Starting then stopping: a nationwide register-based study on the magnitude, predictors, and urban-rural patterns of under-vaccination variation across health centers in The Gambia.

OBJECTIVES: Six million children were under-vaccinated in 2022. Our study aimed to 1) quantify the magnitude of under-vaccination variation between health facilities, 2) assess to which extent individual and health center level factors contributed to the variation, 3) identify individual and health facility factors associated with under-vaccination, and 4), explore rural vs. urban health facility variations. METHODS: We used data from 61,839 children from The Gambia national routine vaccination register. We cross tabulated under-vaccination status across study variables and fitted two-level random intercept multilevel logistic regression models to measure variance, contribution to the variance, and factors associated with the variance and under-vaccination. RESULTS: We found that 7% of the prevalence of under-vaccination was due to variation between health facilities. Thirty-seven percent of the variation was explained by individual and health center variables. The variables explained 36% of the variance in urban and 19% in rural areas. Children who were not vaccinated at 4 months or with delayed history, due for vaccination in the rainy season, and health facilities with very small or large population to health worker ratios had higher under-vaccination odds. CONCLUSION: Our study indicates that one of the pathways to improving vaccination coverage is addressing factors driving under-vaccination inequities between health facilities through urban-rural differentiated strategies.

Main findings: Variation in under-vaccination rates between health centers contributes to worsening performance overall and in urban and rural areas.Added knowledge: Our study indicates that one of the paths to improving under-vaccination and consequently total coverage is by addressing the factors driving under-vaccination and its inequity between health facilities.Global health impact for policy and action: Children with delayed or non-vaccination history at four months of age, those due for vaccination in the rainy season especially in urban areas, and health facilities with very small or big birth dose to health worker ratios are potential targets for improving under-vaccination.

Fiscal space for the immunisation program in Zambia- an efficiency analysis approach.

OBJECTIVE: The immunisation programme in Zambia remains one of the most effective public health programmes. Its financial sustainability is, however, uncertain. Using administrative data on immunisation coverage rate, vaccine utilisation, the number of health facilities and human resources, expenditure on health promotion, and the provision of outreach services from 24 districts, we used Data Envelopment Analysis to determine the level of technical efficiency in the provision of immunisation services. Based on our calculated levels of technical efficiency, we determined the available fiscal space for immunisation. RESULTS: Out of the 24 districts in our sample, 9 (38%) were technically inefficient in the provision of immunisation services. The average efficiency score, however, was quite high, at 0.92 (CRS technology) and 0.95 (VRS technology). Based on the calculated level of technical efficiency, we estimated that an improvement in technical efficiency can save enough vaccine doses to supply between 5 and 14 additional districts. The challenge, however, lies in identifying and correcting for the sources of technical inefficiency.

Bulletin d'immunisation, v.46, Expériences réussies et primées présentées par des États et des municipalités du Brésil, Mai. 2024 

Brésil est un pays qui compte plus de 200 millions d'habitants et qui dispose d'un système de santé public, universel et gratuit. Plus de 35 ans après sa création, le système de santé unifié (SUS) a réalisé d'importants progrès, notamment en atteignant une couverture vaccinale élevée pour un grand nombre de maladies évitables par la vaccination. Les actions de vaccination dans le pays sont coordonnées par le Programme national d'immunisation (PNI). C'est dans ce contexte que la représentation de l'Organisation panaméricaine de la santé (OPS) au Brésil, en soutien aux initiatives du CONASS et du CONASEMS, a organisé un recueil d'expériences qui sera publié comme supplément au Bulletin d'immunisation de l'OPS. À cette fin, en partenariat avec la CONASS et la CONASEMS, six expériences réussies ont été sélectionnées dans les différentes régions du pays, menées par des municipalités sur environ neuf cents propositions soumises, et trois développées par des États sur les cinquante soumises. Lorsque ces expériences ont été sélectionnées, elles ont pu être présentées lors d'événements organisés par les gestionnaires eux-mêmes, tels que la Chambre technique de surveillance du CONASS, qui s'est tenue en mai 2023, et le XXXVIIe Congrès national des secrétariats municipaux à la santé - CONASEMS, qui s'est tenu en juillet de la même année. Ils ont également présenté leurs rapports lors de la XXVe Journée nationale des vaccinations, organisée en septembre 2023 par la Société brésilienne des vaccinations (SBIm), l'un des plus grands événements au monde sur le sujet. Les rapports que vous pouvez lire maintenant dans ce Bulletin de vaccination ont été écrits directement par les professionnels qui ont développé les expériences présentées ici. On y sent la vivacité d'un système de santé robuste et créatif, alimenté depuis sa création par l'énergie d'anonymes qui luttent chaque jour pour défendre chaque vie et garantir à la population un accès universel et complet à la santé, reconnu au Brésil comme un droit pour tous et un devoir de l'État par la Constitution fédérale.

