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Background Although polioviruses (PVs) replicate in lymphoid tissue of both the pharynx and ileum, research on polio vaccine–induced mucosal immunity has predominantly focused on intestinal neutralizing and binding antibody levels measured in stool. Methods To investigate the extent to which routine immunization with intramuscularly injected inactivated polio vaccine (IPV) may induce nasal and pharyngeal mucosal immunity, we measured PV type-specific neutralization and immunoglobulin (Ig) G, IgA, and IgM levels in nasal secretions, adenoid cell supernatants, and sera collected from 12 children, aged 2–5 years, undergoing planned adenoidectomies. All participants were routinely immunized with IPV and had no known contact with live PVs. Results PV-specific mucosal neutralization was detected in nasal and adenoid samples, mostly from children who had previously received 4 IPV doses. Across the 3 PV serotypes, both nasal (Spearman ρ ≥ 0.87, P ≤.0003 for all) and adenoid (Spearman ρ ≥ 0.57, P ≤.05 for all) neutralization titers correlated with serum neutralization titers. In this small study sample, there was insufficient evidence to determine which Ig isotype(s) was correlated with neutralization. Conclusions Our findings provide policy-relevant evidence that routine immunization with IPV may induce nasal and pharyngeal mucosal immunity. The observed correlations of nasal and pharyngeal mucosal neutralization with serum neutralization contrast with previous observations of distinct intestinal and serum responses to PV vaccines. Further research is warranted to determine which antibody isotype(s) correlate with polio vaccine–induced nasal and pharyngeal mucosal neutralizing activity and to understand the differences from intestinal mucosal immunity. [ABSTRACT FROM AUTHOR]

Polio vaccine hesitancy remains high in Pakistan due to various socio-political, religious, and economic factors. To address this, the government of Pakistan and its international partners such as UNICEF have devised a multipronged communication strategy to counter resistance to polio vaccine in hard-to-reach areas of the country. In this strategy, mainstream news media has been identified as a key stakeholder, as they have the potential to reach a wide range of population and disseminate easy to understand messages including both visuals and text. However, less scholarly attention has been paid to how mainstream news media in Pakistan frame polio and polio vaccine in their visuals. This study aims to fill this gap. Using visual framing as a theoretical framework, we analyzed 115 images from three selected newspapers published from 2010 to 2022. Our results suggest that the newspapers depicted hard-to-reach areas in Khyber Pakhtunkhwa (KP) province which were more affected by polio and highlighted the criminality and securitization of polio vaccine in the country. In addition, female polio healthcare workers, who are instrumental in eradicating the disease, have been given marginal coverage, reflecting the importance of gender sensitivity in the region. Overall, this study contributes to the fields of visual communication, health communication, and international communication, particularly related to the Global South. [ABSTRACT FROM AUTHOR]

Despite their efficacy, the currently available polio vaccines, oral polio vaccine (OPV) and inactivated polio vaccine (IPV), possess inherent flaws posing significant challenges in the global eradication of polio. OPV, which uses live Sabin attenuated strains, carries the risk of reversion to pathogenic forms and causing vaccine-associated paralytic poliomyelitis (VAPP) and vaccine-derived polio disease (VDPD) in incompletely vaccinated or immune-compromised individuals. Conventional IPVs, which are non-replicative, are more expensive to manufacture and introduce biohazard and biosecurity risks due to the use of neuropathogenic strains in production. These types of limitations have led to a call by the Global Polio Eradication Initiative and others for the development of updated polio vaccines. We are developing a novel Ultraviolet-C radiation (UVC) inactivation method that preserves immunogenicity and is compatible with attenuated strains of polio. The method incorporates an antioxidant complex, manganese-decapeptide-phosphate (MDP), derived from the radioresistant bacterium Deinococcus radiodurans. The inclusion of MDP protects the immunogenic neutralizing epitopes from damage during UVC inactivation. The novel vaccine candidate, ultraIPVTM, produced using these methods demonstrates three crucial attributes: complete inactivation, which precludes the risk of vaccine-associated disease; use of non-pathogenic strains to reduce production risks; and significantly enhanced yield of doses per milligram of input virus, which could increase vaccine supply while reducing costs. Additionally, ultraIPVTM retains antigenicity post-freeze–thaw cycles, a testament to its robustness. [ABSTRACT FROM AUTHOR]

The article discusses the impact of vaccine hesitancy on public health, particularly in the context of the COVID-19 pandemic and the upcoming flu season. It highlights the various factors contributing to vaccine hesitancy, such as safety concerns, skepticism about efficacy, and mistrust in medical and governmental institutions. The research emphasizes the importance of understanding and addressing vaccine hesitancy to ensure individuals are informed and able to protect their health effectively. Additionally, the article explores how vaccine hesitancy has affected flu vaccine coverage and emphasizes the need for reliable health information to combat misinformation and promote vaccination. [Extracted from the article]

Circulating vaccine-derived polioviruses (cVDPVs) can emerge and lead to outbreaks of paralytic polio as well as asymptomatic transmission in communities with a high percentage of undervaccinated children. Using data from the World Health Organization Polio Information System and Global Polio Laboratory Network, this report describes global polio outbreaks due to cVDPVs during January 2023-June 2024 and updates previous reports. During the reporting period, 74 cVDPV outbreaks were detected in 39 countries or areas (countries), predominantly in Africa. Among these 74 cVDPV outbreaks, 47 (64%) were new outbreaks, detected in 30 (77%) of the 39 countries. Three countries reported cVDPV type 1 (cVDPV1) outbreaks and 38 countries reported cVDPV type 2 (cVDPV2) outbreaks; two of these countries reported cocirculating cVDPV1 and cVDPV2. In the 38 countries with cVDPV2 transmission, 70 distinct outbreaks were reported. In 15 countries, cVDPV transmission has lasted >1 year into 2024. In Nigeria and Somalia, both countries with securitycompromised areas, persistent cVDPV2 transmission has spread to neighboring countries. Delayed implementation of outbreak response campaigns and low-quality campaigns have resulted in further international spread. Countries can control cVDPV outbreaks with timely allocation of resources to implement prompt, high-quality responses after outbreak confirmation. Stopping all cVDPV transmission requires effectively increasing population immunity by overcoming barriers to reaching children. [ABSTRACT FROM AUTHOR]

