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1.
Background
Although measles mortality has declined dramatically in Sub-Saharan Africa, measles remains a major public health problem in countries like the Democratic Republic of Congo (DRC). Here, we describe the large measles epidemic that occurred in the Democratic Republic of Congo between 2010 and 2013 using data from the national surveillance system as well as vaccine coverage surveys to provide a snapshot of the epidemiology of measles in DRC.Methods
Standardized national surveillance data were used to describe measles cases from 2010 to 2013. Attack rates and case fatality ratios were calculated and the temporal and spatial evolution of the epidemic described. Data on laboratory confirmation and vaccination coverage surveys as a part of routine program monitoring are also presented.Findings
Between week 1 of 2010 and week 45 of 2013, a total of 294,455 cases and 5,045 deaths were reported. The cumulative attack rate (AR) was 0.4%. The Case Fatality Ratio (CFR) was 1.7% among cases reported in health structures through national surveillance. A total of 186,178 cases (63%) were under 5 years old, representing an estimated AR of 1.4% in this age group. Following the first mass vaccination campaigns, weekly reported cases decreased by 21.5%. Results of post-vaccination campaign coverage surveys indicated sub-optimal (under 95%) vaccination coverage among children surveyed.Conclusions
The data reported here highlight the need to seek additional means to reinforce routine immunization as well as ensure the timely implementation of Supplementary Immunization Activities to prevent large and repeated measles epidemics in DRC. Although reactive campaigns were conducted in response to the epidemic, strategies to ensure that children are vaccinated in the routine system remains the foundation of measles control.2.
Influenza vaccination motivators among healthcare personnel in a large acute care hospital in Israel
Background
Vaccinating healthcare personnel (HCP) against influenza is important to prevent transmission and morbidity among patients and staff.Methods
We conducted an online survey assessing knowledge, perceptions and attitudes concerning influenza vaccination among HCP. Multivariate logistic regression was performed to identify independent predictors of vaccination.Results
The survey was completed by 468 HCP representing all categories of staff. Doctors believed that vaccination was the best way to prevent influenza and perceived the vaccine less harmful as compared to nurses and allied health professionals. Getting vaccinated was associated with a greater likelihood of recommending vaccination to patients: 86 % vs. 54 % in vaccinated and unvaccinated HCP, respectively. Reasons for vaccine refusal were fear of needles (19 %); fear of side effects (66 %) and lack of time (16 %). In the multivariate analysis, survey items that were independently associated with vaccination were beliefs that: vaccine effectively prevents influenza (OR 4.07 95 % CI 2.51, 6.58); HCP are at increased risk of influenza (OR 2.82 95 % CI 1.56, 5.13); vaccine can cause influenza (OR 0.41 95 % CI 0.25, 0.65); contracting influenza is likely in the absence of vaccination (OR 1.96 95 % CI 1.12, 3.42); and that HCP might transmit influenza to their family (OR 4.54 95 % CI 1.38, 14.97). The belief that HCP might transmit influenza to patients was not independently associated with vaccine uptake.Conclusion
Our study revealed misconceptions and knowledge gaps concerning the risk of influenza and the influenza vaccine. There were significant differences in knowledge and attitudes between healthcare professions. HCP decline vaccination because they do not perceive a personal risk of influenza infection and are concerned about side effects. Thus, in order to increase vaccination rates it is important to educate HCP to correct misconceptions concerning vaccine efficacy and safety, while promoting the benefit of getting vaccinated in order to protect themselves and their families.3.