Immunization Newsletter, v.46, Special Issue on Brazil, May 2024 

Brazil is a vast country, home to more than 200 million people and with a public, universal and free health system. Over the more than 35 years since its creation, the Unified Health System (SUS) has made significant progress, including achieving high vaccination coverage for a large number of vaccine-preventable diseases. Immunization actions in the country are coordinated by the National Immunization Program (NIP). It is in this context that the Brazilian office of the Pan American Health Organization (PAHO), in support of initiatives by CONASS and CONASEMS, has organized a collection of experiences to be published as a supplement to the PAHO Immunization Bulletin. To this end, in partnership with CONASS and CONASEMS, six successful experiences were selected from the different regions of the country, carried out by municipalities out of approximately nine hundred proposals submitted, and three developed by states out of fifty submitted. When these experiences were selected, they were able to present them at events run by the managers themselves, such as the CONASS Technical Chamber on Surveillance, held in May 2023, and at the XXXVII National Congress of Municipal Health Secretariats - CONASEMS, held in July of the same year. They also presented their reports at the XXV National Immunization Conference, held in September 2023 by the Brazilian Society of Immunizations (SBIm), one of the world's largest events on the subject. The reports you can read now in this Immunization Bulletin were written directly by the professionals who developed the experiences presented here. You can feel in them the vivacity of a robust, creative health system that has been fed, since its creation, by the energy of anonymous people who fight every day to defend every life and guarantee the population universal and comprehensive access to health, recognized in Brazil as a right for all and a duty of the State by the Federal Constitution.

Appendice. Pour une meilleure immunité : l’approche du parcours de vie pour une longévité en bonne santé

Cette publication est une annexe au document technique "Building better immunity : Une approche du parcours de vie pour une longévité en bonne santé", avec les contributions de plusieurs experts en la matière au sein et en dehors de l'Organisation panaméricaine de la santé (OPS). Cette annexe fournit des exemples d'activités au sein du programme national de vaccination qui peuvent améliorer les taux de couverture et réduire les occasions manquées pour quatre groupes de population : les femmes enceintes, les adolescents, les travailleurs de la santé et les personnes âgées. Ces exemples traduisent les principes et les concepts de l'approche fondée sur le parcours de vie en activités concrètes, qui peuvent être utilisées par les responsables des programmes nationaux de vaccination et par les vaccinateurs, respectivement, pour améliorer les taux de couverture vaccinale. Ces quatre groupes représentent des étapes de la vie pour lesquelles il existe des vaccins très efficaces et qui peuvent grandement influencer leurs capacités sanitaires. L'application des séries primaires, des rappels et des doses de vaccin de rattrapage dans ces groupes est essentielle pour combler les déficits d'immunité émergents. Les activités sont regroupées en huit composantes : (i) gestion et plaidoyer, (ii) équité, (iii) ressources humaines et financement, (iv) organisation et prestation de services, (v) génération de la demande et engagement communautaire, (vi) systèmes d'information, (vii) formation et (viii) évaluation et recherche. Les exemples doivent être évalués, adaptés, mis en œuvre et éventuellement élargis par les États membres pour s'aligner sur les contextes nationaux et locaux. Ce document s'inscrit dans le cadre des efforts déployés par l'OPS pour promouvoir l'application d'une approche de la vaccination fondée sur le parcours de vie dans les pays et territoires des Amériques et pour aider les ministères de la santé à mettre en place des stratégies de santé publique aux niveaux infranational et local afin de préserver la santé et le bien-être des personnes de tous âges.

