Vaccine hesitancy in East Malaysia (Sabah): A survey of the national COVID-19 immunisation programme

The Malaysian government has introduced the National COVID-19 Immunisation Programme (PICK) as a new mechanism to address the transmission of coronavirus disease 2019 (COVID-19). Unfortunately, the number of PICK registrations is still unsatisfactory and is now even lower. The low level of participation of the Sabah (East Malaysia) population significantly impacts the PICK registrations. Therefore, this study aims to identify the factors that cause vaccine hesitancy among the people of Sabah. This study seeks to identify these trends based on zone and district boundaries. A total of 1024 respondents were sampled in this study. Raw data collected through the survey method were analysed using K-means clustering, principal component analysis (PCA), and spatial analysis. The study discovered that factors including confidence, authority, mainstream media, complacency, social media, and convenience are the top causes of vaccine hesitancy among respondents. This study also revealed that the Sabah population’s key variables causing vaccine hesitancy to vary by region (zones and districts). The conclusion is significant as a source of supporting data for stakeholders seeking to identify the Sabah population’s constraints in each region and therefore, it would help improve PICK management’s performance in Sabah.

Adaptive Leadership and Independent Opinions: Lessons From the National COVID-19 Immunisation Programme

Malaysia was slow to begin its COVID-19 immunization program for various reasons. However, it is one of the fastest developing countries to vaccinate 80% of its adult population. Nontraditional health leadership played a large role in the implementation of the National COVID-19 Immunisation Programme (NCIP). Independent opinions from academia also helped the NCIP and may be useful as a way of pushing forward recommendations that may otherwise be difficult to make.

Real-world data on immune responses following heterologous prime-boost COVID-19 vaccination schedule with Pfizer and AstraZeneca vaccines in England

Background There are limited data on immune responses to heterologous COVID–19 immunisation schedules, especially following an extended ≥12–week interval between doses. Methods SARS–CoV–2 infection–naïve and previously–infected adults receiving ChAd–BNT (ChAdOx1 nCoV–19, AstraZeneca followed by BNT162b2, Pfizer–BioNTech) or BNT–ChAd as part of the UK national immunisation programme provided blood samples at 30 days and 12 weeks after their second dose. Geometric mean concentrations (GMC) of anti–SARS–CoV–2 spike (S-antibody) and nucleoprotein (N-antibody) IgG antibodies and geometric mean ratios (GMR) were compared with a contemporaneous cohort receiving homologous ChAd–ChAd or BNT–BNT. Results During March–October 2021, 75,827 individuals were identified as having received heterologous vaccination, 9,489 invited to participate, 1,836 responded (19.3%) and 656 were eligible. In previously–uninfected adults, S–antibody GMC at 30 days post–second dose were lowest for ChAd–ChAd (862 (95%CI, 694– 1069)) and significantly higher for ChAd–BNT (6233 (5522– 7035); GMR 6.29; (5.04– 7.85); p<0.001), BNT-ChAd (4776 (4066– 5610); GMR 4.55 (3.56– 5.81); p<0.001) and BNT–BNT (5377 (4596– 6289); GMR 5.66 (4.49– 7.15); p<0.001). By 12 weeks after dose two, S–antibody GMC had declined in all groups and remained significantly lower for ChAd–ChAd compared to ChAd–BNT (GMR 5.12 (3.79– 6.92); p<0.001), BNT–ChAd (GMR 4.1 (2.96– 5.69); p<0.001) and BNT–BNT (GMR 6.06 (4.32– 8.50); p<0.001). Previously infected adults had higher S–antibody GMC compared to infection–naïve adults at all time–points and with all vaccine schedules. Conclusions These real–world findings demonstrate heterologous schedules with adenoviral–vector and mRNA vaccines are highly immunogenic and may be recommended after a serious adverse reaction to one vaccine product, or to increase programmatic flexibility where vaccine supplies are constrained.

Adolescent vaccination with BNT162b2 (Comirnaty, Pfizer-BioNTech) vaccine and effectiveness of the first dose against COVID-19: national test-negative case-control study, England

Adolescents in the UK were recommended to have their first dose of mRNA vaccine during a period of high community transmission due to the highly transmissible Delta variant, followed by a second dose at an extended interval of 8-12 weeks. We used national SARS-CoV-2 testing, vaccination and hospitalisation data to estimate vaccine effectiveness (VE) using a test-negative case-control design, against PCR-confirmed symptomatic COVID-19 in England. VE against symptomatic disease increased to 80% within two weeks of the first dose of BNT162b2 vaccine (higher than in adults aged 18-64 years) and then declines rapidly to 40% within 8 weeks (similar to adults). Early data in 16-17-year-olds also indicate high protection against hospitalisation and a rapid increase in VE against symptomatic COVID-19 after the second dose. Our data highlight the importance of the second vaccine dose for protection against symptomatic COVID-19 and raise important questions about the objectives of an adolescent immunisation programme. If prevention of infection is the primary aim, then regular COVID-19 vaccine boosters will be required.