Background
Measles vaccination effectiveness studies showed dramatic decreases in all-cause mortality in excess of what would be expected from the prevention of measles disease alone. This invited speculation that measles infection may increase the risk of diarrhea morbidity and mortality subsequent to the acute phase of the disease. The aim of the present systematic review is to summarize the existing evidence in the publically available literature pertaining to the putative causal link between measles and diarrhea in the period 4–26 weeks following measles rash onset.Methods
We searched the PubMed, Embase, Open Grey and Grey Literature Report databases for relevant literature using broad search terms. Prospective, retrospective and case-control studies in low- and middle-income countries involving children under five wherein relevant evidence were presented were included. Data were extracted from the articles and summarized.Results
Fifty abstracts retrieved through the database searches met the initial screening criteria. Twelve additional documents were identified by review of the references of the documents found in the initial searches. Six documents representing five unique studies that presented evidence relevant to the research question were found. Four of the included studies took place in Bangladesh. One of the included studies took place in Sudan. Some measles vaccine effectiveness studies show lower diarrhea morbidity and mortality among the vaccinated. However, children who received vaccine may have differed in important ways from children who did not, such as health service utilization. Additionally, cohort studies following unvaccinated children showed no difference in diarrhea morbidity and mortality between cases and controls more than 4 weeks after measles rash onset. One study showed some evidence that severe measles may predispose children to gastroenteritis, but was not able to show a corresponding increase in the risk of diarrhea mortality.Conclusions
The available evidence suggests that the risk of measles-associated diarrhea mortality is largely limited to the 5-week period 1 week prior to and 4 weeks after measles rash onset, and that there is no increased risk of diarrhea mortality in the longer-term caused by measles.4.
Background
Childhood vaccination rates in Nigeria are among the lowest in the world and this affects morbidity and mortality rates. A 2011 mixed methods study in two states in Nigeria examined coverage of measles vaccination and reasons for not vaccinating children.Methods
A household survey covered a stratified random cluster sample of 180 enumeration areas in Bauchi and Cross River States. Cluster-adjusted bivariate and then multivariate analysis examined associations between measles vaccination and potential determinants among children aged 12-23 months, including household socio-economic status, parental knowledge and attitudes about vaccination, and access to vaccination services. Focus groups of parents in the same sites subsequently discussed the survey findings and gave reasons for non-vaccination. A knowledge to action strategy shared findings with stakeholders, including state government, local governments and communities, to stimulate evidence-based actions to increase vaccination rates.Results
Interviewers collected data on 2,836 children aged 12-23 months in Cross River and 2,421 children in Bauchi. Mothers reported 81.8% of children in Cross River and 42.0% in Bauchi had received measles vaccine. In both states, children were more likely to receive measles vaccine if their mothers thought immunisation worthwhile, if immunisation was discussed in the home, if their mothers had more education, and if they had a birth certificate. In Bauchi, maternal awareness about immunization, mothers’ involvement in deciding about immunization, and fathers’ education increased the chances of vaccination. In Cross River, children from communities with a government immunisation facility were more likely to have received measles vaccine. Focus groups revealed lack of knowledge and negative attitudes about vaccination, and complaints about having to pay for vaccination. Health planners in both states used the findings to support efforts to increase vaccination rates.Conclusion
Measles vaccination remains sub-optimal, particularly in Bauchi. Efforts to counter negative perceptions about vaccination and to ensure vaccinations are actually provided free may help to increase vaccination rates. Parents need to be made aware that vaccination should be free, including for children without a birth certificate, and vaccination could be an opportunity for issuing birth certificates. The study provides pointers for state level planning to increase vaccination rates.5.
Background
Many adults in Germany do not receive immunizations as recommended. False assumptions about vaccinations and the risk of infectious diseases are important reasons why people fail to receive recommended immunizations.Aim
Our aim was to provide new possibilities to improve vaccination rates among adults. We directed special attention to some newsworthy infectious diseases (e.g. measles, pertussis).Results
Owing to their special range of responsibilities and their numerous medical attendances, occupational health physicians are in a position to improve the immunization rates of adults as well as to collect epidemiologic data of this broad age group.Conclusions
The use of a mobile cart vaccination program in the workplace might increase vaccination rates.6.