Apéndice. Lograr una mejor inmunidad: El enfoque del curso de vida para una longevidad saludable

Esta publicación es un apéndice del documento técnico "Lograr una mejor inmunidad: el enfoque de curso de vida para una longevidad saludable", con las contribuciones de varios expertos en la materia dentro y fuera de la Organización Panamericana de la Salud (OPS). Este apéndice proporciona ejemplos de actividades dentro del programa nacional de inmunización que pueden mejorar las tasas de cobertura y reducir las oportunidades perdidas para cuatro grupos de población: mujeres embarazadas, adolescentes, trabajadores sanitarios y adultos mayores. Estos ejemplos traducen los principios y conceptos del Enfoque del Ciclo Vital en actividades concretas, que pueden ser utilizadas por los gestores de los programas nacionales de inmunización y por los vacunadores, respectivamente, para reforzar las tasas de cobertura de vacunación. Estos cuatro grupos representan etapas de la vida para las que existen vacunas muy eficaces y que pueden influir enormemente en sus capacidades sanitarias. La aplicación de dosis de vacunas de la serie primaria, de refuerzo y de recuperación en estos grupos es fundamental para cerrar las brechas de inmunidad emergentes. Las actividades se agrupan en ocho componentes (i) administración y promoción, (ii) equidad, (iii) recursos humanos y financiación, (iv) organización y prestación de servicios, (v) generación de demanda y participación de la comunidad, (vi) sistemas de información, (vii) formación y (viii) evaluación e investigación. Los ejemplos deben ser evaluados, adaptados, implementados y posiblemente ampliados por los Estados Miembros para alinearlos con los contextos nacionales y locales. Este documento forma parte de los esfuerzos de la OPS para promover la aplicación de un enfoque de inmunización a lo largo de la vida por parte de los países y territorios de las Américas y para apoyar a los Ministerios de Salud a establecer estrategias de salud pública a nivel subnacional y local para salvaguardar la salud y el bienestar de las personas de todas las edades.

Experiences from a COVID-19 vaccination center at a tertiary care teaching hospital in Delhi, India: Challenges and solutions.

India began its nationwide coronavirus disease 2019 (COVID-19) vaccination program on January 16, 2021, in a phased manner. In this paper, we have discussed our experience at one of the COVID-19 vaccination centers in the country and have identified a few of the major challenges and their implications. The guidelines for COVID-19 vaccination in the country were changing frequently, leading to ambiguity among the beneficiaries. Co-WIN software, used for program implementation, had some glitches, which caused dissatisfaction among the service providers and beneficiaries. Vaccine hesitancy and eagerness caused low vaccine uptake initially and overcrowding at vaccination centers later. Some of the vaccination centers had the potential to become hot spots for further spread of the virus due to insufficient infrastructure. The disparity in access to vaccines for the homeless and other vulnerable groups was another hurdle for adequate vaccination coverage. These challenges could have been addressed by pretesting the information technology platform, long-term planning with a vision for handling vaccine hesitancy and eagerness, strong communication systems, removing disparities in vaccine access, and maintaining uniformity in messages for frequently updating guidelines.

Direct impact of COVID-19 vaccination in Chile: averted cases, hospitalizations, ICU admissions, and deaths.

BACKGROUND: Chile rapidly implemented an extensive COVID-19 vaccination campaign, deploying a diversity of vaccines with a strategy that prioritized the elderly and individuals with comorbidities. This study aims to assess the direct impact of vaccination on the number of COVID-19 related cases, hospital admissions, ICU admissions and deaths averted during the first year and a half of the campaign. METHODS: Via Chile's transparency law, we obtained access to weekly event counts categorized by vaccination status and age. Integrating this data with publicly available census and vaccination coverage information, we conducted a comparative analysis of weekly incidence rates between vaccinated and unvaccinated groups from December 20, 2020 to July 2, 2022 to estimate the direct impact of vaccination in terms of the number of cases, hospitalizations, ICU admissions and deaths averted, using an approach that avoids the need to explicitly specify the effectiveness of each vaccine deployed. RESULTS: We estimated that, from December 20, 2020 to July 2, 2022 the vaccination campaign directly prevented 1,030,648 (95% Confidence Interval: 1,016,975-1,044,321) cases, 268,784 (95% CI: 264,524-273,045) hospitalizations, 85,830 (95% CI: 83,466-88,194) ICU admissions and 75,968 (95% CI: 73,909-78,028) deaths related to COVID-19 among individuals aged 16 years and older. This corresponds to a reduction of 26% of cases, 66% of hospital admissions, 70% of ICU admissions and 67% of deaths compared to a scenario without vaccination. Individuals 55 years old or older represented 67% of hospitalizations, 73% of ICU admissions and 89% of deaths related to COVID-19 prevented. CONCLUSIONS: This study highlights the role of Chile's vaccination campaign in reducing COVID-19 disease burden, with the most substantial reductions observed in severe outcomes.