Background: Infant vaccination coverage rates in Peru have declined in recent years, exacerbated by the COVID-19 pandemic. Introduction of the fully-liquid diphtheria, tetanus, and acellular pertussis (DTaP)-inactivated polio vaccine (IPV)-hepatitis B (HB)-Haemophilus influenzae type B (Hib) hexavalent vaccine (DTaP-IPV-HB-Hib) in Peru's infant National Immunization Program may help improve coverage. We evaluated costs and healthcare outcomes, including coverage, of switching from a pentavalent vaccine containing whole-cell pertussis component (DTwP-HB-Hib) plus IPV/oral polio vaccine (IPV/OPV) to the hexavalent vaccine for the primary vaccination scheme (2, 4 and 6 months). Methods: The analysis was performed over a 5-year period on a cohort of children born in Peru in 2020 (N = 494,595). Four scenarios were considered: the pentavalent plus IPV/OPV scheme (S1); replacing the pentavalent plus IPV/OPV scheme with the hexavalent scheme (S2); expanded delivery of the pentavalent plus IPV/OPV scheme (S3); expanded delivery of the hexavalent scheme (S4). Vaccine coverage and incidence of adverse reactions (ARs) were estimated using Monte Carlo simulations and previous estimates from the literature. Cases of vaccine-preventable diseases were estimated using a Markov model. Logistical and healthcare costs associated with these outcomes were estimated. Impact of key variables (including coverage rates, incidence of ARs and vaccine prices) on costs was evaluated in sensitivity analyses. Results: The overall cost from a public health payer perspective associated with the pentavalent plus IPV/OPV vaccine scheme (S1) was estimated at $56,719,350, increasing to $61,324,263 (+ 8.1%), $59,121,545 (+ 4.2%) and $64,872,734 (+ 14.4%) in scenarios S2, S3 and S4, respectively. Compared with the status quo (S1), coverage rates were estimated to increase by 3.1% points with expanded delivery alone, and by 9.4 and 14.3% points, if the hexavalent vaccine is deployed (S2 and S4, respectively). In both scenarios with the hexavalent vaccine (S2 and S4), pertussis cases would also be 5.7% and 8.7% lower, and AR rates would decrease by 32%. The cost per protected child would be reduced when the hexavalent vaccine scheme. Incidence of ARs was an important driver of cost variability in the sensitivity analysis. Conclusions: Implementation of the hexavalent vaccine in Peru's National Immunization Program has a positive public health cost consequence. [ABSTRACT FROM AUTHOR]

Background: Circulating Vaccine‐Derived Poliovirus Type 2 (cVDPV2) was isolated in sewage and later in stool samples from children with acute flaccid paralysis (AFP) in northern Ghana. Method: A multidisciplinary and multisectoral team investigated this outbreak and reported on epidemiological and laboratory investigations. Sewage/wastewater samples were collected from the environment, while stool samples were collected from AFP/contact children under 5 years of age. The samples were processed for virus isolation, and positive isolates were sequenced. We also conducted a descriptive investigation involving a review of records, active case search, and Monovalent Oral Polio Vaccine 2 campaigns. Additionally, we interviewed caregivers about the vaccination status of their children, as well as their knowledge on polio prevention. Water quality, sanitation, hygiene practices, and health‐seeking behaviours were also assessed. Results: A total of 18 cVDPV2 were confirmed in the three regions of Ghana during the outbreak in 2019–2020. All strains were genetically linked to a Nigerian cVDPV2 strain NIE‐KWS‐KSB‐18‐006HC29 that circulated in 2018. Evaluation of the surveillance system shows that officers have good knowledge of AFP and know how to collect samples, package them, and ship them to the laboratory. Few communities had access to potable water. Open defecation was common, and the water supply, sanitation, and hygiene practices of the communities were poor. Conclusion: The cVDPV2 outbreak represents the first time cVDPV2 has circulated in the country since Ghana embarked on the polio eradication program in 1996. However, with quality mOPV2 mop‐up campaigns, a nationwide IPV catch‐up campaign coupled with enhanced surveillance measures, transmission was interrupted. [ABSTRACT FROM AUTHOR]

Background Polio has not been detected in Morocco since 1989. The aim of this study was to examine the surveillance system for acute flaccid paralysis (AFP) in the province of Kenitra, assess its strengths and weaknesses, and suggest ways to improve it. Method & materials A qualitative and quantitative evaluation was carried out within the Kenitra Provincial Epidemiology Unit. The AFP case database was analyzed using the standards for evaluation of public health surveillance systems defined by the Centers for Disease Control and Prevention (CDC) in 2001 and WHO indicators. The surveillance system was found to be flexible and effective. Result The sensitivity of the system reached 50%, with an average notification rate of 3.04 cases. More than 40% of patients were reported within 7 days of onset of paralysis. Investigation time was approximately 70% within 48 hours of notification. 80% of stool samples were sent to the laboratory within 72 hours of collection. Conclusion: The AFP surveillance system in Kenitra is effective, adaptable and highly vigilant, allowing a rapid response. Maintaining AFP surveillance is essential until polio is eradicated worldwide. [ABSTRACT FROM AUTHOR]

Background: Many of the infectious diseases can be prevented by effective vaccines. Efficacy of vaccine can be compromised due to improper handling, not storing vaccine in recommended cold chain equipment and faulty transport that could be the possible reasons for break in cold chain. Change in temperature can alter the stability of vaccines. Smallpox-pox has been eradicated from the world and poliomyelitis is going to be eradicated. This proves that vaccination is the only way and best strategy in medical to control infectious diseases. Methodology: A cross sectional study was conducted in urban area of Central India. Vaccine providers were interviewed about various immunization practices. Results: Study population were private practitioners who were doing vaccination in private clinics and private hospital. The response rate was 91%. Conclusion: This study found lacunae in vaccine dose reporting. Cold chain monitoring in private clinics was not effective as per WHO recommended guidelines. [ABSTRACT FROM AUTHOR]

Aims: The route of transmission of wild and circulating vaccine-derived polioviruses remains controversial, between respiratory and faecal-oral, and we aim to identify the most plausible one to settle the controversy. Methods: We explored available epidemiological clues and evidence in support of either route in order to arrive at an evidence-based conclusion. Results: Historically the original concept was respiratory transmission based on epidemiological features of age distribution, which was later revised to faecal-oral as the rationale for popularising the live attenuated oral polio vaccine in preference to the inactivated poliovirus vaccine. Through epidemiological logic, we find no evidence for the faecal-oral route from available studies and observations, but all available information supports the respiratory route. Conclusions: The route is respiratory, not faecal-oral. The global polio eradication initiative assumed it was faecal-oral – and its gargantuan efforts based on this assumption have failed in two ways: eradication remains pending and circulating vaccine-derived polioviruses have seeded widely. With clarity on the route of transmission the choice of vaccine is also clear – it can only be the inactivated poliovirus vaccine. [ABSTRACT FROM AUTHOR]

Background Despite multiple revisions of targets and timelines in polio eradication plans since 1988, including changes in supplemental immunization activities (SIAs) that increase immunity above routine immunization (RI) coverage, poliovirus transmission continues as of 2024.Methods We reviewed polio eradication plans and Global Polio Eradication Initiative (GPEI) annual reports and budgets to characterize key phases of polio eradication, the evolution of poliovirus vaccines, and the role of SIAs. We used polio epidemiology to provide context for successes and failures and updated prior modeling to show the contribution of SIAs in achieving and maintaining low polio incidence compared to expected incidence for the counterfactual of RI only.Results We identified multiple phases of polio eradication that included shifts in targets and timelines and the introduction of different poliovirus vaccines, which influenced polio epidemiology. Notable shifts occurred in GPEI investments in SIAs since 2001, particularly since 2016. Modeling results suggest that SIAs play(ed) a key role in increasing (and maintaining) high population immunity to levels required to eradicate poliovirus transmission globally.Conclusions Shifts in polio eradication strategy and poliovirus vaccine usage in SIAs provide important context for understanding polio epidemiology, delayed achievement of polio eradication milestones, and complexity of the polio endgame.

