Implementing WHO guidance on conducting and analysing vaccination coverage cluster surveys: Two examples from Nigeria

In 2015, the World Health Organization substantially revised its guidance for vaccination coverage cluster surveys (revisions were finalized in 2018) and has since developed a set of accompanying resources, including definitions for standardized coverage indicators and software (named the Vaccination Coverage Quality Indicators—VCQI) to calculate them.–The current WHO vaccination coverage survey manual was used to design and conduct two nationally representative vaccination coverage surveys in Nigeria–one to assess routine immunization and one to measure post-measles campaign coverage. The primary analysis for both surveys was conducted using VCQI. In this paper, we describe those surveys and highlight some of the analyses that are facilitated by the new resources. In addition to calculating coverage of each vaccine-dose by age group, VCQI analyses provide insight into several indicators of program quality such as crude coverage versus valid doses, vaccination timeliness, missed opportunities for simultaneous vaccination, and, where relevant, vaccination campaign coverage stratified by several parameters, including the number of previous doses received. The VCQI software furnishes several helpful ways to visualize survey results. We show that routine coverage of all vaccines is far below targets in Nigeria and especially low in northeast and northwest zones, which also have highest rates of dropout and missed opportunities for vaccination. Coverage in the 2017 measles campaign was higher and showed less geospatial variation than routine coverage. Nonetheless, substantial improvement in both routine program performance and campaign implementation will be needed to achieve disease control goals.

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Implementing WHO Guidance on Conducting and Analysing Vaccination Coverage Cluster Surveys: Two Examples from Nigeria

10.20944/preprints202009.0645.v2 ◽

2020 ◽

Author(s):

John Ndegwa Wagai ◽

Dale A. Rhoda ◽

Mary L. Prier ◽

Mary Kay Trimner ◽

Caitlin B. Clary ◽

...

Keyword(s):

Vaccination Coverage ◽

Vaccination Campaign ◽

Vaccine Dose ◽

Substantial Improvement ◽

World Health ◽

Primary Analysis ◽

Missed Opportunities ◽

Campaign Coverage ◽

Nationally Representative ◽

Health Organization

In 2015, the World Health Organization substantially revised its guidance for vaccination coverage cluster surveys (revisions were finalized in 2018) and has since developed a set of accompanying resources, including definitions for standardized coverage indicators and software (named the Vaccination Coverage Quality Indicators - VCQI) to calculate them. The current WHO vaccination coverage survey manual was used to design and conduct two nationally representative vaccination coverage surveys in Nigeria – one to assess routine immunization and one to measure post-measles campaign coverage. The primary analysis for both surveys was conducted using VCQI. In this paper, we describe those surveys and highlight some of the analyses that are facilitated by the new resources. In addition to calculating coverage of each vaccine-dose by age group, VCQI analyses provide insight into several indicators of program quality such as crude coverage versus valid doses, vaccination timeliness, missed opportunities for simultaneous vaccination, and, where relevant, vaccination campaign coverage stratified by several parameters, including the number of previous doses received. The VCQI software furnishes several helpful ways to visualize survey results. We show that routine coverage of all vaccines is far below targets in Nigeria and especially low in northeast and northwest zones, which also have highest rates of dropout and missed opportunities for vaccination. Coverage in the 2017 measles campaign was higher and showed less geospatial variation than routine coverage. Nonetheless, substantial improvement in both routine program performance and campaign implementation will be needed to achieve disease control goals.

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Implementing WHO Guidance on Conducting and Analysing Vaccination Coverage Cluster Surveys: Two Examples from Nigeria

10.20944/preprints202009.0645.v1 ◽

2020 ◽

Author(s):

John Ndegwa Wagai ◽

Dale A. Rhoda ◽

Mary L. Prier ◽

Mary Kay Trimner ◽

Caitlin Clary ◽

...

Keyword(s):

Vaccination Coverage ◽

Vaccination Campaign ◽

World Health ◽

Guidance Document ◽

Primary Analysis ◽

Missed Opportunities ◽

Campaign Coverage ◽

Survey Results ◽

Nationally Representative ◽

Health Organization

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Use of the revised World Health Organization cluster survey methodology to classify measles-rubella vaccination campaign coverage in 47 counties in Kenya, 2016

PLoS ONE ◽

10.1371/journal.pone.0199786 ◽

2018 ◽

Vol 13 (7) ◽

pp. e0199786 ◽

Cited By ~ 4

Author(s):

Saleena Subaiya ◽

Collins Tabu ◽

James N’ganga ◽

Abdulkadir Amin Awes ◽

Kibet Sergon ◽

...