Human Papillomavirus vaccination coverage among the female population living in the state of Goiás, Brazil, 2014-2020: a time series study.

OBJECTIVE: To analyze the temporal trend of human papillomavirus (HPV) vaccination coverage among the female population aged 10 to 14 years, living in the state of Goiás, Brazil, between 2014 and 2022. METHODS: This was an ecological time series study using data from the Brazilian National Health System Information Technology Department (Departamento de Informática do Sistema Único de Saúde - DATASUS); the annual vaccination coverage rate was calculated based on the number of second doses administered; the trend of the rates was analyzed using the Prais-Winsten model. RESULTS: A total of 407,217 second doses of the quadrivalent HPV vaccine were administered to the female population aged 10-14 years, with annual vaccination coverage rates ranging from 12.3% (2019) to 30.0% (2015), and an annual percentage change (APC) of 0.7% (95%CI 0.9; 0.2; p-value = 0.030). CONCLUSION: In Góias state, the quadrivalent HPV vaccine coverage rate was below the national target (80%), showing a stationary trend in the time series.

Estruturação do plano de imunização no combate a covid-19: (des)ordem nos acordos entre os poderes / Structuring the immunization plan to fight covid-19: (dis)order in agreements between the powers / Estructura del plan de inmunización para combatir el covid-19: (des)orden en acuerdos entre potencias

Objetivo: Fomentar o debate acerca da ordenação do plano de vacinação nacional, considerando os aspectos organizacionais entre união, estados e municípios. Métodos: Revisão de literatura, tendo como base os periódicos Cientific Electronic Library Online (SCIELO), Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) e Biblioteca Virtual de Saúde (BVS), usando como descritores: Pandemia, Vacina e Plano de Imunização. Com essa busca foram encontradas, inicialmente, 48 publicações. Após a realização da análise, foram incluídos 11 artigos científicos na revisão. Os textos foram submetidos à análise de conteúdo semântica. Resultados: Foram levantadas duas categorias: estratégias de combate a pandemia do covid-19 no Brasil, e a manipulação da sociedade civil e a desordem da cobertura vacinal. Conclusão: as reflexões aqui apresentadas podem contribuir para que os profissionais de enfermagem desenvolvam uma postura reflexiva frente a demanda vacinal, processo de planejamento e percepções da sociedade civil, podendo desencadear uma melhora na preparação para a educação em saúde. (AU)

Objective: To encourage the debate about the ordering of the national vaccination plan, considering the organizational aspects between the union, states and municipalities. Methods: Literature review, based on scientific journals Electronic Library Online (SCIELO), Coordination for the Improvement of Higher Education Personnel (CAPES) and Virtual Health Library (VHL), using as descriptors: Pandemia, Vaccine and Immunization Plan. With this search, 48 publications were initially found. After the analysis, 11 scientific articles were included in the review. The texts were subjected to semantic content analysis. Results: Two categories were raised: strategies to combat the covid-19 pandemic in Brazil, and the manipulation of civil society and the disorder of vaccination coverage. Conclusion: The reflections presented here can contribute for nursing professionals to develop a reflexive posture in face of the vaccine demand, planning process and civil society perceptions, which can trigger an improvement in the preparation for health education. (AU)

