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WHAT'S NEW THIS TUESDAY; FIVE ON ROUTINE IMMUNIZATION

Sunday, 22nd of July 2012

FIVE ON ROUTINE IMMUNIZATION

Healthcare workers’ role in keeping MMR vaccination uptake high in Europe: a review of evidence

Abstract below; full text is at http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20206

Eurosurveillance, Volume 17, Issue 26, 28 June 2012

Review articles

B Simone^1,2, P Carrillo-Santisteve¹, P L Lopalco ( )¹

European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
Institute of Hygiene, Universitá Cattolica del Sacro Cuore, Rome, Italy

Measles is a highly contagious and potentially fatal disease. Europe is far from the 95% coverage rates necessary for elimination of the disease, although a safe and cost-effective vaccine is available. We reviewed the literature on studies carried out in European countries from January 1991 to September 2011 on knowledge, attitudes and practices of health professionals towards measles vaccination and on how health professionals have an impact on parental vaccination choices. Both quantitative and qualitative studies were considered: a total of 28 eligible articles were retrieved. Healthcare workers are considered by parents as a primary and trustworthy source of information on childhood vaccination. Gaps in knowledge and poor communication from healthcare workers are detrimental to high immunisation rates. Correct and transparent information for parents plays a key role in parental decisions on whether to have their children vaccinated. Healthcare workers’ knowledge of and positive attitudes towards measles-mumps-rubella (MMR) vaccination are crucial to meeting the measles elimination goal. An effort should be made to overcome potential communication barriers and to strengthen vaccine education among healthcare professionals.

· INDIVIDUAL AND CONTEXTUAL FACTORS ASSOCIATED WITH LOW CHILDHOOD IMMUNISATION COVERAGE IN SUB-SAHARAN AFRICA: A MULTILEVEL ANALYSIS

Wiysonge CS, Uthman OA, Ndumbe PM, Hussey GD.

Source

Vaccines for Africa Initiative, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa.

Abstract below; full text is at http://dx.plos.org/10.1371/journal.pone.0037905

BACKGROUND:

In 2010, more than six million children in sub-Saharan Africa did not receive the full series of three doses of the diphtheria-tetanus-pertussis vaccine by one year of age. An evidence-based approach to addressing this burden of un-immunised children requires accurate knowledge of the underlying factors. We therefore developed and tested a model of childhood immunisation that includes individual, community and country-level characteristics.

METHOD AND FINDINGS:

We conducted multilevel logistic regression analysis of Demographic and Health Survey data for 27,094 children aged 12-23 months, nested within 8,546 communities from 24 countries in sub-Saharan Africa. According to the intra-country and intra-community correlation coefficient implied by the estimated intercept component variance, 21% and 32% of the variance in unimmunised children were attributable to country- and community-level factors respectively. Children born to mothers (OR 1.35, 95%CI 1.18 to 1.53) and fathers (OR 1.13, 95%CI 1.12 to 1.40) with no formal education were more likely to be unimmunised than those born to parents with secondary or higher education. Children from the poorest households were 36% more likely to be unimmunised than counterparts from the richest households. Maternal access to media significantly reduced the odds of children being unimmunised (OR 0.94, 95%CI 0.94 to 0.99). Mothers with health seeking behaviours were less likely to have unimmunised children (OR 0.56, 95%CI 0.54 to 0.58). However, children from urban areas (OR 1.12, 95% CI 1.01 to 1.23), communities with high illiteracy rates (OR 1.13, 95% CI 1.05 to 1.23), and countries with high fertility rates (OR 4.43, 95% CI 1.04 to 18.92) were more likely to be unimmunised.

CONCLUSION:

We found that individual and contextual factors were associated with childhood immunisation, suggesting that public health programmes designed to improve coverage of childhood immunisation should address people, and the communities and societies in which they live.

INEQUITY IN CHILDHOOD IMMUNIZATION IN INDIA

Key messages below; full text, http://www.indianpediatrics.net/mar2012/203.pdf

• There are limited nation-wide data exploring inequity in childhood immunization in India; among these the three National Family Health Surveys are methodologically the most robust. Data from an apparently methodologically robust ICMR survey in 1999 was not corroborated by contemporary NFHS survey data.

• Data from smaller, focused surveys often yielded conclusions similar to the NFHS data; however in some cases there were clear differences in the conclusions.

• There is a high level of disparity in vaccination coverage in different states. The traditionally poor performing states have greater inequities; however there is significant inequity even among better performing states.

• There are considerable inequities in childhood vaccination by various individual (gender, birth order), family (area of residence, wealth, parental education), social (religion, caste), and societal (access to health-care, community literacy level) characteristics.

• In general, girls fare worse than boys; there is an almost 5% relative difference between boys and girls. Higher birth order infants have lower vaccination rate; the precise reasons for this have not been elucidated.

• Urban infants have higher coverage than rural infants and those living in urban slums. There is an almost direct relationship between household wealth and vaccination rates.

• The vaccination rates are lower among infants with mothers having no or low literacy, and families with insufficient empowerment of women. Paternal literacy has an inconsistent positive relationship with infant vaccination.

• There is a relationship between religion and caste, and childhood vaccination; however data are limited to determine whether these are independent influences or reflections of other inequities.

• Access to health services and other infrastructure, is associated with better vaccination coverage of infants.

