Investigating sources of non-response bias in a population-based seroprevalence study of vaccine-preventable diseases in the Netherlands.

BACKGROUND: PIENTER 3 (P3), conducted in 2016/17, is the most recent of three nationwide serological surveys in the Netherlands. The surveys aim to monitor the effects of the National Immunisation Programme (NIP) by assessing population seroprevalence of included vaccine preventable diseases (VPDs). The response rate to the main sample was 15.7% (n = 4,983), following a decreasing trend in response compared to the previous two PIENTER studies (P1, 55.0%; 1995/1996 [n = 8,356] and P2, 33.0%; 2006/2007 [n = 5,834]). Non-responders to the main P3 survey were followed-up to complete a "non-response" questionnaire, an abridged 9-question version of the main survey covering demographics, health, and vaccination status. We assess P3 representativeness and potential sources of non-response bias, and trends in decreasing participation rates across all PIENTER studies. METHODS: P3 invitees were classified into survey response types: Full Participants (FP), Questionnaire Only (QO), Non-Response Questionnaire (NRQ) and Absolute Non-Responders (ANR). FP demographic and health indicator data were compared with Dutch national statistics, and then the response types were compared to each other. Random forest algorithms were used to predict response type. Finally, FPs from all three PIENTERs were compared to investigate the profile of survey participants through time. RESULTS: P3 FPs were in general healthier, younger and higher educated than the Dutch population. Random forest was not able to differentiate between FPs and ANRs, but when predicting FPs from NRQs we found evidence of healthy-responder bias. Participants of the three PIENTERs were found to be similar and are therefore comparable through time, but in line with national trends we found P3 participants were less inclined to vaccinate than previous cohorts. DISCUSSION: The PIENTER biobank is a powerful tool to monitor population-level protection against VPDs across 30 years in The Netherlands. However, future PIENTER studies should continue to focus on improving recruitment from under-represented groups, potentially by considering alternative and mixed survey modes to improve both overall and subgroup-specific response. Whilst non-responder bias is unlikely to affect seroprevalence estimates of high-coverage vaccines, the primary aim of the PIENTER biobank, other studies with varied vaccination/disease exposures should consider the influence of bias carefully.

ASVAC2022 : 8th Asian Vaccine Conference.

Aiming to further the Immunization Partners in Asia Pacific (IPAP)'s vision of a world where no one suffers from a vaccine preventable disease, the 8th Asian Vaccine Conference (ASVAC 2022) was held in Colombo, Sri Lanka and virtually from 15 to 18, September 2022 (www.asianvaccine.com). This conference followed those held in Siem Reap, Cambodia (2009), Manila, Philippines (2010), Jakarta, Indonesia (2011), Cebu, Philippines (2013), Hanoi, Vietnam (2015), Singapore (2017) and Naypyidaw and Yangon, Myanmar (2019). The ASVAC2022 themed "Immunization: in Era of Pandemics," commenced with the EPI Managers' Workshop, followed by pre-conference workshops and Vaccinology Masterclass, followed by the main conference featuring 5 plenary lectures, 6 partner-led symposia, free paper and poster presentations, and industry-supported lunch and evening sessions. There were over 1830 registered participants, with 112 attending in person and 998 virtually from 63 countries. The conference was organized by IPAP and hosted by the Vaccine and Infectious Disease Forum of Sri Lanka, Sri Lanka College of Pediatricians, Sri Lanka College of Microbiologists and College of General Practitioners of Sri Lanka, with the support of the Ministry of Health, Sri Lanka. The 9th ASVAC is scheduled to be held in Davao City, Philippines in late 2023.