Keyword(s):

World Health Organization ◽

Survey Methodology ◽

Vaccination Campaign ◽

World Health ◽

Cluster Survey ◽

Campaign Coverage ◽

Health Organization ◽

Rubella Vaccination

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Vaccination Coverage for Routine Vaccines and Herd Immunity Levels against Measles and Pertussis in the World in 2019

Vaccines ◽

10.3390/vaccines9030256 ◽

2021 ◽

Vol 9 (3) ◽

pp. 256

Author(s):

Pedro Plans-Rubió

Keyword(s):

Vaccination Coverage ◽

Action Plan ◽

Herd Immunity ◽

World Health ◽

Immunization Programs ◽

National Immunization ◽

The World ◽

Measles Vaccination ◽

The Mean ◽

Health Organization

In 2012, the World Health Organization (WHO) established the Global Vaccine Action Plan with the objective to promote essential vaccinations in all countries and achieve at least 90% vaccination coverage for all routine vaccines by 2020. The study assessed the mean percentages of vaccination coverage in 2019 for 13 routine vaccines, vaccination coverage variation from 2015 to 2019, and herd immunity levels against measles and pertussis in 2019 in countries and regions of WHO. In 2019, the mean percentages of vaccination coverage were lower than 90% for 10 (78.9%) routine vaccines. The mean percentages of vaccination coverage also decreased from 2015 to 2019 for six (46.2%) routine vaccines. The prevalence of individuals with vaccine-induced measles immunity in the target measles vaccination population was 88.1%, and the prevalence of individuals with vaccine-induced pertussis immunity in the target pertussis vaccination population was 81.1%. Herd immunity against measles viruses with Ro = 18 was established in 63 (32.5%) countries but not established in any region. Herd immunity against pertussis agents was not established in any country and in any region of WHO. National immunization programs must be improved to achieve ≥90% vaccination coverage in all countries and regions. Likewise, it is necessary to achieve ≥95% vaccination coverage with two doses of measles vaccines and three doses of pertussis vaccines in all countries and regions.

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Are the Objectives Proposed by the WHO for Routine Measles Vaccination Coverage and Population Measles Immunity Sufficient to Achieve Measles Elimination from Europe?

Vaccines ◽

10.3390/vaccines8020218 ◽

2020 ◽

Vol 8 (2) ◽

pp. 218

Author(s):

Pedro Plans-Rubió

Keyword(s):

World Health Organization ◽

Vaccination Coverage ◽

Herd Immunity ◽

World Health ◽

Measles Elimination ◽

Reproduction Numbers ◽

The World ◽

Measles Vaccination ◽

Health Organization ◽

Measles Vaccination Coverage

Background: The World Health Organization (WHO) proposed two-dose measles vaccination coverage of at least 95% of the population and percentages of measles immunity in the population of 85%−95% in order to achieve measles elimination in Europe. The objectives of this study were: (1) to determine the measles vaccination coverage required to establish herd immunity against measles viruses with basic reproduction numbers (Ro) ranging from 6 to 60, and (2) to assess whether the objectives proposed by the WHO are sufficient to establish herd immunity against measles viruses. Methods: The herd immunity effects of the recommended objectives were assessed by considering the prevalence of protected individuals required to establish herd immunity against measles viruses with Ro values ranging from 6 to 60. Results: The study found that percentages of two-dose measles vaccination coverage from 88% to 100% could establish herd immunity against measles viruses with Ro from 6 to 19, assuming 95% measles vaccination effectiveness. The study found that the objective of 95% for two-dose measles vaccination coverage proposed by the WHO would not be sufficient to establish herd immunity against measles viruses with Ro ≥ 10, assuming 95% measles vaccination effectiveness. By contrast, a 97% measles vaccination coverage objective was sufficient to establish herd immunity against measles viruses, with Ro values from 6 to 13. Measles immunity levels recommended in individuals aged 1−4 years (≥85%) and 5−9 years (≥90%) might not be sufficient to establish herd immunity against most measles viruses, while those recommended in individuals aged 10 or more years (≥95%) could be sufficient to establish herd immunity against measles viruses with Ro values from 6 to 20. Conclusion: To meet the goal of measles elimination in Europe, it is necessary to achieve percentages of two-dose measles vaccination coverage of at least 97%, and measles immunity levels in children aged 1−9 years of at least 95%.

