Process evaluation of pulse polio immunisation in Delhi

The aim of the study was to assess the functional aspects and the staffing at Pulse Polio immunisations posts. Interns and medical students conducted the survey in eighty seven pulse polio immunisation posts scattered all over National Capital Territory of Delhi on 18th January 1997. A lire-tested structured format containing information pertaining to dose utilisation and staffing was filled. Number of children given pulse polio was on an average 459.2 per immunisation post (474.7 rural, 516.35 slums and 435.0 urban). Average number of neonates (below one month) per immunisation post given polio drops was 5.1 (1.1%). The break-up for rural area, slums and urban area was 3.0 (0.63%), 6.7 (1.30%) and 4.9 (1.13%) respectively. By 12 pm, 67.8% and by 2 pm 88.7% of the doses had been administered. Staffing at most of the immunisation posts was adequate for all categories of staff except doctors (0.48 per booth).     

Impact of annual immunisation programme with oral polio vaccine on the prevalence of paralytic poliomyelitis

Lameness survey was conducted in a rural community development block of Haryana in 1985. Enumerators contacted school teachers, anganwadi workers and several key informants in the community to identify lame children in 1–11 years agegroup. Physician verified 219 lame cases to be due to poliomyelitis. Prevalence of poliomyelitis lameness was 7.3/ 1000 children born in 1974–76, 7.7/1000 children born in 1977–1980 and 2.3/1000 children born in 1981–1984 (expected to increase to 3.1/1000 when all children born in 1981–84 cross 5th year of life). Immmunisation coverage with 3 doses of oral polio vaccine (OPV) was less than 10% during 1974–80 when immunisation was a clinic based activity. Coverages increased from 50 to 80% during 1981–85 when OPV was given in annual immunisation campaign. The results indicate that prevalence of paralytic poliomyelitis dropped at least by 60% after giving OPV in annual immunisation campaigns.     

Awareness about vaccine vial monitor at pulse polio booths

All members present on booth, working on National Immunization Day during January and February, 2007 were interviewed by using predesigned and pretested questionnaires to assess their awareness regarding type of OPV and VVM in urban areas of Valsad district. Correct identification of trivalent OPV was highest (54.8%) among health staff members working at booths, but for monovalent OPV it was poor (38.7%). More than half (51.6%) of staff members interviewed had not heard of VVM. Awareness was very poor for VVM among those who have heard regarding its function, how to read VVM and when OPV should be discarded.     

Evaluation of pulse polio immunisation (1996) in Chandigarh, India

An evaluation survey on pulse polio immunization (PPI) was conducted in Union Territory of Chandigarh with a population of 88, 100 children under the age of five years. Information was collected by interviewing the companions of 438 children in 18 polio centres, selected by stratified random sampling. Participation of children in the age-group of 4 and 5 years was found to be low. Awareness regarding various components of pulse polio immunization was found to be good in urban areas whereas it was unsatisfactory in slums. Two-dose-coverage of polio drops in 1996 campaign was recorded to be 81.5%. High risk pockets like slums need more attention for the success of polio eradication.     

Evaluation of pulse polio and routine immunisation coverage: Alwar district, Rajasthan

During the last decade, India achieved 88% reduction in reported poliomyelitis incidence. However, absolute number of reported cases still remains high. As an added effort to eradicate the disease, the country observed its first National Immunisation Days (NIDs) on 9.12.95 and 20.1.96. The present study evaluates the performance of Alwar district, Rajasthan. Modified 30 cluster technique was used to collect information. Overall coverage in rural and urban areas was 89% and 91% respectively. Main source of information was television in urban and health staff in rural areas. Most of the respondents knew about the usefulness of such special activity and had favourable opinion about the facilities provided. Urban Alwar had 80% OPV3 coverage but, in rural area it was almost half. The reported coverage of NIDs and UIP was found to be conflicting with the study results. The existing “dose enumeration method” of calculating reported coverage was attributed to be the cause. The study emphasises the need to incorporate an in-built community-based evaluation of future NIDs and utilisation of such results for planning.     

Measles immunisation coverage in urban slums

A cross-sectional, community-based study was conducted in 32 slums of Udaipur city to assess the prevalence of missed opportunities for measles immunisation, reason for their occurrence and potential impact of avoiding them on measles immunisation coverage. Two hundred and sixty five children, between the age of 9 and 24 months were enlisted for the study, using a practical cluster sampling method. Immunisation status of the children, visits to health facilities after 9 months of age and reasons for non-immunisation were noted. Missed opportunities for measles immunisation was defined as any visit by an eligible child to a health facility, which did not result in his/her vaccination. Measles immunisation coverage amongst the study population was 50.61%. The prevalence of missed opportunities for measles immunisation was 14.3%. Not offering measles immunisation at curative visits (86.9%) was the major reason for missing opportunities. Avoiding all missed opportunities could have increased the measles immunisation coverage to 64.9%.     

