specific COVID-19 vaccine allocation strategies within India on SARS CoV-2-related mortality and infection. MethodsWe used an age-structured, expanded SEIR model with social contact matrices to assess different age-specific vaccine allocation strategies in India. We used state-specific age structures and disease transmission coefficients estimated from confirmed Indian incident cases of COVID-19 between 28 January and 31 August 2020. Simulations were used to investigate the relative reduction in mortality and morbidity of vaccinate allocation strategies based on prioritizing different age groups, and the interactions of these strategies with several concurrent non-pharmacologic interventions (i.e., social distancing, mandated masks, lockdowns). Given the uncertainty associated with current COVID-19 vaccine development, we also varied several vaccine characteristics (i.e., efficacy, type of immunity conferred, and rollout speed) in the modelling simulations. ResultsIn nearly all scenarios, prioritizing COVID-19 vaccine allocation for older populations (i.e., >60yrs old) led to the greatest relative reduction in deaths, regardless of vaccine efficacy, control measures, rollout speed, or immunity dynamics. However, preferential vaccination of this target group often produced higher total symptomatic infection counts and more pronounced estimates of peak incidence than strategies which targeted younger adults (i.e., 20-40yrs or 40-60yrs) or the general population irrespective of age. Vaccine efficacy, immunity type, target coverage and rollout speed all significantly influenced overall strategy effectiveness, with the time taken to reach target coverage significantly affecting the relative mortality benefit comparative to no vaccination. ConclusionsOur findings support global recommendations to prioritize COVID-19 vaccine allocation for older age groups. Including younger adults in the prioritisation group can reduce overall infection rates, although this benefit was countered by the larger mortality rates in older populations. Ultimately an optimal vaccine allocation strategy will depend on vaccine characteristics, strength of concurrent non-pharmaceutical interventions, and region-specific goals such as reducing mortality, morbidity, or peak incidence.
ABSTRACT
While mortality attributable to COVID-19 has devastated global health systems and economies, striking regional differences have been observed. The Bacille Calmette Guerin (BCG) vaccine has previously been shown to have non-specific protective effects on infections, as well as long-term efficacy against tuberculosis. Using publicly available data we built a simple log-linear regression model to assess the association of BCG use and COVID-19-attributable mortality per 1 million population after adjusting for confounders including country economic status (GDP per capita), and proportion of elderly among the population. The timing of country entry into the pandemic epidemiological trajectory was aligned by plotting time since the 100th reported case. Countries with economies classified as lower-middle-income, upper-middle-income and high-income countries (LMIC, UMIC, HIC) had median crude COVID-19 log-mortality of 0.4 (Interquartile Range (IQR) 0.1, 0.4), 0.7 (IQR 0.2, 2.2) and 5.5 (IQR 1.6, 13.9), respectively. COVID-19-attributable mortality among BCG-using countries was 5.8 times lower [95% CI 1.8-19.0] than in non BCG-using countries. Notwithstanding limitations due to testing constraints in LMICs, case ascertainment bias and a plausible rise of cases as countries progress along the epidemiological trajectory, these analyses provide intriguing observations that urgently warrant mobilization of resources for prospective randomized interventional studies and institution of systematic disease surveillance, particularly in LMICs.
ABSTRACT
Tuberculosis (TB) is a significant contributor to mortality in HIV-infected patients. Concurrent TB infection is also a significant contributing factor to maternal mortality in human immunodeficiency virus (HIV)-infected pregnant women. Studies addressing the outcomes of TB and HIV co-infection among pregnant women are generally infrequent. Although limited, the records maintained by the Revised National Tuberculosis Control Programme (RNTCP) and the National AIDS Control Programme (NACP) in Karnataka State, Southern India provide information about the numbers of pregnant women who are co-infected with TB and HIV and their pregnancy outcomes. We reviewed the data and conducted this study to understand how TB-HIV co-infection influences the outcomes of pregnancy in this setting. We sought to determine the incidence and treatment and delivery outcomes of TB-HIV co-infected pregnant women in programmatic settings in Karnataka State in southern India. The study participants were all the HIV-infected pregnant women who were screened for tuberculosis under the NACP from 2008 to 2012. For the purposes of this study, the program staff in the field gathered the data regarding on treatment and delivery outcomes of pregnant women. A total of seventeen pregnant women with TB-HIV co-infection were identified among 3,165,729 pregnant women (for an incidence of 5.4 per million pregnancies). The median age of these pregnant women was 24 years, and majority were primiparous women with WHO HIV stage III disease and were on a stavudine-based ART regimen. The maternal mortality rates were 18% before delivery and 24% after delivery. The abortion rate was 24%, and the neonatal mortality rate was 10%. The anti-tuberculosis treatment and anti-retroviral treatment outcome mortality rates were 30% and 53%, respectively. Although the incidence of TB among the HIV-infected pregnant women was marginally less than that among the non-HIV-infected women, the delivery outcomes were relatively poorer. The current strategy for the management of TB among the HIV-positive pregnant women needs urgent review.