Neil?Andersson Anne?Cockcroft Noor?M?Ansari Khalid?Omer Manzoor?Baloch Ari?Ho Foster Bev?Shea George?A?Wells José?Legorreta?Soberanis 《BMC international health and human rights》2009,9(Z1):S8
Background
Childhood vaccination rates are low in Lasbela, one of the poorest districts in Pakistan's Balochistan province. This randomised cluster controlled trial tested the effect on uptake of informed discussion of vaccination costs and benefits, without relying on improved health services.Methods
Following a baseline survey of randomly selected representative census enumeration areas, a computer generated random number sequence assigned 18 intervention and 14 control clusters. The intervention comprised three structured discussions separately with male and female groups in each cluster. The first discussion shared findings about vaccine uptake from the baseline study; the second focussed on the costs and benefits of childhood vaccination; the third focussed on local action plans. Field teams encouraged the group participants to spread the dialogue to households in their communities. Both intervention and control clusters received a district-wide health promotion programme emphasizing household hygiene. Interviewers in the household surveys were blind of intervention status of different clusters. A follow-up survey after one year measured impact of the intervention on uptake of measles and full DPT vaccinations of children aged 12-23 months, as reported by the mother or caregiver.Results
In the follow-up survey, measles and DPT vaccination uptake among children aged 12-23 months (536 in intervention clusters, 422 in control clusters) was significantly higher in intervention than in control clusters, where uptake fell over the intervention period. Adjusting for baseline differences between intervention and control clusters with generalized estimating equations, the intervention doubled the odds of measles vaccination in the intervention communities (OR 2.20, 95% CI 1.24-3.88). It trebled the odds of full DPT vaccination (OR 3.36, 95% CI 2.03-5.56).Conclusion
The relatively low cost knowledge translation intervention significantly increased vaccine uptake, without relying on improved services, in a poor district with limited access to services. This could have wide relevance in increasing coverage in developing countries.Trial registration
ISRCTN12421731.7.
Ashish Kumar Upadhyay Swati Srivastava 《Zeitschrift fur Gesundheitswissenschaften》2017,25(6):581-589
Aim
This study aims to examine the association between the Haemophilus influenza type B (Hib) vaccination and child anthropometric outcomes in India.Subject and methods
The study used prospective cohort data from the Young Lives Study (YLS) conducted in Andhra Pradesh, India. The participants were 1,824 children (aged 54–76 months). Stunting and underweight were used to measure the child anthropometric outcomes. The study used the multivariate logistic regression model to examine the association between Hib vaccination and childhood stunting and underweight.Results
The result shows that stunting was lower among children who were vaccinated against Hib as compared to those who were not vaccinated (30.8% versus 39.5%). Similarly, the prevalence of underweight was also lower among the vaccinated children than the non-vaccinated ones (39.1% versus 48.0%). The results of the multivariate logistic regression analysis also suggest that children vaccinated against Hib were significantly less likely to be stunted (AOR: 0.76, 95% CI: 0.61–0.95) and underweight (AOR: 0.79, 95% CI: 0.64–0.98) than children who were not vaccinated against Hib, after controlling potentially confounding variables.Conclusions
The study concludes that vaccination against Hib, in addition to being a major intervention for reducing childhood infectious diseases and mortality, may be considered as a potential tool for reducing the burden of undernutrition in India. Therefore, the inclusion of the Hib vaccine into the Universal Immunization Programme will be helpful in reducing the burden of child malnutrition in India.8.
Background
Immunization rates for human papillomavirus (HPV) infections remain low among teenagers despite strong evidence of the effectiveness of vaccines. Physician recommendations of the vaccine are far from universal. Several states have enacted policies that mandate HPV vaccination or distribute educational materials.Objectives
To provide policy makers, physicians, and researchers information on the relative importance of physician recommendations and early state-level policies to promote HPV vaccinations among targeted age groups.Methods
We first use probit models to determine the strongest correlates of immunization in a nationally representative US sample of teenagers. We then use instrumental variable probit models to determine the direct role that physician recommendations play in vaccination using plausibly exogenous physician encounters that are likely not the result of more health-conscious parents seeking out information on the vaccine.Results
We show that children in the targeted age range who are more likely to encounter physicians for reasons other than seeking out the vaccine, such as through mandatory wellness exams or previous asthma diagnoses, are significantly more likely to get the vaccine. There is no consistent evidence that the state policies we analyze have been effective.Conclusion
Encouraging recommendations by physicians may be the most effective path toward increasing HPV vaccination. State-level mandates and policies are yet to exhibit effectiveness.9.
