Assessment of knowledge about adverse events following immunization among health care workers of Raipur city

Background: Vaccines used in national immunization programme are extremely safe and effective. Although, no vaccine is 100% safe and effective and adverse effects occurs. Process of immunization itself is potential source of adverse reactions. Knowledge and reporting of adverse events following immunization (AEFI) is very important for health care workers. Objective of this study is to assess knowledge about AEFI among health care workers.Methods: This cross-sectional study was conducted among health care workers of primary health care centres of Raipur City. All the ANM, Staff Nurse and MPWs posted in all the primary health centers of Raipur city (C.G.) were selected for the study. A pre designed pretested questionnaire was administered after taking verbal consent. Data was collected, compiled and analyzed in MS excel.Results: A total 157 health care workers participated in study. Mean age of the participants was 36.4±8.8. More than 80% participants knew vaccine product and vaccine quality defect-related reaction as possible causes of AEFI. 87.3% knew about swelling as commonest AFEI. The 59.9% had knowledge about management of common AEFI. 99.3% Health care workers knew anaphylaxis as one of severe AEFI and 91.08% were aware that AEFI should be reported.Conclusions: Majority of study participants had knowledge about possible causes of AEFI, minor and serious AEFI.

Tolerability of MenACWY-TT vaccination in adolescents in the Netherlands; a cross-sectional study

Background In 2018, meningococcal ACWY-TT vaccine (MenACWY-TT) was offered to adolescents in the Netherlands within the National Immunization Programme at 14 years of age. A questionnaire study assessed the tolerability of this vaccine. Methods Five thousand adolescents were invited to participate and to fill in two questionnaires about systemic events in the week before vaccination and local reactions and systemic events in the week after vaccination. Frequencies of local and systemic adverse events in the week after vaccination were calculated. Association between the occurrence of systemic symptoms in the week before and after the vaccination was tested by using generalized mixed models (GLMM). Results Of all adolescents, 139 returned one or both questionnaires. Any local reaction within 7 days after vaccination was reported by 55.6% of the adolescents. Pain (50%) and reduced use of the injected arm (21.3%) were most often reported. Any systemic event was reported by 67.6% of the participants, with myalgia as the most often reported event (37.0%). Compared with the week before vaccination, there were no increased odds of experiencing systemic symptoms in the week after vaccination (OR 0.95; 95%CI 0.40–2.27). Conclusions After vaccination with MenACWY-TT vaccine, most adolescents reported one or more adverse events, which were mostly mild and transient. Systemic symptoms were not reported more often in the week after compared to the week before vaccination. Unfortunately, due to a low response rate we were not able to detect the absolute elevated risks the sample size calculation was based on. However, despite limited data, our results are in line with results from prelicensure data, and indicate that MenACWY-TT vaccination is well tolerated in adolescents.

Trends for rotavirus acute gastroenteritis in children under 5 years old before and after vaccine introduction, Morocco, 2006–2014

Background: In Morocco, acute gastroenteritis in children is a public health issue. Since 1987, several strategies have been conducted to reduce its burden by the Moroccan Ministry of Health, including the introduction of the anti-rotavirus vaccine into the national immunization programme in 2010. Aims: To evaluate the impact of the anti-rotavirus vaccine in outpatients and inpatients with acute gastroenteritis under 5 years old. Methods: We conducted descriptive studies and a retrospective cohort study using data from the hospital’s sentinel surveillance system and the national ambulatory surveillance registry for acute gastroenteritis from 2006 to 2014. This include the period before and after the implementation of the rotavirus (RV) vaccine on children under age 5 years. Results: The decrease in acute gastroenteritis cases was about 5.2%, mainly among children aged 0–11 months. The proportion of acute RV gastroenteritis (RVGE) decreased from 37.0% to 31.1% after the vaccine’s introduction; it was statistically significant among the children aged 0–11 months (38.8% to 28.1%; P = 0.009). The proportion of RVGE among inpatients decreased from 97.0% to 91.7% (P = 0.022). Diarrheal disease cases without dehydration increased from 7.8% to 11.1% (P < 0.001); RVGE was 2.3 times more frequent among unvaccinated children. The vaccine effectiveness was estimated at 57%. The proportion of G1P[8] genotype infections decreased after the introduction of the RV vaccine (56% to 40%; P < 0.001), while the G2P[4] genotype became more frequent (13% to 21%; P = 0.015). Conclusions: The introduction of the RV vaccination into the national immunization programme in Morocco has allowed significant reduction in the incidence and severity of RVGE among children under 5 years old

