Epidemiological Characteristics and the Trend of Animal Bites during the years 2014-2018

Background: Animal bite is a serious and dangerous threat to human health. The highest prevalence rate of animal bite in Iran is in Golestan, Ardabil and, then Khorasan. The present study examined the epidemiological characteristics and the trend of animal bites during 2014-2018. Results: In this study, out of 3784 cases bitten by animals, 2821 happened by a sudden attack. Most reports of the animal bite were from dogs. Also, the trend of animal bite during 2014-2018 was increasing and the charts showed that the trend will continue to increase the next year. Conclusion: Due to the increasing trend of animal bites, it is necessary to take basic measures such as training endangered groups, forming a committee to eliminate stray dogs, and strengthening the care system and immunization program.

SARS-CoV-2 Vaccinated Breakthrough Infections With Fatal and Critical Outcomes in the Department of Antioquia, Colombia

The introduction of variants of concern and interest in the Departamento of Antioquia, Colombia, was concomitant with the beginning of the COVID-19 immunization program. Genomic surveillance indicates that none of the emerging variants –alpha, gamma, lambda, mu or delta– were dominant between January and August 2021. The immunization includes CoronaVac, BNT162b2, Ad26.COV2.S and ChAdOx1-S vaccines. By September 10th, 34.43% inhabitants were fully vaccinated. We characterized, SARS-CoV-2 breakthrough infections in 96 patients, 30 with fatal outcomes, 13 with ICU hospitalization and 53 with mild or asymptomatic disease. Even though gamma and mu variants co-circulated at similar levels, the latter was found to be predominant in patients with fatal outcomes and in those with ICU hospitalizations. We found a significant occurrence of the B.1.625 variant in these patients. Genetic substitutions of therapeutic and immunological concern, E484K and N501Y, are consistently observed in 90.1% and 79.5% of these variants, respectively. Evidence suggests that it is less probable to become infected after 60 days post-treatment with BNT162b2 than with CoronaVac. Importantly, we found that advanced age and comorbidities foster conditions for fatal and ICU outcomes in vaccinated patients. Our observations demonstrate the effectiveness of vaccination and identify patients with higher risks of subsequent breakthrough infections.

Economic impact of switching from partially combined vaccine “Pentaxim® and hepatitis B” to fully combined vaccine “Hexaxim®” in the Malaysian National Immunization Program

Background The decision to implement new vaccines should be supported by public health and economic evaluations. Therefore, this study was primarily designed to evaluate the economic impact of switching from partially combined vaccine (Pentaxim® plus hepatitis B) to fully combined vaccine (Hexaxim®) in the Malaysian National Immunization Program (NIP) and to investigate healthcare professionals (HCPs)’ and parents’/caregivers’ perceptions. Methods In this economic evaluation study, 22 primary healthcare centers were randomly selected in Malaysia between December 2019 and July 2020. The baseline immunization schedule includes switching from Pentaxim® (four doses) and hepatitis B (three doses) to Hexaxim® (four doses), whereas the alternative scheme includes switching from Pentaxim® (four doses) and hepatitis B (three doses) to Hexaxim® (four doses) and hepatitis B (one dose) administered at birth. Direct medical costs were extracted using a costing questionnaire and an observational time and motion chart. Direct non-medical (cost for transportation) and indirect costs (loss of productivity) were derived from parents’/caregivers’ questionnaire. Also, HCPs’ and parent’s/caregivers’ perceptions were investigated using structured questionnaires. Results The cost per dose of Pentaxim® plus hepatitis B vs. Hexaxim® for the baseline scheme was Malaysian ringgit (RM) 31.90 (7.7 United States dollar [USD]) vs. 17.10 (4.1 USD) for direct medical cost, RM 54.40 (13.1 USD) vs. RM 27.20 (6.6 USD) for direct non-medical cost, RM 221.33 (53.3 USD) vs. RM 110.66 (26.7 USD) for indirect cost, and RM 307.63 (74.2 USD) vs. RM 155.00 (37.4 USD) for societal (total) cost. A similar trend was observed for the alternative scheme. Compared with Pentaxim® plus hepatitis B, total cost savings per dose of Hexaxim® were RM 137.20 (33.1 USD) and RM 104.70 (25.2 USD) in the baseline and alternative scheme, respectively. Eighty-four percent of physicians and 95% of nurses supported the use of Hexaxim® in the NIP. The majority of parents/caregivers had a positive perception regarding Hexaxim® vaccine in various aspects. Conclusions Incorporation of Hexaxim® within Malaysian NIP is highly recommended because the use of Hexaxim® has demonstrated substantial direct and indirect cost savings for healthcare providers and parents/caregivers with a high percentage of positive perceptions, compared with Pentaxim® plus hepatitis B. Trial registration Not applicable.

