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• Review of vaccination services, January 2015 - June 2019 in 25 humanitarian crises. • Crisis emergent risk factors lead to heightened risk of excess morbidity from VPDs. • Vaccination decisions largely do not correspond to local disease risks. • Inconsistencies and inequities in vaccine provision to crisis-affected populations. The risk factors that emerge with the onset and protraction of humanitarian crises leave populations at a heightened risk of excess morbidity and mortality from vaccine-preventable diseases (VPDs). There is currently little clarity on which vaccines are being used in crises throughout the world, and whether vaccination decisions correspond to local disease threats. This review aimed to collect and analyse such information. We reviewed vaccination services from January 2015 to June 2019 across all 25 humanitarian responses that had an activated coordination mechanism during this period. A range of online sources and informants within the humanitarian sector were consulted to compile data on which vaccines were provided in each crisis, and the modality and timing of vaccine provision. The package of vaccination services since the start of each crisis was then compared with local disease burden (baseline + excess due to crisis-emergent risk factors). The range of vaccines used in humanitarian crises appears limited. When offered, vaccines were primarily delivered through the pre-existing routine schedule, with few supplementary actions taken in recognition of the need for rapidly enhancing population immunity. Vaccine packages mostly did not address the actual range of VPDs that likely accounted for substantial disease risk. This review suggests inconsistencies and inequities in vaccine provision to crisis-affected populations. A consistent, standardised and broader approach to vaccine use in crises is needed. [ABSTRACT FROM AUTHOR]

Globally, there is a growing concern with accountability and health systems. This has been attributed majorly to discontent with health system performance. Within the Nigerian health system, weak accountability has been consistently singled out as a key challenge underpinning the poor performance of the immunisation programme. In preparation for the 2017/2018 Measles Vaccination Campaign in Nigeria, the National Measles Technical Coordinating Committee (NMTCC) was inaugurated with one of its key mandates being to ensure accountability in the conduct of the 2017/2018 MVC. This paper aims to share the innovative measures applied in the 2017/2018 Measles MVC to improve accountability and to highlight the contribution of the accountability framework to improving measles vaccination coverage. We identified gaps in accountability from the post-campaign coverage reports and reviews of previous campaigns. We adapted an accountability framework developed by the Nigeria National Routine Immunization Strategic Plan (2013–2015),- which cuts across all levels. Selected indicators were used to monitor the implementation of the framework. Administrative actions such as sanctions and rewards were taken as necessary. We found that the implementation of the accountability framework was highly instrumental in achieving a high level of coordination among all stakeholders and to improving efficient utilization of resources. We also found that the implementation of the accountability framework in the 2017/2018 MVC contributed to the improved performance of states in terms of measles vaccination coverage compared to the 2015/2016 campaign. We have demonstrated that the implementation of the accountability framework in the 2017/2018 MVC led to a considerable reduction in the misuse and abuse of resources and also contributed to remarkable improvement in the measles vaccination coverages across states compared to the 2015/2016 MVC. [ABSTRACT FROM AUTHOR]