Impact of varicella vaccine on nosocomial outbreaks and management of post exposure prophylaxis following in a paediatric hospital

Introduction In 2015, varicella vaccine was introduced to the National Immunization Programme in a one-dose regimen for infants aged 15 months. The aim of this study was to describe and compare the epidemiologic characteristics, management strategies and costs of varicella outbreaks in Ricardo Gutierrez Children’s Hospital (HNRG) from 2000 to 2019, before (PreV period) and after (PostV period) the introduction of the varicella vaccine. Methods A retrospective, analytic study of the impact of nosocomial varicella outbreaks at the HNRG, based on active epidemiologic surveillance. We compared nosocomial varicella outbreaks rates (per 10,000 discharges) between PreV and PostV, excluding the intervention year (2015). Results During PreV, an average of 15.87 (13.91–18.02) outbreaks per year was observed and in PostV 5.5 per year (3.44–8.32). Outbreaks adjusted by all cause discharges showed a reduction of 59.13% (-36.68%, -73.62%) after vaccine introduction. Considering that in PreV the average of susceptible cases per outbreak was 5.0 and in PostV 7.8, with a cost per susceptible of AR$ $6,522 (80.27 USD) PreV and 6,708 PostV the economic impact on the reduction of outbreaks after the introduction of the vaccine, showed an estimated average savings per year of AR$ -252,128 AR$ (-3,103.11 USD). Conclusions The number of annual varicella hospital outbreaks at the HNRG decreased significantly after varicella vaccine was introduced to NIP in Argentina with a relevant reduction in terms of costs.

Impact of 13-valent pneumococcal conjugate vaccine on laboratory-confirmed pneumococcal meningitis and purulent meningitis among children ˂5 years in Cameroon, 2011–2018

Background The 13-valent pneumococcal conjugate vaccine (PCV13) entered Cameroon’s childhood national immunization programme (NIP) in July 2011 under a 3-dose schedule (6, 10, 14 weeks of age) without any catch-up. We described the impact of PCV13 onserotype distribution among pneumococcal meningitis cases over time. Methods We used laboratory-based sentinel surveillance data to identify meningitis cases among 2- to 59-month-old children with clinically-suspected bacterial meningitis (CSBM) admitted to hospitals in Yaoundé (August 2011-December 2018). Purulent meningitis cases had a cerebrospinal fluid (CSF) white blood cell (WBC) count ≥20 per mm3. Pneumococcal meningitis cases had S. pneumoniae identified from CSF, with serotyping by polymerase chain reaction. Years 2011-2014 were described as early PCV13 era (EPE) and years 2015-2018 as late PCV13 era (LPE) impact periods. Results Among children hospitalized with CSBM who had a lumbar puncture obtained, there was no significant change from the EPE versus the LPE in the percentage identified with purulent meningitis: 7.5% (112/1486) versus 9.4% (154/1645), p = 0.0846. The percentage of pneumococcal meningitis cases due to PCV13 vaccine-serotype (VST) decreased from 62.0% (31/50) during the EPE to 35.8% (19/53) in the LPE, p = 0.0081. The most frequent pneumococcal meningitis VSTs during the EPE were 6A/6B (30%) and 5 (6%), and during the LPE were 14 (13.2%), 3 (7.6%), 4 (5.6%) and 18C (5.6%). Conclusion Four to seven years after PCV13 introduction, the proportion of pneumococcal meningitis due to vaccine serotypes has declined, mainly due to reductions of serotypes 6A/6B, 1, 19A, and 23F; nevertheless, PCV13 VSTs remain common. Because the analyzed surveillance system was not consistent or population based, we could not estimate incidence or overall impact; this emphasizes the need for improved surveillance to document further the utility of PCV13 immunization in Cameroon.

