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Immunization is widely recognized as one of the most successful and cost-effective health interventions, preventing two to three million deaths from vaccine-preventable diseases each year. Although progress has been made in recent years, substantial operational challenges persist in resource-limited settings with frequent stock-outs contributing to sub-optimal immunization coverage and inequality in vaccine access. In this paper, we investigate the role of rainy season induced supply chain disruptions on vaccination coverage and inequalities. We develop a modeling framework combining spatial modeling—to predict flood disruptions in road networks—and a discrete-event simulation of a multi-tiered vaccine supply chain (VSC). Our models are fitted using data from the Malagasy VSC network and validated to the best extent possible with scarce data. Our baseline simulation predicts the national vaccination coverage with good accuracy and suggests that 67% of regions with low reported immunization coverage are affected by rainy season disruptions or operational inefficiencies, causing significant geographical inequalities in vaccine access. We investigate various mitigation strategies to increase the resiliency of VSCs and find that, by strategically placing buffer inventory at targeted facilities prior to the rainy season, the proportion of children receiving all basic vaccines in these areas is increased by 8% and the geographical inequality in vaccination coverage between areas affected and not affected by the rainy season is reduced by 11%. By also increasing the replenishment frequency from every third month to every month, the national vaccination coverage improves by 41%. Our results contribute to achieving the UN Sustainable Development Goals (SDGs) by providing actionable insights for improving vaccination coverage (SDG 3) and investigating the resiliency of the VSC to increased flooding due to climate change (SDG 13).

Background Despite the proposed ethical link between mandatory immunization and Vaccine Injury Support Programs (VISPs), relatively few jurisdictions, even those with mandatory immunization, have implemented such programs. Although it may be assumed that individuals injured by a vaccine in a non-VISP country receive less support than in countries possessing such programs, the extent of the discrepancy is not clear; nor is the nature of any discrepancy. Methods In our 2018 survey of 28 Global NITAG (National Immunization Technical Advisory Group) Network (GNN) countries, we asked respondents about mandatory immunization and the availability of VISPs. Responses were supplemented with desktop research and review of scholarly literature for further information regarding VISP availability and details. Results Although only two of 14 (14%) surveyed jurisdictions with mandatory immunization had formal VISPs, responses from additional countries suggested the presence of less formal avenues of compensation for serious Adverse Events Following Immunization (AEFIs); similarly, we found five of 15 (33%) of countries without mandatory immunization had implemented formal VISPs, but another three such countries suggested similar informal methods of compensation. Conclusions From our data, it is evident that at least some countries with mandatory immunization may discharge their (perceived or actual) ethical obligation to provide financial assistance to vaccine-injured individuals through more informal avenues rather than structured VISPs, although the extent and impact of this practice is by its nature difficult to assess. Further, the nature of VISPs may vary significantly from jurisdiction to jurisdiction, and simple VISP/non-VISP classification of jurisdiction may fail to capture nuance in support for AEFI victims in many jurisdictions. Future assessments of VISPs should consider the possibility of these more informal avenues of support for vaccine injuries.

Major public and private laboratories have entered into a race to find an effective Covid-19 vaccine. When that vaccine arrives, the governments will have to implement vaccination programs to achieve the necessary immunization levels to prevent the disease transmission. In this context, the ethical dilemma of compulsory vaccination vs. voluntary vaccination will be raised. Underlying this dilemma, lies the problem of the ethical models on which the political decisions of governments in matters of health are based. The article proposes and argues the need to base health policy decisions on an ethical "first person" model, based on responsibility, that allows us to move from a normative ethic to an ethic of responsible behavior. This change in the ethical model, together with certain proposals for political action, will help us to restore institutional trust so that the necessary levels of collective immunity against Covid-19 can be achieved through the voluntary vaccination of the citizens.

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As the COVID-19 pandemic continues to impact everyone to some degree, it has become clear that experts from many disparate fields must work together to overcome such public health crises. Even now, a significant portion of United States residents remain hesitant to receive a vaccine. In the quest to safely return to a fully open economy, time is of the essence, as many lives and livelihoods can be saved by even marginal improvements in vaccination rates. To reach widespread immunization sooner, science stands to benefit by using market segmentation strategies with vaccine holdouts, much like brands do with customers. As evidence, we present results from a national survey segmented into four groups of COVID-19 vaccine holdouts. When viewed and considered as separate segments, important distinctions regarding the nature and strength of reasons behind COVID-19 vaccine aversion, and the solutions to which people are most open, become clearer. This article is protected by copyright. All rights reserved.

Objectives Amid a pandemic, vaccines represent a promising solution for mitigating public health and economic crises, and an improved understanding of individuals’ vaccination intentions is crucial to design optimal immunization campaigns. This study predicts uptake rates for different COVID-19 vaccine specifications and identifies personal characteristics that moderate an individual’s responsiveness to vaccine attributes. Methods We developed an online survey with contingent specifications of a COVID-19 vaccine, varying in effectiveness, risks of side effects, duration of immunity, and out-of-pocket cost. Using population-averaged logit models, we estimated vaccine uptake rates that account for uncertainty, heterogeneity across respondents, and interactions between vaccine and personal characteristics. Results We obtained 3047 completed surveys. The highest uptake rate for an annual vaccine, 62%, is predicted when vaccine effectiveness is 80% to 90%, side effects are minimal, and the vaccine is provided at zero cost, with decreases seen in the uptake rate for less effective vaccines, for example, 50% for 50% to 60% effectiveness. Moreover, we found that Americans’ response to vaccine effectiveness depends on their self-reported concern, that is, concerned respondents report a higher willingness to get vaccinated. Our findings also indicate that COVID-19 vaccine uptake rates decrease with vaccine cost and that responsiveness to vaccine cost is moderated by income. Conclusions Although providing the COVID-19 vaccine at zero cost will motivate many individuals to get vaccinated, a policy focused exclusively on vaccine cost may not be enough to reach herd immunity thresholds. Although those concerned with COVID-19 will participate, further evidence is needed on how to incentivize participation among the unconcerned (43%) to prevent further pandemic spread.

Summary Background Childhood immunisation is one of the most cost-effective health interventions. However, despite its known value, global access to vaccines remains far from complete. Although supply-side constraints lead to inadequate vaccine coverage in many health systems, there is no comprehensive analysis of the funding for immunisation. We aimed to fill this gap by generating estimates of funding for immunisation disaggregated by the source of funding and the type of activities in order to highlight the funding landscape for immunisation and inform policy making. Methods For this financial modelling study, we estimated annual spending on immunisations for 135 low-income and middle-income countries (as determined by the World Bank) from 2000 to 2017, with a focus on government, donor, and out-of-pocket spending, and disaggregated spending for vaccines and delivery costs, and routine schedules and supplementary campaigns. To generate these estimates, we extracted data from National Health Accounts, the WHO–UNICEF Joint Reporting Forms, comprehensive multi-year plans, databases from Gavi, the Vaccine Alliance, and the Institute for Health Metrics and Evaluation's 2019 development assistance for health database. We estimated total spending on immunisation by aggregating the government, donor, prepaid private, and household spending estimates. Findings Between 2000 and 2017, funding for immunisation totalled US$112·4 billion (95% uncertainty interval 108·5–118·5). Aggregated across all low-income and middle-income countries, government spending consistently remained the largest source of funding, providing between 60·0% (57·7–61·9) and 79·3% (73·8–81·4) of total immunisation spending each year (corresponding to between $2·5 billion [2·3–2·8] and $6·4 billion [6·0–7·0] each year). Across income groups, immunisation spending per surviving infant was similar in low-income and lower-middle-income countries and territories, with average spending of $40 (38–42) in low-income countries and $42 (39–46) in lower-middle-income countries, in 2017. In low-income countries and territories, development assistance made up the largest share of total immunisation spending (69·4% [64·6–72·0]; $630·2 million) in 2017. Across the 135 countries, we observed higher vaccine coverage and increased government spending on immunisation over time, although in some countries, predominantly in Latin America and the Caribbean and in sub-Saharan Africa, vaccine coverage decreased over time, while spending increased. Interpretation These estimates highlight the progress over the past two decades in increasing spending on immunisation. However, many challenges still remain and will require dedication and commitment to ensure that the progress made in the previous decade is sustained and advanced in the next decade for the Immunization Agenda 2030. Funding Bill & Melinda Gates Foundation.