The effect of introduction of routine immunization for rotavirus vaccine on paediatric admissions with diarrhoea and dehydration to Kenyan Hospitals: an interrupted time series study

Background: Dehydration secondary to diarrhoea is a major cause of hospitalization and mortality in children aged less than five years. Most diarrhoea cases in childhood are caused by rotavirus, and routine introduction of rotavirus vaccine is expected to reduce the incidence and severity of dehydration secondary to diarrhoea in vaccinated infants. Previously, studies have examined changes in admissions with stools positive for rotavirus but this study reports on all admissions with dehydration secondary to diarrhoea regardless of stool rotavirus results. We aimed to assess the changes in all-cause severe diarrhoea and dehydration (DAD) admissions following the vaccine’s introduction. Methods: We examined changes in admissions of all clinical cases of DAD before and after introduction of routine vaccination with rotavirus vaccine in July 2014 in Kenya. We use data from 13 public hospitals currently involved in a clinical network, the Clinical Information Network (CIN). Routinely collected data for children aged 2-36 months were examined. We used a segmented mixed effects model to assess changes in the burden of diarrhoea and dehydration after introduction of rotavirus vaccine. For sensitivity analysis, we examined trends for non-febrile admissions (surgical or burns). Results: There were 17,708 patients classified as having both diarrhoea and dehydration. Average monthly admissions due to DAD for each hospital before vaccine introduction (July 2014) was 35 (standard deviation: ±22) and 17 (standard deviation: ±12) after vaccine introduction. Segmented mixed effects regression model showed there was a 33% (95% CI, 30% to 38%) decrease in DAD admissions immediately after the vaccine was introduced to the Kenya immunization program in July 2014. There was no change in admissions due to non-febrile admissions pre-and post-vaccine introduction. Conclusion: The rotavirus vaccine, after introduction into the Kenya routine immunization program resulted in reduction of all-cause admissions of diarrhoea and dehydration in children to public hospitals.

Key Challenges and Opportunities for Implementing School Located Vaccination Clinics for COVID-19 and Influenza: Roundtables With School Nurses and Immunization Programs

School-located vaccination clinics (SLVs) are an established strategy to offer influenza and routine vaccinations and improve student and community health. The COVID-19 pandemic has led many communities to expand SLVs to include COVID-19 vaccines. However, these SLVs are less documented than in the past due to the fast-paced nature of the pandemic and the additional pressures put on schools and public health organizations. We conducted five virtual roundtables with 30 school nurses and state immunization program managers from across the United States to gain insight into SLVs occurring during the COVID-19 pandemic. Roundtables explored participants’ experiences planning and implementing SLVs, including factors influencing success and available resources. Findings highlighted SLVs as an opportunity to increase access and equity for vaccines. Participants shared strategies for School-located vaccination (SLV) funding, partnership building, vaccine storage and management, consent, data sharing, messaging, and promotion. These shared experiences offer useful insights for those interested in future and sustained SLV implementation.