Anne?Cockcroft Neil?Andersson Khalid?Omer Noor?M?Ansari Amir?Khan Ubaid?Ullah?Chaudhry Umaira?Ansari 《BMC international health and human rights》2009,9(Z1):S4
Background
Rates of childhood vaccination in Pakistan remain low.There is continuing debate about the role of consumer and service factors in determining levels of vaccination in developing countries.Methods
In a stratified random cluster sample of census enumeration areas across four districts in Pakistan, household interviews about vaccination of children and potentially related factors with 10,423 mothers of 14,542 children preceded discussion of findings in separate male and female focus groups. Logistic regression analyses helped to clarify local determinants of measles vaccination.Results
Across the four districts, from 17% to 61% of mothers had formal education and 50% to 86% of children aged 12-23 months had received measles vaccination. Children were more likely to receive measles vaccination if the household was less vulnerable, if their mother had any formal education, if she knew at least one vaccine preventable disease, and if she had not heard of any bad effects of vaccination. Discussing vaccinations in the family was strongly associated with vaccination. In rural areas, living within 5 km of a vaccination facility or in a community visited by a vaccination team were associated with vaccination, as was the mother receiving information about vaccinations from a visiting lady health worker. Focus groups confirmed personal and service delivery obstacles to vaccination, in particular cost and poor access to vaccination services. Despite common factors, the pattern of variables related to measles vaccination differed between and within districts.Conclusions
Vaccination coverage varies from district to district in Pakistan and between urban and rural areas in any district. Common factors are associated with vaccination, but their relative importance varies between locations. Good local information about vaccination rates and associated variables is important to allow effective and equitable planning of services.10.
Linda Sanftenberg Hedwig Roggendorf Maximilian Babucke Henna Riemenschneider Karen Voigt Jörg Schelling Pascal O. Berberat 《Pr?vention und Gesundheitsf?rderung》2017,12(4):267-272
Background
Insufficient immunization rates among health care personnel and general public cause recurring measles outbreaks. To achieve higher immunization rates, a profound knowledge and positive attitude concerning vaccinations are needed, as well as confident vaccination consultations provided by a treating physician. As medical students in future are main contact persons for patients regarding vaccination, we analysed their attitudes towards and the knowledge about measles immunization in Munich and Dresden in order to take into account possible influences of different vaccination policies.Materials and methods
In summer term 2015, we invited medical students in their last three years of the studies (5th–10th semester) during compulsory and voluntary courses at the Technische Universität München (TUM) and Technische Universität Dresden (TUD) to participate in our study.Results
In all, 508 students of the TUM and 216 students of the TUD could be included in our study. On average, 46.7% of the knowledge items were answered correctly at both study sites. The age of the participants seemed to have the strongest influence on the knowledge. The attitudes towards measles vaccinations were very positive at both study sites (93.1% approval on average). Neither the study site, nor the state of origin of the participants, or a previous medical education showed a significant influence on the attitude towards measles vaccination.Conclusions
The knowledge of the study participants seemed to be insufficient, although their attitudes towards measles vaccination were positive. It is important that medical students are confronted more with the topic vaccination during their studies.11.