Prevalence of recent immunisation in children with febrile convulsions

AIM: To determine the prevalence of recent immunisation amongst children under 7 years of age presenting for febrile convulsions. METHODS: This is a retrospective study of all children under the age of seven presenting with febrile convulsions to a tertiary referral hospital in Sydney. A total of 78 cases occurred in the period January 2011 to July 2012 and were included in the study. Data was extracted from medical records to provide a retrospective review of the convulsions. RESULTS: Of the 78 total cases, there were five medical records which contained information on whether or not immunisation had been administered in the preceding 48 h to presentation to the emergency department. Of these five patients only one patient (1.28% of the study population) was confirmed to have received a vaccination with Infanrix, Prevnar and Rotavirus. The majority of cases reported a current infection as a likely precipitant to the febrile convulsion. CONCLUSION: This study found a very low prevalence of recent immunisation amongst children with febrile convulsions presenting to an emergency department at a tertiary referral hospital in Sydney. This finding, however, may have been distorted by underreporting of vaccination history.     

Manpower utilization in pulse polio immunization

The present study was conducted in Union Territory of Chandigarh to find out the utilization pattern of manpower engaged in the implementation of Pulse Polio Campaign (PPI) on 7th December, 1997 with the objective to achieve a coverage close to 100% and thereby, eradicating poliomyelitis. Over 100,000 under-five children were expected to participate on PPI day. Out of 240 polio centres established in the Union Territory, 16 were selected by stratified random sampling covering 14,858 children. The observing teams recorded the information about the children and presence of staff members throughout the day between 8.00 a.m. and 5.00 p.m. It was observed that nearly half of the children received the polio drops within the first three hours while only a little over 5% visited polio centres in the last two hours. The average number of manpower varied between 5 and 6 throughout the day (more than the recommended four). The staff posted at urban, rural and slum centres did not visit the houses except for the few volunteers in slums. Unimmunized children should be identified by the staff in last two hours when the load at polio centres is extremely low. Adequate utilization of the full potential of the manpower will help in enhancing the PPI coverage close to 100%.     

Epidemiological evaluation of oral polio vaccine efficacy in Delhi

Forty seven cases of poliomyelitis and 94 controls were studied for immunization status. Unmatched analysis with one control per case and two controls per case was done to find out the ratio of the odds of immunization in diseased individuals as compared with the nondiseased (odds ratio). This ratio (OR) was used further to calculate oral polio vaccine efficacy. OPV efficacy was found to be 93% with 95% confidence limits of 75–98%.     

Potency of oral polio vaccine stored at distribution centers in madras

This study was done with the objective to measure, monitor, and document the potency of oral polio vaccine and the storage conditions in the city of Madras for a period of one year from May 88. The Corporation of Madras which takes care of indenting and supplying the vaccine has 87 centers for storage and distribution. We took 12 samples a month from these centers by stratified random sampling technique adopting proportionate sampling. The samples were coded and sent to the laboratory. The investigator noted the storage conditions in a specially designed data card. Results were notified to the managers concerned. 122 samples were tested out of which 28 (23%) showed loss of potency (< log 10584). The loss of potency is statistically significant in centers not having dial thermometer and where inappropriate carrier was used for transport of vaccine. It was least in Maternity and Child Health Centers probably due to the orientation of the personnel. The frequency of loss of potency was more in the beginning of the study and decreased as the study progressed. Monitoring of storage conditions and potency of vaccine along with periodic training and reorientation of health personnel are stressed.     

Apnoea and bradycardia in preterm infants following immunisation with pentavalent or hexavalent vaccines

There is a lack of data regarding the incidence and clinical significance of apnoea or bradycardia (AB) following immunisation with combination vaccines containing an acellular pertussis (Pa) component in respiratory stable preterm infants. Medical records of respiratory stable preterm infants who received a first dose of a combined diphtheria (D) and tetanus (T) toxoids, Pa, Haemophilus influenzae type b (Hib), inactivated poliovirus (IPV) vaccine with or without hepatitis B virus (HBV) in the neonatal intensive care unit (NICU) of the University Childrens Hospital Basel between January 2000 and June 2003 were analysed. For each infant, clinical data were recorded for a 72 h period before and after immunisation. Of 53 infants with a mean gestational age of 28 weeks, 7 (13%) showed a transient recurrence of or increase in episodes of AB following immunisation. Five of these seven infants required intervention ranging from tactile stimulation to bag and mask ventilation. Regarding risk factors, children with recurrent or increased AB were indistinguishable from those without such events. The rate of fever (>38°C) following immunisation was higher in affected infants compared to those without recurrence of or increase in AB (3/7 vs 2/46, P =0.01). Conclusion:Although most infants tolerated immunisation well, the incidence of recurrent or increased apnoea or bradycardia in respiratory stable preterm infants following the first immunisation with penta- or hexavalent vaccines was 13%. Most apnoea or bradycardia events required intervention but did not have serious consequences. Monitoring of all preterm infants following immunisation in the neonatal intensive care unit is recommended.