Effect of measles prevalence and vaccination coverage on other disease burden: evidence of measles immune amnesia in 46 African countries

Abstract Background In Japan, mumps vaccination coverage is low, since it is a voluntary vaccination. In this situation, the number of mumps cases as reported by pediatric sentinel hospitals suggests the occurrence of periodical mumps outbreaks. Methods To examine the annual incidences of mumps and mumps-related complications, we analyzed data from the health insurance reimbursement database for subscribers aged 0-64 years between 2005 and 2017. Cases with mumps and mumps-related complications including meningitis, orchitis, deafness, were extracted according to ICD-10 codes entered into the disease section for health insurance reimbursement. Results During the 13 year period, 68,307 of 5,209,660 subjects were reimbursed for mumps, with an incidence of 325 per 100,000 person-years (95% confidence interval (CI): 323-328). Among the 68,307 mumps cases, 787 were reimbursed for mumps-related complications, with an incidence of 11.5 per 1,000 mumps cases (95% CI: 10.7-12.4). Incidence of mumps-related complications (per 1,000 mumps cases) was highest for orchitis (6.6), followed by meningitis (5.8), deafness (1.3), pancreatitis (0.5), and encephalitis (0.3). Mumps incidence was highest among children aged 0-5 years, while incidence of mumps-related complications was highest among adults aged 26-35 years. Conclusions In Japan, the disease burden of mumps remains high among adults, as well as children. Key messages To reduce the disease burden of mumps among all ages in Japan, immunization in childhood is required. A national immunization program for children would result in high vaccination coverage and lower disease burden.

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Institutional mistrust and child vaccination coverage in Africa

BMJ Global Health ◽

10.1136/bmjgh-2020-004595 ◽

2021 ◽

Vol 6 (4) ◽

pp. e004595

Author(s):

Nik Stoop ◽

Kalle Hirvonen ◽

Jean-Francois Maystadt

Keyword(s):

Vaccination Coverage ◽

Fixed Effects ◽

Local Population ◽

Principal Component ◽

Electoral System ◽

Vaccine Hesitancy ◽

Institutional Trust ◽

African Countries ◽

Local Authorities ◽

Child Vaccination

IntroductionDespite considerable improvements in vaccination coverage over the last decade, half of the world’s unvaccinated and undervaccinated children are located in Africa. The role of institutional trust in explaining vaccination gaps has been highlighted in several qualitative reports but so far has only been quantified in a small number of high-income countries.MethodsWe matched information on child vaccination status from the Demographic Health Surveys with information on institutional trust from the Afrobarometer surveys at the subnational level. A total of 166 953 children from 41 surveys administered in 22 African countries covering 216 subnational regions were used. Based on a principal component analysis, we constructed an institutional mistrust index that combined the level of mistrust in the head of state, parliament, electoral system, courts and local government. Associations between institutional mistrust and child vaccination uptake were assessed with multivariable fixed effects logistic regressions that controlled for time-invariant subnational region characteristics and various child, caregiver, household and community characteristics.ResultsA 1 SD increase in the institutional mistrust index was associated with a 10% (95% CI of ORs: 1.03 to 1.18) increase in the likelihood that a child had not received any of eight basic vaccines and with a 6% decrease in the likelihood a child had received all of the basic vaccines (95% CI: 0.92 to 0.97). Institutional mistrust was negatively associated with the likelihood that a child had received each of the eight basic vaccinations (p<0.05).ConclusionsChild vaccination rates in Africa are considerably lower in areas in which the local population displays high levels of mistrust towards local authorities. Institutional mistrust is an important dimension of vaccine hesitancy, considered as one of the most important threats to global health. Empowering local authorities with resources and communication strategies to address institutional mistrust may be needed to close the remaining vaccination gaps in Africa.

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Rotavirus disease burden pre-vaccine introduction in young children in Rural Southern Mozambique, an area of high HIV prevalence

PLoS ONE ◽

10.1371/journal.pone.0249714 ◽

2021 ◽

Vol 16 (4) ◽

pp. e0249714

Author(s):

Sozinho Acácio ◽

Tacilta Nhampossa ◽

Llorenç Quintò ◽

Delfino Vubil ◽

Marcelino Garrine ◽

...