Background
Attempts to maintain or increase vaccination coverage almost all focus on supply side interventions: improving availability and delivery of vaccines. The effectiveness and cost-effectiveness of efforts to increase demand is uncertain.Methods
We performed a systematic review of studies that provided quantitative estimates of the impact of demand side interventions on uptake of routine childhood vaccination. We retrieved studies published up to Sept 2008.Results
The initial search retrieved 468 potentially eligible studies, including four systematic reviews and eight original studies of the impact of interventions to increase demand for vaccination. We identified only two randomised controlled trials. Interventions with an impact on vaccination uptake included knowledge translation (KT) (mass media, village resource rooms and community discussions) and non-KT initiatives (incentives, economic empowerment, household visits by extension workers). Most claimed to increase vaccine coverage by 20 to 30%. Estimates of the cost per vaccinated child varied considerably with several in the range of $10-20 per vaccinated child.Conclusion
Most studies reviewed here represented a low level of evidence. Mass media campaigns may be effective, but the impact depends on access to media and may be costly if run at a local level. The persistence of positive effects has not been investigated. The economics of demand side interventions have not been adequately assessed, but available data suggest that some may be very cost-effective.12.
Marina Kümmerle Karen Voigt Jeannine Schübel Antje Bergmann Henna Riemenschneider 《Pr?vention und Gesundheitsf?rderung》2017,12(4):261-266
Background
Vaccination coverage among medical students is often insufficient. Regarding vaccination coverage of students of other fields, there are no currently published data for Germany. Based on high international mobility, an insufficient or unknown vaccination status increases the health risk among students.Objective
What is the vaccination status among students of different subjects? Are there group-based differences concerning knowledge of ones own vaccination status? Are there differences concerning attitudes towards vaccination?Material and methods
The survey was conducted at the Technische Universität Dresden during the summer semester 2012 using a semi-standardized questionnaire. Data from 428 students (subjects: medicine, sociology, architecture and physics) were analyzed.Results
Significantly less medical students reported an unknown vaccination status regarding all the nine vaccinations analyzed compared to students of sociology or technical subjects. Significantly more medical students reported complete vaccination status compared to students of other subjects (χ2-test: p ≤ 0.001; Z?test p ≤ 0.05). Significantly more medical students had the opinion that vaccinations were absolutely necessary compared to students of other subjects (χ2-test: p ≤ 0.001; Z?test p ≤ 0.05).Conclusion
University students often have insufficient vaccination coverage. Students of subjects other than medicine are often not aware of their own vaccination status. Low-threshold opportunities to check vaccination status and to be vaccinated if necessary should be established, e.?g. at university and the workplace.13.
Abdel?Karim?Koumaré Drissa?Traore Fatouma?Haidara Filifing?Sissoko Issa?Traoré Sékou?Dramé Karim?Sangaré Karim?Diakité Bréhima?Coulibaly Birama?Togola Aguissa?Ma?ga 《BMC international health and human rights》2009,9(Z1):S13
Background
In 1986, the Government of Mali launched its Expanded Program on Immunization (EPI) with the goal of vaccinating, within five years, 80% of all children under the age of five against six target diseases: diphtheria, tetanus, pertussis, poliomyelitis, tuberculosis, and measles. The Demographic and Health Survey carried out in 2001 revealed that, in Kita Circle, in the Kayes region, only 13% of children aged 12 to 23 months had received all the EPI vaccinations. A priority program was implemented in 2003 by the Regional Health Department in Kayes to improve EPI immunization coverage in this area.Methods
A cross-sectional survey using Henderson's method (following the method used by the Demographic and Health Surveys) was carried out in July 2006 to determine the level of vaccination coverage among children aged 12 to 23 months in Kita Circle, after implementation of the priority program. Both vaccination cards and mothers' declarations (in cases where the mother cannot make the declaration, it is made by the person responsible for the child) were used to determine coverage.Results
According to the vaccination cards, 59.9% [CI 95% (54.7-64.8)] of the children were fully vaccinated, while according to the mothers' declarations the rate was 74.1% [CI 95% (69.3-78.4)]. The drop-out rate between DTCP1 and DTCP3 was 5.5%, according to the vaccination cards. The rate of immunization coverage was higher among children whose mothers had received the anti-tetanus vaccine [OR = 2.1, CI 95% (1.44-3.28)]. However, our study found no difference associated with parents' knowledge about EPI diseases, distance from the health centre, or socio-economic status. Lack of information was one reason given for children not being vaccinated against the six EPI diseases.Conclusion
Three years after the implementation of the priority program (which included decentralization, the active search for missing children, and deployment of health personnel, material and financial resources), our evaluation of the vaccination coverage rates shows that there is improvement in the EPI immunization coverage rate in Kita Circle. The design of our study did not, however, enable us to determine the extent to which different aspects of the program contributed to this increase in coverage. Efforts should nevertheless be continued, in order to reach the goal of 80% immunization coverage.Abstract in French
See the full article online for a translation of this abstract in French.14.
