The Landscape of State and Local School-Located Vaccination Clinics: Practices, Policies, and Lessons Learned for Providing COVID-19 and Routine Vaccinations

For decades, school-located vaccinations clinics (SLVs) have successfully offered influenza and routine childhood immunizations that have contributed to lowering the morbidity and mortality of vaccine-preventable diseases. These SLVs laid the foundation for state and local health departments and school districts to quickly implement SLVs in response to COVID-19. To support school nurses and immunization programs in implementing future SLVs during the COVID-19 pandemic, we explored the landscape of SLVs between August 2019 and late summer 2021 using publicly available information from school and health department websites, news articles reporting on SLVs, and internal documents provided by school nurses and immunization programs who hosted SLVs. Our scan identified variability in the reach, scope, and approach to SLVs, but consistent themes persist such as the importance of partnerships and SLVs as an opportunity to promote equitable access to vaccinations. Useful documents and resources for planning and hosting SLV clinics were compiled into a table. With COVID-19 vaccines now available to all school-age children, SLVs provide an even greater opportunity to improve school and community health. The included resources are designed to provide support for those interested in SLV implementation.

Decline in Uptake of Childhood Vaccinations in a Tertiary Hospital in Northern Ghana during the COVID-19 Pandemic

At the beginning of the COVID-19 pandemic, early modelling studies estimated a reduction in childhood vaccinations in low- and middle-income countries. Regular provision of both curative and preventive services such as antenatal care and childhood immunizations has been negatively affected since the onset of the pandemic. Our study was aimed at examining the impact that the pandemic had on childhood vaccination services at the Tamale Teaching Hospital (TTH). A mixed methods study design was employed for the study, which was conducted at the Child Welfare Clinic (CWC) of the TTH. With quantitative approach, we retrospectively looked at the uptake of the various vaccines during the pandemic era, defined as the period between 1st March 2020 and 28th February, 2021, and the prepandemic era defined as the period 1st March 2019 to 29th February, 2020. The qualitative approach was used to understand the perspective of five healthcare providers at the CWC and the four caregivers of children who have missed a vaccine or delayed in coming, on the factors accounting for any observed change. Data analysis was done using Microsoft Excel 2016 and thematic content analysis. Quantitative data were presented in frequencies, percentages, and line graphs. With the exception of the Measles Rubella (MR) 2 vaccine, we observed a decline ranging from 47% (2298) to 10.5% (116), with the greatest decline seen in the BCG and the least decline seen in the MR1 vaccine. The month of May 2020 saw the greatest decline, that is, 70.6% (813). A decline of 38.3% (4473) was noted when comparison was made between the designated prepandemic and pandemic eras, for all the vaccines in our study. Fear of COVID-19 infection and misinformation were commonly given as reasons for the decline. Catch-up immunization schedule should be instituted to curtail possible future outbreaks of vaccine-preventable diseases.

Trends in Homeschooling Rates Following Elimination of Nonmedical Exemptions to Childhood Immunizations, 2012-2020

Introduction: In 2015 California passed Senate Bill No. 277 (SB 277) and became the first state in over 30 years to eliminate nonmedical exemptions to mandatory childhood immunizations for school entry. One concern that emerged was that the law created an incentive for parents to remove children from brick-and-mortar schools to bypass the immunization requirements. Objective: To assess the impact of eliminating nonmedical exemptions to childhood immunizations on homeschooling rates. Design: Pre-Post Intervention study. We calculated homeschooling rates as the number of K-8 students enrolled through each of California's three homeschooling mechanisms (Independent Study Program, Private School Affidavit, and Private School Satellite Program) divided by all K-8 students enrolled in the same academic year. Data on homeschooling rates was obtained from the California Department of Education. We then conducted an interrupted time series analyses in which the outcome variable was percent of students enrolled in a homeschool program pre- and post-SB 277. Setting: California homeschools Participants: K-8 students enrolled through each of the state's three homeschooling mechanisms (Independent Study Program, Private School Affidavit, and Private School Satellite Program) Intervention: Passage of SB 277 which eliminated nonmedical exemptions to childhood immunizations for school entry Main Outcome: K-8 homeschooling rates Results: The homeschooling enrollment for K-8 students in California increased from 0.8% (35,122 students) during SY 2012-13 to 1.9% (86,574 students) during SY 2019-20; however, we found no significant increase in the percent of students enrolled in homeschooling programs in California following the implementation of SB 277 beyond the secular trend. Conclusions and Relevance: Legislative action to limit nonmedical exemptions to compulsory vaccination for school entry is not associated with removal from classroom-based instruction in brick-and-mortar institutions.

Determinants of Hesitancy to Childhood Immunizations in a Peri -Urban Settlement; A Case Study of Nansana Municipality, Uganda