Analysis of Immunization Program Management in Achieving Universal Child Immunization (UCI) Coverage at Bebesen Health Center, Central Aceh Regency

The purpose of the study was to analyze the implementation of immunization program management in an effort to achieve UCI at the Bebesen Health Center, Central Aceh Regency. This research uses descriptive qualitative method. The research location is Bebesen Public Health Center, Central Aceh Regency. Sources of data used consisted of primary data, secondary data and tertiary data. Data collection techniques in the form of observation, in-depth interviews with 10 informants and documentation. Data analysis techniques are carried out through data reduction, data presentation and drawing conclusions. To analyze the availability of resources for the implementation of the immunization program at the Bebesen Health Center, Central Aceh Regency, the researchers used management theory including input, process and output consisting of the availability of officers, sources of funds and facilities and infrastructure. The implementation of the immunization program consists of planning, implementation, monitoring and evaluation. The output can be seen in the UCI coverage at the Bebesen Health Center. It has not yet reached the target where the achievement is still 71.4%. The conclusion of this study is that the staff's resources have met the qualification standards, namely having a medical or nursing educational background and having STR with a minimum education of DIII in the field of Health, as well as sufficient funds, facilities and infrastructure. The evaluation has been carried out and it is necessary to increase cross-sectoral collaboration.

Estimating the impact of implementation and timing of COVID-19 vaccination program in Brazil: a counterfactual analysis

The vaccines developed in 2020-2021 against the SARS-CoV-2 virus were designed to prevent severity and deaths due to COVID-19. However, how effective this vaccination campaign was at saving lives remains a methodological challenge. In this work, we developed a Bayesian statistical model to estimate the number of deaths and hospitalizations in individuals above 60 years old in Brazil. Using the actual number of hospitalized and deaths from the Brazilian database, and also the coverage of second dose according to the National Immunization Program, we rebuilt the realized scenario as well as the hypothetical scenario without vaccination in Brazil in order to perform a counterfactual analysis. By computing the difference between the hypothetical and realized scenarios, we were able to estimate the direct effect of COVID-19 vaccination in Brazil. We also evaluated two other hypothetical, but not impossible, scenarios considering earlier vaccination roll-outs. We estimated that more than 165 thousand of 60+ years old individuals were not hospitalized due to COVID-19 until August 28, 2021, and other approximately 100 thousand individuals could not have been hospitalized if the immunization started as soon it was approved in Brazil. We also estimate that more than 75 thousand lives were saved in the period analysed for the same age group, and additional 48 thousand lives could have been saved if the Brazilian Government started the immunization 8 weeks earlier.

Implementation of a neonatal hepatitis B immunization program in rural Karenni State, Myanmar: A mixed-methods study

Background Hepatitis B infection is a major health concern in Myanmar. Hepatitis B birth dose vaccination to prevent mother-to-child transmission is not universal, especially in births outside of health care facilities. Little is documented about delivery of immunization programs in rural Myanmar or in conflict-affected regions. To address this gap, this study describes the implementation of a novel community delivered neonatal hepatitis B immunization program in rural Karenni State, Myanmar. Methods A mixed-methods study assessed the effectiveness and feasibility of hepatitis B birth dose immunization program. 1000 pregnant women were screened for hepatitis B virus (HBV) infection using point of care testing. Neonates of HBV positive mothers were immunized with a three dose HBV vaccine schedule at birth, 1, and 6 months of age. HBV testing was completed for children at 9 months to assess for infection. Descriptive statistics were collected including demographic data of mothers, neonatal vaccination schedule completion, and child HBV positivity at 9 months. Qualitative data examining barriers to implementation were collected through semi-structured interviews, participant-observation, and analysis of program documents. Themes were codified and mapped onto the Consolidated Framework for Implementation Research. Results 46 pregnant women tested HBV positive leading to 40 live births. 39 women-child dyads were followed until the 9-month age mark. With the exception of two neonates who received their birth dose past 24 hours, all children received their vaccines on time. None of the 39 children tested positive for HBV at nine months. Themes regarding barriers included adaptability of the program to the rural setting, friction with other stakeholders and not meeting all needs of the community. Identified strengths included good communication and leadership within the implementing ethnic health organization. Conclusion A community delivered neonatal HBV vaccination program by ethnic health organizations is feasible and effective in rural Myanmar.