• Post licensure safety data of Typbar-TCV® is not available from a population wide campaign setting. • 207,000 doses of Typbar-TCV were administered in a campaign setting of Hyderabad, Pakistan. • No death, disability or hospitalization associated with Typbar-TCV during 14 days of vaccination was observed. • Fever and local reactogenicity were the frequently observed adverse events. Pakistan is facing the world's largest outbreak of extensively drug-resistant (XDR) Typhoid. Vaccination campaign for children aged 6 months to 10 years old with Typhoid Conjugate Vaccine (Typbar-TCV®) was conducted in high-risk areas of Hyderabad during 2018. About 207,000 children were vaccinated. Here we report the adverse events following immunization (AEFI) during the campaign. The campaign was carried out using outreach and fixed centre strategy. Community mobilizers visited each household to perform line listing and mobilize parents with age-eligible children. Children were observed for 30 min post-vaccination. Two-pronged strategy was used for ascertainment of AEFI. A 24/7 hotline number was provided to all parents/caretakers (n = 199,861) to report AEFI during 14 days following immunization. An age-stratified (n = 7139 children) were actively followed at days 7 and 14 for the ascertainment of AEFI. All AEFI were examined by three trained medical officers. A structured questionnaire using Brighton collaboration criteria with level 3 diagnostic certainty was used for the recording of AEFI. Data were analysed using Microsoft Excel Office 365. Overall, 499 AEFI (433 in the subset actively followed and 66 self-reported through hotline) were observed. The rate of AEFI was significantly higher among very young children (age group 6 to 12 months) as compared to 2 to 3 years old children (0.54% vs. 0.33% respectively; p-value < 0.001). Fever was the most common AEFI self-reported through the hotline (38/199,861 = 0.02%) and among the subset followed actively for 14 days (206/7139 = 2.89%). Fever was followed by local reactogenicity 10/199,861(0.01%), and 134/7139 (1.88%) through self-reported hotline and active follow-up, respectively. No serious AEFI was observed. Administration of a single dose of Typbar-TCV among children aged 6 months to 10 years old during an outbreak setting of Hyderabad Pakistan was safe. [ABSTRACT FROM AUTHOR]

• Influenza and pertussis vaccine uptake is moderate in pregnant women in Ireland. • Vaccines uptake increases with awareness of campaign and by socio-economic status. • General practitioners are the primary source for vaccine recommendation. • Multifaceted campaigns should target population in all socio-economic groups. • Omnibus surveys represent a timely and cost-saving method to reach specific target groups. In Ireland seasonal influenza and pertussis vaccination during pregnancy is recommended and every year national campaigns are organised to raise awareness and improve uptake. We estimated influenza and pertussis vaccine uptake and identified factors associated with vaccination status in pregnant women in 2017/18. We conducted a face-to-face omnibus survey, with quota sampling, among women aged 18–55 years and collected socio-demographic characteristics, self-reported vaccination status, awareness of vaccine campaigns, and attitudes towards vaccination. Sample was weighted to ensure representativeness with the target population. We performed univariate and multivariable logistic regression analyses on survey data. Overall, 241 pregnant women were enrolled. Influenza and pertussis vaccine uptake was 61.7% and 49.9%, respectively. Awareness of vaccine campaign and socio-economic status (SES) were associated with both influenza and pertussis vaccine uptake. The association between SES and uptake of vaccines differed by awareness. Women aware of the influenza vaccine campaign and with mid and low SES were less likely to be vaccinated, compared to those with high SES (aOR = 0.46; 95%CI: 0.22–0.97; aOR = 0.27; 95%CI: 0.12–0.60, respectively); women not aware of the pertussis vaccine campaign and with mid and low SES were less likely to be vaccinated, compared to those aware and with high SES (aOR = 0.15; 95%CI: 0.04–0.48; aOR = 0.05; 95%CI: 0.01–0.24, respectively). General practitioner (GP) recommendation was the main reason for receiving influenza vaccine (39.2%), and 71.8% of women were recommended pertussis vaccination from their GPs. The survey reports moderate uptake of vaccines among pregnant women, inequalities in uptake by SES and identifies GPs as primary source for vaccine recommendation. We recommend multifaceted campaigns, by engaging GPs, to target all socio-economic groups. [ABSTRACT FROM AUTHOR]

• Vaccine given to previously immune children incurs unnecessary cost. • A vaccination record review to determine eligibility has been previously proposed. • There are savings possible for vaccine, syringe, and waste boxes costs. • Total cost impact depends on previous vaccination rates and record availability. • Type of vaccine and reviewer skill level are also key drivers of total cost impact. Measles vaccination is a cost-effective way to prevent infection and reduce mortality and morbidity. However, in countries with fragile routine immunization infrastructure, coverage rates are still low and supplementary immunization campaigns (SIAs) are used to reach previously unvaccinated children. During campaigns, vaccine is generally administered to every child, regardless of their vaccination status and as a result, there is the possibility that a child that is already immune to measles (i.e. who has had 2+ vaccinations) would receive an unnecessary dose, resulting in excess cost. Selective vaccination has been proposed as one solution to this; children who were able to provide documentation of previous vaccination would not be vaccinated repeatedly. While this would result in reduced vaccine and supply cost, it would also require additional staff time and increased social mobilization investment, potentially outweighing the benefits. We utilize Monte Carlo simulation to assess under what conditions a selective vaccination policy would indeed result in net savings. We demonstrate that cost savings are possible in contexts with a high joint probability of an individual child having both 2+ previous measles doses and also an available record. We also find that the magnitude of net cost savings is highly dependent on whether a country is using measles-only or measles-rubella vaccine and on the required skill set of the individual who would review the previous vaccination records. [ABSTRACT FROM AUTHOR]