ABSTRACTBackground New York State (NYS) reported a polio case (June 2022) and outbreak of imported type 2 circulating vaccine-derived poliovirus (cVDPV2) (last positive wastewater detection in February 2023), for which uncertainty remains about potential ongoing undetected transmission.Research Design and Methods Extending a prior deterministic model, we apply an established stochastic modeling approach to characterize the confidence about no circulation (CNC) of cVDPV2 as a function of time since the last detected signal of transmission (i.e. poliovirus positive acute flaccid myelitis case or wastewater sample).Results With the surveillance coverage for the NYS population majority and its focus on outbreak counties, modeling suggests a high CNC (95%) within 3–10 months of the last positive surveillance signal, depending on surveillance sensitivity and population mixing patterns. Uncertainty about surveillance sensitivity implies longer durations required to achieve higher CNC.Conclusions In populations that maintain high overall immunization coverage with inactivated poliovirus vaccine (IPV), rare polio cases may occur in un(der)-vaccinated individuals. Modeling demonstrates the unlikeliness of type 2 outbreaks reestablishing endemic transmission or resulting in large absolute numbers of paralytic cases. Achieving and maintaining high immunization coverage with IPV remains the most effective measure to prevent outbreaks and shorten the duration of imported poliovirus transmission.

Background: Indonesia has successfully eradicated wild poliovirus since 2005 using robust immunization and AFP surveillance programs. However, circulating vaccine-derived poliovirus type 2 has challenged these commitments, followed by the 2024 outbreak in East Java. Purpose: The study aims to analyze the polio eradication initiative by assessing polio immunization coverage and AFP surveillance in East Java. Methods: A descriptive, quantitative study design and retrospective analysis of polio immunization coverage and AFP surveillance indicators from the Provincial Health Office, East Java, from 2018–2022. The data was collected and analyzed using Excel, EpiInfo7, and Health Mapper software. Results: OPV4 coverage ranged from 89.95% to 100.76%, while IPV coverage ranged from 73.98 % to 94.18% from 2018 to 2020; the proportion of districts and cities for IPV coverage increased from 0% in 2018 to 44.74% in 2022, below the 95% WHO target. Of the 826 cases of AFP reported, 820 (99.27%) were actual AFP cases

This review traces the development of vaccines from ancient times to the present, highlighting major milestones and challenges. It covers the significant impact of vaccines on public health, including the eradication of diseases such as smallpox and the reduction of others such as polio, measles, and influenza. The review provides an in-depth look at the COVID-19 vaccines, which were developed at unprecedented speeds due to the urgent global need. The study emphasizes the ongoing potential of vaccine development to address future global health challenges, demonstrating the critical role vaccines play in disease prevention and public health. Moreover, it discusses the evolution of vaccine technology, from live-attenuated and inactivated vaccines to modern recombinant and mRNA vaccines, showcasing the advancements that have enabled rapid responses to emerging infectious diseases. The review underscores the importance of continued investment in research and development, global collaboration, and the adoption of new technologies to enhance vaccine efficacy and coverage. By exploring historical and contemporary examples, the article illustrates how vaccines have transformed medical practice and public health outcomes, providing valuable insights into future directions for vaccine innovation and deployment. [ABSTRACT FROM AUTHOR]

Background: Effective vaccination governance in conflict-affected regions poses unique challenges. This study evaluates the governance of vaccination programs in northwest Syria, focusing on effectiveness, efficiency, inclusiveness, data availability, vision, transparency, accountability, and sustainability. Methods: Using a mixed-methods approach, and adapting Siddiqi's framework for health governance, data were collected through 14 key informant interviews (KIIs), a validating workshop, and ethnographic observations. Findings were triangulated to provide a comprehensive understanding of vaccination governance. Results: The study highlights innovative approaches used to navigate the complex health governance landscape to deliver vaccination interventions, which strengthened sub-national vaccination structures such as The Syria Immunisation Group (SIG). The analysis revealed several key themes. Effectiveness and efficiency were demonstrated through cold-chain reliability and extensive outreach activities, though formal reports lacked detailed analysis of vaccine losses and linkage between disease outbreak data and coverage statistics. Key informants and workshop participants rated the vaccination strategy positively but identified inefficiencies due to irregular funding and bureaucracy. Inclusiveness and data availability were prioritised, with outreach activities targeting vulnerable groups. However, significant gaps in demographic data and reliance on paper-based systems hindered comprehensive coverage analysis. Digitalisation efforts were noted but require further support. The SIG demonstrated a clear strategic vision supported by international organizations such as the World Health Organization, yet limited partner participation in strategic planning raised concerns about broader ownership and engagement. While the SIG was perceived as approachable, the lack of public documentation and financial disclosure limited transparency. Internal information sharing was prevalent, but public communication strategies were insufficient. Accountability and sustainability faced challenges due to a decentralized structure and reliance on diverse donors. Despite stabilizing factors such as decentralization and financial continuity, fragmented oversight and reliance on donor funding remained significant concerns. Discussion: The study highlights the complexities of vaccination governance in conflict-affected areas. Comparisons with other conflict zones underscore the importance of local organisations and international support. The SIG's role is pivotal, but its legitimacy, transparency, and inclusivity require improvement. The potential transition to early recovery in Syria poses additional challenges to SIG's sustainability and integration into national programs. Conclusion: The governance of vaccination in northwest Syria is multifaceted, involving multiple stakeholders and lacking a legitimate government. Enhancing transparency, local ownership, and participatory decision-making are crucial for improving governance. The role of international bodies is essential, emphasising the need for structured feedback mechanisms and transparent monitoring processes to ensure the program's success and sustainability. Key message: • A hybrid governance model that combines top-down and bottom-up approaches effectively improves immunisation programs in conflict settings and promotes local ownership. • In conflict settings, immunisation programmes require strong and direct intervention from the WHO with central management and coordination of the vaccine activities. • In conflict areas, when the government is a party to the conflict or has limited access to some areas, United Nations institutions must intervene to manage or support vaccine activities in partnership with local entities, regardless of notions of national sovereignty. • In Syria, the reluctance of United Nations institutions to fill the void left by the state in areas outside its control and provide vaccines led to the emergence of many diseases, including polio in 2013 and measles in 2017. [ABSTRACT FROM AUTHOR]