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Insights on exclusive breastfeeding norms in Kinshasa: findings from a qualitative study

BMC Pregnancy and Childbirth ◽

10.1186/s12884-020-03273-4 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Francine E. Wood ◽

Anastasia J. Gage ◽

Dieudonné Bidashimwa

Keyword(s):

Social Norms ◽

Exclusive Breastfeeding ◽

Democratic Republic Of Congo ◽

Cultural Beliefs ◽

Optimal Growth ◽

Capital City ◽

World Health ◽

Group Discussions ◽

Nationally Representative ◽

Health Organization

Abstract Background For optimal growth and development, the World Health Organization recommends that children be exclusively breastfed for the first 6 months of life. However, according to the nationally-representative 2013–2014 Demographic and Health Survey, under 50% of babies in the Democratic Republic of Congo are exclusively breastfed. Although breastfeeding was common in the capital city of Kinshasa, one in five newborns received alternatives to breastmilk during the first 3 days of life. This analysis aimed to identify social norms influencing exclusive breastfeeding, the role of a young first-time mother’s (FTM’s) social network for her choice to exclusively breastfeed, and perceived social sanctions associated with breastfeeding practices in Kinshasa. Methods The qualitative analysis was based on a vignette presented during 14 focus group discussions, with a purposively selected sample (n = 162) of FTMs age 15–24, and the male partners, mothers and mothers-in-law of FTMs age 15–24 in three health zones in Kinshasa in 2017. Thematic content analysis was performed to identify concepts and patterns in the participants’ discussions. Results Overall, community norms were not supportive of exclusive breastfeeding. The main barriers to exclusive breastfeeding were the belief held by most FTMs that exclusive breastfeeding was an uncommon practice; the desire to avoid negative sanctions such as name-calling and mockery for refusal to give babies water in the first 6 months of life; the desire to please key members of their social networks, specifically their mothers and friends, by doing what these influencers expected or preferred them to do; FTMs’ own lack of experience with infant feeding; and trust placed in their mothers and friends. Conclusion Social norms can be maintained by the belief about what others do, perceived expectations about what individuals ought to do, the negative sanctions they can face and their preference to conform to social expectations. Thus, addressing cultural beliefs and targeting sensitization efforts to key influencers that provide support to FTMs are needed to promote exclusive breastfeeding in Kinshasa. In doing so, strategies should address the barriers to exclusive breastfeeding including related misconceptions, and improve FTMs’ self-efficacy to overcome the influence of others.

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COVID-19 vaccine hesitancy and resistance: Correlates in a nationally representative longitudinal survey of the Australian population

10.1101/2020.11.13.20231480 ◽

2020 ◽

Author(s):

Ben Edwards ◽

Nicholas Biddle ◽

Matthew Gray ◽

Kate Sollis

Keyword(s):

Vaccination Coverage ◽

Online Survey ◽

Significant Proportion ◽

World Health Organisation ◽

World Health ◽

Vaccine Hesitancy ◽

Policy Measures ◽

Low Levels ◽

Nationally Representative ◽

Territory Government

AbstractBackgroundHigh levels of vaccination coverage in populations will be required even with vaccines that have high levels of effectiveness to prevent and stop outbreaks of coronavirus. The World Health Organisation has suggested that governments take a proactive response to vaccine hesitancy ‘hotspots’ based on social and behavioural insights.MethodsRepresentative longitudinal online survey of over 3000 adults from Australia that examines the demographic, attitudinal, political and social attitudes and COVID-19 health behavior correlates of vaccine hesitance and resistance to a COVID-19 vaccine.ResultsOverall, 59% would definitely get the vaccine, 29% had low levels of hesitancy, 7% had high levels of hesitancy and 6% were resistant. Females, those living in disadvantaged areas, those who reported that risks of COVID-19 was overstated, those who had more populist views and higher levels of religiosity were more likely to be hesitant or resistant while those who had higher levels of household income, those who had higher levels of social distancing, who downloaded the COVID-Safe App, who had more confidence in their state or territory government or confidence in their hospitals, or were more supportive of migration were more likely to intend to get vaccinated.ConclusionsOur findings suggest that vaccine hesitancy, which accounts for a significant proportion of the population can be addressed by public health messaging but for a significant minority of the population with strongly held beliefs, alternative policy measures may well be needed to achieve sufficient vaccination coverage to end the pandemic.

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Trends in snakebite mortality in India from 2000 to 2019 in a nationally representative mortality study

10.1101/2020.05.15.20103234 ◽

2020 ◽

Author(s):

Wilson Suraweera ◽

David Warrell ◽

Romulus Whitaker ◽

Geetha R Menon ◽

Rashmi Rodrigues ◽

...

