Combining First Nations Research Methods with a World Health Organization Guide to Understand Low Childhood Immunisation Coverage in Children in Tamworth, Australia

In Australia, we used the World Health Organization’s Tailoring Immunization Programmes to identify areas of low immunisation coverage in First Nations children. The qualitative study was led by First Nations researchers using a strength-based approach. In 2019, Tamworth had 179 (23%) children who were overdue for immunisations. Yarning sessions were conducted with 50 parents and health providers. Themes that emerged from this research included: (a) Cultural safety in immunisation services provides a supportive place for families, (b) Service access could be improved by removing physical and cost barriers, (c) Positive stories promote immunisation confidence among parents, (d) Immunisation data can be used to increase coverage rates for First Nations children. Knowledge of these factors and their impact on families helps ensure services are flexible and culturally safe.

Monitoring of Group A Rotavirus Strains Circulating in the Environment and Among Children with Acute Gastroenteritis

Rotavirus A is the causative agent of 90% of acute gastroenteritis in children under 5, which kills 1 to 3 million children per year. Their strong resistance in the environment, their inter-species transmission as well as their power of genetic recombination can give rise to new reasserting that may be harmful to public health. The simultaneous search for the presence of rotavirus A in different environmental and clinical biotopes and matrices as well as the monitoring of the seasonal evolution of episodes is of major importance. At cost, genetic monitoring of rotaviruses shows a correlation between the presence of different genotypes of RVA in the environment and the rate of morbidity, Hence the need to monitor the emergence of new circulating strains with a view to integrating them into routine immunization programmes appropriate for each region in order to limit the spread of the disease.

Characterization of immunization secondary analyses using demographic and health surveys (DHS) and multiple indicator cluster surveys (MICS), 2006–2018

Background Infant immunization coverage worldwide has plateaued at about 85%. Using existing survey data to conduct analyses beyond estimating coverage may help immunization programmes better tailor strategies to reach un- and under-immunized children. The Demographic and Health Survey (DHS) and the Multiple Indicators Cluster Survey (MICS), routinely conducted in low and middle-income countries (LMICs), collect immunization data, yet vaccination coverage is often the only indicator reported and used. We conducted a review of published immunization-related analyses to characterize and quantify immunization secondary analyses done using DHS and MICS databases. Methods We conducted a systematic search of the literature, of immunization-related secondary analyses from DHS or MICS published between 2006 and August 2018. We searched 15 electronic databases without language restrictions. For the articles included, relevant information was extracted and analyzed to summarize the characteristics of immunization-related secondary analyses. Results are presented following the PRISMA guidelines. Results Among 1411 papers identified, 115 met our eligibility criteria; additionally, one article was supplemented by the Pan American Health Organization. The majority were published since 2012 (77.6%), and most (68.9%) had a first or corresponding author affiliated with institutions in high-income countries (as opposed to LMICs where these surveys are conducted). The median delay between survey implementation and publication of the secondary analysis was 5.4 years, with papers with authors affiliated to institutions in LMIC having a longer median publication delay (p < 0.001). Over 80% of the published analyses looked at factors associated with a specific vaccine or with full immunization. Quality proxies, such as reporting percent of immunization data from cards vs recall; occurrence and handling of missing data; whether survey analyses were weighted; and listing of potential biases or limitations of the original survey or analyses, were infrequently mentioned. Conclusion Our review suggests that more needs to be done to increase the increase the utilization of existing DHS and MICS datasets and improve the quality of the analyses to inform immunization programmes. This would include increasing the proportion of analyses done in LMICs, reducing the time lag between survey implementation and publication of additional analyses, and including more qualitative information about the survey in the publications to better interpret the results.

How to evaluate the implementation of complex health programmes in low-income settings: the approach of the Gavi Full Country Evaluations

Vaccination, like most other public health services, relies on a complex package of intervention components, functioning systems and committed actors to achieve universal coverage. Despite significant investment in immunization programmes, national coverage trends have slowed and equity gaps have grown. This paper describes the design and implementation of the Gavi Full Country Evaluations, a multi-country, prospective, mixed-methods approach whose goal was to monitor and evaluate processes, inputs, outputs and outcomes of immunization programmes in Bangladesh, Mozambique, Uganda and Zambia. We implemented the Full Country Evaluations from 2013 to 2018 with the goal of identifying the drivers of immunization programme improvement to support programme implementation and increase equitable immunization coverage. The framework supported methodological and paradigmatic flexibility to respond to a broad range of evaluation and implementation research questions at global, national and cross-country levels, but was primarily underpinned by a focus on evaluating processes and identifying the root causes of implementation breakdowns. Process evaluation was driven by theories of change for each Gavi funding stream (e.g. Health Systems Strengthening) or activity, ranging from global policy development to district-level programme implementation. Mixing of methods increased in relevance and rigour over time as we learned to build multiple methods into increasingly tailored evaluation questions. Evaluation teams in country-based research institutes increasingly strengthened their level of embeddedness with immunization programmes as the emphasis shifted over time to focus more heavily on the use of findings for programme learning and adaptation. Based on our experiences implementing this approach, we recommend it for the evaluation of other complex interventions, health programmes or development assistance.