Background
It was long speculated that there could be under-immunized pockets in the war affected Northern part of Sri Lanka relative to other areas. With the cessation of hostilities following the military suppression of the rebellion, opportunities have arisen to appraise the immunization status of children in areas of re-settlement in former war ravaged districts.Methods
We conducted a cross-sectional study to describe the coverage and age appropriateness of infant vaccinations in a former conflict district during the phase of re-settlement. The target population comprised all children of re-settled families in the age group of 12 – 23 months in the district. We selected a study sample of 300 children from among the target population using the WHO’s 30 cluster EPI survey method. Trained surveyors collected data using a structured checklist. The infant vaccination status was ascertained by reviewing vaccination records in the Child Health Development Record or any other alternative documentary evidence.Results
The survey revealed that the proportion of fully vaccinated children in the district was 91%. For individual vaccines, it ranged from 92% (measles) to 100% (BCG, DPT/OPV1). However, the age appropriateness of vaccination was less than 50% for all antigens except for BCG (94%). The maximum number of days of delay of vaccinations ranged from 21 days for BCG to 253 days for measles. Age appropriate vaccination rates significantly differed for DPT/OPV1-3 and measles during the conflict and post-conflict stages while it did not for the BCG. Age appropriate vaccination rates were significantly higher for DPT/OPV1-3 during the conflict while for the measles it was higher in the post conflict stage.Conclusions
Though the vaccination coverage for infant vaccines in the war affected Kilinochchi district was similar to other districts in the country, it masked a disparity in terms of low age-appropriateness of infant immunizations given in field settings. This finding underscores the need for investigation of underlying reasons and introduction of remedial measures in the stage of restoring Primary Health Care services in the ex-conflict zone.15.
Background
The United States is implementing plans to immunize 500,000 hospital-based healthcare workers against smallpox. Vaccination is voluntary, and it is unknown what factors drive vaccine acceptance. This study's aims were to estimate the proportion of workers willing to accept vaccination and to identify factors likely to influence their decisions.Methods
The survey was conducted among physicians, nurses, and others working primarily in emergency departments or intensive care units at 21 acute-care hospitals in 10 states during the two weeks before the U.S. national immunization program for healthcare workers was announced in December 2002. Of the questionnaires distributed, 1,165 were returned, for a response rate of 81%. The data were analyzed by logistic regression and were adjusted for clustering within hospital and for different number of responses per hospital, using generalized linear mixed models and SAS's NLMIXED procedure.Results
Sixty-one percent of respondents said they would definitely or probably be vaccinated, while 39% were undecided or inclined against it. Fifty-three percent rated the risk of a bioterrorist attack using smallpox in the United States in the next two years as either intermediate or high. Forty-seven percent did not feel well-informed about the risks and benefits of vaccination. Principal concerns were adverse reactions and the risk of transmitting vaccinia. In multivariate analysis, four variables were associated with willingness to be vaccinated: perceived risk of an attack, self-assessed knowledge about smallpox vaccination, self-assessed previous smallpox vaccination status, and gender.Conclusions
The success of smallpox vaccination efforts will ultimately depend on the relative weight in people's minds of the risk of vaccine adverse events compared with the risk of being exposed to the disease. Although more than half of the respondents thought the likelihood of a bioterrorist smallpox attack was intermediate or high, less than 10% of the group slated for vaccination has actually accepted it at this time. Unless new information about the threat of a smallpox attack becomes available, healthcare workers' perceptions of the vaccine's risks will likely continue to drive their ongoing decisions about smallpox vaccination.16.