Keyword(s):

Literature Review ◽

Rural Areas ◽

Treatment Strategies ◽

World Health ◽

The World ◽

Prevention And Treatment ◽

Substantial Progress ◽

Low Altitude ◽

Nationally Representative ◽

Health Organization

The World Health Organization call to halve global snakebite deaths by 2030 will requires substantial progress in India. We analyzed 2,833 snakebite deaths from 611,483 verbal autopsies in the nationally representative Indian Million Death Study from 2001-14, and conducted a systematic literature review from 2000-19 covering 87,590 snakebites. We estimate that India had 1.2 million snakebite deaths (average 58,000/year) from 2000-19. Nearly half occurred at ages 30-69 years and over a quarter in children <15 years. Most occurred at home in rural areas. About 70% occurred in eight higher-burden states and half during the rainy season and at low altitude. The risk of an Indian dying from snakebite before age 70 is about 1 in 250, but notably higher in some areas. More crudely, we estimate 1.11-1.77 million bites occurred in 2015, of which 70% showed symptoms of envenomation. Prevention and treatment strategies might substantially reduce snakebite mortality in India.

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Report of simultaneous measles outbreaks in two different health regions in Portugal, February to May 2017: lessons learnt and upcoming challenges

Eurosurveillance ◽

10.2807/1560-7917.es.2019.24.3.1800026 ◽

2019 ◽

Vol 24 (3) ◽

Cited By ~ 2

Author(s):

Gonçalo Figueiredo Augusto ◽

Andreia Silva ◽

Natália Pereira ◽

Teresa Fernandes ◽

Ana Leça ◽

...

Keyword(s):

Vaccination Coverage ◽

Measles Virus ◽

Control Measures ◽

World Health ◽

Population Immunity ◽

First Case ◽

Rapid Control ◽

Measles Vaccination ◽

Health Organization ◽

Measles Outbreaks

In Portugal, measles vaccination coverage and population immunity are high, and no endemic measles cases had been reported since 2004. The World Health Organization classified measles as eliminated in the country in 2015 and 2016, based on data from the previous 3 years. However, in a context of increasing incidence in several European countries in 2016 and 2017, Portugal experienced two simultaneous measles outbreaks with a total of 27 laboratory-confirmed cases (0.3 cases/100,000 population) in two health regions between February and May 2017. Nineteen cases (70.1%) were adults, of whom 12 were healthcare workers. Overall, 17 cases (63.0%) were not vaccinated, of whom five were infants younger than 12 months of age. One unvaccinated teenager died. Genotype B3 was identified in 14 cases from both regions. Measles virus sequencing identified different possible origins of the virus in each region affected. Although measles transmission was stopped in less than 2 months from the first case being notified, these outbreaks represent an opportunity to reinforce awareness of measles diagnosis. We highlight the intensity of the control measures taken and their impact on the rapid control of the outbreaks and also the fact that high vaccination coverage was crucial to stop transmission.

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Reducing missed opportunities for vaccination in selected provinces of Mozambique: A study protocol

Gates Open Research ◽

10.12688/gatesopenres.12761.1 ◽

2017 ◽

Vol 1 ◽

pp. 5 ◽

Cited By ~ 5

Author(s):

Bvudzai Priscilla Magadzire ◽

Gabriel Joao ◽

Stephanie Shendale ◽

Ikechukwu Udo Ogbuanu

Keyword(s):

Health Workers ◽

Vaccine Coverage ◽

Health Facilities ◽

World Health ◽

Group Discussions ◽

Immunization Program ◽

Missed Opportunities ◽

Target Sample Size ◽

Health Organization ◽

Missed Opportunity

Background: A missed opportunity for vaccination (MOV) refers to any contact with health services by an individual who is eligible for vaccination, which does not result in the person receiving the vaccine doses for which he or she is eligible. A consortium of partners, including VillageReach, the Ministry of Health in Mozambique and the World Health Organization, will implement a strategy to reduce MOV in Mozambique. The strategy involves demonstrating the magnitude of missed opportunities and their causes, and exploring tailored health system interventions to reduce them, with the aim of increasing vaccination coverage and timeliness of vaccinations. Methods: A mixed-methods approach will incorporate both quantitative and qualitative tools. The assessment will target caregivers of children between the ages of 0–23 months who attend a health facility in the selected districts on the day of the assessment. Caregivers who are at least 18 years old will be eligible for inclusion. Another component of the assessment will target all health workers in the selected health facilities on the day of the assessment. A sample of 30 health facilities in different regions of the country will be assessed, with a target sample size of 600 caregiver exit interviews, 300 health worker interviews and focus group discussions with both caregivers and health workers. Data collection will commence late 2017, and the data will be electronically captured, managed and analyzed. Thematic analysis of data from the qualitative aspects of the assessment will be conducted, presenting the scope of interviews, representative verbatim quotes and key conclusions. Conclusions: A concerted effort to reduce or eliminate MOV could increase vaccine coverage by up to 30% and may contribute to wider improvements in efficiencies of service delivery beyond the immunization program. In addition, the findings could contribute to a better understanding of MOV in similar settings.

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