One of the main issues of the Ministry of Health of the Republic of Indonesia in 2019 is the scope of complete basic immunization. One of the problems in the implementation of basic immunization is rejection from the community due to a lack of communication and information from health workers or the media. Based on the results of a preliminary study at Alang-Alang Lebar Public Health Center and 23 Ilir Public Health Center Palembang in 2019, it was found that the utilization of the KIA book was low (81.8%), and there was a lack of mother’s knowledge of basic immunization (40.9%). Along with the development of the 4.0 industrial revolution that changes how humans work from manual to digitalization, an application can be used as a representation in public service. This study aimed to produce an android-based Immunecare application on basic immunization services. This study used a research and development model. The source of data for this study was obtained from mothers with children aged 0-11 months, midwives, material experts, and media experts. The results of the feasibility test for this application by a material expert was highly feasible (94%), media expert was feasible (73%), and field practitioners was feasible (72%). The results of the questionnaire on Immunecare application showed a very good category from mothers (73%) and showed a very good category from midwives (82%), and mothers with good knowledge (86.7%). This study concluded that the Immunecare application is feasible (79.6%) to be used on basic immunization services.

Expansion of immunization coverage is dependent in part on delivering potent vaccines in an equitable and timely manner to immunization outreach session sites from Cold Chain Points (CCPs). When duration of travel between the last CCP and the session site (Time-to-Supply) is too long, three consequences may arise: decreased potency due to exposure to heat and freezing, beneficiary dropouts due to delayed session starts, and, increased operational costs for the Health Facility (HF) conducting the outreach sessions. Guided by the Government of India’s recommendation on cold chain point expansion to ensure that all session sites are within a maximum of 60 min from the last CCP, CHAI and the State Routine Immunization Cell in the state of Madhya Pradesh collaborated to pilot a novel approach to cold chain network optimization and expansion in eight districts of Madhya Pradesh. Opportunities for realignment of remote sub-health centers (SHCs) and corresponding session sites to alternative existing CCPs or to HFs which could be converted to new CCPs were identified, and proposed using a greedy adding algorithm-based optimization which relied on health facility level geo-location data. Health facility geo-coordinates were collected through tele-calling and site visits, and a Microsoft Excel based optimization tool was developed. This exercise led to an estimated reduction in the number of remote SHCs falling beyond the permissible travel time from CCPs by 56.89 percent (132 remote sites), from 232 to 100. The 132 resolved sites include 73 sites realigned to existing CCPs, and 59 sites to be attached to 22 newly proposed CCPs. Both the network optimization approach and the institutional capacity built during this project will continue to be useful to India’s immunization program. The approach is replicable and may be leveraged by developing countries facing similar challenges due to geographical, institutional, and financial constraints.

Background: The coverage of immunization among children in Jambi City decreased during COVID-19 pandemic.Purpose: This study aims to identify the factors that might be associated with basic vaccination compliance among mothers in Jambi, Indonesia.Methods: This study uses a case control design in 5 Jambi City Regions in March-May 2021. The sample in this study is mothers who have children in age 9-24 months. The sampling that is used in this study is cluster sampling with total sample of 506 mothers. The data analysis used in this study is descriptive statistical analysis of univariate, bivariate using chi square test.Results: The results of data analysis showed that the variables related to compliance were perceptions of receiving immunization, attitudes, knowledge, husband's support with p value < 0.01, and distance traveled with p value < 0.05.Conclusion: Effort to improve compliance in the pediatric immunization Pandemic are needed to strengthen mother’s perception, knowledge, attitudes during COVID-19. Analysis with predictive models is highly recommended to determine the odd-ratios and adjusted odd-ratios between factors related to the complying for basic vaccination.

While previous studies have shown that communicating herd immunity can increase immunization intentions, it is unclear how the definition of the beneficiaries influences intentions. In a vignette study, using a new hypothetical influenza virus, 4,172 participants from five European countries (Bulgaria, N=873; Denmark, N=896; England, N=873; Estonia, N=916; and Italy, N=745) were randomized to one of three experimental conditions: (1) control (no mention of herd immunity), (2) society (social benefit of immunization for overall society mentioned), and (3) friends (social benefit for friends and family members mentioned). While the study did not find that communicating herd immunity influenced overall immunization intentions across the five countries, it found substantial cross-country differences in the effect of the communication. In England, friends increased intentions, while society increased intentions in Denmark but decreased it in Italy. While communicating the social benefit of immunization can influence intentions, its contrasting effects highlight the importance of empirically testing.

Best practices of adult learning were used to develop a training of trainers program for the Ghana Health Service immunization workforce. The program supported translating learning to behavior change, used class time for practice-teaching and action plan development, linked formal instruction with specific activities, and offered follow-up mentorship., Key Findings The published literature regarding adult learning and training of trainers provides practical guidance for developing performance-based training of trainers, such as for the Ghana Health Service immunization workforce.Training of trainers (TOT), while a common capacity-building strategy, presents several risks that must be carefully mitigated.The Ghana 2YL TOT was designed with a systems approach, including audience selection, class activities, evaluation methods, and postworkshop action planning.Performance-focused class activities, including practice teaching, increased participants’ confidence as technicians and trainers. Key Implications Program managers should consider the risks involved in TOTs and be prepared to support the cascade with human and financial resources.Technical experts can take practical steps to ensure TOTs follow adult learning and TOT best practices.TOT designers should include opportunities for practice teaching and feedback to prepare participants for their training role.Program managers and designers should develop reporting tools and processes and monitor trainers’ field activities., Introduction: A 2016 assessment of frontline health care workers (HCWs) in Ghana identified knowledge, skill, and attitude gaps related to immunization during the second year of life (2YL). The U.S. Centers for Disease Control and Prevention subsequently supported the Ghana Health Service Immunization Program to apply best practices of adult learning and training of trainers (TOT) for a cascade training program for 2YL. Methods: Five districts from each of the 3 regions (Greater Accra, Northern, and Volta) were selected for the TOT based on key measles and rubella vaccination coverage indicators. The design incorporated best practices of adult learning and TOT. The curriculum integrated 3 major topical themes: technical (immunization topics), operational, and training adults. The technical and operational content was based on HCW tasks most directly affecting 2YL objectives. A cross-functional team developed all classroom, field activity, and training evaluation materials. Results: Seventy-four participants attended TOT workshops in 2017. Based on a rubric defined by the course designers, 99% of the participants reported an acceptable level of confidence to apply and teach the course content. After the TOTs, participants conducted 65 workshops, 43 field visits, and 4 review meetings, reaching 1,378 HCWs within 7 months. Fifty-four percent of HCWs who received training from TOT participants reported an acceptable level of confidence in using the skills, and 92% reported they would prioritize applying the skills acquired during the training. Discussion: The success factors for effective adult learning and TOT can be applied to design and implement high-quality TOT even in resource-limited settings. The factors include using a variety of approaches, spending enough class time to prepare TOT participants for their training role, setting specific expectations for cascading the training, and following up through mentorship and reporting. Strong collaboration across the administrative levels of the Ghana Health Service enabled cascade training.

Background Immunization supply chain management is among the components of immunization program, making vaccines delivery possible to reach every child. Nevertheless, it has been found to be static with rapid changes linked to the introduction of new vaccines. The success of Rwanda immunization program with coverage of 94.3% was attributed to human resource and capital investment from both the Ministry of Health and its development partners. However, the current distribution system design does not contribute to self-financing of the program in the long-run considering the distribution mode and frequency applied. The cost analysis study has never been done before and is expected to address the issue of long-term sustainability of the program as it will inform the system re-design activities. Objective Assessing how much the program would save if the system is re-designed by changing distribution mode and frequency from the Central Vaccine Store to District Vaccine Stores. Methods Administrative and financial records were reviewed to determine the cost of the current vaccine distribution system to be compared to estimated cost of a proposed distribution system with reduced frequencies between Central Vaccine Store and District Vaccine Stores. Results By comparing the costs of the two systems, applying the proposed distribution model with less distribution frequencies reduced the current cost by 37%. Conclusion The findings confirm a huge opportunity of getting the current vaccine distribution costs reduced when the distribution system is redesigned, hence contributing to financial sustainability of the vaccination program. Rwanda J Med Health Sci 2021;4(2): 207-221