Objetivo: Fomentar el debate sobre la ordenación del plan nacional de vacunación, considerando los aspectos organizativos entre sindicato, estados y municipios. Métodos: Revisión de la literatura, con base en revistas científicas Biblioteca Electrónica en Línea (SCIELO), Coordinación para el Perfeccionamiento del Personal de Educación Superior (CAPES) y Biblioteca Virtual en Salud (BVS), utilizando como descriptores: Pandemia, Vacuna y Plan de Inmunización. Con esta búsqueda se encontraron inicialmente 48 publicaciones. Después del análisis, se incluyeron 11 artículos científicos en la revisión. Los textos fueron sometidos a análisis de contenido semántico. Resultados: Se plantearon dos categorías: estrategias para combatir la pandemia de covid-19 en Brasil y la manipulación de la sociedad civil y el desorden de la cobertura de vacunación. Conclusión: Las reflexiones aquí presentadas pueden contribuir para que los profesionales de enfermería desarrollen una postura reflexiva ante la demanda de vacunas, el proceso de planificación y las percepciones de la sociedad civil, lo que puede desencadenar una mejora en la preparación para la educación en salud. (AU)

Guaranteed Cash Incentives Boosted COVID-19 Vaccinations Of Young Adults: Evidence From West Virginia.

Guaranteed small cash incentives were widely employed by policy makers during the COVID-19 vaccination campaign, but the impact of these programs has been largely understudied. We were the first to exploit a statewide natural experiment of one such program implemented in West Virginia in 2021 that provided a $100 incentive to fully vaccinated adults ages 16-35. Using individual-level data from the Census Bureau's Household Pulse Survey, we isolated the policy effect through a difference-in-discontinuities design that exploited the discontinuity in incentive eligibility at age thirty-five. We found that the $100 incentive was associated with a robust increase in the proportion of people ever vaccinated against COVID-19 and the proportion who completed or intended to complete the primary series of COVID-19 vaccines. The policy effects were also likely to be more pronounced among people with low incomes, those who were unemployed, and those with no prior COVID-19 infection. The guaranteed cash incentive program may have created more equitable access to vaccines for disadvantaged populations. Additional outreach may also be needed, especially to unvaccinated people with prior COVID-19 infections.

Second dose of measles-containing vaccine coverage and associated factors among children aged 24-36 months in Gondar city, Central Gondar, Northwest Ethiopia, 2023.

Background: Measles caused 207,000 deaths worldwide in 2019. Ethiopia ranks among the top 10 countries in the world with the highest number of measles cases. However, the coverage of the second dose of measles-containing vaccine (MCV2) remains low. To increase coverage, the government of Ethiopia launched a nationwide measles vaccination campaign. Despite this intervention, the coverage is still below target, and there is scarce information in the study area. Therefore, this study aimed to assess MCV2 coverage and associated factors among children aged 24-36 months in Gondar city, Central Gondar, Northwest Ethiopia, 2023. Methods: A community-based cross-sectional study was conducted among 621 children aged 24-36 months using a systematic random sampling technique from 25 April to 25 May. A pre-tested, interviewer-administered, and structured questionnaire was used and collected using Kobo Toolbox and then transferred to Stata version 17 for further analysis. The binary logistic regression model was used to identify factors, and the presence of an association was declared using a p-value of <0.05. Similarly, an adjusted odds ratio with a 95% confidence interval was used to interpret the direction and strength of an association. Results: A total of 621 children, with a response rate of 98.1%, participated in the study. The coverage of the second dose of MCV was 75.68% (95% CI: 72.1-78.9). The following factors were significantly associated with measles-containing vaccine second dose (MCV2) coverage: father as the household head (AOR: 3.06, 95% CI: 1.43-6.44), first birth order (AOR: 4.45, 95% CI: 1.21-16.3), four and above antenatal care (ANC) follow-ups (AOR: 5.18, 95% CI:1.62-16.5), postnatal care (PNC) service utilization (AOR: 2.57, 95% CI:1.27-5.15), at least two doses of vitamin A uptake (AOR: 6.39, 95% CI: 2.67-15.2), mothers having high awareness (AOR: 1.97, 95% CI:1.15-3.4), and good perception (AOR: 3.6, 95% CI: 2-6.47) about measles vaccination. Conclusion and recommendations: The coverage of MCV2 in the study area is lower than the national and global target of above 95%. Head of household, birth order, ANC follow-up, PNC service utilization, vitamin A uptake, awareness, and perception of mothers about measles vaccination were significant factors for MCV2 coverage. Creating awareness, increasing the perception of mothers about measles vaccination, and strengthening the ANC and PNC services will increase the coverage.

[Effects of the vaccination campaign on hospitalization and mortality linked to measles in Brazil in the last decade]. / Efeitos da campanha de vacinação nas internações e mortalidade relacionados ao sarampo no Brasil na última década.