Since its launch in 1988, the Global Polio Eradication Initiative has made substantial progress toward the eradication of wild poliovirus (WPV), including eradicating two of the three serotypes, and reducing the countries with ongoing endemic transmission of WPV type 1 (WPV1) to just Afghanistan and Pakistan. Both countries are considered a single epidemiologic block. Despite the occurrence of only a single confirmed WPV1 case during the first half of 2023, Pakistan experienced widespread circulation of WPV1 over the subsequent 12 months, specifically in the historical reservoirs of the cities of Karachi, Peshawar, and Quetta. As of June 30, 2024, eight WPV1 cases had been reported in Pakistan in 2024, compared with six reported during all of 2023. These cases, along with more than 300 WPV1-positive environmental surveillance (sewage) samples reported during 2023-2024, indicate that Pakistan is not on track to interrupt WPV1 transmission. The country's complex sociopolitical and security environment continues to pose formidable challenges to poliovirus elimination. To interrupt WPV1 transmission, sustained political commitment to polio eradication, including increased accountability at all levels, would be vital for the polio program. Efforts to systematically track and vaccinate children who are continually missed during polio vaccination activities should be enhanced by better addressing operational issues and the underlying reasons for community resistance to vaccination and vaccine hesitancy. [ABSTRACT FROM AUTHOR]

Background: Indonesia has successfully eradicated wild poliovirus since 2005 using robust immunization and AFP surveillance programs. However, circulating vaccine-derived poliovirus type 2 has challenged these commitments, followed by the 2024 outbreak in East Java. Purpose: The study aims to analyze the polio eradication initiative by assessing polio immunization coverage and AFP surveillance in East Java. Methods: A descriptive, quantitative study design and retrospective analysis of polio immunization coverage and AFP surveillance indicators from the Provincial Health Office, East Java, from 2018-2022. The data was collected and analyzed using Excel, EpiInfo7, and Health Mapper software. Results: OPV4 coverage ranged from 89.95% to 100.76%, while IPV coverage ranged from 73.98 % to 94.18% from 2018 to 2020; the proportion of districts and cities for IPV coverage increased from 0% in 2018 to 44.74% in 2022, below the 95% WHO target. Of the 826 cases of AFP reported, 820 (99.27%) were actual AFP cases <15 years of age, with most (49.02%) being <5 years of age. Non-polio AFP rates ranged from 0.80 in 2020 to 2.59 in 2022 per 100,1000 <15 years of age, with the proportion of districts and cities slightly declining from 55.26% in 2018 to 50% in 2022. The annual mean percentage of AFPadequate specimens is 61.15%, with the proportion of districts and cities significantly declining from 31.58% in 2018 to 10.53% in 2022, below the 80% target. Conclusion: IPV immunization coverage and AFP surveillance indicators are below the WHO-recommended targets across districts and cities in East Java. [ABSTRACT FROM AUTHOR]

Background: Poliomyelitis is always a great concern in Pakistan and is a public health emergency. COVID‐19 and recent floods have increased the challenge. Aim: This article highlights the situation of polio in Pakistan and also recommends several steps to eradicate the disease as early as possible. Methodology: Selected articles were selected from electronic databases such as PubMed, Google Scholar, and Scopus using keywords such as Wild Poliovirus, Vaccine Derived Polio Infection, Acute Flaccid Paralysis, Vaccine, and Pakistan. Result: Polio infection has two types, wild poliovirus and vaccine‐derived polio infection. 2019 and 2020 were a challenging time as cases were increased at that time in Pakistan. Acute flaccid paralysis is the most common complication of this disease. The maximum cases of polio are being reported from Khyber Pakhtunkhwa. Conclusion: A special public health importance should be given in this province. Regular vaccination and strict surveillance are important. It is also important to spread awareness among the people. Early identification and timely diagnosis are very important. Early diagnosis, proper timely treatment, vaccination, awareness, and community‐based research will help Pakistan to eradicate this disease as early as possible. [ABSTRACT FROM AUTHOR]

Population movement dynamics are a critical part of understanding communicable disease transmission patterns and determining where, when, and with whom to deliver appropriate prevention interventions. This study aimed to identify the origin of the Afghan population and their patterns of movement within Karachi, to assess the polio vaccination status of children under the age of five, and to investigate the travel history and guest arrival patterns of individuals from Afghanistan and other regions known to be affected by wild poliovirus type 1 (WPV1) within the past six months. A cross-sectional survey was conducted in selected 12 union councils of Karachi, Pakistan. The data were collected through interviews with Afghan household members and from the frontline workers (FLWs) responsible for the polio vaccination of the children of the same households. Cohen's kappa was used to check the agreement between information provided by the household participant and FLWs. A total of 409 Afghan household members were interviewed. Travel of any household member outside the city within the last six months was reported by 105 (25.7%) participants, 140 (34.2%) hosted guests within the last six months, and 92 (22.5%) participants reported that guest children were vaccinated in their households. A total of 230 (56.2%) participants observed polio teams at relatives' households within Karachi, and 127 (31.1%) observed polio teams at relatives' households outside Karachi in different districts of Pakistan and Afghanistan. Fair to moderate agreement was observed between information provided by the household members and FLWs on the variable's duration of living at current residence (Kappa = 0.370), travel history (Kappa = 0.429), guest arrival (Kappa = 0.395), and household children vaccinated for OPV (Kappa = 0.419). Substantial population mobility was observed between Afghanistan and Pakistan as well as significant movement of the Afghan population within Karachi in the last six months. These findings warrant attention and targeted implementation of interventions to enhance and sustain both routine and supplementary immunization activities within this demographic group. [ABSTRACT FROM AUTHOR]

In the context of polio eradication, novel oral polio vaccines for type 2 (nOPV2) were developed, and types 1 and 3 polioviruses are being developed. We aimed to generate trivalent oral poliovirus vaccine (tOPV) safety and immunogenicity data as a reference for comparing with novel OPV formulations. This was a single-center, open-label, phase 4 study in March 2016 in the Dominican Republic with healthy children previously vaccinated with ≥3 doses of tOPV receiving one dose of tOPV and vaccine-naïve infants receiving 3 doses of tOPV. Safety and immunogenicity were assessed. No serious adverse reactions or important medical reactions were reported. Seroconversion (SC) rates at Day 28 in children were 32.7%, 36.7%, and 46.9% for types 1, 2, and 3, respectively, and seroprotection (SP) rates 28 days after one dose increased from 89.8% at baseline to 93.9%, 98.0% to 100%, and 83.7% to 98.0% for types 1, 2, and 3, respectively. In infants, SC rates were 88.5%, 98.1%, and 96.2% for types 1, 2, and 3, respectively. SP rates at Day 84 were 93.3%, 100%, and 96.2% for types 1, 2, and 3, respectively. This information can be used as a reference to compare with novel monovalent or trivalent OPVs under development. [ABSTRACT FROM AUTHOR]