Incremento de los costos del Programa Nacional de Inmunización por la introducción del candidato vacunal contra neumococo / Increase in the costs of the National Immunization Program due to the introduction of the pneumococcal vaccine candidate

Introducción: La industria nacional ha desarrollado un candidato vacunal contra neumococo. Ante su posible introducción en el sistema de salud debe valorarse el costo incremental que acarrearía. Objetivo: Estimar el incremento de los costos del Programa Nacional de Inmunización por la introducción del candidato vacunal contra neumococo. Métodos: Estudio de descripción de costos desde la perspectiva social para el año 2021. Se estudiaron ocho policlínicos de La Habana y se entrevistaron 38 familiares de lactantes. Se estimó el costo institucional, el gasto de bolsillo y el costo indirecto mediante microcosteo. Se estimó el costo incremental para un esquema de tres dosis (2p+1), concomitantes con otras vacunas. Resultados: El costo total para el Programa Nacional de Inmunización en estos policlínicos estuvo entre los 337 000,00 CUP y los 513 000,00 CUP, con un costo por dosis entre 33,11 CUP y 47,30 CUP. El 31,6 por ciento de las familias reportó gastos en transportación de entre 5,00 CUP y 40,00 CUP. La introducción de la vacuna representaría un incremento entre 8,43 por ciento y 18,99 por ciento del costo base del Programa Nacional de Inmunización en los policlínicos. El costo por dosis sería de entre 34,17 CUP y 47,82 CUP, para un incremento de entre 0,28 CUP y 1,33 CUP. Conclusiones: La mayor parte del costo del Programa Nacional de Inmunización lo asume el Estado. La aplicación de la vacuna cubana contra neumococo solo aumentaría muy levemente el costo por dosis(AU)

Introduction: The national industry has developed a vaccine candidate against pneumococcus. Given its possible introduction into the health system, the incremental cost that it would entail must be assessed. Objective: To estimate the increase in the costs of the National Immunization Program due to the introduction of the pneumococcal vaccine candidate. Methods: Study of cost description from the social perspective for the year 2021. Eight polyclinics in Havana were studied and 38 relatives of infants were interviewed. Institutional cost, out-of-pocket costs and indirect costs were estimated through microcost. The incremental cost was estimated for a three-dose schedule (2p+1), concomitant with other vaccines. Results: The total cost for the National Immunization Program in these polyclinics was between 337,000.00 CUP and 513,000.00 CUP, with a cost per dose between 33.11 CUP and 47.30 CUP. 31.6percent of families reported transportation expenses from 5.00 CUP to 40.00 CUP. The introduction of the vaccine would represent an increase between 8.43 percent and 18.99 percent of the base cost of the National Immunization Program in polyclinics. The cost per dose would be between 34.17 CUP and 47.82 CUP, for an increase of between 0.28 CUP and 1.33 CUP. Conclusions: Most of the cost of the National Immunization Program is borne by the State. The application of the Cuban pneumococcal vaccine would only slightly increase the cost per dose(AU)

Evolving strategies for meningococcal vaccination in Europe: Overview and key determinants for current and future considerations.

Invasive meningococcal disease (IMD) is a life-threatening, unpredictable condition. Vaccines are available against 5 of the 6 meningococcal serogroups (Men) accounting for nearly all IMD cases worldwide; conjugate monovalent MenC, quadrivalent MenACWY, and protein-based MenB vaccines are commonly used. We provide a comprehensive overview of the evolution of meningococcal vaccination strategies employed in national immunization programmes (NIPs) and their impact on IMD incidence in Europe. A more in-depth description is given for several countries: the United Kingdom (UK), the Netherlands, Greece, Italy, and Ireland. We searched European health authorities' websites and PubMed. Various vaccines and immunization schedules are used in 21 NIPs. Most countries implement MenC vaccination in infants, MenACWY in adolescents, and a growing number, MenB in infants. Only Malta has introduced MenACWY vaccination in infants, and several countries reimburse immunization of toddlers. The UK, Italy, Ireland, Malta, Andorra, and San Marino recommend MenB vaccination in infants and MenACWY vaccination in adolescents, targeting the most prevalent serogroups in the most impacted age groups. Main factors determining new vaccination strategies are fluctuating IMD epidemiology, ease of vaccine implementation, ability to induce herd protection, favorable benefit-risk balance, and acceptable cost-effectiveness. Since 1999, when the UK introduced MenC vaccination, the reduction in IMD incidence has been gradually enhanced as other countries adopted routine meningococcal vaccinations. Meningococcal vaccination strategies in each country are continually adapted to regional epidemiology and national healthcare priorities. Future strategies may include broader coverage vaccines when available (e.g., MenABCWY, MenACWY), depending on prevailing epidemiology.

