Millions of Bangladeshi Children Missed Their Scheduled Vaccination Amidst COVID-19 Pandemic

The Government of Bangladesh imposed a movement control order as a mass quarantine strategy to control the outbreak of coronavirus disease 2019 (COVID-19). Adherence to the home quarantine may put children at risk by missing routine vaccination. In this study, we investigated the impact of COVID-19 on child routine immunization in a rural area of Bangladesh and consider the broader implications. Data for this study comes from the Chakaria Health and Demographic Surveillance System (HDSS) of icddr,b with a population of 90,000 people residing in 16,000 households in 49 villages in a rural, coastal area of Southeast Bangladesh. We used an explanatory sequential mixed methods design which involved two phases between March 1, 2020, and May 31, 2020: first, we observed 258 outreach sessions of 86 EPI centers. We calculated the number of Expanded Program on Immunization (EPI) outreach sessions suspended and the number of children who missed their routine vaccination due to the COVID-19. We extrapolated the number of Bangladeshi children who missed their routine vaccination using Chakaria HDSS observations. Secondly, we conducted in-depth interviews to explain the quantitative results. The EPI outreach session (EOS) declined to 74.42% (95% CI 63.97–83.22), 10.45% (95% CI 5.00–18.94), and 3.45% (95% CI 1.00–9.75) from 2019 levels in March, April, and May 2020, respectively. By extrapolation, in Bangladesh, between March and May 2020, 3.2 million children missed their scheduled vaccination compared to 2019. Results from in-depth interviews showed that the unwillingness of villagers to hold EOS and the absenteeism of the vaccinators due to social distancing recommendations and lack of personal safety measures were the main reasons for the discontinuation of the EOS. Resuming EPI outreach sessions and introducing a special catch-up program is essential to prevent future outbreaks and deaths due to vaccine-preventable diseases in Bangladesh and the countries where children missed their routine vaccination due to COVID-19. This health system failure should be considered a factor in all future pandemic preparedness plans.

Immunization

Immunization strategies and schedules?, Transport and storage of vaccines?, Needle use and disposal?, Administration of vaccines ?, Adverse reactions?, Contraindications to vaccination?, Immunization of HIV+ individuals?, Expanded program on immunization recommended vaccines?, Other vaccines?

Evaluation of the Cold Chain Expanded Program on Immunization at Governmental and Private Health Care Centers in Riyadh City, Saudi Arabia

Objective: Vaccine storage is essential to ensure optimal vaccine effectiveness. Cold chain is a series of storage and transport links, designed to keep the vaccine at the correct temperature till it reaches the user. To evaluate the Cold Chain Expanded Program on Immunization at Governmental and Private Health Care Centers in Riyadh city, Saudi Arabia. Methods: A cross-sectional study was conducted from March to May 2021 in government and private primary health care centers of Riyadh, Saudi Arabia were included. Data collection was carried out using standardized check list developed by Saudi Ministry of Health (MOH) and World Health Organization (WHO). Data were analysed using IBM SPSS Statistics 26 (C) and IBM SPSS 26 (IBM Inc.) Results: The results showed that the mean score of Room and Refrigerator Elements for governmental PHCs was 8.8(±0.82), while it was 8.3(±1.86) for private PHCs. The mean temperature monitoring device score for government PHCs was 4.0 (0.0), and the 3.65 (±0.92) for PHCs centers. The mean temperature chart (record keeping) score for governmental PHCs was 2.55(±0.5) and 1.8(±1.2) for private PHCs. The mean maintenance and operations score for governmental PHCs was 4.6 (±0.49), while it was 4.1 (±0.84) for private PHCs. The mean scores of all cold chain components differed significantly between government and private facilities (p=0.000). Conclusion: Our study highlights the cold chain management programs Saudi Arabia. More importantly governmental PHC centers in the current settings comply with the standards to the guidelines, provided by Saudi Ministry of Health and WHO, was observed, in comparison to private PHC centers.