To analyse subnational inequality in diphtheria-tetanus-pertussis (DTP) immunization dropout in 24 African countries using administrative data on receipt of the first and third vaccine doses (DTP1 and DTP3, respectively) collected by the Joint Reporting Process of the World Health Organization and the United Nations Children's Fund.Districts in each country were grouped into quintiles according to the proportion of children who dropped out between DTP1 and DTP3 (i.e. the dropout rate). We used six summary measures to quantify inequalities in dropout rates between districts and compared rates with national dropout rates and DTP1 and DTP3 immunization coverage.The median dropout rate across countries was 2.4% in quintiles with the lowest rate and 14.6% in quintiles with the highest rate. In eight countries, the difference between the highest and lowest quintiles was 14.9 percentage points or more. In most countries, underperforming districts in the quintile with the highest rate tended to lag disproportionately behind the others. This divergence was not evident from looking only at national dropout rates. Countries with the largest inequalities in absolute subnational dropout rate tended to have lower estimated national DTP1 and DTP3 immunization coverage.There were marked inequalities in DTP immunization dropout rates between districts in most countries studied. Monitoring dropout at the subnational level could help guide immunization interventions that address inequalities in underserved areas, thereby improving overall DTP3 coverage. The quality of administrative data should be improved to ensure accurate and timely assessment of geographical inequalities in immunization.Analyser les inégalités régionales en matière de taux d'abandon du vaccin diphtérique-tétanique-coquelucheux (DTC) dans 24 pays de la région Afrique, en se fondant sur les données administratives relatives à l'injection de la première et de la troisième dose du vaccin (DTC1 et DTC3, respectivement) collectées dans le cadre du Rapport conjoint de notification de l'Organisation mondiale de la Santé et du Fonds des Nations Unies pour l'enfance.Dans chaque pays, les districts ont été regroupés en quintiles selon le pourcentage d'enfants ayant interrompu la vaccination entre DTC1 et DTC3 (taux d'abandon). Nous avons employé six mesures synthétiques afin de quantifier les inégalités en matière de taux d'abandon entre districts, puis nous avons comparé ces taux avec les taux d'abandon nationaux ainsi qu’avec la couverture vaccinale DTC1 et DTC3.Le taux d'abandon médian dans les différents pays s'élevait à 2,4% dans les quintiles affichant le taux le plus bas, et atteignait 14,6% dans les quintiles affichant le taux le plus haut. Dans huit pays, l'écart entre le quintile le plus haut et le quintile le plus bas était égal ou supérieur à 14,9 points de pourcentage. Dans la plupart des pays, les districts enregistrant les moins bonnes performances dans le quintile avec le taux le plus élevé étaient plus enclins à se laisser exagérément distancer par les autres. Une divergence qui passait inaperçue lorsqu'on ne tenait compte que des taux d'abandon nationaux. Les pays confrontés aux plus importantes inégalités en termes de taux d'abandon régional absolu étaient plus enclins, selon les estimations, à présenter une couverture vaccinale DTC1 et DTC3 moins élevée à l'échelle nationale.Dans la plupart des pays étudiés, nous avons constaté de fortes disparités entre districts concernant les taux d'abandon du vaccin DTC. Assurer un contrôle sur ces taux d'abandon au niveau régional pourrait orienter les campagnes de vaccination visant à réduire les inégalités dans les zones mal desservies, ce qui offrirait une meilleure couverture DTC3 globale. Enfin, la qualité des données administratives devrait être améliorée afin de fournir des évaluations précises et ponctuelles des variations géographiques en matière de vaccination.Analizar la desigualdad subnacional en el abandono de la inmunización contra la difteria, el tétanos y la tos ferina (DTP) en 24 países africanos utilizando datos administrativos sobre la recepción de la primera y la tercera dosis de la vacuna (DTP1 y DTP3, respectivamente) recogidos por el proceso de informes conjuntos de la Organización Mundial de la Salud y el Fondo de las Naciones Unidas para la Infancia.Los distritos de cada país se agruparon en quintiles según la proporción de niños que abandonaron la vacunación entre la DTP1 y la DTP3 (es decir, la tasa de abandono). Se utilizaron seis medidas de resumen para cuantificar las desigualdades en las tasas de abandono entre los distritos y se compararon estas tasas con las tasas nacionales de abandono y la cobertura de inmunización DTP1 y DTP3.La mediana de la tasa de abandono de la vacunación en todos los países fue del 2,4 % en los quintiles con la tasa más baja y del 14,6 % en los quintiles con la tasa más alta. En ocho países, la diferencia entre los quintiles más altos y más bajos era de 14,9 puntos porcentuales o más. En la mayoría de los países, los distritos con peores resultados en el quintil con la tasa más alta tendían a estar desproporcionadamente por detrás de los demás. Esta divergencia no era evidente si se observaban únicamente las tasas nacionales de abandono de la vacunación. Los países con las mayores desigualdades en la tasa absoluta de abandono de la vacunación subnacional tendían a tener una cobertura nacional estimada de inmunización DTP1 y DTP3 más baja.En la mayoría de los países estudiados hubo desigualdades claras en las tasas de abandono de la vacunación DTP entre los distritos. El seguimiento del abandono a nivel subnacional podría ayudar a orientar las intervenciones de inmunización que abordan las desigualdades en las zonas desatendidas, mejorando así la cobertura general de DTP3. La calidad de los datos administrativos debe mejorarse para garantizar una evaluación precisa y oportuna de las desigualdades geográficas en la inmunización.لتحليل حالة التفاوت دون الوطنية في التسرب من التحصين ضد الدفتيريا والتيتانوس والسعال الديكي (DTP) في 24 دولة أفريقية باستخدام البيانات الإدارية عند تلقي جرعتي التحصين الأولى والثالثة (DTP1 وDTP3 على التوالي)، والتي تم جمعها بواسطة عملية الإبلاغ المشتركة لمنظمة الصحة العالمية، ومنظمة الأمم المتحدة للطفولة.تم تجميع المناطق في كل دولة في مجموعات خمسية وفقًا لنسبة الأطفال الذين تسربوا بين الجرعتين DTP1 وDTP3 (أي معدل التسرب). استخدمنا ستة مقاييس موجزة لقياس حالات التفاوت في معدلات التسرب بين المناطق، وقمنا بمقارنة هذه المعدلات مع معدلات التسرب الوطنية وتغطية التحصين ضد الجرعتين DTP1 وDTP3.كان متوسط معدل التسرب عبر الدول 2.4% في المجموعات الخمسية ذات المعدل الأقل، و14.6% في المجموعات الخمسية ذات المعدل الأعلى. في ثماني دول، كان الفرق بين أعلى وأقل شريحتين 14.9 نقطة مئوية أو أكثر. في معظم الدول، كانت المناطق ذات الأداء الضعيف في المجموعة الخمسية ذات أعلى معدل، تميل إلى التدهور بشكل غير متناسب عن غيرها من المناطق. لم يكن هذا الاختلاف واضحًا من مجرد النظر فقط إلى معدلات التسرب الوطنية. تميل الدول التي لديها أكبر تفاوتات في معدل التسرب المطلق دون الوطني، إلى أن يكون لديها تغطية تحصين وطنية تقديرية أقل من الجرعتين DTP1 وDTP3.كانت هناك تفاوتات ملحوظة في معدلات التسرب من التحصين ضد الدفتيريا والتيتانوس والسعال الديكي بين المناطق في معظم الدول التي شملتها الدراسة. يمكن لمراقبة التسرب على المستوى دون الوطني أن تساعد في توجيه تدخلات التحصين التي تعالج التفاوتات في المناطق المحرومة، وبالتالي تحسين التغطية الشاملة للجرعة DTP3. يجب تحسين جودة البيانات الإدارية لضمان التقييم الدقيق وفي الوقت المناسب للتفاوتات في التحصين.使用世界卫生组织和联合国儿童基金会联合报告中收集的有关接种第一剂和第三剂疫苗（分别为 DTP1 和 DTP3）的管理数据，分析24个非洲国家关于白喉-破伤风-百日咳 (DTP) 免疫接种的地区不均问题。.根据要接种 DTP1 和 DTP3 却未完成全部接种的儿童比例（即辍接种率），将每个国家的地区按五分位置划分。我们使用六种综合测量方法来量化地区之间辍接种率的不均衡，并将其与国家辍接种率以及 DTP1 和 DTP3 免疫覆盖率进行比较。.各国的辍接种率中位数最低的五分之一为 2.4%，最高的五分之一为 14.6%。在八个国家中，最高和最低五分之一之间的差距为 14.9 个百分点或更多。在大多数国家，辍接种率最高的五分之一中，表现不佳的地区，远远落后于其他地区。仅从国家间的辍接种率来看，这种差异并不明显。地区辍接种率不均衡程度最大的国家，往往具有较低的预计国家 DTP1 和 DTP3 免疫覆盖率。.在大多数受调查的国家中，各地区之间 DTP 辍接种率存在明显不均。监测地区辍接种率，有助于对服务欠缺地区的不均衡问题进行免疫干预指导，从而提高 DTP3 的整体覆盖率。应提高管理数据的质量，以确保准确、及时地评估免疫接种方面的地域不均问题。.По коэффициентам выбытия проанализировать неравенство на субнациональном уровне в области охвата иммунизацией коклюшно-дифтерийно-столбнячной вакциной (КДС) в 24 африканских странах с использованием административных данных о получении первой и третьей доз вакцины (КДС-1 и КДС-3 соответственно), собранных в рамках Единого процесса отчетности Всемирной организации здравоохранения и Детского фонда Организации Объединенных Наций.Районы в каждой стране были сгруппированы по квинтилям согласно доле детей, выбывших между получением доз КДС-1 и КДС-3 (т. е. коэффициент выбытия). Мы использовали шесть сводных показателей для количественной оценки неравенства по коэффициентам выбытия между районами и сравнили коэффициенты с национальными коэффициентами выбытия и охватом иммунизацией КДС-1 и КДС-3.Для всех стран в квинтилях с наиболее низкими коэффициентами выбытия медианное значение выбытия составило 2,4%, в квинтилях с наиболее высокими коэффициентами выбытия — 14,6%. В восьми странах разница в показателях между квинтилями с наиболее высокими и наиболее низкими коэффициентами выбытия составила 14,9 процентного пункта или больше.. В большинстве стран отстающие районы в квинтилях с наиболее высокими коэффициентами выбытия имели тенденцию к непропорциональному отставанию по сравнению с другими районами. Это расхождение не было очевидным, если ориентироваться только на национальные коэффициенты выбытия. Страны с самым высоким уровнем неравенства по абсолютным коэффициентам выбытия на субнациональном уровне, как правило, имели более низкий оценочный уровень национального охвата иммунизацией КДС-1 и КДС-3.В большинстве изученных стран наблюдалось неравенство между районами в коэффициентах выбытия в период получения КДС-вакцины. Мониторинг выбытия на субнациональном уровне может помочь в проведении мероприятий по иммунизации, направленных на устранение неравенства в недостаточно обслуживаемых районах, тем самым улучшая общий охват иммунизацией КДС-3. Качество административных данных должно быть улучшено для обеспечения точной и своевременной оценки географического неравенства в области охвата иммунизацией.