Rotavirus Vaccination of Infants Delayed and Limited within the National Immunization Programme in the Netherlands: An Opportunity Lost.

In this study, we estimated the benefits of rotavirus vaccination for infants had the rotavirus vaccine been introduced in the Netherlands as of its market authorization in 2006. An age-structured, deterministic cohort model was developed to simulate different birth cohorts over a period of 15 years from 2006 until 2021, comparing both universal and targeted high-risk group vaccination to no vaccination. Different scenarios for the duration of protection (5 or 7 years) and herd immunity (only for universal vaccination) were analyzed. All birth cohorts together included 2.6 million infants, of which 7.9% were high-risk individuals, and an additional 13.2 million children between 1-15 years born prior to the first cohort in 2006. The costs and health outcomes associated with rotavirus vaccination were calculated per model scenario and discounted at 4% and 1.5%, respectively. Our analysis reveals that, had rotavirus vaccination been implemented in 2006, it would have prevented 356,800 (51% decrease) and 32,200 (5% decrease) cases of rotavirus gastroenteritis after universal and targeted vaccination, respectively. Over the last 15 years, this would have led to significant avoided costs and quality-adjusted life year losses for either vaccination strategy with the most favorable outcomes for universal vaccination. Clearly, an opportunity has been lost.

[Committee for Immunization Programme and Registry and changes in the National Immunization Programme in Spain]. / Ponencia de Programa y Registro de Vacunaciones y evolución del calendario de vacunación en España.

The Committee for Immunization Programme and Registry (Ponencia de Programa y Registro de Vacunaciones) was created in 1991 to advise the Interterritorial Council of the National Health System on the situation of vaccine preventable diseases and the establishment and evaluation of measures for their prevention and control. Among other functions, this Committee evaluates the immunization programmes taking into account the scientific evidence and the epidemiological situation. In this way the Committee advises decision makers on the Public Health Commission of the Interterritorial Council. Any change in the National Immunization Programme, since the first one published in 1996 by the Interterritorial Council to the current Immunization Programme throughout life, has been advised from the technical and scientific point of view by this Committee. Taking into account both the work developed and the methodology used for developing the technical advice, the Committee for Immunization Programme and Registry is considered the National Immunization Technical Advisory Group for Spain. This paper reviews the functions and work developed by the Committee for Immunization Programme and Registry, the changes conducted in the National Immunization Programme under its advice and the current challenges.

La Ponencia de Programa y Registro de Vacunaciones se creó en 1991 para asesorar al Consejo Interterritorial del Sistema Nacional de Salud en el conocimiento de las enfermedades inmunoprevenibles y el establecimiento y evaluación de medidas para su prevención y control. Entre otras funciones, la Ponencia evalúa los programas de vacunación teniendo en cuenta la evidencia científica y la situación epidemiológica. De esta manera, asesora en la toma de decisiones que se realiza en la Comisión de Salud Pública del Consejo Interterritorial. Desde su creación, la Ponencia ha realizado recomendaciones desde el punto de vista técnico y científico en las modificaciones que se han realizado en el calendario de vacunación, incluyendo la incorporación de vacunas y el cambio de pautas de vacunación, desde el primer calendario del Consejo Interterritorial de 1996 hasta el actual calendario común de vacunación a lo largo de toda la vida. La Ponencia es considerada el Comité Técnico Asesor de Vacunaciones de España, tanto por las funciones que desarrolla como por la metodología utilizada para la elaboración de propuestas. En este artículo se revisan las funciones que desarrolla la Ponencia de Programa y Registro de Vacunaciones, las modificaciones que se han realizado en el calendario con su asesoramiento y los retos en el momento actual.

Impact of the 13-valent pneumococcal conjugate vaccine on the incidences of community-acquired pneumonia and pneumonia-related hospitalizations in children ≤5 years after its implementation into the national immunization program of Turkey.