Keyword(s):

Risk Factors ◽

Disease Burden ◽

Conditional Logistic Regression ◽

Epidemiological Data ◽

Daily Basis ◽

African Countries ◽

Severe Diarrhea ◽

Vaccine Introduction ◽

Rotavirus Vaccines ◽

The Impact

Background Rotavirus vaccines have been adopted in African countries since 2009, including Mozambique (2015). Disease burden data are needed to evaluate the impact of rotavirus vaccine. We report the burden of rotavirus-associated diarrhea in Mozambique from the Global Enteric Multicenter Study (GEMS) before vaccine introduction. Methods A case-control study (GEMS), was conducted in Manhiça district, recruiting children aged 0–59 months with moderate-to-severe diarrhea (MSD) and less-severe-diarrhea (LSD) between December 2007 and November 2012; including 1–3 matched (age, sex and neighborhood) healthy community controls. Clinical and epidemiological data and stool samples (for laboratory investigation) were collected. Association of rotavirus with MSD or LSD was determined by conditional logistic regression and adjusted attributable fractions (AF) calculated, and risk factors for rotavirus diarrhea assessed. Results Overall 915 cases and 1,977 controls for MSD, and 431 cases and 430 controls for LSD were enrolled. Rotavirus positivity was 44% (217/495) for cases and 15% (160/1046) of controls, with AF = 34.9% (95% CI: 32.85–37.06) and adjusted Odds Ratio (aOR) of 6.4 p< 0.0001 in infants with MSD compared to 30% (46/155) in cases and 14% (22/154) in controls yielding AF = 18.7%, (95% CI: 12.02–25.39) and aOR = 2.8, p = 0.0011 in infants with LSD. The proportion of children with rotavirus was 32% (21/66) among HIV-positive children and 23% (128/566) among HIV-negative ones for MSD. Presence of animals in the compound (OR = 1.9; p = 0.0151) and giving stored water to the child (OR = 2.0, p = 0.0483) were risk factors for MSD; while animals in the compound (OR = 2.37, p = 0.007); not having routine access to water on a daily basis (OR = 1.53, p = 0.015) and washing hands before cooking (OR = 1.76, p = 0.0197) were risk factors for LSD. Conclusion The implementation of vaccination against rotavirus may likely result in a significant reduction of rotavirus-associated diarrhea, suggesting the need for monitoring of vaccine impact.

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No such thing as a free-rider? Understanding multicountry drivers of childhood and adult vaccination

10.1101/2020.12.07.20245118 ◽

2020 ◽

Author(s):

Frederik Verelst ◽

Roselinde Kessels ◽

Lander Willem ◽

Philippe Beutels

Keyword(s):

Vaccination Coverage ◽

Peer Influence ◽

Disease Burden ◽

Herd Immunity ◽

Free Rider ◽

Vaccine Effectiveness ◽

Vaccine Uptake ◽

Vaccine Hesitancy ◽

Vaccine Preventable Disease ◽

Preventable Disease

AbstractBackgroundIncreased vaccine hesitancy and refusal negatively affects vaccine uptake leading to vaccine preventable disease reemergence. We aimed to quantify the relative importance of characteristics people consider when making vaccine decisions for themselves, or for their child, with specific attention for underlying motives arising from context, such as required effort (accessibility) and opportunism (free riding on herd immunity).MethodsWe documented attitudes towards vaccination and performed a discrete choice experiment in 4802 respondents in The United Kingdom, France and Belgium eliciting preferences for six attributes: (1) vaccine effectiveness, (2) vaccine preventable disease burden, (3) vaccine accessibility in terms of co-payment, vaccinator and administrative requirements, (4) frequency of mild vaccine-related side-effects, (5) vaccination coverage in the country’s population and (6) local vaccination coverage in personal networks. We distinguished adults deciding on vaccination for themselves (‘oneself’ group) from parents deciding for their youngest child (‘child’ group).ResultsWhile all six attributes were found to be significant, vaccine effectiveness and accessibility stand out in all (sub)samples, followed by vaccine preventable disease burden. We confirmed that people attach more value to severity of disease compared to its frequency and discovered that peer influence dominates free-rider motives, especially for the vaccination of children.ConclusionsThese behavioral data are insightful for policy and are essential to parameterize dynamic vaccination behavior in simulation models. In contrast to what most game theoretical models assume, social norms dominate free-rider incentives. Therefore policy-makers and healthcare workers should actively communicate on high vaccination coverage, and draw attention to the effectiveness of vaccines, while optimizing their practical accessibility.