In December 2019, SARS-CoV-2 caused the coronavirus disease (COVID-19) to spread to all countries, infecting thousands of people and causing death. COVID-19 causes mild illness in most cases, although it can make some people seriously ill. Therefore, vaccines are in various phases of clinical progress, and some of them have been approved for national use. The current state of affairs reveals that there is a critical need for a quick and timely solution to the need for a Covid-19 vaccine. Non-clinical methods such as data mining and machine learning techniques can help to do this. This study will focus on US COVID-19 Vaccination Advances using Machine learning classification algorithms and Using Geospatial analysis to visualize the results. The paper's findings indicate which algorithm is better for a given data set. Naive Bayes algorithm is used to run tests on real world data, and is used to analyze and draw conclusions. Period of Accuracy and performance, and it was found that Naive Bayes is very superior in terms of time and accuracy.

The work that market research companies conduct on behalf of their clients is often understood in terms of market intermediaries that help clients identify both marketing strategies and new marketing opportunities. This article challenges this understanding by interpreting market research work in terms of detachment from the market. Drawing on the example of an experimental market research test town in Germany, the article identifies the role of market researchers as that of slowly taking new product concepts out of the hands of their clients and transforming these concepts into test objects. Market researchers who use consumer panels in the test town apply various detachment and immunization strategies that help absorb products into their own test systems. From the perspective of research clients, the detachment from their product concepts is of an ascetic nature as it involves an exercise to give up control in order to master the world.

ObjectiveTo explore the use of health plan quality measures specified for electronic clinical data to monitor immunizations.Materials and MethodsWe analyzed 2018 data submitted by health plans reporting 2 new Healthcare Effectiveness Data and Information Set measures assessing receipt of clinically recommended vaccines among pregnant women and adults. We analyzed the number of plans reporting a valid performance rate and electronic data source used. We consulted expert panels and reviewed coverage rates from other sources to understand the results.ResultsWe received 136 data submissions across commercial, Medicaid and Medicare plans and 87 submissions across commercial and Medicaid plans for the adult and prenatal immunization measures, respectively. These submissions represent approximately 15% of possible submissions. Plans used claims, registries and electronic health records. Mean performance rates for adult immunizations were 21.2 (commercial), 14.0 (Medicaid) and 19.5% (Medicare). Mean rates for prenatal immunizations were 33.1 (commercial) and 16.7% (Medicaid).DiscussionResults from the first year of reporting 2 electronic clinical data measures suggest health plans can feasibly report these measures and are seeking electronic data to supplement claims. Comparison of rates to other national results showed lower than expected rates for the adult immunization measure. However, prenatal immunization rates were on par with those from a national survey, suggesting this measure is closer to use for quality improvement.ConclusionQuality measure reporting that encourages connection to electronic data sources is a step forward in performance monitoring and improvement. The use of electronic sources may advance health information exchange for patient care.

The maternity benefit scheme piloted as Indira Gandhi Matritva Sahyog Yojana (IGMSY) since 2011 and recently rolled out as Pradhan Mantri Matru Vandana Yojana (PMMVY) incentivizes mothers to participate in infant health-promoting activities. It has become India's largest conditional cash transfer program ever, outrivaling the country's first-generation maternity benefit scheme Janani Suraksha Yojana (JSY), which incentivizes institutional delivery and has been criticized for its unintended side effects on fertility. We approach IGMSY's geographically targeted pilot phase as a natural experiment and use data from a large national health survey to estimate its effects by a matched-pair difference-in-differences approach. Consistent with the program's conditions, we find increases in infant immunization. As side effect, long-term utilization of public health facilities becomes more frequent and intervals between eligible births increase by 17%. Our findings suggest that India'ns second-generation maternity benefit scheme has been more carefully designed than its predecessor, with side effects that support the program's broader objectives. But both direct and indirect effects are small and can make only a small contribution to redressing India's dismal maternal and child health record.

The National Immunization Survey (NIS) is the United States' primary tool for assessing immunization coverage among 19- to 35-month- old children. Although annual estimates from the NIS are quite precise at the national level, US State-level estimates have much larger sampling error than national-level estimates. We combined two independent unbiased estimates of US State-level coverages within a given year to obtain new estimates which are more precise than previously published estimates. We first calculated a model-based estimate for each State for 2001 using multiple years of NIS data. Next, we combined each model-based estimate with the corresponding, previously reported NIS estimate for 2001. Our resulting estimates of State-level immunization coverage had smaller standard errors than the previously published estimates. To make similar improvements in precision by increasing sample size would, depending on State, require an increase in sample size of 30% - 120%. 1. Background Childhood immunizations in the United States have made rare many diseases that once caused enormous morbidity and mortality. Maintaining high rates of immunization in each new birth cohort is the key to continued success; coverage among infants and young children is monitored by the National Immunization Survey (NIS), which estimates coverage nationally, for the 51 US States (we treat the District of Columbia as a State, resulting in one more State than the usual 50), and for selected urban areas. The NIS produces annual estimates of immunization coverage for each geographic area considered. At the national level, annual NIS coverage estimates are quite precise, with standard errors smaller than 0.5 percentage points. At the level of US States and urban areas, which have smaller sample sizes than the national estimate, standard errors are of size up to 3 percentage points. However, precise estimates

PurposeThe purpose of this paper is to achieve effective governance of online rumors through the proposed rumor propagation model and immunization strategy.Design/methodology/approachThe paper leverages the agent-based modeling (ABM) method to model individuals from two aspects, behavior and attitude. Based on the analysis and research of online data, we propose a rumor propagation model, namely the Untouched view transmit removed-Susceptible hesitate agree disagree (Unite-Shad), and devise an immunization strategy, namely the Gravity Immunization Strategy (GIS). A graph-based framework, namely Pregel, is used to carry out the rumor propagation simulation experiments. Through the experiments, the rationality of the Unite-Shad and the effectiveness of the GIS are verified.FindingsThe study discovers that the inconsistency between human behaviors and attitudes in rumor propagation can be explained by the Unite-shad model. Besides, the GIS, which shows better performance in small-world networks than in scale-free networks, can effectively suppress rumor propagation in the early stage.Research limitations/implicationsThis paper provides an effective immunization strategy for rumor governance. Specifically, the Unite-Shad model reveals the mechanism of rumor propagation, and the GIS provides an effective governance method for selecting immune nodes.Originality/valueThe inconsistency of human behaviors and attitudes in real scenes is modeled in the Unite-Shad model. Combined with the model, the definition of diffusion domain is proposed and a novel immunization strategy, namely GIS, is designed, which is significant for the social governance of rumor propagation.