Reducing missed opportunities for vaccination in Mozambique: findings from a cross-sectional assessment conducted in 2017

ObjectiveMissed opportunities for vaccination (MOV) are a significant contributor to low vaccination coverage. To better understand the magnitude and underlying causes of MOV among children aged 0–23 months in Mozambique, we conducted an assessment and developed a roadmap for strengthening the country’s childhood immunisation programme.SettingThree provinces in North, South and Central Mozambique.MethodsThe assessment applied a mixed-method approach. From a sample of 41 health facilities, we conducted exit interviews with caregivers of children aged 0–23 months (n=546), surveys with health workers (n=223), focus group discussions with caregivers (n=6) and health workers (n=5), and in-depth interviews with health facility managers (n=9). We analysed the data to assess the magnitude of MOV and to identify causes of MOV and ways of preventing them.ResultsVaccination records were available for 538 children. Sixty per cent (n=324) were eligible for vaccination on arriving for their health facility visit. Of these, 76% (n=245) were not fully vaccinated, constituting MOV. Our analysis shows that these MOV were most frequently attributable to practices of caregivers and health workers and also to health systems reasons. Inadequate information about vaccination among both caregivers and health workers, poor or poorly understood health facility practices, inadequate integration of curative and preventative services, inadequate tracking systems to identify children due for vaccination and, less often, limited supply of vaccines, syringes and other related supplies at service points resulted in MOV.ConclusionsThe results of the assessment informed the development of roadmaps for reducing MOV that may be applicable to other settings. The global immunisation community should continue to invest in efforts to reduce MOV and thereby make health service visits more effective and efficient for vaccination.

Anti-HBs levels in children under the age of two years born to HBV carrier mothers after immunoprophylaxis: a multicenter cross-sectional study

Background Serological testing for the presence of Hepatitis B Virus (HBV) markers and anti-HBs titers in infants born to HBsAg positive women is critically important for estimation in immunisation programme. Methods This was a multi-center and cross-sectional study conducted in Zhejiang province, China. Children aged 7 to 24 months born to HBsAg positive women during December 2018 to February 2019, completed additional HBV serological markers screening. We indicated distribution of HBV serological markers and anti-HBs titers in children. Multiple logistic regression model with adjusted odds ratio and 95% confidence interval (ORadj and 95% CI) was used to explore the factors associated with inadequate immune response (anti-HBs titers< 100 mIU/ml) among children. Results A total of 1849 children were included. Overall 25 children tested HBsAg positive, giving HBsAg positive rate of 1.35%(95%CI: 0.83-1.88%). 92.00% (23/25) HBsAg positive children were delivered by HBeAg positive mothers. The proportion of protective seroconversion (anti-HBs titers≥10mIU/ml) was 99.29% in all children, and 86.48% children were reported with adequate anti-HBs titers (≥100mIU/ml).We found a significant higher proportions of early antenatal health care (< 13 gestational weeks), and term birth in children with adequate response compared with inadequate response (all P < 0.05). Logistic regression showed preterm birth was a negative factor for inadequate anti-HBs titers (ORadj = 1.868,95%CI 1.132-3.085,P = 0.015). Conclusions Children delivered by HBeAg positive mothers had higher risk of vertical transmission of HBV, despite completion of 3 doses of hepatitis B vaccine and HBIG injection. Inadequate anti-HBs level was significantly associated with preterm birth in HBsAg positive women.

Rotavirus Genotypes in Abuja, Nigeria

Introduction: Nigeria had planned to introduce the rotavirus vaccine in the National Immunisation Programme in 2014, but this has yet to be done. Nigeria has the continent's highest mortality due to diarrhoeal diseases with little information on specific, prevalent genotypes. Aim: The study's main objectives were to identify the predominant rotavirus genotypes and examine the effects of existing local vaccination programs on prevailing rotavirus genotypes and on preventing rotavirus diarrhoea. Methodology: A one-year prospective descriptive study of children under 5 with acute diarrhoea was conducted from June 2018 to May 2019. Children with acute diarrhoea attending Asokoro District Hospital, Abuja. Children without diarrhoea were also recruited as a control group. Rotavirus ELISA and RNA extraction were done with commercially available kits, and positive samples were subjected to RT-PCR and electrophoresis to determine VP7 (G) and VP4 (P) genotypes. Results: Rotavirus-ELISA was positive among 231 (17.8%) children with diarrhoea and 29 (2.2%) of controls, with November, December. The predominant VP7 genotypes was G1 (n=116, 50.2%) followed by G9 (n=66, 28.5%). Viral Protein, VP4 (P) was mostly P [8] (n=143, 74.8%) followed by P [4] (n=21, 10.9%). The predominant genotype combinations found were G1 P [8] (n=108, 46.7%), G9 P [8] (n=62, 26.8%), and G2 P [4] (n=18, 7.7%). Very few mixed infections were found in the study, 2 (0.8%). Among 94 unvaccinated children with rotavirus isolates that were genotyped, G1 P [8] (n=88, 49.4%) and G9 P [8] (n=43, 24.1%) were predominant. Among 32 vaccinated children, G1 P [8] (n=13, 40.2%) and G9 P [8] (n=9, 28.1%) were predominant. Conclusion: The emergence of new genotypes such as G 12 P [4] found in this study emphasize the need for continued prospective monitoring of rotavirus at the molecular level to detect new threats to vaccine programs in future.