In 2022, global poliovirus modeling suggested that coordinated cessation of bivalent oral poliovirus vaccine (bOPV, containing Sabin-strain types 1 and 3) in 2027 would likely increase the risks of outbreaks and expected paralytic cases caused by circulating vaccine-derived polioviruses (cVDPVs), particularly type 1. The analysis did not include the implementation of planned, preventive supplemental immunization activities (pSIAs) with bOPV to achieve and maintain higher population immunity for types 1 and 3 prior to bOPV cessation. We reviewed prior published OPV cessation modeling studies to support bOPV cessation planning. We applied an integrated global poliovirus transmission and OPV evolution model after updating assumptions to reflect the epidemiology, immunization, and polio eradication plans through the end of 2023. We explored the effects of bOPV cessation in 2027 with and without additional bOPV pSIAs prior to 2027. Increasing population immunity for types 1 and 3 with bOPV pSIAs (i.e., intensification) could substantially reduce the expected global risks of experiencing cVDPV outbreaks and the number of expected polio cases both before and after bOPV cessation. We identified the need for substantial increases in overall bOPV coverage prior to bOPV cessation to achieve a high probability of successful bOPV cessation. [ABSTRACT FROM AUTHOR]

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Introduction: There is limited guidance on strategies for delivering complex global health programs. We synthesized available evidence on implementation strategies and outcomes utilized in the global polio eradication initiative (GPEI) across low and middle-income country (LMIC) settings. Methods: We nested our scoping review into a literature review conducted as part of a parent study, STRIPE. This review systematically searched PubMed for articles between 1 January 1988 and 25 April 2018 using polio search terms. Strategies from included studies were organized according to the Expert Recommendations for Implementing Change (ERIC) framework, specified using Proctor's framework, and linked to various outcomes (implementation, services delivery, impact). Results: 152 unique articles fulfilled our inclusion criteria (from 1,885 articles included in the parent study). Only 43 out of the 152 articles described a suitable quantitative study design for evaluating outcomes. We extracted 66 outcomes from the 43 unique studies. Study publication dates ranged from 1989 to 2018 and represented diverse country settings. The most common implementation strategies were developing mechanisms for feedback, monitoring, and evaluation (n = 69); increasing awareness among the population (n = 58); involving stakeholders, workers, and consumers in the implementation efforts (n = 46); conducting workshops (n = 33); using mass media (n = 31); and building robust record systems to capture outcomes (n = 31). Coverage (n = 13) and morbidity (n = 12) were the most frequently identified outcomes, followed by effectiveness (n = 9) and fidelity (n = 6). Feasibility and sustainability were rarely evaluated. Conclusions: This review provides a catalogue of implementation strategies and outcomes relevant for advancing global health services delivery in LMICs drawing from the GPEI. Implementation strategies reviewed were poorly described and not adequately linked to outcomes. It calls for additional implementation research to unravel the mechanisms of implementation strategies and their effectiveness, and adaptation of the ERIC framework in LMICs. [ABSTRACT FROM AUTHOR]

Background/Objectives: Post-polio syndrome (PPS) affects former polio patients, manifesting decades after initial infection with progressive symptoms like pain, fatigue, and muscle weakness. Diagnosis relies on the clinical criteria and exclusion of other probable causes. The purpose of this study is to determine the scope and new diagnostic value of magnetic resonance imaging (MRI) in identifying muscle involvement in PPS and distinguishing it from prior poliomyelitis (PPM). Methods: This study was approved by the Koç University Ethics Committee with Approval No. 2023.409.IRB2.090. Electronic medical archives from two academic institutions were searched for records tagged with ICD code B-91 for poliomyelitis sequalae. The resulting search query of 291 records was manually sorted for PPS and PPM, medical history, clinical examination findings, and lumbar MR images down to 32 patients. Two independent radiologists evaluated the paraspinal musculature in the MRIs using the Mercuri scale. Inter-rater agreement, comparison of the paraspinal musculatures between groups, and their relationship to leg involvement were assessed with the resulting data. Results: Inter-rater agreement was found to be almost perfect across all muscles, except for the multifidus muscle. When clinical examination findings were included for these muscles, quadratus lumborum (QL) degradation was found in both right-side (p = 0.017) and left-side (p = 0.002) leg involvement. Conclusions: QL muscle deterioration may serve as a diagnostic marker for PPS, potentially guiding lumbar pain treatment through rehabilitation. [ABSTRACT FROM AUTHOR]

Viral infections, ranging from the common cold to severe illnesses like HIV/AIDS, Ebola, and SARS-CoV-2, are a major public health concern. The Noguchi Memorial Institute for Medical Research (NMIMR) has a comprehensive research program on viral diseases. During the seventh annual research meeting (ARM), presentations highlighted NMIMR's role in Ghana's preparedness for epidemic-prone diseases, national surveillance, and policy support. NMIMR hosts several key centres, including the National Influenza Centre and the Regional Reference Laboratories for Polio and Rotavirus. During the COVID-19 pandemic, NMIMR established Ghana's first testing facility and expanded testing capacity through training and novel methodologies like sample pooling. The Institute has tested hundreds of thousands of samples and conducted genomic sequencing to track SARS-CoV-2 variants. NMIMR's polio laboratory, the WHO Regional Reference Lab for Africa, processes samples from several West African countries. The lab's genomic sequencing has been crucial for tracking poliovirus and informing immunisation strategies. The institute also plays a key role in monitoring viral hemorrhagic fevers (VHF), and diagnosing diseases like Lassa fever, yellow fever, and Marburg. NMIMR's research and surveillance efforts have been pivotal in shaping Ghana's response to viral diseases, ensuring timely diagnosis, effective outbreak management, and informed policy-making. [ABSTRACT FROM AUTHOR]

