scholarly journals Contracting Out National Immunization Program Does Not Improve Vaccination Rate Nor Socioeconomic Inequality: A Case Study of Seasonal Influenza Vaccination in South Korea

2021 ◽  
Vol 9 ◽  
Author(s):  
Daseul Moon ◽  
Saerom Kim ◽  
Myoung-Hee Kim ◽  
Dawoon Jeong ◽  
Hongjo Choi
Keyword(s):  
South Korea ◽  
Influenza Vaccination ◽  
Interrupted Time Series ◽  
Vaccination Rate ◽  
Multivariate Logistic Regression Model ◽  
National Immunization Program ◽  
Immunization Program ◽  
Contracting Out ◽  
National Immunization ◽  
Before And After

The objective of the present study was to investigate if the policy for contracting out the Korean influenza National Immunization Program (NIP) for individuals aged ≥ 65 years affects a reduction in vaccination inequality based on gender and socioeconomic position (SEP). In South Korea, initially only public health centers provided influenza vaccination for free; however, starting from the fall of 2015, the program was expanded to include private medical institutions. The policy was expected to improve overall vaccination rate and reduce its inequality, through improving access to vaccination. The present study analyzed how the gap in the vaccination rate changed between before and after contracting out. A multivariate logistic regression model stratified by gender and SEP of individuals aged ≥ 65 years was used. The study also analyzed changes in the unvaccinated rates between before and after contracting out based on an interrupted time series model. The gap in the unvaccinated rate based on SEP present prior to contracting out of the NIP for individuals aged ≥ 65 years did not decrease afterwards. In particular, the step changes were 0.94% (95% confidence interval [CI]: 0.00, 1.89) and 1.34% (95% CI: 1.17, 1.52) in men and women, respectively. In the pre-policy period, among women, the unvaccinated rate of the medical aid beneficiaries group was 1.22-fold higher (95% CI: 1.12, 1.32) than that of the health insurance beneficiaries, and the difference was not reduced post-policy implementation (odds ratio: 1.27, 95% CI: 1.20, 1.36). The findings of the study were that contracting out of the NIP was not effective in improving vaccination rate nor resolving vaccination inequality. Future studies should focus on identifying the mechanism of vaccination inequality and exploring measures for resolving such inequality.

scholarly journals Whole genome sequence analysis of Salmonella Typhi isolated in Thailand before and after the introduction of a national immunization program

2016 ◽  
Author(s):  
Zoe A. Dyson ◽  
Duy Pham Thanh ◽  
Ladaporn Bodhidatta ◽  
Carl Jeffries Mason ◽  
Apichai Srijan ◽  
...  
Keyword(s):  
Typhoid Fever ◽  
Low Income ◽  
Whole Genome ◽  
Immunization Programs ◽  
National Immunization Program ◽  
Immunization Program ◽  
National Immunization ◽  
Before And After ◽  
Endemic Areas ◽  
The Impact

AbstractVaccines against Salmonella Typhi, the causative agent of typhoid fever, are commonly used by travellers, however, there are few examples of national immunization programs in endemic areas. There is therefore a paucity of data on the impact of typhoid immunization programs on localised populations of S. Typhi. Here we have used whole genome sequencing (WGS) to characterise 44 historical bacterial isolates collected before and after a national typhoid immunization program that was implemented in Thailand in 1977 in response to a large outbreak; the program was highly effective in reducing typhoid case numbers. Thai isolates were highly diverse, including 10 distinct phylogenetic lineages or genotypes. Novel prophage and plasmids were also detected, including examples that were previously only reported in Shigella sonnei and Escherichia coli. The majority of S. Typhi genotypes observed prior to the immunization program were not observed following it. Post-vaccine era isolates were more closely related to S. Typhi isolated from neighbouring countries than to earlier Thai isolates, providing no evidence for the local persistence of endemic S. Typhi following the national immunization program. Rather, later cases of typhoid appeared to be caused by the occasional importation of common genotypes from neighbouring Vietnam, Laos, and Cambodia. These data show the value of WGS in understanding the impacts of vaccination on pathogen populations and provide support for the proposal that large-scale typhoid immunization programs in endemic areas could result in lasting local disease elimination, although larger prospective studies are needed to test this directly.Author SummaryTyphoid fever is a systemic infection caused by the bacterium Salmonella Typhi. Typhoid fever is associated with inadequate hygiene in low-income settings and a lack of sanitation infrastructure. A sustained outbreak of typhoid fever occurred in Thailand in the 1970s, which peaked in 1975-1976. In response to this typhoid fever outbreak the government of Thailand initiated an immunization program, which resulted in a dramatic reduction in the number of typhoid cases in Thailand. To better understand the population of S. Typhi circulating in Thailand at this time, as well as the impact of the immunization program on the pathogen population, we sequenced the genomes of 44 S. Typhi obtained from hospitals in Thailand before and after the immunization program. The genome sequences showed that isolates of S. Typhi bacteria isolated from post-immunization era typhoid cases were likely imported from neighbouring countries, rather than strains that have persisted in Thailand throughout the immunization period. Our work provides the first historical insights into S. Typhi in Thailand during the 1970s, and provides a model for the impact of immunization on S. Typhi populations.

Invasive Group A Streptococcus Infection in Children in Southern Israel Before and After the Introduction of Varicella Vaccine

2019 ◽  
Vol 9 (2) ◽  
pp. 236-239
Author(s):  
Ori Hasin ◽  
Guy Hazan ◽  
Assaf Rokney ◽  
Roy Dayan ◽  
Orli Sagi ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Group A Streptococcus ◽  
Varicella Vaccine ◽  
National Immunization Program ◽  
Immunization Program ◽  
Predisposing Factor ◽  
Invasive Group ◽  
National Immunization ◽  
Before And After ◽  
Group A

Abstract The annual rates of group A Streptococcus bacteremia per 100 000 children in southern Israel declined after introduction of the varicella vaccine to the national immunization program, from 2.43 (95% confidence interval, 1.73–3.13) in 1995–2002 to 1.30 (95% confidence interval, 0.91–1.72) in 2010–2016 (P = .04). This reduction correlated with the disappearance of varicella rash as a predisposing factor.

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