Background and Purpose The study objective was to determine differences in student pharmacists' knowledge, confidence, and preferences when the in-class portion of the American Pharmacists Association (APhA) Immunization Certificate was conducted in two different scheduling formats. Educational Activity and Setting A two-phase, pre-post design was utilized to compare delivery layouts of the certificate program for first-year student pharmacists. In fall 2018, students completed the certificate in eight, one-hour sessions. In fall 2019, students completed the certificate in one, eight-hour session. A pre- and post-survey assessed confidence in immunization-specific skills and scheduling preferences. The APhA self-study and final exams and faculty created knowledge questions were utilized to assess student knowledge before, during, and after the course. Findings Student confidence in both fall 2018 and fall 2019 increased significantly between the pre- and post-survey. However, when comparing cohorts, no difference was found in self-confidence or knowledge. Students did tend to show preference for how the course was delivered. Students in fall 2018 slightly leaned towards eight, one-hour sessions (approximately 51%) while students in fall 2019 strongly leaned towards one, eight-hour session (approximately 72%). Summary Variation in scheduling of the in-class portion of the APhA Immunization Certificate was not associated with a difference in student confidence or knowledge. However, a difference in student preference for delivery was noted. It is important for instructors to consider student preferences along with best pedagogical practices to ensure learning when scheduling formats are selected.

Introduction Economic evidence on how much it may cost for vaccinators to reach populations is important to plan vaccination programs. Moreover, knowing the incremental costs to reach populations that have traditionally been undervaccinated, especially those hard-to-reach who are facing supply-side barriers to vaccination, is essential to expanding immunization coverage to these populations. Methods We conducted a systematic review to identify estimates of costs associated with getting vaccinators to all vaccination sites. We searched PubMed and the Immunization Delivery Cost Catalogue (IDCC) in 2019 for the following costs to vaccinators: (1) training costs; (2) labor costs, per diems, and incentives; (3) identification of vaccine beneficiary location; and (4) travel costs. We assessed if any of these costs were specific to populations that are hard-to-reach for vaccination, based on a framework for examining supply-side barriers to vaccination. Results We found 19 studies describing average vaccinator training costs at $0.67/person vaccinated or targeted (SD $0.94) and $0.10/dose delivered (SD $0.07). The average cost for vaccinator labor and incentive costs across 29 studies was $2.15/dose (SD $2.08). We identified 13 studies describing intervention costs for a vaccinator to know the location of a beneficiary, with an average cost of $19.69/person (SD $26.65), and six studies describing vaccinator travel costs, with an average cost of $0.07/dose (SD $0.03). Only eight of these studies described hard-to-reach populations for vaccination; two studies examined incremental costs per dose to reach hard-to-reach populations, which were 1.3–2 times higher than the regular costs. The incremental cost to train vaccinators was $0.02/dose, and incremental labor costs for targeting hard-to-reach populations were $0.16–$1.17/dose. Conclusion Additional comparative costing studies are needed to understand the potential differential costs for vaccinators reaching the vaccination sites that serve hard-to-reach populations. This will help immunization program planners and decision-makers better allocate resources to extend vaccination programs.

Background: National Family Health Survey-4 (NFHS-4) revealed a significant improvement in the percentage of complete immunization attained in India. Even though determinants of immunization coverage in India are addressed by some studies, the impact of missing data in such large-scale surveys has not been accounted earlier. The present study aimed to identify the potential factors associated with immunization coverage in India using the complete case analysis (CCA) and multiple imputation by chained equations (MICE) analysis. Materials and methods: We created a dichotomous immunization variable based on the status of all the vaccines given to the child. All relevant variables were summarized using appropriate descriptive statistics along with the proportion of missingness. Further, MICE procedure was performed to impute the missing values after assessing the missing data mechanism. Multiple logistic regression after accounting for the sampling weights were used to report the estimates of odds-ratio (OR) and 95% confidence intervals (CI) for both CCA and MICE analysis and compared. Results: The percentage of children under five years of age who had total immunization was 69%. Further, we observed that female sex and rural habitation had higher odds of getting immunized in both CCA and MICE. Moreover, wealth index, number of antenatal visits, checkup after delivery and place of birth played an important role in the immunization coverage. Conclusion: MICE provided more precise risk estimates on potential factors associated with vaccination coverage compared to CCA, even if the major findings did not alter due to large sample size. Key words: Immunization, Health surveys, missing data, Logistic regression, complete case analysis, MICE.

Background Between 2010 and 2016, the proportion of children 12–23 months of age who received full immunization in Malawi decreased from 81% to 76%. Most studies on immunization have mainly focused on the risk factors of vaccination coverage while data on dropouts and equity gaps is very scanty. Thus the aim of the present study was to describe the trend in immunization coverage, dropout rates and effective immunization coverage (EIC) among children ages 12–23 months in Malawi. Methods Secondary analyses of the cross-sectional data obtained from the three waves of the Demographic and Health Surveys (2004, 2010 and 2015–16) were conducted. Using bottleneck analysis, outputs were generated based on service coverage, demand/equity (service utilization) and quality (full immunization). The World Health Organization benchmarks were used to assess gaps in the immunization coverage indicators. Results The coverage was >90.0% in most of the antigens while full immunization status was estimated at 65%, 84% and 73% in 2004, 2010 and 2015, respectively. The highest coverage was observed in Bacillus Calmette–Guérin (BCG) and lowest in oral polio vaccine 1 (OPV1). OPV1 coverage was 10% in 2004. The logistic regression analyses showed that children were significantly less likely to be immunized with Penta3 and MCV1 in all cohort years compared with Penta1. Conclusions Although immunization coverage was in line with the national and district targets for various antigens, full vaccination coverage (FVC) is still lagging behind. Furthermore, the dropout rates for Penta3 and MCV1 showed upside U-shaped patterns. Thus health education, supervision and orientation of service providers are urgently needed to address disparities that are existing in FVC.

Given that altruism is crucial in assisting impoverished households to cope with health and economic crises, it is important to improve our understanding of how preferences and motives for giving differ during a pandemic. We implemented a web-based, contingent valuation survey to estimate Americans' willingness to give for nongovernmental immunization programs in the context of the COVID-19 pandemic. Our results indicate that the median person is willing to give a one-time donation of $26, or at least $13 when willingness-to-give estimates are corrected for uncertainty regarding future donations. We find that willingness to give is related to income, concern levels, vaccine usage, and sociodemographic characteristics. Our findings also shed light on purely and impurely altruistic motives underlying the willingness to fund immunization programs.

While previous studies have validated vaccine hesitancy scales with uptake behavior at the individual level, the conditions under which aggregated survey data are useful are less clear. We show that vaccine public opinion data aggregated at the subnational level can serve as a valid indicator of aggregate vaccine behaviour. We use a public opinion survey (Eurobarometer EB 91.2) with data on vaccine hesitancy for the EU in 2019. We link this information to (subnational) regional immunization coverage rates for childhood vaccines - DTP3, MCV1, and MCV2 -- obtained from the WHO for 2019. We conduct multilevel regression analyses with data for 177 regions in 20 countries. Given the variation in vaccine hesitancy and immunization rates between countries and within countries, we affirm the valuable role that surveys can play as a public health surveillance tool when it comes to vaccine behavior. We find statistically significantly lower regional vaccine immunization rates in regions where vaccine hesitancy is more pronounced. Our results suggest that different uptake rates across subnational regions are due, at least in part, to differences in attitudes towards vaccines and vaccination. The results are robust to several alternative specifications.