Introduction: The survival of total knee arthroplasty (TKA) in patients with poliomyelitis remains a debated topic due to the high recurrence of postoperative genu recurvatum. This study aims to report the long-term survival of TKA in patients with poliomyelitis, using data from the Italian Register of Prosthetic Implantology. Materials and methods: A registry-based population study was conducted, utilizing data from the Emilia Romagna orthopedic arthroplasty implants registry (RIPO - Registro Implantologia Protesica Ortopedica). The cohort consisted of 71 patients with poliomyelitis-related arthritis who underwent TKA. The study assessed and analyzed demographic data, implant type, fixation method, insert type, and level of constraint. Additionally, variations in preoperative and postoperative both clinical and functional Knee Society Scores (KSS) were collected. Results: Eight implants required revision surgery (16%), and three patients died (6.1%), resulting in a 10-year survival rate of 86.6% and a 15-year survival rate of 53.9%. Aseptic loosening was the primary cause of revision, accounting for 37.5% of failures, followed by insert wear (25%). No statistically significant correlation was found between the level of constraint and implant survival (p=0.0887, log-rank). Both the clinical and functional KSS improved postoperatively. Conclusion: TKA is a viable alternative to knee arthrodesis and, in properly selected patients, might represent the first-choice treatment for articular degeneration due to its high survivorship. Despite the complexity of these cases, TKA can effectively alleviate articular pain, instability, and angular deviation, thereby preserving knee functionality. [ABSTRACT FROM AUTHOR]

To explore if intestinal immunity induced by infection with live viruses in the oral poliovirus vaccine (OPV) is essential, necessary or even helpful in interrupting transmission of wild poliovirus (WPV) for global polio eradication. We reviewed the biology of virus-host interactions in WPV infection and its alterations by OPV-induced immunity for direct evidence of the usefulness of intestinal immunity. We also explored indirect evidence by way of the effect of the inactivated poliovirus vaccine (IPV) on the biology and on transmission dynamics of WPV. Immunity, systemic and intestinal, induced by infection with WPV or vaccine viruses, does not prevent re-infection with WPV or vaccine viruses respectively, when exposed. Such re-infected hosts shed virus in the throat and in faeces and are sources of further transmission. Immunity protects against polio paralysis-hence reinfection always remain asymptommatic and silent. Vaccine virus-induced intestinal immunity is not necessary for polio eradication. The continued and intensive vaccination efforts using OPV under the assumption of its superiority over IPV have resulted in the well-known undesirable effects, namely vaccine associated paralytic polio and the emergence of de-attenuated circulating vaccine-derived polioviruses, in addition to the delay in completing global WPV eradication. [ABSTRACT FROM AUTHOR]

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Background: Total knee arthroplasty (TKA) for poliomyelitis patients is controversial due to its higher complication rate compared with that of TKA for osteoarthritis. In this study we evaluated the results, at a minimum of 10 years, of a consecutive series of third-generation rotating hinge total knee arthroplasties (RHKs) in patients affected by poliomyelitis. Methods: We conducted a retrospective analysis of 14 patients (15 TKA) performed between January 2000 and October 2021 that underwent a third-generation rotating hinge arthroplasty (Nex Gen RHK Zimmer). The clinical results using the American Knee Society Score (AKSS) were evaluated at an average follow-up of 154 months (min 120–max 216 months). Result: Of the 15 cases, 2 were lost at follow-up and 1 was excluded by the final evaluation due to infection. Of the remaining 12 cases at the final follow-up, the average AKKS clinical score improved from 30.08 points preoperatively, to 78.83 points postoperatively, while the average AKKS function score improved from 29.17 points to 56.25 points. We report only one intraoperative complication consisting of a femoral fracture at the tip of the stem, and a case of patellar fracture occurred 3 months after the index procedure. The presence of radiolucent lines was sporadic, while radiosclerotic lines were commonly visible around the stem extension, predominantly at the tip. Conclusions: The third generation of rotating hinge knee replacement has proved to be effective in polio patients, improving clinical and functional scores, and no cases of mechanical failure occurred. [ABSTRACT FROM AUTHOR]

This article discusses the resurgence of circulating vaccine-derived poliovirus type 2 (cVDPV2) in Indonesia, which has become a setback in the global efforts to eradicate polio. The article provides details on six cases of cVDPV2 in Indonesia, including the age, gender, district, province, vaccination history, and genetic sequencing findings of each case. It highlights the challenges faced in eradicating polio in Indonesia, such as suboptimal vaccine coverage, vaccine hesitancy, and disruptions caused by the COVID-19 pandemic. The article emphasizes the need for comprehensive management strategies, including active case finding, environmental surveillance, and targeted vaccination campaigns, to control the spread of cVDPV2 and achieve polio eradication. [Extracted from the article]

Enteroviruses are important human pathogens with diverse serotypes, posing a major challenge to develop vaccines for individual serotypes, the success of polio vaccines in controlling and eradicating polio, along with the recent emergence and high prevalence of enterovirus‐caused infectious diseases, highlights the importance of enterovirus vaccine development. Given our previous report on enteroviruses weakened by the 2 A S/T125A mutation, we assessed the potential of the EV‐A71 2A‐125A mutant as a vaccine candidate to address this challenge. We found that the 2A‐125A mutant caused transient mild symptoms, low viral loads, and no significant pathological changes mild pathological changes in hSCARB2‐KI mice, producing long‐lasting cross‐neutralizing antibodies against two EV‐A71 wild strains. Pre‐exposure to the 2A‐125A mutant substantially protected against the EV‐A71 Isehara wild‐type strain, causing minor pathologies, significantly reducing muscle and lung inflammation, and preventing neurological damage, with reduced viral loads in vivo. Pre‐exposure also distinctly suppressed the expression of pro‐inflammatory cytokines, correlating to the severity of clinical symptoms. Collectively, the EV‐A71 2A‐125A mutant was attenuated and could generate a robust and protective immune response, suggesting its potential as a vaccine candidate and global solution for specific enterovirus vaccine development. [ABSTRACT FROM AUTHOR]

The Government of India, in collaboration with the World Health Organization (WHO), established the National Polio Surveillance Project (NPSP) in 1997 and initiated acute flaccid paralysis (AFP) surveillance to achieve the goal of polio eradication. The WHO South-East Asia Region, comprising of 11 countries, including India, was certified as polio-free in March 2014. India was also validated to have eliminated maternal and neonatal tetanus in May 2015. Over the years, the surveillance of other vaccine-preventable diseases (VPDs) was integrated with AFP surveillance in the country. Outbreak-based measles–rubella (MR) surveillance was initiated in 2005 using AFP surveillance as a platform, case-based fever–rash (FR) surveillance started in 2021 as one of the strategies to achieve measles and rubella elimination in the country. The surveillance of diphtheria, pertussis, and neonatal tetanus was integrated with AFP surveillance in a phased manner during 2015–2022. The surveillance system for VPDs in India, supported by a laboratory network of 10 polio laboratories, 28 measles–rubella laboratories, and 20 diphtheria–pertussis laboratories, has enhanced the national health capacity and security. The setting up and expansion of the surveillance system in the country involved the important component of capacity building of personnel on various components of surveillance, including case identification, case investigation, sample collection and shipment, data analysis and public health response. These capacities have been used effectively during other emergencies, such as the recent COVID-19 pandemic, as well as during outbreaks of other diseases and natural calamities. [ABSTRACT FROM AUTHOR]