The aim of the study was to investigate changes in the incidences of community-acquired pneumonia (CAP) and CAP-related hospitalizations following introduction of 13-valent pneumococcal conjugate vaccine (PCV13) in children ≤5 years of age into the national immunization programme (NIP) of Turkey. PCV7 was included in the NIP of Turkey in November 2008 and was replaced by PCV13 in late 2011. Changes in the incidences of CAP and CAP-related hospitalizations per 100,000 children admissions were investigated from 2011 to 2017. A total of 225,963 children visits were recorded; CAP was diagnosed in 4863 (2.15%) children and 1086 (22%) of them hospitalized between 2011 and 2017. The incidence of CAP declined from 5448 to 1144/100,000 from 2011 to 2017 (p = .001, r = -0.965). When the mean annual incidence of CAP between the transition period of PCV13 (2011/2012) was compared with a post-PCV13 period (2016/2017), CAP incidence was found to be 22% lower (p = .009). Also, the incidence of CAP-related hospitalization decreased significantly from 943 to 335/100,000 from 2011 to 2017 (p = .004 r = -0.91). Moreover, the mean incidence of CAP hospitalization declined 35% (p = .01) between the transition period of PCV13 and a post-PCV13 period. Thus, our study showed a significant reductions in the incidences of CAP and CAP-related hospitalization in children ≤5 years-old after the implementation of PCV13 into the NIP of Turkey.

ASVAC2019: 7th Asian Vaccine Conference.

The 7th Asian Vaccine Conference (ASVAC 2019) was held in Yangon, Myanmar from 13 to 15, September 2019. It brought together stakeholders in the field of vaccination to address challenges and issues relevant to clinical practice and immunization programs in the region. The conference themed "Immunization: sustaining health security in Asia", included pre-conference workshops, a Vaccinology Masterclass, plenary lectures, symposia, and poster presentations. There were over 700 participants ~ 400 local and 300 international from 31 countries ~ and 55 international and local speakers from 19 countries. An Asian EPI managers' meeting was also held on 11-12 September in Naypyidaw, the new capital of Myanmar, and was hosted by the Ministry of Health and Sports, Myanmar with support from World Health Organization, UNICEF and other partners. This inter-regional meeting aimed to strengthen the cooperation and collaboration of EPI Managers and others involved in implementing immunization programs in the region. The conference was organized by the Immunization Partners in Asia Pacific (IPAP) and hosted by Myanmar Pediatric Society and the Ministry of Health and Sports, Myanmar. Other partners included the Confederation of Meningitis Organization, Philippine Foundation of Vaccination, Pediatric Infection Disease Society of the Philippines, Asia Pacific Alliance for the Control of Influenza, PATH, ROTA Council, International Society of Tropical Pediatrics, Asian Society for Pediatric Infection Diseases and other partners. Previous conferences have been held in Siem Reap (2009), Manila (2010), Jakarta (2011), Cebu (2013), Hanoi (2015) and Singapore (2017). The 8th Asian Vaccine Conference will be held in Penang, Malaysia in 2021 to further IPAP's vision of a world where no one suffers from a vaccine-preventable disease.

Factors associated with and screening models of national immunization programme vaccine series completion among preschool children in Fujian Province, south-eastern China.

BACKGROUND: An effective method for the rapid identification of vulnerable preschool children at risk of not completing the national immunization programme (NIP) vaccine series in China is still lacking. METHODS: A cross-sectional study involving 772 preschool children born between September 1 2009 and August 31, 2011 was conducted in 2015 in Fujian Province, south-eastern China. The data were collected by face-to-face interviews with the parents or guardians of the children using a standard questionnaire. RESULTS: Children who received the first dose of a hepatitis B vaccine (HepB) less than 24h after birth and those who received one or more doses of surrogate for-fee vaccines (SFVs) were more likely to complete the NIP vaccine series with adjusted odds ratios (ORs) of 3.12 (95% confidence interval [CI]: 1.19-8.23) and 4.74 (1.41-15.90), respectively. The cut-off value of the prediction score for the completion of the NIP vaccine series was 92.5%, and the sensitivity, specificity, and positive and negative predictive values were 87.5%, 47.1%, 11.4% and 98.0%, respectively. CONCLUSIONS: The receipt of a timely first dose of HepB and one or more doses of SFVs were associated with and good predictors of NIP vaccine series completion by preschool children in Fujian, China.

[Research progression of prophylactic HPV vaccine application].