1.C. Workshop: How are digital solutions contributing to enhance immunization programmes and policies?

As vaccine hesitancy and decreasing immunization coverage have been identified by the World Health Organization as global alarming health threats, it is of crucial importance to exploit the potential offered by digital solutions to enhance immunization programmes and ultimately increase vaccine uptake. We have previously developed and published a conceptual framework outlining how digitalization can support immunization at different levels: i) when adopted for health education and communication purposes, ii) in the context of immunization programmes delivery, and iii) in the context of immunization information systems management. The proposed workshop is co-organized by the EUPHA Digital health section (EUPHA-DH) and EUPHA Infectious diseases control section (EUPHA-IDC) and aims at discussing the current AVAILABILITY, USE and IMPACT of digital solutions to support immunization programmes at the international, national and local level, as well as, debating on how technical infrastructures on one side and normative and policy frameworks on the other side enable their implementation. We plan to have a rich set of contributions covering the following: the presentation of a conceptual framework identifying and mapping the digital solutions' features having the potential to bolster immunization programmes, namely: i) Personalization and precision; ii) Automation; iii) Prediction; iv) Data analytics (including big data and interoperability); and v) Interaction; the dissemination of key results and final outputs of a Europe-wide funded project on the use of Information & Communication Technology to enhance immunization, with particular reference to the use and comparative impact of email remainders and personal electronic health records, as well as the results of an international survey conducted to map and collect best practices on the use of different digital solutions within immunization programmes at the national and regional level; the firsthand experience of the United Kingdom NHS Digital Child Health Programme which developed, implemented and is currently evaluating a number of solutions to increase childhood vaccination uptake in England, including an information standard and information sharing services developed to ensure that the details of children's vaccinations can be shared between different health care settings the perspective and experience of the European Centre for Disease Prevention and Control (ECDC) for Europe and of the World Health Organization (WHO) for the global level of what has worked so far in the digitalization of immunization programmes around the world, what recommendations were developed and which barriers identified at the technical normative and policy level Key messages Digitalization has great potential to support immunization programmes but its practice and impact need to be measured. Country-level and international experiences have created qualitative and quantitative evidence on the effectiveness of digital intervention aimed at increasing vaccine uptake.

Digitalization of immunization programmes in Europe: results from the EUVIS project

The second and final phase of the EUVIS (EUrope Vaccines ICT Strategies) project, coordinated by the School of Public Health of the University Vita-Salute San Raffaele in Milan (Italy), aims at collecting best practices on the use and impact of Information and Communication Technologies (ICT) and digital tools to increase vaccine uptake and ultimately vaccination coverage in Europe. The field of ICT has flourished in recent years revolutionizing the processes of gathering, spreading and utilizing health information among healthcare providers, citizens and mass media. In particular, we are interested in any digital technology that can improve vaccine uptake supporting actions aimed at both increasing the demand of vaccines (i.e provide access to information through telecommunications, networks, the Internet, wireless, mobile devices), and the supply of effective and efficient life-course immunization services (i.e ICT-based interventions to support immunization programmes delivery and their monitoring). Within EUVIS we have previously conducted a series of systematic reviews to pool available evidence from experimental studies on the impact of selected ICT-based intervention (i.e. e-mail reminders, personal health records, among others) to improve vaccine uptake and other associated outcomes. In the current study, second and final phase of the EUVIS project, we are conducting a survey at the European level to gather original data on the use and impact of ICT and digital tools within immunization programmes in selected countries. The survey tool was developed on the basis of findings from EUVIS phase one and experts' consultation; it consisted on a 55-item questionnaire, distributed to public health professionals working in health agencies, institutions and the academia to build “ICT and immunization” countries' profile, as well as to gather, pool and critically appraise data on perceived potential and challenges of immunization programmes' digitalization in Europe.

Vaccinal prevention of chickenpox: relevance of the problem

Chickenpox is an acute viral infection which is a serious public health problem. According to the World Health Organization, there are 4,2 million severe forms of disease requiring hospitalization and 4,200 deaths annually. The CP cause is DNA-containing herpesvirus 3, Varicella-zoster. The first symptoms of the disease appear after the incubation period, which lasts from 10 to 21 days, and are manifested by fever, malaise and the appearance of a characteristic rash in the form of small vesicles with transparent content on the skin and mucous membranes. The vesicles are progressively covered with crust, which disappears within 7–10 days. Chicken pox is more frequent in the mild and moderate form, but it may develop severe forms, atypical course, complications (most often bacterial skin infections and lesions of the nervous system are registered in children (more often – chicken encephalitis), and in adults - pneumonia). Vaccinal prevention is the most effective and scientifically proven method of infection control, and chickenpox currently belongs to such infections. The currently used chickenpox vaccines were developed in the mid 1970s, used in some countries from the mid 1980s, and from the early 1990s began to be used in routine immunization programmes in leading countries. Since then, their safety and immunogenicity as well as high efficiency of routine chickenpox vaccine prevention in both healthy and high-risk individuals have been proved. Accumulated experience has shown that a vaccine can reduce the number of cases and the frequency of hospitalizations and deaths when mass immunization is carried out.