Developing countries scramble to contain and mitigate the spread of coronavirus disease 2019 (COVID-19), and world leaders demand equitable distribution of vaccines to trigger economic recovery. Although numerous strategies, including education, quarantine, and immunization, have been used to control COVID-19, the best method to curb this disease is vaccination. Due to the high demand for COVID 19 vaccine, developing countries must carefully identify and prioritize vulnerable populations and rationalize the vaccine allocation process. This study presents a mixed-integer linear programming model for equitable COVID-19 vaccine distribution in developing countries. Vaccines are grouped into cold, very cold, and ultra-cold categories where specific refrigeration is required for their storage and distribution. The possibility of storage for future periods, facing a shortage, budgetary considerations, manufacturer selection, order allocation, time-dependent capacities, and grouping of the heterogeneous population are among the practical assumptions in the proposed approach. Real-world data is used to demonstrate the efficiency and effectiveness of the mathematical programming approach proposed in this study.

Immunization, which is usually done by giving vaccinations, is the process of forming immunity in individuals against infectious diseases. The target in the Strategic Plan of the Ministry of Healht of the Republic of Indonesia in 2015-2019 aimed for 93 % of coverage. However, according to the report of the Indonesian Basic Health Survey (IBHR), there is actually a decrease in basic immunization coverage for the period of 2012–2015 when compared to the previous period. This study aimed to determine the correlation between parental knowledge, attitudes, and behavior towards complete course of basic immunization among parents of an elementary school in North Jakarta, Indonesia, in 2018 and 2019. This was a cross-sectional analytical descriptive study involving 110 respondents. Data were obtained through a questionnaire that was distributed to parents that included questions on knowledge, attitude, and behavior towards complete basic immunization. Out of 110 respondents, 70% stated that their child received the full basic immunization course while the remaining 30% stated that their child only received some of the vaccines required in the basic immunization course. There was no correlation, based on the bivariate analytical test, between parental behavior (p = 0.868), parental attitude (p = 0.647), and full course of basic immunization. In contrast, parental knowledge influences whether the child will receive the full course of basic immunization or not (p=0.000).

O ano de 2020 foi marcado pela propagação planetária do novo co­ronavírus que transformou brutalmente o cotidiano das pessoas. E, apesar de 2021 ter-se iniciado com a expectativa de imunização pelas vacinas, que muito lentamente começaram a ser aplicadas, ainda se convive com o alto índice de mortes diárias, principalmente no Brasil. A finalidade deste artigo consiste em mostrar como a presente pandemia é efeito do capitalismo an­corado no governo da racionalidade neoliberal. Assinala-se também de que modo os procedimentos técnicos de criatividade e inovação contribuem com a atualização do regime capitalista, ao implantar projetos que garantem a melhor concorrência. Por fim, propõe-se a possibilidade de pensar como in­terceptar essa lógica.

In the coming years, about a dozen middle-income countries are excepted to transition out of development assistance for health (DAH) based on their economic growth. This anticipated loss of external funds at a time when there is a need for accelerated progress towards universal health coverage (UHC) is a source of concern. Evaluating country readiness for transition towards country ownership of health programmes is a crucial step in making progress towards UHC. We used in-depth interviews to explore: (1) the preparedness of the Nigerian health system to transition out of DAH, (2) transition policies and strategies that are in place in Nigeria, (3) the road map for the implementation of these policies and (4) challenges and recommendations for making progress on such policies. We applied Vogus and Graff’s expanded transition readiness framework within the Nigerian context to synthesize preparedness plans, gaps, challenges and stakeholders’ recommendations for sustaining the gains of donor-funded programmes and reaching UHC. Some steps have been taken to integrate and institutionalize service delivery processes toward sustainable immunization and responsive primary healthcare in line with UHC. There are ongoing discussions on integrating human immunodeficiency virus (HIV) services with other services and the possibility of covering HIV services under the National Health Insurance Scheme (NHIS). We identified more transition preparedness plans within immunization programme compared with HIV programme. However, we identified gaps in all the nine components of the framework that must be filled to be able to sustain gains and make significant progress towards country ownership and UHC. Nigeria needs to focus on building the overall health system by identifying systematic gaps instead of continuing to invest in parallel programmes. Programmes need to be consolidated within the overall health system, health financing priorities and policies. A comprehensive and functional structure will provide continuity even in the event of decreasing external funds or donor exits.

Time constraints parents face can affect whether infant children are vaccinated on time. Using the National Immunization Survey, we employ a synthetic control difference-in-difference estimation technique to establish a causal relationship arising from California's implementation of Paid Parental Leave Program as a natural experiment. We find California Paid Family Leave reduced late vaccinations by up to 5 percentage points or approximately 10% for children born to parents in California after the policy was implemented. Further, the policy had a stronger impact on families below the poverty line. Thus access to paid family leave can improve on-time immunization of infants.

Reminders, alerting patients to the need for vaccines that will be due in the future, and recall messages, informing patients about vaccines that are overdue, have been shown to improve immunization rates for children and adolescents in numerous systematic reviews. Therefore, reminder and recall interventions (R/R) are recommended by the Task Force on Community Preventive Services for increasing immunization rates on the basis of strong evidence. R/R messages can be delivered by mail (letter or postcard), via personal or auto-dialer phone calls, by text or e-mail or via patient-portals and can simply be alerts to action or can include educational material with the aim of motivating patients to seek vaccination. R/R has also been shown to be a relatively low-cost intervention with high cost-effectiveness compared with other recommended strategies. However, although R/R as a strategy is consistently effective and cost-effective overall, there is wide variation in the impact of R/R by 1) modality of how it is delivered, 2) the targeted vaccine, 3) the age group, and 4) whether the R/R is conducted centrally by a health system or Immunization Information System or by individual practices. This narrative review summarizes the literature about effectiveness of R/R within each of these categories. We also discuss limitations of R/R, with a focus on the potential impact of parental vaccine hesitancy in blunting its effectiveness and problems with data integrity, on which R/R relies. We also discuss challenges to sustaining R/R efforts, including potential methods of funding for R/R efforts.

Reproductive cycling in fattening gilts can be associated with undesirable effects, such as estrus-related aggressive behavior, reduced feed intake and, in production systems where gilts are co-housed with entire males, unwanted pregnancy. Immunization against Gonadotrophin Releasing Factor (IM) can temporarily suppress ovarian activity, including related negative consequences on animal welfare and productivity. Feed intake has been shown to be higher after IM, resulting in both increased growth and increased carcass fat. A series of studies was conducted to confirm these effects on production and look at their dynamics over time. Three trials were performed to a similar design, each involving 240 gilts divided into 4 experimental groups at 12 weeks of age. One group remained untreated while the others had the two dose, IM course completed 8, 6 or 4 weeks before harvest, which was on a single day at 24, 25 or 26 weeks of age depending on the study. Feed intake was measured daily and bodyweight weekly, allowing growth parameters to be calculated on a weekly basis and for specific longer periods. Carcass weight, backfat depth and lean meat percentage were recorded at harvest. No effects were observed before the second application of the immunological product (V2) and completion of the IM course. Starting in the second week after V2 all IM groups showed a marked and consistent increase in Average Daily Feed Intake (ADFI), typically peaking at over 120% of the control group 3 to 4 weeks after V2 and then slowly declining, but still remaining elevated at 8 weeks. Weekly Average Daily Gain (ADG) showed a similar pattern but with a faster decline, resulting in the initially favorable impact on feed efficiency becoming less favorable as the V2 to harvest interval (V2 H) progressed. Carcass weights were higher in IM gilts and backfat depths were greater, with the effects increasing with increasing V2 H. Correspondingly, carcass lean meat percentage tended to decrease, although the higher carcass weights meant that the absolute weight of lean meat remained similar or higher. Carcass yield was generally unaffected by IM, but some between-group differences were statistically significant, and it is possible that different factors predominated at different times after V2, creating a complex relationship with V2 H duration. The optimum IM protocol will depend on local conditions and production objectives but, as a generalization and assuming ad libitum feeding, a shorter V2 H will favor efficient growth, while a longer duration will maximize carcass changes, such as increased fat coverage. It is suggested that the growth performance changes seen after IM in gilts might be viewed as a process of adjustment to a heavier and fatter target body type.