Vaccinating healthcare workers against influenza takes tens of thousands of hours of work annually. This study was undertaken to determine the acceptability, success rate, and time to vaccinate healthcare workers in nurse-led groups that self-vaccinated with intradermal influenza vaccine compared with nurse-administered intramuscular vaccine. Methods Volunteer hospital workers were randomly assigned to groups that either self-administered intradermal influenza vaccine (Intanza ® ) in a nurse-led group or received nurse-administered intramuscular vaccine (Vaxigrip ® ). Research assistants timed vaccination procedures; pre- and post-injection questionnaires assessed acceptability and reactogenicity. Results 810 adults, 21–69 years of age, from two study sites were vaccinated: 401 self-administered the intradermal vaccine while 409 received their intramuscular vaccine from a nurse. Of those who self-administered for the first time, 98.5% were successful on their first attempt with an additional 1.5% on their second attempt. Acceptability was high: 96% were very or somewhat certain that they administered the vaccine correctly, 83% would choose intradermal influenza vaccine again and of those, 75% would choose self-administration again, if given the choice. It took 51.3–72.6 s per person for the nurses to guide the groups through the self-administration process, which was significantly less time than it took to individually administer the intramuscular vaccines (93.6 s). Conclusion Self-administration of intradermal influenza vaccine by people working in healthcare settings is a possible alternative to nurse administered vaccinations, with nurse-led group sessions a good way of teaching the technique while being available to respond to unanticipated problems (NCT01665807). [ABSTRACT FROM AUTHOR]

This paper presents results of a study determining the efficacy of a values based approach to changing vaccination attitudes. It reports an evaluation survey of the “I Immunise” campaign, conducted in Fremantle, Western Australia, in 2014. “I Immunise” explicitly engaged with values and identity; formulated by locals in a community known for its alternative lifestyles and lower-than-national vaccine coverage rates. Data was collected from 304 online respondents. The campaign polarised attitudes towards vaccination and led some to feel more negatively. However, it had an overall positive response with 77% of participants. Despite the campaign only resonating positively with a third of parents who had refused or doubted vaccines, it demonstrates an important in-road into this hard-to-reach group. [ABSTRACT FROM AUTHOR]

Highlights: [•] The first field use of MenAfriVac's new label allowed the vaccine to be kept at up to 40°C for up to 4 days. [•] 155,000 people were vaccinated using the CTC approach in the Meningitis A campaign in northern Benin in 2012. [•] 98.7% of supervisors and 100% of vaccinators would prefer to conduct their next campaign using CTC. [•] They saw CTC benefits as: more people vaccinated, no need to return to health centre every night, reduced logistic burden. [•] Taking advantage of the flexibility offered by CTC opens the door for the implementation of new immunization strategies. [ABSTRACT FROM AUTHOR]

Abstract: This study is the first systematic documentation of the potency of monovalent oral polio vaccine type 3 (mOPV3) kept at ambient temperatures during a polio immunization campaign in Chad. During the study test vials were exposed to temperatures of up to 47.1°C, and kept outside of the 2–8°C range for a maximum of 86.9hours. Post-campaign laboratory testing confirmed that the test vials were still potent, and in conformity with the defined release specifications. Further, the Vaccine Vial Monitors performed as expected, giving an early warning indication of when cumulative exposure to heat reached levels that may have negatively affected the vaccine''s potency. This study provides proof-of-concept evidence that certain types of OPV remain potent and thus can be kept, for limited periods of time, as well as administered at ambient temperatures. [Copyright &y& Elsevier]