• The precise impact of specific risk factors operating singly or in combination cannot be calculated from this systematic review; however it provides directions for targeting the most vulnerable sections of the population.

GLOBAL IMMUNIZATION VISION AND STRATEGY (GIVS): A MID-TERM ANALYSIS OF PROGRESS IN 50 COUNTRIES

Health Policy Plan. 2012 Mar 12. [Epub ahead of print]

Kamara L, Lydon P, Bilous J, Vandelaer J, Eggers R, Gacic-Dobo M, Meaney W, Okwo-Bele JM.

Abstract below; full text available to journal subscribers

Source

Immunization Vaccines and Biologicals Department (IVB), Expanded Program on Immunization (EPI), World Health Organization, Geneva, Switzerland, Geneva Switzerland, Health Program Division, UNICEF, New York, USA, Athlone Institute of Technology, Athlone, Ireland.

Abstract

Within the overall framework set out in the Global Immunization Vision and Strategy (GIVS) for the period 2006-2015, over 70 countries had developed comprehensive Multi-Year Plans (cMYPs) by 2008, outlining their plans for implementing the GIVS strategies and for attaining the GIVS Goals at the midpoint in 2010 or earlier. These goals are to: (1) reach ≥90% and ≥80% vaccination coverage at national and district level, respectively; and (2) reduce measles-related mortality by 90% compared with the 2000 level. Fifty cMYPs were analysed along the four strategic areas of the GIVS: (1) protecting more people in a changing world; (2) introducing new vaccines and technologies; (3) integrating immunization, other health interventions and surveillance in the health system context; and (4) immunizing in the context of global interdependence. By 2010, all 50 countries planned to have introduced hepatitis B (HepB) vaccine, 48 the Haemophilus influenzae type B (Hib) vaccine and only a few countries had firm plans to introduce pneumococcal or rotavirus vaccines. Countries seem to be inadequately prepared in terms of cold-chain requirements to deal with the expected increases in storage that will be required for vaccines, and in making provisions to establish a corresponding surveillance system for planned new vaccine introductions. Immunization contacts are used to deliver other health interventions, especially in the countries in the World Health Organization (WHO) Africa Region. The cost for the planned immunization activities will double to U$27 per infant, of which U$5 per infant is the expected shortfall. Global Alliance for Vaccines and Immunization (GAVI) funding is becoming the largest contributor to immunization programmes.

NEW INVESTMENT TOPS YEAR OF PROGRESS IN PROVIDING WORLD'S POOREST CHILDREN WITH EQUITABLE ACCESS TO LIFE-SAVING VACCINES

WASHINGTON, D.C. 13 June 2012 — Seeking to address the devastating resurgence of measles, the GAVI Alliance will provide up to an additional US$ 162 million to control and prevent outbreaks in developing countries. This funding will help countries bridge critical gaps in their efforts to build sustainable systems to control this deadly disease.

GAVI will exceptionally make up to US$ 107 million available for measles control and prevention in six high-risk countries: Afghanistan, Chad, DR Congo, Ethiopia, Nigeria and Pakistan. A further US$ 55 million will be offered through the Measles & Rubella Initiative for rapid response vaccination campaigns in GAVI-eligible countries where outbreaks occur.

Delivering on the promise

Today's decision by the GAVI Board tops a year of progress outlined in a report card reviewing developments since GAVI's first pledging conference on 13 June 2011, at which donors pledged funding to immunise an additional 250 million children by 2015 to save four million lives.

By targeting measles we can have a major impact on health equity and ensure that people are protected against this disease no matter where they live.

Dagfinn Høybråten, Chair of the GAVI Alliance Board

The increased measles support, between now and 2017, will strengthen routine immunisation systems and follows a decision last November to provide more than US$ 600 million to tackle rubella through a combined measles-rubella (MR) vaccine. It is expected that 48 countries will introduce the MR vaccine by 2018 with GAVI’s support.

“By targeting measles we can have a major impact on health equity and ensure that people are protected against this disease no matter where they live,” said Dagfinn Høybråten, Chair of the GAVI Alliance Board. “This strategic investment is critical for the countries where children are at highest risk of infection.”

Canary in the coal mine

Measles is highly infectious and can cause serious illness, life-long disability, and death. In 1980, before widespread use of a global vaccine, an estimated 2.6 million people died worldwide. Increased routine vaccination has led to a 74% drop in measles mortality, from an estimated 535,000 deaths in 2000 to 139,000 in 2010. Rubella is the leading cause of vaccine-preventable birth defects leading to life-long disabilities.

In recent years, however, progress at further reducing the measles death toll has stalled due to outbreaks in Africa and a high disease burden in India.

“Measles is the ‘canary in the coal mine’ because outbreaks can signal that routine immunisation coverage is faltering,” said Dr Seth Berkley, CEO of the GAVI Alliance. “In order to eliminate measles, vaccine coverage must be at least 90 % so that adequate herd immunity is created. Fighting back when outbreaks occur and ensuring high routine coverage are critical to controlling measles and all other vaccine-preventable diseases.”

Over the past year, a growing number of new private donors have joined GAVI’s mission. The Church of Jesus Christ of Latter-day Saints announced a US$ 1.5 million gift yesterday, which was doubled through the GAVI Matching Fund by the Bill & Melinda Gates Foundation. The gift makes the Church-sponsored LDS Charities the seventh partner in the programme.