Introduction Tuberculosis is a principal mortality causes in world, and vaccination with BCG is a key for your prevention. Objective To evaluate the effect of studies plan from Medicine Bachelor's Degree of Universidad Guadalajara LAMAR about the knowledge about immunization against tuberculosis. Material and methods Quasi-experimental study type pre-experimental of comparison with a static group. Emplacement: Vallarta's Campus. Temporality: January-May 2018. Universe: 267 students. Sample: Non-randomized, n = 230 students, 94 from 1st semester (G1, intervention moment “A”), 106 from 4th semester (G2, intervention moment “B”) and 30 from 7th semester (G3, intervention moment “C”) from Medicine Bachelor's Degree, more 37 students from 1st semester from Bachelor's Degree not related with health sciences (G0, control). Sampling: Propositive. Selection criteria: Any age and gender and answer the instrument. Variables: Age, gender and knowledge about management of immunization against tuberculosis. Instrument: Written test collegiate. Analysis: Comparison by mean of statistics non-parametric (p = 0,05). Results Levels “high” and “very high” of knowledges: G0 0%, G1 0%, G2 32% and G3 37% (?2, p Conclusion The studies plan showed develops high knowledges about management of immunization against tuberculosis. There is a significant gap in this knowledge that does not vary substantially in advanced semesters.

Pakistan is one of the only two countries in the world where poliomyelitis virus is still not eradicated. Efforts from government such as Expanded Programme on Immunizations (EPI), which has received ample international funding, have not been successful as some sub-sections of population have a negative attitude towards vaccinations. These people generally belong to areas with a lack of education as well as strong influence of religious leaders, who are known to perpetuate misconceptions that the purpose of vaccinations is to sterilize future generations, they are not made from halal products, or are an agenda by Western intelligence agencies to gather information. Also, there are other cultural and social barriers, such as lack of female vaccinators and concerns about their handling. The stance of local people is compared with Muslim leaders and laws of other Islamic countries. Furthermore, a global vaccine confidence survey is discussed to evaluate Pakistan’s position in the broader context.

Introduction Immunization supply chains (iSC) are essential for ensuring access to vaccines that prevent diseases. Guinea, Madagascar, and Niger initiated iSC system design efforts to conduct analysis of alternative supply chain scenarios to identify areas for improvement. Methodology Key stakeholders from Ministries of Health and immunization programs identified bottlenecks in the current iSC and prioritized five general design scenarios to model in each country. Scenarios included aspects of integration, changing supply chain levels and delivery frequency, ignoring administrative boundaries, and direct delivery. Primary and secondary data were collected and cleaned. Analysis was completed using Supply Chain Guru (Madagascar and Niger) and AnyLogistix (Guinea) modeling software to build a virtual representation of the iSC physical components and operating policies. Results Modeling results were compared using both quantitative and qualitative criteria (total operating costs, cost per dose, cold chain capacity, risk of mishandling, logistics burden on healthcare workers, feasibility to implement, and equity). Using a Stop Light Analysis for user-friendly understanding of positive, negative or minimal impact on scenarios, cost savings were realized in most scenarios in Madagascar (except using autonomous aerial vehicles); proposed scenarios in Guinea increased costs or had minimal impact; in Niger, eliminating regional tiers reduced costs. Facility level cold chain was sufficient in all countries. Effect on qualitative indicators largely depended on the scenario and country context. Discussion Similarities in scenarios selected were seen across the three countries. Results suggest that efficiencies can be found through changes to the iSC design, but the benefits of each scenario must be considered in the country context. Results of the analysis do not provide “the right answer” but rather options and guidance which then must be grounded in the country context and used as evidence for decision making to ensure reliable availability of vaccines.

BACKGROUND: Achieving universal immunization coverage and reaching every child with life-saving vaccines will require the implementation of pro-equity immunization strategies, especially in poorer countries. Gavi-supported countries continue to implement and report strategies that aim to address implementation challenges and improve equity. This paper summarizes the first mapping of these strategies from country reports. METHODS: Thirteen Gavi-supported countries were purposively selected with emphasis on Gavi's priority countries. Following a scoping of different documents submitted to Gavi by countries, 47 Gavi Joint Appraisals (JAs) for the period 2016-2019 from the 13 selected countries were included in the mapping. We used a consolidated framework synthesized from 16 different equity and health systems frameworks, which incorporated UNICEF's coverage and equity assessment approach - an adaptation of the Tanahashi model. Using search terms, the mapping was conducted using a combination of manual search and the MAXQDA qualitative analysis tool. Pro-equity strategies meeting the inclusion criteria were identified and compiled in an Excel database, and then populated on a tableau visualization dashboard. RESULTS: In total, 258 pro-equity strategies were implemented by the 13 sampled Gavi-supported countries between 2016 and 2019. The framework determinants of social norms, utilization, and management and coordination accounted for more than three-quarters of all pro-equity strategies implemented in these countries. The median number of strategies reported per country was 17. Afghanistan, Nigeria, and Uganda reported the highest number of strategies that we considered as pro-equity. CONCLUSION: Findings from this mapping can be useful in addressing equity gaps, reaching partially immunized, and 'zero-dose' vaccinated children, and valuable resource for countries planning to implement pro-equity strategies, especially as immunization stakeholders reimagine immunization delivery in light of COVID-19, and as Gavi finalizes its fifth organizational strategy. Future efforts should seek to identify pro-equity strategies being implemented across additional countries, and to assess the extent to which these strategies have improved immunization coverage and equity.

Innovative learning strategies are needed to improve frontline health workers' skills for achieving immunization coverage goals—now even more important with COVID-19. Peer mentoring and WhatsApp networking are low-cost and useful blended learning methods for need-based and individualized capacity building of health workers for improving immunization services that don't disrupt the health care workers' regular work., Key Messages We piloted peer mentoring with WhatsApp for immunization capacity building of maternal and child health (MCH) nurses in the Lari and Machakos subcounties of Kenya. Each mentor was assigned 4 mentees and provided on-site mentoring and hands-on training for 1 year. WhatsApp networking groups supported peer-mentoring efforts. In both subcounties, we observed positive changes in mentees' immunization knowledge, skills, and practices. The WhatsApp platform improved mentees' engagement with peers and promoted discussion and learning., Evidence from available studies suggests that peer mentoring is a useful tool to build health workers' knowledge, skills, and practices. However, there is a dearth of research on use of this method of learning in immunization programs. Although WhatsApp has been used as a networking platform among health care professionals, there is limited research on its potential contribution to improving the immunization competencies of health workers. This study showed that peer mentoring and WhatsApp networking are useful blended learning methods for need-based and individualized capacity building of health workers providing immunization services. Future research to assess the comparative cost-benefit between classroom-based training and peer mentoring (along with WhatsApp networking) will be useful.

Achievement of universal eradication of paralytic poliomyelitis has remained a challenge. Despite the general decline in cases, multiple outbreaks attributed to poor vaccination still occur. Noncompliance from vaccination can be improved through education on various media platforms. In the internet age, online health-seeking behavior plays a significant role in this regard. Hence, our study investigated the association between global online search interest in polio with the number of polio cases and vaccination coverage. This infodemiological and ecological study utilized Google Trends' search volume index (SVI) for "polio" and the World Health Organization data on the number of polio cases (PC) and vaccine coverage rate (VCR) per country between 2006 and 2019. Associations between SVI for "polio" with PC and with VCR were evaluated. From the years 2006 to 2019, the global inquiry for this term was highest (i.e., SVI at 100) last October 2018. There was a direct correlation between the SVI for "polio" and PC while there was an inverse relationship between SVI and VCR per country per year. Both relationships have weak to moderate strength of associations. Based on our models, a one-unit increase in the SVI leads to a 3.8% increase in the number of polio cases. On the other hand, a one-unit increase in the SVI leads to a 0.01% decrease in the VCR.Conclusions: Dynamic changes in global SVIs for polio may reflect fluctuations in the number of polio cases and rates of vaccine coverage. Our study brings into light the largely untapped and potential use of online search behavior for polio to anticipate changes in PC and VCR in real-time. What is Known: •Parental vaccine hesitancy is a strong hindrance to the eradication of vaccine-preventable diseases. •The internet is a major source of information that modifies this attitude. What is New: •Internet health-seeking behavior can be measured using Google Trends' search volume index and can be used to correlate to certain aspects of public health determinants of a certain disease. •Google Trends' search volume index correlates with the number of polio cases/immunization rates, and this provides a basis for considering public health measures online.