Measles is one of the main causes of morbidity and mortality in the pediatric population and it can be prevented with 100% effectiveness by vaccination. However, the disease remains active in throughout Brazil. The scope of this article is to evaluate the population's adherence to vaccination and the potential connection with hospitalizations and mortality in relation to measles in Brazil. This is an ecological study based on secondary data on mortality and hospitalizations due to measles and vaccination coverage against the disease in Brazil from 2013 to 2022. The peak of adherence to the measles vaccination schedule occurred in the 3 years that preceded the eradication of the disease in the country, which occurred in 2016. In this interval, there are the lowest hospitalization rates, with zero mortality from 2014 to 2017. On the other hand, there has been a marked drop in vaccination rates since 2019, when the disease resurfaced in Brazil. Concomitantly, hospitalization and mortality rates reach the highest recorded values. Population adherence to the complete measles vaccination schedule, which is essential to control the disease and related deaths, is insufficient, which is reflected in hospitalization and mortality rates.

O sarampo é uma das principais causas de morbidade e mortalidade na população pediátrica e pode ser prevenido com 100% de eficácia pela vacinação. No entanto, a doença permanece ativa no território brasileiro. O objetivo do artigo é avaliar a adesão da população à vacinação e a possível relação com hospitalização e mortalidade em relação ao sarampo no Brasil. Trata-se de um estudo ecológico realizado a partir de dados secundários de mortalidade e internações acerca do sarampo e da cobertura vacinal contra a doença no Brasil nos anos de 2013 a 2022. O ápice de adesão ao calendário vacinal contra o sarampo se deu nos três anos que precederam a erradicação da doença no país, ocorrida em 2016. Nesse intervalo, tem-se as menores taxas de internação, com a mortalidade zerada de 2014 a 2017. Em contrapartida, verifica-se, desde então, queda na taxas de vacinação, acentuadas a partir de 2019, quando a doença reaparece no Brasil. Concomitantemente, as taxas de internação e mortalidade atingem os valores mais altos registrados. A adesão populacional ao calendário vacinal completo contra o sarampo, essencial ao controle da doença e dos óbitos relacionados, está insuficiente, o que se reflete nas taxas de internações e mortalidade.

Effect of the HPV vaccination programme on incidence of cervical cancer and grade 3 cervical intraepithelial neoplasia by socioeconomic deprivation in England: population based observational study.

OBJECTIVES: To replicate previous analyses on the effectiveness of the English human papillomavirus (HPV) vaccination programme on incidence of cervical cancer and grade 3 cervical intraepithelial neoplasia (CIN3) using 12 additional months of follow-up, and to investigate effectiveness across levels of socioeconomic deprivation. DESIGN: Observational study. SETTING: England, UK. PARTICIPANTS: Women aged 20-64 years resident in England between January 2006 and June 2020 including 29 968 with a diagnosis of cervical cancer and 335 228 with a diagnosis of CIN3. In England, HPV vaccination was introduced nationally in 2008 and was offered routinely to girls aged 12-13 years, with catch-up campaigns during 2008-10 targeting older teenagers aged <19 years. MAIN OUTCOME MEASURES: Incidence of invasive cervical cancer and CIN3. RESULTS: In England, 29 968 women aged 20-64 years received a diagnosis of cervical cancer and 335 228 a diagnosis of CIN3 between 1 January 2006 and 30 June 2020. In the birth cohort of women offered vaccination routinely at age 12-13 years, adjusted age standardised incidence rates of cervical cancer and CIN3 in the additional 12 months of follow-up (1 July 2019 to 30 June 2020) were, respectively, 83.9% (95% confidence interval (CI) 63.8% to 92.8%) and 94.3% (92.6% to 95.7%) lower than in the reference cohort of women who were never offered HPV vaccination. By mid-2020, HPV vaccination had prevented an estimated 687 (95% CI 556 to 819) cervical cancers and 23 192 (22 163 to 24 220) CIN3s. The highest rates remained among women living in the most deprived areas, but the HPV vaccination programme had a large effect in all five levels of deprivation. In women offered catch-up vaccination, CIN3 rates decreased more in those from the least deprived areas than from the most deprived areas (reductions of 40.6% v 29.6% and 72.8% v 67.7% for women offered vaccination at age 16-18 and 14-16, respectively). The strong downward gradient in cervical cancer incidence from high to low deprivation in the reference unvaccinated group was no longer present among those offered the vaccine. CONCLUSIONS: The high effectiveness of the national HPV vaccination programme previously seen in England continued during the additional 12 months of follow-up. HPV vaccination was associated with a substantially reduced incidence of cervical cancer and CIN3 across all five deprivation groups, especially in women offered routine vaccination.