Prophylactic HPV vaccine was a milestone in the prevention and control of HPV-related diseases, especially cervical cancer. The first HPV vaccine has been marketed in the world for more than 10 years. The follow-up study of HPV vaccine clinical trials further confirms the effectiveness and safety. Since HPV vaccine had been introduced into more and more national immunization programs, the population-level effectiveness of HPV vaccine was increasingly proved: Reduced the incidence of HPV infection, genital warts and high-grade precancerous lesions, and improved the herd immunity effect among non-vaccinated populations. However, improvement of the coverage of HPV vaccine, especially in low-and-middle income countries, is the major challenge in putting the HPV vaccine into practice.

National introduction of fractional-dose inactivated polio vaccine in Sri Lanka following the global “switch”

As part of the Polio eradication and endgame strategic plan 2013–2018 to achieve and sustain apolio-free world, the use of oral polio vaccine (OPV) must eventually be stopped. This process startedin April 2016, with the worldwide, planned synchronized “switch”, whereby use of OPV containingpoliovirus type 2 ceased. Prior to the switch, in line with international guidance on risk mitigation, SriLanka had introduced a single full dose (0.5 mL intramuscularly) of inactivated polio vaccine (IPV)into routine immunization. However, the two global suppliers of World Health Organization (WHO)-prequalified IPV had significant challenges in scaling up production to meet the new demand, resultingin a global shortage in April 2016. The WHO Strategic Advisory Group of Experts on Immunizationrecommended that countries should consider a two-dose schedule of intradermal fractional IPV (fIPV).After rapid consideration of the programmatic cost and logistic implications, Sri Lanka was the firstcountry to roll out this dose-sparing schedule nationwide. The country ensured smooth implementationof fIPV use, reaching out to all eligible infants, maintaining equity and sustaining the IPV vaccination.With expedited refresher training in intradermal vaccination, confident, well-trained and dedicatedhealth-care staff, from the field up to provincial levels, worked together as a dedicated team. Healthauthorities at all levels reported that public acceptance of the additional injections of the new schedulewas high. A post-introduction evaluation and an assessment of population-level immunity are under way

National introduction of fractional-dose inactivated polio vaccine in Sri Lanka following the global "switch".

As part of the Polio eradication and endgame strategic plan 2013-2018 to achieve and sustain a polio-free world, the use of oral polio vaccine (OPV) must eventually be stopped. This process started in April 2016, with the worldwide, planned synchronized "switch", whereby use of OPV containing poliovirus type 2 ceased. Prior to the switch, in line with international guidance on risk mitigation, Sri Lanka had introduced a single full dose (0.5 mL intramuscularly) of inactivated polio vaccine (IPV) into routine immunization. However, the two global suppliers of World Health Organization (WHO)-prequalified IPV had significant challenges in scaling up production to meet the new demand, resulting in a global shortage in April 2016. The WHO Strategic Advisory Group of Experts on Immunization recommended that countries should consider a two-dose schedule of intradermal fractional IPV (fIPV). After rapid consideration of the programmatic cost and logistic implications, Sri Lanka was the first country to roll out this dose-sparing schedule nationwide. The country ensured smooth implementation of fIPV use, reaching out to all eligible infants, maintaining equity and sustaining the IPV vaccination. With expedited refresher training in intradermal vaccination, confident, well-trained and dedicated health-care staff, from the field up to provincial levels, worked together as a dedicated team. Health authorities at all levels reported that public acceptance of the additional injections of the new schedule was high. A post-introduction evaluation and an assessment of population-level immunity are under way.

Pneumococcal Vaccines - How Many Serotypes are Enough?

Streptococcus pneumoniae causes meningitis, pneumonia, septicemia, arthritis, sinusitis and otitis media specially in children and over 65 y age groups. It contributes significantly to under-five mortality and morbidity worldwide as well as in India. Use of pneumococcal vaccine seems to be the most effective measure to decrease the disease burden and reduction of under-five mortality. Many countries have already included Pneumococcal Conjugate Vaccines (PCV) in their National Immunization Programmes (NIP). Government of India has announced recently to include PCV13 in NIP in a phased manner. Superiority of a vaccine over the other depends upon serotype coverage, vaccine efficacy, cost effectiveness and safety profile. These facts will be discussed for the vaccines available in India. Further research is warranted to know the disease burden and develop vaccines to have more serotype coverage.