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Comparison of school based and supplemental vaccination strategies in the delivery of vaccines to 5-19 year olds in Africa - a systematic review

F1000Research ◽

10.12688/f1000research.12804.1 ◽

2017 ◽

Vol 6 ◽

pp. 1833 ◽

Cited By ~ 1

Author(s):

Eposi C. Haddison ◽

Leila H. Abdullahi ◽

Rudzani Muloiwa ◽

Gregory D. Hussey ◽

Benjamin M. Kagina

Keyword(s):

Systematic Review ◽

Children And Adolescents ◽

Vaccination Coverage ◽

Age Groups ◽

School Age Children ◽

School Age ◽

African Countries ◽

Routine Immunisation ◽

Public Health Burden ◽

School Based

Background: Some vaccine preventable diseases (VPDs) still remain a public health burden in many African countries. The occurrence of VPDs in all age groups has led to the realization of the need to extend routine immunisation services to school age children, adolescents and adults. Supplemental immunisation activities (SIAs) and school based vaccinations (SBVs) are common strategies used to complement the expanded programme on immunisation (EPI). This review aimed to assess the effectiveness of SIAs compared to SBVs in the administration of vaccines to 5-19 year olds in Africa. Methods: Systematic review methods were used to address our study aim. Several electronic databases were searched up to March 30, 2017 for primary studies investigating the delivery of vaccines via SIAs or SBVs to 5-19 year olds. This search was complemented by browsing reference lists of potential studies obtained from search outputs. Outcomes considered for inclusion were: vaccination coverage, costs of the strategy or its effect on routine immunisation services. Results: Out of the 4938 studies identified, 31 studies met the review inclusion criteria. Both SIAs and SBVs showed high vaccination coverage. However, the SIAs reported higher coverage than SBVs: 91% (95% CI: 84%, 98%) versus 75% (95% CI: 67%, 83%). In most settings, SBVs were reported to be more expensive than SIAs. The SIAs were found to negatively affect routine immunisation services. Conclusions: Both SIAs and SBVs are routinely used to complement the EPI in the delivery of vaccines in Africa. In settings where school enrolment is suboptimal, as is the case in many African countries, our results show SIAs may be more effective in reaching school age children and adolescents than SBVs. Our results re-iterate the importance of evaluating systematic evidence to best inform African authorities on the optimal vaccine delivery strategies targeting school age children and adolescents.

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Census and vaccination coverage of owned dog populations in four resource-limited rural communities, Mpumalanga province, South Africa

Journal of the South African Veterinary Association ◽

10.4102/jsava.v88i0.1529 ◽

2017 ◽

Vol 88 ◽

Author(s):

Anne Conan ◽

Joy A.C. Geerdes ◽

Oluyemisi A. Akerele ◽

Bjorn Reininghaus ◽

Gregory J.G. Simpson ◽

...

Keyword(s):

South Africa ◽

Rural Communities ◽

Vaccination Coverage ◽

Herd Immunity ◽

Public Health Issue ◽

Human Rabies ◽

African Countries ◽

Cross Sectional ◽

Mpumalanga Province ◽

Sub Saharan

Dogs (Canis familiaris) are often free-roaming in sub-Saharan African countries. Rabies virus circulates in many of these populations and presents a public health issue. Mass vaccination of dog populations is the recommended method to decrease the number of dog and human rabies cases. We describe and compare four populations of dogs and their vaccination coverage in four different villages (Hluvukani, Athol, Utah and Dixie) in Bushbuckridge Municipality, Mpumalanga province, South Africa. Cross-sectional surveys were conducted in the villages of Athol, Utah and Dixie, while data from a Health and Demographic Surveillance System were used to describe the dog population in Hluvukani village. All households of the villages were visited to obtain information on the number, sex, age and rabies vaccination status of dogs. From May to October 2013, 2969 households were visited in the four villages and 942 owned dogs were reported. The populations were all young and skewed towards males. No differences were observed in the sex and age distributions (puppies 0–3 months excluded) among the villages. Athol had a higher proportion of dog-owning households than Hluvukani and Utah. Vaccination coverages were all above the 20% – 40% threshold required for herd immunity to rabies (38% in Hluvukani, 51% in Athol, 65% in Dixie and 74% in Utah). For the preparation of vaccination campaigns, we recommend the use of the relatively stable dog:human ratio (between 1:12 and 1:16) to estimate the number of dogs per village in Bushbuckridge Municipality.