Specialist nurse's health promotion work with the national childhood immunization programme: A qualitative study.

PURPOSE: Childhood immunizations have proven to be one of the most beneficial interventions to promote public health and prevent childhood deaths due to disease. However, global coverage of childhood immunization has decreased throughout the world due to guardians' growing hesitancy towards immunizations. This study aims to describe how specialist nurses promote legal guardians to adhere to national childhood immunization programmes. DESIGN AND METHODS: This study had a qualitative design. Semistructured interviews with 11 specialist nurses, who were paediatric primary care nurses or nurse practitioners, were conducted. Data were analysed using qualitative content analysis. RESULTS: The findings, with four main categories including four subcategories, showed nurses using both local guidelines and national guidelines to promote guardians to adhere to the childhood immunization programme. The main intervention the nurses did to promote childhood immunization coverage was giving legal guardians general information about the programme. With hesitant guardians, adopting a person-centred approach towards the legal guardian improved adherence. PRACTICE IMPLICATIONS: Further research should focus on how specialist nurses can respond to guardians who decline immunization for their children, as this study identified difficulties in this area. Furthermore, research on guardians' perspectives towards childhood immunization may also help generate further effective guidance on how to promote immunization coverage among children.

Progress Toward Poliomyelitis Eradication - Worldwide, January 2022-December 2023.

In 1988, poliomyelitis (polio) was targeted for eradication. Global efforts have led to the eradication of two of the three wild poliovirus (WPV) serotypes (types 2 and 3), with only WPV type 1 (WPV1) remaining endemic, and only in Afghanistan and Pakistan. This report describes global polio immunization, surveillance activities, and poliovirus epidemiology during January 2022-December 2023, using data current as of April 10, 2024. In 2023, Afghanistan and Pakistan identified 12 total WPV1 polio cases, compared with 22 in 2022. WPV1 transmission was detected through systematic testing for poliovirus in sewage samples (environmental surveillance) in 13 provinces in Afghanistan and Pakistan, compared with seven provinces in 2022. The number of polio cases caused by circulating vaccine-derived polioviruses (cVDPVs; circulating vaccine virus strains that have reverted to neurovirulence) decreased from 881 in 2022 to 524 in 2023; cVDPV outbreaks (defined as either a cVDPV case with evidence of circulation or at least two positive environmental surveillance isolates) occurred in 32 countries in 2023, including eight that did not experience a cVDPV outbreak in 2022. Despite reductions in paralytic polio cases from 2022, cVDPV cases and WPV1 cases (in countries with endemic transmission) were more geographically widespread in 2023. Renewed efforts to vaccinate persistently missed children in countries and territories where WPV1 transmission is endemic, strengthen routine immunization programs in countries at high risk for poliovirus transmission, and provide more effective cVDPV outbreak responses are necessary to further progress toward global polio eradication.

Randomised experimental evaluation of a social media campaign to promote COVID-19 vaccination in Nigeria.

Background: The coronavirus disease 2019 (COVID-19) pandemic has challenged public health and behaviour change programmes, and has led to the development of innovative interventions and research. In low -and middle-income countries (LMICs) such as Nigeria, new strategies to promote vaccination, increase pro-vaccination social norms, and reduce vaccine hesitancy have been deployed through social media campaigns and evaluated using digital media platforms. Methods: We conducted two randomised experimental evaluations of social media content designed to promote COVID-19 vaccination and to complement research on a nationwide vaccination promotion campaign in Nigeria run in 2022. We conducted two studies in March and August 2022 among Nigerians drawn from 31 states that had not been targeted in the aforementioned nationwide campaign. We randomised the participants to either receive the pro-vaccination social media campaign or not and collected data at pre- and post-test time points to evaluate psychosocial predictors of vaccination and vaccination outcomes following the Theory of Change based on Diffusion of Innovations; the Social Norms Theory, and the Motivation, Opportunity, Ability (MOA) framework. Data were collected through a novel intervention delivery and data collection platform through social media. Results: We found that pro-vaccination social norms and vaccination rates increased, while vaccine hesitancy decreased among participants randomised to the social media intervention study arm. Conclusions: Social media campaigns are a promising approach to increasing vaccination at scale in LMICs, while social norms are an important factor in promoting vaccination, which is consistent with the Social Norms Theory. This study demonstrates the capability and potential of new social media-based data collection techniques. We describe implications for future vaccination campaigns and identify future research priorities in this area. Registration: Pan African Clinical Trial Registry: PACTR202310811597445.