Vaccine hesitancy to immunization against the childhood vaccine-preventable diseases is increasingly becoming a concern worldwide, which negatively impacts the parents’ willingness to vaccinate their children. The objective of this study was to establish the current prevalence of vaccine hesitancy and the factors that determine parent’s hesitancy to childhood immunizations in Nansana Municipality, Wakiso District, Uganda. This was a cross-sectional mixed methods study, utilizing both qualitative and quantitative approaches. Evaluation of the determinants of vaccine hesitancy was carried out on 344 parents of children under 24 months, using simple random sampling on pre-tested structured questionnaires. Data was analyzed using SPSS 20.0 software. Additionally, 2 focus group discussions with parents were also conducted. Vaccine hesitancy was found to be 27.6%. Education level (AOR=4.9, 95% CI, 2.6 -29.5, p=0.01), belief in vaccine effectiveness (AOR= 0.47, 95% CI, 0.17 – 0.97, p=0.01), health workers attitude (AOR=0.22, 95% CI, 0.06 - 0.86, p=0.03), timing of immunization service clinic (AOR = 3.4, 95% CI, 1.8 – 6.4, p=0.01) and adequate information provision (AOR = 0.64, 95% CI, 0.16 – 0.99, p=0.04), were the factors that were independently determining vaccine hesitancy. The vaccine hesitancy prevalence rate is comparatively similar to previous urban area studies. Despite parents overwhelmingly believing in vaccines protecting their children from vaccine-preventable disease, these same parents, express concerns regarding timing of the clinic and the side effects of vaccines. There is a need to improve on communication and information flow to address the many vaccine safety concerns, such as side effects. Keywords: Childhood, Determinants, Hesitancy, Immunization, Urban.

Interventions to improve vaccination coverage of children in hard-to-reach population: A systematic review

In the last decade, vaccination has reduced a quarter of child deaths worldwide. Vaccination coverage increased, but the coverage remains low in the hard-to-reach population. We searched articles from Pubmed MEDLINE, SCOPUS, Web of Science, and Science Direct to systematically review interventions to improve children's vaccination coverage in hard-to-reach populations. The expected outcome was vaccination coverage, which mentioned Odds Ratio, mean difference, or difference-in-difference with a 95% CI or p-value. Out of 102 articles identified, five articles from four different countries met the inclusion criteria. Four of the five studies reported a positive impact in increasing vaccination coverage. Interventions that showed good effectiveness in increasing the coverage of childhood immunizations were the application of mHealth given to vaccinators, multiple interventions involving the community, modification of immunization schedules during outreach activities, and immunization screening cards. Despite the inconsistent finding, mHealth with SMS reminders was the most effective intervention to increase vaccination coverage and relatively low-cost. More research was needed in developing a strategic intervention to increase vaccination coverage of children in hard-to-reach populations.

Understanding childhood immunizations, their serological interpretation and vaccines - A review article

The practice of immunization dates back hundreds of years. Buddhist monks drank snake venom to confer immunity to snake bite and variolation (smearing of a skin tear with cowpox to confer immunity to smallpox) was practiced in 17th century China. Edward Jenner is considered the founder of vaccinology in the West in 1796, after he inoculated an 8 year-old-boy with vaccinia virus (cowpox), and demonstrated immunity to smallpox. In 1798, the first smallpox vaccine was developed. Over the 18th and 19th centuries, systematic implementation of mass smallpox immunization culminated in its global eradication in 1979. Vaccination is when a vaccine is administered to you (usually by injection). Immunization is what happens in your body after you have the vaccination. The vaccine stimulates your immune system so that it can recognize the disease and protect you from future infection (i.e., you become immune to the infection.). Immunization is a proven tool for controlling and eliminating life-threatening infectious diseases and is estimated to avert between 2 and 3 million deaths each year. It is one of the most cost-effective health investments, with proven strategies that make it accessible to even the most hard-to-reach and vulnerable populations. It has clearly defined target groups; it can be delivered effectively through outreach activities; and vaccination does not require any major lifestyle change.

Immunity to childhood vaccines following high dose chemotherapy (HDCT) and autologous stem cell transplantation (ASCT) for germ cell tumors (GCT) with comparison to Hodgkin lymphoma (HL).

5017 Background: HDCT/ASCT represents a curative salvage treatment for patients with GCT but is rarely used for other solid tumors. Patients undergoing HDCT/ASCT for hematologic neoplasms require revaccination for their childhood immunizations. Whether this is necessary in patients with GCT is unknown. Methods: In this prospective longitudinal study, patients with GCT undergoing HDCT-ASCT from 11/2010 to 5/2018 had serologies for Measles, Mumps, Rubella, Diphtheria, Tetanus, Polio, and Varicella Zoster measured before HDCT and at 3, 6, and in a subset, 12+ months after the last HDCT with results at these timepoints compared using descriptive statistics. In addition, titer levels at ≥6 months post-transplant were matched 1:1 for age and gender with HL patients who underwent HDCT/ASCT during the same time period. Immunity was compared between cohorts using the Cochran-Mantel-Haenszel test. Results: Of 80 patients with GCT (median age 30, 84% nonseminoma), 91% received 3 sequential transplants and 68 had repeat titers at ≥6 months. Immunity at baseline was >95% for Diphtheria, Tetanus and Polio and 89% for Varicella Zoster but lower for Measles (74%), Mumps (85%), and Rubella (83%) (Table). Compared to baseline, proportional immunity for all infections was similar at 3, 6, and 12 months post-transplant in the GCT population (≥6 months shown in Table). Matching resulted in 58 GCT-HL pairs. One-year immunity was numerically lower for most infections in the HL vs. GCT patients and significantly decreased for Measles and Rubella (Table). Conclusions: To our knowledge, this is the first study to assess vaccine titers following HDCT/ASCT for GCT. We demonstrate that HDCT/ASCT does not result in loss of immunity to childhood vaccines and that GCT patients retain protective titers more frequently than those with HL. However, 15-31% of GCT patients lack MMR immunity at baseline and at 1-year post-ASCT. Therefore, we recommend checking MMR titers at 1-year post-ASCT with revaccination of those lacking immunity. Titer evaluation and revaccination is not necessary for other childhood immunizations.[Table: see text]