Conducting clinical research in a resource-constrained setting: lessons from a longitudinal cohort study in The Gambia

Clinical research conducted to Good Clinical Practice (GCP) standards is increasingly being undertaken in resource-constrained low-income and middle-income countries (LMICs) settings. This presents unique challenges that differ from those faced in high-income country (HIC) contexts, due to a dearth of infrastructure and unique socio-cultural contexts. Field experiences by research teams working in these LMIC contexts are thus critical to advancing knowledge on successful research conduct in these settings. The Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine has operated in The Gambia, a resource-constrained LMIC for over 70 years and has developed numerous research support platforms and systems. The unit was the lead clinical collaborator in a recently completed Expanded Program on Immunization Consortium (EPIC) study, involving a multicountry collaboration across five countries including the USA, Canada, Belgium, Papua New Guinea and The Gambia. The EPIC study recruited and completed follow-up of 720 newborn infants over 2 years. In this paper, we provide in-depth field experience covering challenges faced by the Gambian EPIC team in the conduct of this study. We also detail some reflections on these challenges. Our findings are relevant to the international research community as they highlight practical day-to-day challenges in conducting GCP standard clinical research in resource-constrained LMIC contexts. They also provide insights on how study processes can be adapted early during research planning to mitigate challenges.

THE STATUS OF FULL AND ON- SCHEDULE VACCINATION WITH 8 TYPES OF VACCINES AMONG CHILDREN UNDER 1 YEAR OLD AT QUAN TRIEU WARD, THAI NGUYEN CITY

Vaccination is one of the greatest achievements of modern medicine. The expanded program onimmunization has significantly reduced the morbidity and the mortality of children under 5 years oldcaused by infectious diseases. Alongside the achievements of the expanded program on immunization,in recent years, some diseases that had vaccines still outbroke in some locals. To improve theefficiency of the vaccination program, we conduct this study with this following target: To describethe status of full and on schedule vaccination with 8 types of vaccines among children under 1 yearold at Quan Trieu Ward, Thai Nguyen City. Research subjects and methods: The descriptive, crosssectional study was conducted among 105 children by immediately interviewing the major caregiversand checking the vaccination records. Research results: The complete vaccination coverage for eachvaccine: Hepatitis B: 99%, TB: 100%, DPT-Hib: 99%, polio: 99% and measles: 100%. The rates ofon-schedule vaccination for each type of vaccines are: Hepatitis B: 83.8%, TB: 87.6%, DPT-Hib:83.8%, polio: 83.8% and measles: 71.4%. The complete vaccination coverage of 8 types of vaccinesis 99% whilst the on-schedule vaccination rate of 8 types of vaccines is only 57.1%.

Immunization Coverage and Antibody Retention against Rabies in Domestic Dogs in Lusaka District, Zambia

Rabies remains endemic in Zambia. Despite conducting canine vaccinations in Lusaka district, the vaccination coverage and actual seropositivity in the dog population in Lusaka district are rarely evaluated. This study estimated the seropositivity-based immunization coverage in the owned dog population in Lusaka district using the expanded program on immunization cluster survey method. The time-series trend of neutralizing antibodies against rabies in vaccinated dogs was also evaluated. Of 366 dogs in 200 dog-owning households in Lusaka district, blood samples were collected successfully from 251 dogs. In the sampled dogs, 42.2% (106/251) had an antibody titer ≥0.5 IU/mL. When the 115 dogs whose blood was not collected were assumed to be seronegative, the minimum immunization coverage in Lusaka district’s owned dog population was estimated at 29.0% (95% confidence interval: 22.4–35.5). It was also found that a single vaccination with certified vaccines is capable of inducing protective levels of antibodies. In contrast, higher antibody titers were observed in multiple-vaccinated dogs than in single-vaccinated dogs, coupled with the observation of a decline in antibody titer over time. These results suggest the importance of continuous booster immunization to maintain herd immunity and provide useful information to plan mass vaccination against rabies in Zambia.