Steven?Mitchell Neil?Andersson Noor?Mohammad?Ansari Khalid?Omer José?Legorreta?Soberanis Anne?Cockcroft 《BMC international health and human rights》2009,9(Z1):S7
Background
Achieving equity means increased uptake of health services for those who need it most. But the poorest families continue to have the poorest service. In Pakistan, large numbers of children do not access vaccination against measles despite the national government's effort to achieve universal coverage.Methods
A cross-sectional study of a random sample of 23 rural and 9 urban communities in the Lasbela district of south Pakistan, explored knowledge, attitudes and discussion around measles vaccination. Several socioeconomic variables allowed examination of the role of inequities in vaccination uptake; 2479 mothers provided information about 4007 children aged 10 to 59 months. A Mantel-Haenszel stratification analysis, with and without adjustment for clustering, clarified determinants of measles vaccination in urban and rural areas.Results
A high proportion of mothers had appropriate knowledge of and positive attitudes to vaccination; many discussed vaccination, but only one half of children aged 10-59 months accessed vaccination. In urban areas, having an educated mother, discussing vaccinations, having correct knowledge about vaccinations, living in a community with a government vaccination facility within 5 km, and living in houses with better roofs were associated with vaccination uptake after adjusting for the effect of each of these variables and for clustering; maternal education was an equity factor even among those with good access. In rural areas, the combination of roof quality and access (vaccination post within 5 km) along with discussion about vaccines and knowledge about vaccines had an effect on uptake.Conclusion
Stagnating rates of vaccination coverage may be related to increasing inequities. A hopeful finding is that discussion about vaccines and knowledge about vaccines had a positive effect that was independent of the negative effect of inequity - in both urban and rural areas. At least as a short term strategy, there seems to be reason to expect an intervention increasing knowledge and discussion about vaccination in this district might increase uptake.17.
Francesco Saverio Mennini Paolo Bonanni Florence Bianic Chiara de Waure Gianluca Baio Giacomo Plazzotta Mathieu Uhart Alessandro Rinaldi Nathalie Largeron 《Cost effectiveness and resource allocation : C/E》2017,15(1):11
Background
In Italy HPV vaccination with the quadrivalent vaccine (Gardasil®) is offered actively and free of charge to girls aged 12 since 2007. A nine-valent vaccine (Gardasil 9®) received the European market authorization in 2015 to protect, with only 2 doses, against around 90% of all HPV positive cancers, over 80% of high-grade precancerous lesions and 90% of genital warts caused by HPV types 6/11.Methods
A dynamic transmission model simulating the natural history of HPV-infections was calibrated to the Italian setting and used to estimate costs and QALYs associated with vaccination strategies. The analyses compared two strategies with the nine-valent vaccine (cervical cancer screening and vaccination in girls only or vaccination in boys and girls) to four alternative strategies (cervical cancer screening and vaccination with quadrialent vaccine in girls only, in both boys and girls, with bivalent vaccine in girls and screening strategy only). The National Health Service perspective was considered.Conclusion
The switch to the nine-valent vaccine in Italy can further reduce the burden associated to cervical cancer and HPV-related diseases and is highly cost-effective.Results
Compared to the current vaccination program with quadrivalent vaccine, the nine-valent vaccine in a programme including girls and boys shows further reductions of 17% in the incidence of cervical cancer, 35 and 14% in anal cancer for males and females, as well as over a million cases of genital warts avoided after 100 years. The new technology is associated with an ICER of 10,463€ per QALY gained in universal vaccination, decreasing to 4483€ when considering the vaccine switch for girls-only.18.