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Implementation of Antibody Rapid Diagnostic Testing versus Real-Time Reverse Transcription-PCR Sample Pooling in the Screening of COVID-19: a Case of Different Testing Strategies in Africa

mSphere ◽

10.1128/msphere.00524-20 ◽

2020 ◽

Vol 5 (4) ◽

Cited By ~ 1

Author(s):

Tinashe K. Nyazika ◽

Rabelani Kaela ◽

Mathias Mugoni ◽

Kudakwashe Musomekwa ◽

Eric Kyei-Baafour ◽

...

Keyword(s):

Real Time ◽

Reverse Transcription ◽

Disease Burden ◽

Diagnostic Testing ◽

Single Test ◽

African Countries ◽

Rapid Diagnostic Testing ◽

Reverse Transcription Pcr ◽

Testing Strategies ◽

Sample Pooling

ABSTRACT Coronavirus disease 2019 (COVID-19) has wreaked havoc across the globe; although the number of cases in Africa remains lower than in other regions, it is on a gradual upward trajectory. To date, COVID-19 cases have been reported in 54 out of 55 African countries. However, due to limited severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) real-time reverse transcription-PCR (rRT-PCR) testing capacity and scarcity of testing reagents, it is probable that the total number of cases could far exceed published statistics. In this viewpoint, using Ghana, Malawi, South Africa, and Zimbabwe as examples of countries that have implemented different testing strategies, we argue that the implementation of sample pooling for rRT-PCR over antibody rapid diagnostic testing could have a greater impact in assessing disease burden. Sample pooling offers huge advantages compared to single test rRT-PCR, as it reduces diagnostic costs, personnel time, burnout, and analytical run times. Africa is already strained in terms of testing resources for COVID-19; hence, cheaper alternative ways need to be implemented to conserve resources, maximize mass testing, and reduce transmission in the wider population.

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No Such Thing as a Free-Rider? Understanding Drivers of Childhood and Adult Vaccination through a Multicountry Discrete Choice Experiment

Vaccines ◽

10.3390/vaccines9030264 ◽

2021 ◽

Vol 9 (3) ◽

pp. 264

Author(s):

Frederik Verelst ◽

Roselinde Kessels ◽

Lander Willem ◽

Philippe Beutels

Keyword(s):

Discrete Choice Experiment ◽

Discrete Choice ◽

Vaccination Coverage ◽

Choice Experiment ◽

Disease Burden ◽

Free Rider ◽

Vaccine Effectiveness ◽

Vaccine Uptake ◽

Vaccine Preventable Disease ◽

Preventable Disease

Increased vaccine hesitancy and refusal negatively affects vaccine uptake, leading to the reemergence of vaccine preventable diseases. We aim to quantify the relative importance of factors people consider when making vaccine decisions for themselves, or for their child, with specific attention for underlying motives arising from context, such as required effort (accessibility) and opportunism (free riding on herd immunity). We documented attitudes towards vaccination and performed a discrete choice experiment in 4802 respondents in The United Kingdom, France and Belgium, eliciting preferences for six attributes: (1) vaccine effectiveness, (2) vaccine preventable disease burden, (3) vaccine accessibility in terms of copayment, vaccinator and administrative requirements, (4) frequency of mild vaccine-related side-effects, (5) vaccination coverage in the country’s population and (6) local vaccination coverage in personal networks. We distinguished adults deciding on vaccination for themselves from parents deciding for their youngest child. While all attributes were found to be significant, vaccine effectiveness and accessibility stood out in all (sub)samples, followed by vaccine preventable disease burden. We confirmed that people attach more value to severity of disease compared to its frequency, and discovered that peer influence dominates free-rider motives, especially for the vaccination of children. These behavioral data are insightful for policy and are essential to parameterize dynamic vaccination behavior in simulation models. In contrast to what most game theoretical models assume, social norms dominate free-rider incentives. Policy-makers and healthcare workers should actively communicate on high vaccination coverage, and draw attention to the effectiveness of vaccines while optimizing their practical accessibility.