Tolerability of MenACWY-TT Vaccination in Toddlers in the Netherlands; A Questionnaire Study

Background: In May 2018, the monovalent MenC-TT conjugate vaccine given at 14 months of age within the National Immunization Programme in the Netherlands was replaced by a 4-valent MenACWY-TT conjugate vaccine. Methods: Results from a questionnaire about local reactions and systemic events within 4 days after vaccination were compared with data from a comparable tolerability study of a monovalent MenC-TT vaccine. Results: The response rate was 5.5% (1157/20966 questionnaires). Any local reaction was reported for 3.7% of the toddlers, with the highest percentage found for local redness at the injection site (2.9%). Any systemic event was reported for 32.4% of the toddlers, with listlessness (22.4%) most often reported. Fever was the only symptom more frequently reported after MenACWY-TT vaccination compared with MenC-TT vaccination (adj OR 1.61; 95% CI 1.29-2.01).Conclusions: the 4-valent MenACWY-TT vaccine showed to be a little more reactogenic compared with to the monovalent MenC-TT vaccine, with a higher risk of fever within 4 days after vaccination. For the other factors no increased risks were found. Overall, this study shows that MenACWY-TT vaccination is well tolerated in toddlers.

Vaccine hesitancy in India-the challenges: a review

Immunization is the most cost-effective scientific method of reducing childhood morbidity and mortality. In India the national immunization programme has not been able to attain complete coverage of the eligible children and hence mortality due to vaccine preventable diseases is approximately 5 lakhs annually. Every year, 89 lakhs children are at risk to develop vaccine preventable diseases due to lack of immunization. While most people vaccinate according to the recommended schedule, this success is challenged by individuals and groups who delay, hesitant or refuse vaccines due to various reasons. Despite the realization of compulsory scheduling of vaccines, there are an alarming number of parents who do not permit the vaccination of their children as scheduled. Vaccine hesitancy refers to a delay in acceptance or refusal of vaccines despite the availability of vaccination services. WHO in 2019 listed vaccine hesitancy as one of the ten global health threats. The recent vaccination coverage evaluation studies have shown that there is a perceptible drop in the vaccine coverage in most parts of India and also that the disparity in the urban-rural coverage is also widening. Hence an evaluation of the reasons for vaccine hesitancy is vital at present to strengthen the universal immunization program. The authors are trying to trace the present status and reasons for vaccine hesitancy reported in recent times, which can lead to outbreaks of already controlled vaccine preventable diseases and to identify strategies which are being implemented to overcome the vaccine hesitancy.

Measles outbreak in a Roma community in the Eastern region of Slovakia, May to October 2018

BackgroundDespite the effective National Immunization Programme of Slovakia, some population groups are incompletely vaccinated or unvaccinated. We aimed to describe the measles outbreak spread in Eastern Slovakia between May and October 2018, affecting the Roma communities in relation to the existing immunity gaps.MethodsWe defined a group of persons living in socially closed communities with low vaccination coverage.ResultsOf 439 measles cases (median age: 10 years), 264 (60.1%) were vaccinated, 137 (31.2%) received two doses and 127 (28.9%) one dose of measles vaccines, 155 (35.3%) were unvaccinated and 20 (4.6%) had an unknown vaccination status. Samples from 102 patients (with two-dose vaccination status) were additionally tested for antibodies against rubella and mumps. Of 102 cases, 68 (66.7%) cases had a positive IgM and 23 (22.5 %) IgG antibodies against measles. For rubella, only 20 (19.6%) cases had seropositive IgG levels, for mumps higher positivity was detected in 60 persons (58.8%). We could detect only a small percentage with positive serology results of rubella IgG antibodies across all age groups. We have assumed that rubella antibodies had to be produced following the vaccination. Their absence in the cases with two doses of MMR suggests that these vaccines could not have been administrated despite the fact that this data was included in the medical records. Sequential analysis of two samples showed measles genotype B3.ConclusionThis outbreak can outline the existence of a vulnerable group of the Roma. Low vaccinate coverage represents a serious public health threat.