Pathogens of the enterovirus genus, including poliovirus and coxsackieviruses, typically circulate in the summer months suggesting a possible positive association between warmer weather and transmission. Here we evaluate the environmental and demographic drivers of enterovirus transmission, as well as the implications of climate change for future enterovirus circulation. We leverage pre-vaccination era data on polio in the US as well as data on two enterovirus A serotypes in China and Japan that are known to cause hand, foot, and mouth disease. Using mechanistic modeling and statistical approaches, we find that enterovirus transmission appears positively correlated with temperature although demographic factors, particularly the timing of school semesters, remain important. We use temperature projections from Coupled Model Intercomparison Project Phase 6 (CMIP6) to simulate future outbreaks under late 21st-century climate change for Chinese provinces. We find that outbreak size increases with climate change on average, though results differ across climate models depending on the degree of wintertime warming. In the worst-case scenario, we project peak outbreaks in some locations could increase by up to 40%. Climate change is likely to impact the circulation of many infectious diseases. Here, the authors characterize the impact of climatic and demographic factors on enterovirus disease transmission and project how changes in climate may impact future transmission. [ABSTRACT FROM AUTHOR]

This study introduces a fractional order model to investigate the dynamics of polio disease spread, focusing on its significance, unique results, and conclusions. We emphasize the importance of understanding polio transmission dynamics and propose a novel approach using a fractional order model with an exponential decay kernel. Through rigorous analysis, including existence and stability assessment applying the Caputo Fabrizio fractional operator, we derive key insights into the disease dynamics. Our findings reveal distinct disease-free equilibrium (DFE) and endemic equilibrium (EE) points, shedding light on the disease's stability. Furthermore, graphical representations and numerical simulations demonstrate the behavior of the disease under various parameter values, enhancing our understanding of polio transmission dynamics. In conclusion, this study offers valuable insights into the spread of polio and contributes to the broader understanding of infectious disease dynamics. [ABSTRACT FROM AUTHOR]

This article examines the work of two contemporary feminist disabled artists who are originally from India, and who currently live and work in the United States. Bhavna Mehta and Sugandha Gupta both work in textiles, and identify as women with disabilities. Mehta embroiders X-rays of her own body that capture her medical condition as someone with polio and who uses a wheelchair, where she uses embroidery skills passed down to her by female family members in India. Mehta rescripts the medical narratives of her condition so that her disability is accorded a literal and metaphorical personal touch, antithetical to the often-dehumanizing imagery that pervades within the medical industrial complex. Gupta, who was born with albinism, which also impacted her vision at birth, uses felt and other materials inspired by craft research in India to create sensorial fabrics that disrupt the hierarchy of the senses, with an emphasis on the generative tactile properties of objects. By analyzing the work of these two artists, I not only aim to introduce underrepresented feminist art histories, expanding the literature of the Global South, but I also wish to offer an argument that these artists are crafting new feminist forms of disability and re-envisioning Indian textile traditions. [ABSTRACT FROM AUTHOR]

Aim: To describe the childhood experiences of patients with polio from the acute phase of the disease during post‐war Finland in the 1950s and 1960s. Design: Qualitative empirical study based on self‐reported history of nursing rooted in the past, a history of experiences. Methodology: Interview materials were gathered in the form of themes (45) and written interviews (4) (29 September 2018 to 30 June 2019). Data were analysed by reflexive thematic analysis to highlight hidden and latent experiences. This approach generated the study's main theme, themes and subthemes. Results: The main theme, 'shattered childhood', generated from the study results and was then divided into two themes, both of which were influenced in part by the loss of a familiar childhood, the changed environment, the breakdown of the body and the absence of control. Through their childhood memories, polio survivors described their broken childhoods using the following themes: 'betrayal by their bodies' and 'isolation'. In the narratives, the theme 'betrayal by one's own body' was generated by the following subthemes: 'suddenness of the affliction', 'paralysis' and 'being moved to the hospital'. The 'isolation' theme developed from the subthemes 'isolation from the body and surroundings' and 'emotional and social loneliness'. Conclusion: Polio survivors' experiences during the acute stage of the disease were traumatic and demonstrated children's inferior nursing position in Finland in the 1950s and 1960s. Impact: The study increases our understanding of the history of caring for children and families who were affected and disabled by polio and the importance of their experiences in society and healthcare settings. Patient or Public Contribution: The authors collaborated with the Finnish Polio Association to recruit study participants and plan the study. Patients with polio during childhood underwent interviews, and their experiences formulated the data, which were analysed and the basis of the results. Reporting Method: Consolidated criteria for reporting qualitative research (COREQ), a 32‐item checklist for interviews and focus groups, have been used as a reporting and checklist tool. All authors have agreed on the final version and the use of the COREQ criteria, relationship with participants, theoretical framework, setting, data collection and data analysis and report. [ABSTRACT FROM AUTHOR]

Polio memoirs reflect the lived religious experiences of those who survived the disease in the mid-twentieth century. These autobiographical writings draw connections between theodicy, gender, profession, and disability. American Catholic women who survived polio and who wrote about it often viewed their suffering in relationship to a divine calling and frequently connected their vocational choices to the reason for their disability. In part because Catholic women’s religious-cultural contexts defined appropriate career pursuits by prizing service careers and the work of vowed religious, American Catholic women polio survivors entered helping professions, including special education and rehabilitative therapy careers, at higher rates than their male counterparts or non-Catholic women. American Catholic polio survivors and the cultural-religious milieu in which they lived offered opportunities to cultivate understandings of suffering, disability, and service—and new ways of narrating these understandings. [ABSTRACT FROM AUTHOR]

Summary: Background: The Global Polio Eradication Initiative (GPEI) has drastically reduced the global incidence of poliomyelitis since its launch in 1988 thanks to effective vaccines and strong global surveillance systems. However, detections of wild-type as well as vaccine-derived poliovirus (VDPV) still occur, also in the WHO European Region. This study aims to describe the poliovirus detection via the acute flaccid paralysis (AFP), clinical enterovirus, and environmental surveillance systems. Methods: In this study, we review data from annual reports from 2015 to 2022 from the World Health Organization (WHO)'s three core poliovirus surveillance systems in place in the WHO European Region: AFP, clinical enterovirus, and environmental surveillance systems. Findings: A total of 4324 reported samples were found positive for poliovirus: 477 from AFP surveillance, 394 from clinical surveillance and 3453 from environmental surveillance. Of these, 366 were VDPV, 3952 vaccine strains, and 6 were wild-type poliovirus. 709 were identified as type 1, 399 as type 2, and 1944 type 3, while 1272 samples contained more than one type. Temporal and spatial association of positive environmental samples with positive samples from AFP or clinical enterovirus surveillance was found in only eight countries. Interpretation: Analysis of poliovirus-positive samples from AFP, clinical enterovirus, and environmental surveillance revealed that type 3 poliovirus was the most prevalent type detected. Most poliovirus-positive samples were identified as vaccine strains. No information on sequences was available. Funding: This study was funded by WHO Regional Office for Europe and received financial support from the Bill and Melinda Gates Foundation.