Samuel Bawa Faisal Shuaib Mahmoud Saidu Adamu Ningi Suleiman Abdullahi Bashir Abba Audu Idowu Jibrin Alkasim Kulchumi Hammanyero Charity Warigon Sisay G. Tegegne Richard Banda Charles Korir Yared G. Yehualashet Tesfaye Bedada Chukwuji Martin Peter Nsubuga Usman S. Adamu Bassey Okposen Fiona Braka Alemu Wondimagegnehu Rui G. Vaz 《BMC public health》2018,18(4):1312
Background
The Global Vaccine Action Plan (GVAP) seeks to achieve the total realization of its vision through equitable access to immunization as well as utilizing the immunization systems for delivery of other primary healthcare programs. The inequities in accessing hard-to-reach areas have very serious implications for the prevention and control of vaccine-preventable diseases, especially the polio eradication initiative.The Government of Nigeria implemented vaccination in hard-to-reach communities with support from the World Health Organization (WHO) to address the issues of health inequities in the hard-to-reach communities. This paper documents the process of conducting integrated mobile vaccination in these hard-to-reach areas and the impact on immunization outcomes.Methods
We conducted vaccination using mobile health teams in 2311 hard-to-reach settlements in four states at risk of sustaining polio transmission in Nigeria from July 2014 to September 2015.Results
The oral polio vaccine (OPV)3 coverage among children under 1 year of age improved from 23% at baseline to 61% and OPV coverage among children aged 1–5 years increased from 60 to 90%, while pentavalent vaccine (penta3) coverage increased from 22 to 55%. Vitamin A was administered to 78% of the target population and 9% of children that attended the session were provided with treatment for malaria.Conclusions
The hard-to-reach project has improved population immunity against polio, as well as other routine vaccinations and delivery of child health survival interventions in the hard-to-reach and underserved communities.19.
Ifeoma Blessing Umeh Sunday Odunke Nduka Obinna Ikechukwu Ekwunife 《Cost effectiveness and resource allocation : C/E》2016,14(1):8
Background
Human papilloma virus (HPV) vaccination in Nigeria will require substantial financing due to high cost of HPV vaccine and inexistence of structures to support adolescent vaccination. Alternative sources are needed to sustain the government funded HPV vaccination programme. This study assessed Nigerian mothers’ willingness-to-pay (WTP) for HPV vaccine. We also compared the difference between the average WTP and estimated costs of vaccinating a pre-adolescent girl (CVG).Methods
We conducted a quantitative, cross-sectional, survey-based study in which 50 questionnaires were distributed to each of 10 secondary schools located in two rural and one urban city in Anambra state. The questionnaires were then randomly distributed to girls aged 9–12 years of age to give to their mothers. Contingent valuation approach using the payment card technique was used to estimate the average maximum WTP among the survey participants. Correlates of WTP for HPV vaccination were obtained using multivariate logistic regression. Estimated CVG was obtained by adapting cost of HPV vaccine delivery in Tanzania to the Nigerian setting.Results
A total of 438 questionnaires (88 %) were returned. The average WTP was US$ 11.68. This is opposed to estimated delivery cost of US$ 18.16 and US$ 19.26 for urban and rural populations respectively at vaccine price offered by the Vaccine Alliance (Gavi) and US$ 35.16 and US$ 36.26 for urban and rural populations respectively at the lowest obtainable public sector vaccine price. Demand for HPV vaccine was deemed high (91.6 %) and was significantly associated with respondents previously diagnosed of HPV infection.Conclusion
Demand for HPV vaccine was high although short of estimated CVG. High demand for vaccine should be capitalized upon to increase vaccine uptake. Education on cervical cancer and provider-initiated vaccination should be promoted to increase vaccine uptake. Co-payment could be a feasible financing strategy in the event of national HPV vaccination.20.
Marylène?Dugas Eric?Dubé Bocar?Kouyaté Aboubakary?Sanou Gilles?Bibeau 《BMC international health and human rights》2009,9(Z1):S9