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Multilevel Analysis of Individual and Contextual Factors Associated with Polio Non-Vaccination in Africa: Further Analyses to Enhance Policy and Opportunity to Save More Lives

Vaccines ◽

10.3390/vaccines9070683 ◽

2021 ◽

Vol 9 (7) ◽

pp. 683

Author(s):

Olalekan A. Uthman ◽

Duduzile Ndwandwe ◽

Muhammed M. B. Uthman ◽

Sanni Yaya ◽

Charles S. Wiysonge

Keyword(s):

Vaccination Coverage ◽

Formal Education ◽

Contextual Factors ◽

African Countries ◽

Factors Associated ◽

Country Level ◽

Polio Vaccination ◽

Level 3 ◽

The Individual ◽

Free Status

Background: Africa was certified polio-free in 2020 and to maintain the polio-free status, African countries need to attain and maintain optimal routine polio vaccination coverage. One indicator for optimal polio vaccination coverage is the prevalence of children who have received no polio vaccination through routine services. The objective of the study was to examine the individual-, neighbourhood-, and country-level factors associated with non-vaccination against polio in Africa. Methods: We applied multivariable multilevel logistic regression analyses on recent demographic and health survey data collected from 2010 onwards in Africa. We identified 64,867 children aged 12–23 months (Level 1) nested within 16,283 neighbourhoods (Level 2) from 32 countries (Level 3). Results: The prevalence of non-vaccination for polio ranged from 2.19% in Egypt to 32.74% in Guinea. We found the following factors to be independent predictors of the increased odds of non-vaccination for polio: being a male child, born to mother with no formal education, living in poorer households; being from a polygamous family, living in neighbourhoods with high maternal illiteracy, high unemployment rate, and low access to media. Conclusions: We found that both individual and contextual factors are associated with non-vaccination for Polio.

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Crude childhood vaccination coverage in West Africa: Trends and predictors of completeness

Wellcome Open Research ◽

10.12688/wellcomeopenres.10690.1 ◽

2017 ◽

Vol 2 ◽

pp. 12 ◽

Cited By ~ 14

Author(s):

Jacob S. Kazungu ◽

Ifedayo M.O. Adetifa

Keyword(s):

West Africa ◽

Health Facility ◽

Vaccination Coverage ◽

Maternal Education ◽

Sub Saharan Africa ◽

Childhood Vaccination ◽

Demographic And Health Surveys ◽

African Countries ◽

High Coverage ◽

Country Specific

Background: Africa has the lowest childhood vaccination coverage worldwide. If the full benefits of childhood vaccination programmes are to be enjoyed in sub-Saharan Africa, all countries need to improve on vaccine delivery to achieve and sustain high coverage. In this paper, we review trends in vaccination coverage, dropouts between vaccine doses and explored the country-specific predictors of complete vaccination in West Africa. Methods: We utilized datasets from the Demographic and Health Surveys Program, available for Benin, Burkina Faso, The Gambia, Ghana, Guinea, Cote d’Ivoire, Liberia, Mali, Niger, Nigeria, Senegal, Sierra Leone and Togo, to obtain coverage for Bacillus Calmette-Guerin, polio, measles, and diphtheria, pertussis and tetanus (DPT) vaccines in children aged 12 – 23 months. We also calculated the DPT1-to-DPT3 and DPT1-to-measles dropouts, and proportions of the fully immunised child (FIC). Factors predictive of FIC were explored using Chi-squared tests and multivariable logistic regression. Results: Overall, there was a trend of increasing vaccination coverage. The proportion of FIC varied significantly by country (range 24.1-81.4%, mean 49%). DPT1-to-DPT3 dropout was high (range 5.1% -33.9%, mean 16.3%). Similarly, DPT1-measles dropout exceeded 10% in all but four countries. Although no single risk factor was consistently associated with FIC across these countries, maternal education, delivery in a health facility, possessing a vaccine card and a recent post delivery visit to a health facility were the key predictors of complete vaccination. Conclusions: The low numbers of fully immunised children and high dropout between vaccine doses highlights weaknesses and the need to strengthen the healthcare and routine immunization delivery systems in this region. Country-specific correlates of complete vaccination should be explored further to identify interventions required to increase vaccination coverage. Despite the promise of an increasing trend in vaccination coverage in West African countries, more effort is required to attain and maintain global vaccination coverage targets.

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