Childhood vaccination trends during 2019 to 2022 in Tanzania and the impact of the COVID-19 pandemic.

The COVID-19 pandemic has significantly disrupted healthcare systems at all levels globally, notably affecting routine healthcare services, such as childhood vaccination. This study examined the impact of these disruptions on routine childhood vaccination programmes in Tanzania. We conducted a longitudinal study over four years in five Tanzanian regions: Mwanza, Dar es Salaam, Mtwara, Arusha, and Dodoma. This study analyzed the trends in the use of six essential vaccines: Bacille Calmette-Guérin (BCG), bivalent Oral Polio Vaccine (bOPV), Diphtheria Tetanus Pertussis, Hepatitis-B and Hib (DTP-HepB-Hib), measles-rubella (MR), Pneumococcal Conjugate Vaccine (PCV), and Rota vaccines. We evaluated annual and monthly vaccination trends using time-series and regression analyses. Predictive modeling was performed using an autoregressive integrated moving average (ARIMA) model. A total of 32,602,734 vaccination events were recorded across the regions from 2019 to 2022. Despite declining vaccination rates in 2020, there was a notable rebound in 2021, indicating the resilience of Tanzania's immunization program. The analysis also highlighted regional differences in vaccination rates when standardized per 1000 people. Seasonal fluctuations were observed in monthly vaccination rates, with BCG showing the most stable trend. Predictive modeling of BCG indicated stable and increasing vaccination coverage by 2023. These findings underscore the robustness of Tanzania's childhood immunization infrastructure in overcoming the challenges posed by the COVID-19 pandemic, as indicated by the strong recovery of vaccination rates post-2020. We provide valuable insights into the dynamics of vaccination during a global health crisis and highlight the importance of sustained immunization efforts to maintain public health.

The impact of COVID-19 vaccination campaign on pediatric vaccine uptake based on parents' attitudes towards mandatory and recommended vaccination in Southern Italy.

INTRODUCTION: This study investigates the association between parental attitudes towards mandatory and recommended vaccines in the National Immunization Plan (NIP) of Italy and their acceptance of the COVID-19 vaccine in children aged 5-11 years. METHODS: Using data from approximately 42,000 children in Southern Italy, parental attitudes towards previous vaccinations were examined. Mandatory and recommended vaccinations were considered for the analysis, with the first shot of each schedule being considered relevant, regardless of when it was administered or whether the recommended number of doses was administered. A multivariate logistic regression was performed to analyze associations between the covariates of age, sex, adherence to mandatory vaccinations, number of recommended vaccinations, and COVID-19 vaccination. RESULTS: The COVID-19 vaccine acceptance rate was 50.7% in our sample. We revealed a strong association between parental attitudes towards previous vaccinations and the acceptance of the COVID-19 vaccine. Mandatory vaccinations under the NIP showed the highest acceptance rates, and among non-mandatory vaccines, the pneumococcal conjugate vaccine had the highest acceptance rate, potentially due to its co-administration with the hexavalent vaccine. The study identified a trend of lower COVID-19 vaccine coverage in younger children. CONCLUSIONS: The study underscores the importance of co-administration approaches and well-planned vaccination schedules in enhancing vaccine coverage. It suggests that integrating newer vaccines, like the COVID-19 vaccine, into established vaccination schedules could potentially increase acceptance and coverage. The findings highlight the urgency of addressing vaccine hesitancy, particularly in the pediatric population, to ensure high vaccination coverage and effective disease control. Further research is needed to explore the potential strategies to increase vaccine acceptance.