ABSTRACTIn 2019, we conducted a cross-sectional study for polio virus seroprevalence in Guangdong province, China. We assessed the positivity rates of poliomyelitis NA and GMT in serum across various demographic groups, and the current findings were compared with pre-switch data from 2014. Using multistage random sampling method, four counties/districts were randomly selected per city, and within each, one general hospital and two township hospitals were chosen. Healthy individuals coming for medical checkups or vaccination were invited. A total of 1318 individual samples were collected and tested. In non-newborn population, age-dependent positivity rates ranged from 77.8% to 100% for PV1 NA and 70.3% to 98.9% for PV3 NA (p

Background: In response to the 2019 Polio outbreak in the Philippines, it is crucial to examine the current understanding and beliefs about the disease. This study assessed the knowledge and attitudes of mothers towards Polio and Polio vaccination in a rural community. Materials and Methods: Sixty-two mothers in a selected rural barangay in Negros Occidental, Philippines, participated in this cross-sectional study using a survey questionnaire in July 2021. Descriptive statistics and correlation analysis were employed. Results: The results showed that 43.50% of mothers had a high level of knowledge and 74.20% had a favorable attitude towards Polio and Polio immunization. There was a significant relationship (p = 0.05) between knowledge and attitude towards Polio and Polio immunization. Conclusions: This study underscores addressing knowledge gaps through public health campaigns may improve beliefs and perceptions about immunization programs. [ABSTRACT FROM AUTHOR]

The document discusses the impact of earthquakes on Nepal, a seismically active region, with a focus on the devastating 2015 earthquake that resulted in thousands of deaths and injuries. The earthquake caused significant damage to health infrastructure, leading to disruptions in healthcare services and an increase in infectious diseases. The text emphasizes the importance of early warning systems, disease surveillance, hygiene practices, and vaccination programs to prevent and control infectious disease outbreaks following earthquakes. The World Health Organization (WHO) played a crucial role in assisting Nepal in improving emergency response and healthcare services after the earthquakes. [Extracted from the article]

AbstractThe resurgence of polio in Pakistan, with 39 cases as of October 2024, threatens global eradication efforts. Despite progress, Pakistan remains one of two countries where poliovirus transmission persists, alongside Afghanistan. Key challenges include vaccine hesitancy, driven by misinformation and cultural misconceptions and ongoing violence against vaccination workers. While upcoming campaigns aim to vaccinate 45 million children, addressing these challenges requires more than immunisation drives. Strengthened community engagement, enhanced surveillance, and improved security for healthcare workers are critical. To meet the 2025 eradication goal, Pakistan must prioritise localised strategies to overcome barriers and ensure the sustainability of its eradication efforts. [ABSTRACT FROM AUTHOR]

Measles remains a critical public health concern causing significant morbidity and mortality globally. Despite the success of measles vaccination programs, challenges persist, particularly in India. This study investigates dose-wise measles vaccination coverage and explores gaps in immunization focusing on zero-dose, one-dose, and two-dose coverage among children aged 24–35 months. The National Family Health Survey 2019–21 (NFHS-5) served as the data source and the study analyzed information from 43,864 children aged 24–35 months. Sociodemographic variables such as birth order, wealth quintile, gender, social group, religion, residence, mother education, delivery-related factors, and media exposure were considered. Statistical analysis involved weighted estimates, chi-square tests, and multivariate multinomial logistic regression. The study revealed that challenges persist in achieving optimal measles vaccination coverage. Analysis by sociodemographic factors highlighted disparities in coverage, with variations in zero dose prevalence across states and districts. The percentage of zero-dose children was significantly higher, with 11.5% of children in India remaining to receive any measles vaccination. Factors influencing vaccine coverage include birth order, age, wealth quintile, social group, religion, residence, maternal education, place of delivery, media exposure, and mode of delivery. The findings from the spatial analysis show the clustering of zero-dose children is high in the northeastern states of India. Measles zero-dose children pose a significant obstacle to achieving elimination goals. Spatial analysis identifies clusters of unvaccinated populations guiding targeted interventions. The study aligns with global initiatives such as the Immunization Agenda 2030 emphasizing equitable vaccine access and discusses how India can tailor its strategies to achieve the goal. Lessons from polio eradication efforts inform strategies for measles elimination, stressing the importance of high-quality data and surveillance. The study underscores the urgency of addressing last-mile measles vaccination gaps in India. Spatially targeted interventions informed by sociodemographic factors can enhance immunization coverage. Achieving measles elimination requires sustained efforts and leveraging lessons from successful vaccination campaigns. The study findings have the potential to contribute to informed decision-making, supporting India's roadmap for the measles and rubella elimination goal. [ABSTRACT FROM AUTHOR]

Background: With the onset of the COVID-19 pandemic, governments implemented social distancing regulations to limit the spread of the disease. Some health experts warned that these measures could negatively affect access to essential health services, such as routine childhood immunizations. Others noted that without these regulations, COVID-19 cases would increase, leading to overburdened health systems. Methods: We analyze four years (2018–2021) of monthly administrative data on childhood immunizations in all administrative districts in Ghana and exploit variations in social distancing regulations across districts. Given variations in social distancing regulations across Ghanaian districts, we can further differentiate between the effect of public lockdowns and the effect of the pandemic. Results: We find that child immunizations in Ghana declined by 6% during the public lockdown in April 2020, but the country compensated with higher vaccination rates starting in June, and immunization services recovered to pre-pandemic growth levels by 2021. Time-critical vaccines, such as polio, were not affected at all. We do find a substantially larger disruption in April 2020 (14%) and a slower recovery in 2020 in the 40 lockdown-affected districts. Interestingly, vaccination rates already decreased in February and March by about 5% before the public lockdown and before the pandemic had reached Ghana, but with the pandemic already spreading globally and in the news. Conclusion: Our results indicate that the negative effect on child immunization was less severe and shorter than predicted by experts. Fear of COVID-19 and delayed vaccination campaigns had a substantial impact on childhood immunization while rising COVID-19 cases and moderate social distancing regulations did not seem to affect immunization rates. [ABSTRACT FROM AUTHOR]