BACKGROUND: Public understanding of immunization problems, pneumonia cases, and nutrition in children is important to improve children’s health status. Provision of attractive and illustrated media is one option to increase public knowledge in supporting the success of government programs in the health sector. AIM: The purpose of this study is as a form of promotion effort to support an increase in the immunization movement in infants, a decrease in cases of malnutrition and malnutrition, and a decrease in pneumonia cases in infants. METHODS: The research method used is qualitative and quantitative study. Researchers analyzed the promoting media and the value of benefits in the community. Qualitative analyze used content analysis to get an assessment of media from cadres and parents of children. Quantitative study used univariable analysis to see understanding of illness prevention effort. Interesting picture books for immunization, pneumonia, and malnutrition are used as the promoting media. The number of samples was 20 cadres and 20 parents of children under five, done by simple random sampling technique. RESULTS: The results showed that the media used for learning nutrition, immunization, and pneumonia material was effective for cadres and the community about easy to understand, completeness, attractive, assistance, easy to use, and practically. This is evidenced by a positive assessment of the media and increased understanding of the material from 50% to 90%. CONCLUSION: Thus, it can be said that it is necessary to provide educational media to increase public knowledge and understanding of cases that often arise in the community as a problem.

Background: Immunization is a significant public health intervention to reduce child mortality and morbidity. However, its coverage, in spite of free accessibility, is still very low in developing countries. One of the primary reasons for this low coverage is the lack of analysis and proper utilization of immunization data at various healthcare facilities. Purpose: In this paper, the existing machine learning-based data analytics techniques have been reviewed critically to highlight the gaps where this high potential data could be exploited in a meaningful manner. Results: It has been revealed from our review that the existing approaches use data analytics techniques without considering the complete complexity of Expanded Program on Immunization which includes the maintenance of cold chain systems, proper distribution of vaccine and quality of data captured at various healthcare facilities. Moreover, in developing countries, there is no centralized data repository where all data related to immunization is being gathered to perform analytics at various levels of granularities. Conclusion: We believe that the existing non-centralized immunization data with the right set of machine learning and Artificial Intelligence-based techniques will not only improve the vaccination coverage but will also help in predicting the future trends and patterns of its coverage in different geographical locations.

The US response to coronavirus disease 2019 (COVID-19) has been plagued with politics driving public health and messaging. As a result, COVID-19 vaccine rollout is occurring in an environment ill equipped to achieve broad acceptance of the vaccine. Addressing public concerns unlocks the potential for high vaccine coverage; this is best achieved when science and values, not politics, inform public health. A multifaceted and thorough engagement and communication plan that is responsive to the concerns and values of different groups must be swiftly yet carefully implemented in a coordinated manner by federal, state, and local governments. Effective communication will require rapid and rigorous science to promptly differentiate between adverse events following immunization that are causally related versus simply coincidental. Health care providers, in particular, will need support to process the otherwise potentially overwhelming amount of relevant information and effectively integrate it into discussions with their patients to support their decision making. An equitable COVID-19 immunization program could substantively reduce the disproportionate risks associated with this pandemic.

In an effort to reduce the mortality rate due to infection in infants, immunization activities are carried out. Implementation of immunization, namely through Integrated Service Posts. In the current system, child immunization data is recorded on the KMS (Kartu Menuju Sehat) that parents bring to the immunization program. The card is prone to missing, which causes parents to not have their child's immunization history data. The existence of a computerized application can help the health service process to be faster and provide valid and up to date data. Immunization data monitoring application is an application that was built to help organize the data into information needed to support routine monitoring activities at the public health center of Pembina. The design of this application uses the Unified Modeling Language (UML) and is developed using the Rapid Application Development (RAD) method that can produce systems quickly and directly involve the user in the application development process. This research resulted in an immunization data monitoring application intended for parents and officers of the Integrated Service Post at public health center.

• Measles Supplemental Immunization Activities (SIAs) are resource intensive. • SIAs importantly reach some previously unvaccinated (so-called measles zero-dose) children. • We highlight difficulties in measuring how many measles zero-dose children the SIA reaches. • We also suggest some other methods to improve estimation of SIA impact.

We introduce continuity and temporariness into the independent cascade model to depict information diffusion in a social network. Investor behavior changes are determined according to the process of information diffusion, and the investment portfolio model consisting of sentiments is proposed to reveal the fire sales of stocks and the resulting stock price crash risk. Therefore, the relationship between information diffusion and stock price crash risk is established, and the contagion of stock price crash risk is analyzed from the perspective of information diffusion. Furthermore, some immunization strategies of networks are compared to prevent stock price crash risk. The results show that the tendency of stock price crash risk is consistent with that of information diffusion, which indicates that information diffusion before the fire sales is the key to triggering stock price crash risk. Moreover, investors with many ties contribute more to information diffusion than others; hence, immunization strategies of networks based on global information are more effective in preventing stock price crash risk than that based on local information. This study provides a new perspective for the study of contagion risk in the stock market, and it hints at the possibility of regulatory intervention to prevent stock price crash risk.

The polio endgame remains complicated, with many questions about future polio vaccines and national immunization policies. We simulated possible future poliovirus vaccine routine immunization policies for countries stratified by World Bank Income Levels and estimated the expected costs and cases using an updated integrated dynamic poliovirus transmission, stochastic risk, and economic model. We consider two reference cases scenarios: one that achieves the eradication of all wild polioviruses (WPVs) by 2023 and one in which serotype 1 WPV (WPV1) transmission continues. The results show that the addition of inactivated poliovirus vaccine (IPV) to routine immunization in all countries substantially increased the expected costs of the polio endgame, without substantially increasing its expected health or economic benefits. Adding a second dose of IPV to the routine immunization schedules of countries that currently include a single IPV dose further increases costs and does not appear economically justified in the reference case that does not stop WPV transmission. For the reference case that includes all WPV eradication, adding a second IPV dose at the time of successful OPV cessation represents a cost-effective option. The risks and costs of needing to restart oral poliovirus vaccine (OPV) use change the economics of the polio endgame, although the time horizon used for modeling impacts the overall economic results. National health leaders will want to consider the expected health and economic net benefits of their national polio vaccine strategies recognizing that preferred strategies may differ.

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 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.

Negative effects of haze risk can easily spread faster and more widely, however, existing studies rarely investigate the whole period or cycle of diffusion events, which leads to lowered public knowledge, often resulting in exaggerated negative effects. In this paper, the diffusion simulation model based on cellular automata is used to evaluate the diffusion of haze risk information. Firstly, according to the whole-life cycle of emergencies, the public affected by haze risk information is classified by resembling the SEIR infectious disease model. Secondly, a diffusion rule from unknown to exposed individuals is developed based on the theory of cellular automata. Then, according to the individual state transformation at different stages, a whole-life cycle model regarding haze risk information diffusion and propagation model is constructed. Finally, appropriate parameters are selected to calculate the results without intervention. The results show that during the whole evolution process, the unknowns continue to decrease, and the lurkers continue to increase. Due to the existence of the immunization period, the immunized persons reach their maximum number before they are about to lose immunity, and the number of communicators reaches their minimum. Afterward, the number of immunized persons reduced to a stable level, and the number of communicators continues to increase toward an agglomeration benefit. Therefore, in order to achieve effective control of the spread of haze risk information, strong and weak control measures are taken for each type of individuals, and the immunity of unknowns and lurkers is increased for individual type control. For the entire information diffusion control, increase communicator immunity and reduce immunization conversion rate. The study of the spread of haze risk information helps to increase the public's sense of responsibility, helps to improve the government's credibility, and contributes to the establishment of a harmonious society.

Relevance. In modern conditions, special attention is paid to preserving the health and quality of life of the working population through vaccination. The role of corporate medicine in the organization and implementation of a risk-based approach to the immunization of employees in enterprises and institutions is actively discussed. The aim of this study was to discuss the methodological and basic arrangements for the development and implementation of a new technology at an enterprise using vaccination - a corporate immunizations schedule. Materials and methods. The scientific work was carried out on the basis of generalization of our own experience and the experience of some regions of the Russian Federation on the formation and implementation of corporate immunizations schedules in industrial enterprises and in higher educational institutions. Results. The substantiation of the feasibility of introducing corporate immunizations schedules at enterprises and institutions is given, tasks, legal bases, an up-to-datelist of infections to be included in the corporate immunization schedules, conditions for its successful implementation and development prospects are presented. Conclusions. The corporate immunization schedules should be considered as one of the mechanisms for providing the working population with immunobiological drugs during the transition period (before the inclusion of actual infections in the National immunization schedule), actively discussed today in the pages of domestic literature.

There is no doubt that ‘hope’ is the sentiment with which we are approaching 2021. Hope in the new COVID-19 vaccines, and a speedy rollout of immunization campaigns; hope for the kind of economic r...