Research progression of prophylactic HPV vaccine application / 中华肿瘤杂志

Prophylactic HPV vaccine was a milestone in the prevention and control of HPV-related diseases, especially cervical cancer. The first HPV vaccine has been marketed in the world for more than 10 years. The follow-up study of HPV vaccine clinical trials further confirms the effectiveness and safety. Since HPV vaccine had been introduced into more and more national immunization programs, the population-level effectiveness of HPV vaccine was increasingly proved: Reduced the incidence of HPV infection, genital warts and high-grade precancerous lesions, and improved the herd immunity effect among non-vaccinated populations. However, improvement of the coverage of HPV vaccine, especially in low-and-middle income countries, is the major challenge in putting the HPV vaccine into practice.

Taming the fear of voice: Dilemmas in maintaining a high vaccination rate in the Netherlands.

In the context of international public debates on vaccination the National Institute for Public Health and the Environment (RIVM), the Dutch public health body responsible for the National Immunization Programme (NIP), fears that the high vaccination rate of children in the Netherlands obscures the many doubts and criticisms parents may have about vaccination. The question arises as to how the robustness of this vaccination rate and the resilience of the NIP can be assessed. To answer this question, we explore the vaccination practices and relationships between professionals and parents using qualitative methods. Drawing on Hirschman's concepts of exit, voice and loyalty, we distinguish between two different approaches to vaccination: one which enforces parental loyalty to the vaccination programme, and one which allows for voice. The analysis shows that due to their lack of voice in the main vaccination setting, parents' considerations are unknown and insight into their loyalty is lacking. We argue that the Dutch vaccination programme is caught between the insecurity of enforced parental loyalty to the NIP and the insecurity of enabling parental voice and negotiating space. We conclude that to increase the resilience of the NIP, experimenting with voice and exit is inevitable.

Twenty-five years of the WHO vaccines prequalification programme (1987-2012): lessons learned and future perspectives.

The World Health Organization (WHO) vaccines prequalification programme was established in 1987. It is a service provided to United Nations procurement agencies to ensure that the vaccines supplied through these agencies are consistently safe and effective under conditions of use in national immunization programmes. This review describes the purpose and aims of the programme, its evolution during 25 years of existence, its added value, and its role in the context of the WHO strategy to ensure the global availability of vaccines of assured quality. The rationale for changes introduced during the implementation of the programme is provided. The paper also discusses the resources involved, both human and financial, its performance, strengths and weaknesses and steps taken to maximize its efficiency. This historical perspective is used to inform proposed future changes to the service.

Budget process bottlenecks for immunization financing in the Democratic Republic of the Congo (DRC).

BACKGROUND: In Democratic Republic of the Congo (DRC), the availability of domestic resources for the immunization program is limited and relies mostly on external donor support. DRC has introduced a series of reforms to move the country toward performance-based management and program budgets. METHODS: The objectives of the study were to: (i) describe the budget process norm, (ii) analyze the budget process in practice and associated bottlenecks at each of its phases, and (iii) collect suggestions made by the actors involved to improve the situation. Quantitative and qualitative data were collected through: a review of published and gray literature, and individual interviews. RESULTS: Bottlenecks in the budget process and disbursement of funds for immunization are one of the causes of limited domestic resources for the program. Critical bottlenecks include: excessive use of off-budget procedures; limited human resources and capacity; lack of motivation; interference from ministries with the standard budget process; dependency toward the development partner's disbursements schedule; and lack of budget implementation tracking. Results show that the health sector's mobilization rate was 59% in 2011. For the credit line specific to immunization program activities, the mobilization rate for the national Expanded Program for Immunization (EPI) was 26% in 2011 and 43% for vaccines (2010). The main bottleneck for the EPI budget line (2011) and vaccine budget line (2011) occurs at the authorization phase. DISCUSSION: Budget process bottlenecks identified in the analysis lead to a low mobilization rate for the immunization program. The bottlenecks identified show that a poor flow of funds causes an insufficient percentage of already allocated resources to reach various health system levels.