Inventory of projects promoting HPV vaccination coverage in Germany.

Since the first recommendation for HPV vaccination in Germany (2007), a rising number of projects aiming to increase HPV vaccination coverage in Germany have been conducted. From October 2019 to February 2020, we systematically searched for data (project description, evaluation reports) on projects in Germany that aimed to increase HPV vaccination rates. The aim was to provide a comprehensive overview of these projects (duration, implementing organisation, target group/addressees, setting, strategies, reach) and to gain insights for optimising future projects. The inventory of these projects shows that most of the projects focused on the education of children, adolescents and parents, as well as on the training of medical staff. The school was the main setting for education. Rarely were the recorded projects conducted on a long-term and comprehensive basis. It was not possible to make a statement about the impact of the different projects within the framework of this review, as evaluation reports were not available for most of the projects. To optimise the impact on increasing HPV vaccination rates, future projects should be planned on a long-term and nationwide basis. They should also be evaluated to improve the quality and effectiveness of the projects.

[Remuneration for HPV Vaccination Service in Germany - A Relevant Factor for the HPV Immunization Rate?] / Vergütung der HPV-Impfungsleistung in Deutschland ­ ein relevanter Einflussfaktor auf die HPV-Impfrate?

Although HPV vaccination has been recommended in Germany since 2007, vaccination rates for completed HPV vaccination series are still low and there are significant regional differences. Remuneration for vaccination services is being discussed as one of the factors influencing the HPV vaccination rate in Germany. However, data on remuneration of HPV vaccination services show significant differences regarding the amount and way of remuneration depending on the Statutory Health Insurance region in Germany which are not obviously associated with the regional vaccination rate. This suggests that currently the remuneration of HPV vaccination services does not play a significant role in HPV immunization rates. In order to increase HPV vaccination rates, other interventions that have been shown to be effective for this purpose should therefore be prioritized, with policy supporting a comprehensive approach through legislation, the creation of structural frameworks and the provision of resources.

[Approaches to increase HPV vaccination rate in Germany - challenges and opportunities. A qualitative study]. / Ansätze zur Steigerung der HPV-Impfquote in Deutschland ­ Hindernisse und Chancen: Eine qualitative Studie.

BACKGROUND: In Germany, the prevalence of infections with the human papilloma virus (HPV) among women and men is high. High-risk HPV types can lead to certain types of cancer (e. g., cervical cancer). Vaccination against HPV infections associated with cancer and genital warts was introduced in Germany in 2007. Currently, HPV vaccination is recommended for girls and boys by the German Standing Committee on Vaccination. The vaccination rate, however, remains rather low, with rates below 50% in 15-year-old girls and of about 5% in 15-year-old boys in 2019. This suggests that new approaches are urgently needed to increase HPV vaccination coverage in Germany in the coming years. OBJECTIVES: This qualitative study aimed at identifying opportunities and challenges related to the application and implementation of different approaches designed to increase HPV vaccination uptake among male and female adolescents in Germany according to expert views. MATERIALS AND METHODS: From April to July 2020, 43 experts from the field of HPV vaccination in Germany were interviewed using a semi-standardized interview guide. The audiotaped interviews were transcribed and analyzed using qualitative content analysis by Udo Kuckartz. RESULTS AND CONCLUSION: According to the experts interviewed the following would be the most promising approaches to increase HPV vaccination rates in Germany: educational measures, school vaccination programs, increasing participation in the adolescent health check-up "J1", reminder and recall systems. The most reasonable solution would be to pursue several approaches simultaneously. According to the experts, more political support with implementing strategies and reducing bureaucratic obstacles as well as an increase in cooperation between relevant stakeholders is required to achieve the effective implementation of these strategies.

Timely completion of childhood vaccination and its predictors in Burkina Faso.

BACKGROUND: Despite important progress in global vaccination coverage, many countries are still facing preventable disease outbreaks. Timely vaccination is important in getting adequate protection against disease. In light of the paucity of relevant literature, this study investigated the timely completion of childhood routine immunization and identified factors associated with timely vaccination in Burkina Faso. METHODS: We extracted data on child vaccination and other child characteristics from a household survey conducted across 24 districts in 2017. We extracted data on health system characteristics from a parallel facility survey. We applied a Kaplan-Meier time-to-event analysis to estimate timely vaccination coverage defined as the proportion of children that received a given vaccine in the period between three days before and 28 days after the recommended age. We used a Cox proportional hazard model with mixed effects to identify factors associated with timely vaccination. RESULTS: In total, 3,138 children aged between 16 and 36 months who could present an immunization booklet were included in the study.The main finding is the existence of an important gap showing that timely vaccination coverage was lower than vaccination coverage. More specifically,this gap ranged from 16% for BCG to 43% for Penta 3. In addition, region and distance between the household and the nearest health facility were the main factors associated with timely full vaccination coverage and specifically for Penta3, MCV1 and MCV2. CONCLUSIONS: This study highlights that timely vaccination coverage remains substantially lower than vaccination coverage. Timeliness of vaccination should therefore be considered as a metric to assess the status of immunization in a country. Geographical accessibility continues to represent a major barrier to timely vaccination, calling for specific interventions on both supply-side (e.g. outreach activities) and demand-side (e.g. vouchers or community-based interventions for vaccination) to counteract its negative effect.

Measuring effective coverage of curative child health services in rural Burkina Faso: a cross-sectional study.

OBJECTIVE: To estimate both crude and effective curative health services coverage provided by rural health facilities to under 5-year-old (U5YO) children in Burkina Faso. METHODS: We surveyed 1298 child health providers and 1681 clinical cases across 494 primary-level health facilities, as well as 12 497 U5YO children across 7347households in the facilities' catchment areas. Facilities were scored based on a set of indicators along three quality-of-care dimensions: management of common childhood diseases, management of severe childhood diseases and general service readiness. Linking service quality to service utilisation, we estimated both crude and effective coverage of U5YO children by these selected curative services. RESULTS: Measured performance quality among facilities was generally low with only 12.7% of facilities surveyed reaching our definition of high and 57.1% our definition of intermediate quality of care. The crude coverage was 69.5% while the effective coverages indicated that 5.3% and 44.6% of children reporting an illness episode received services of only high or high and intermediate quality, respectively. CONCLUSION: Our study showed that the quality of U5YO child health services provided by primary-level health facilities in Burkina Faso was low, resulting in relatively ineffective population coverage. Poor adherence to clinical treatment guidelines combined with the lack of equipment and qualified clinical staff that performed U5YO consultations seemed to be contributors to the gap between crude and effective coverage.

Field investigation with real-time virus genetic characterisation support of a cluster of Ebola virus disease cases in Dubréka, Guinea, April to June 2015.

On 11 May 2015, the Dubréka prefecture, Guinea, reported nine laboratory-confirmed cases of Ebola virus disease (EVD). None could be epidemiologically linked to cases previously reported in the prefecture. We describe the epidemiological and molecular investigations of this event. We used the Dubréka EVD registers and the Ebola treatment centre's (ETC) records to characterise chains of transmission. Real-time field Ebola virus sequencing was employed to support epidemiological results. An epidemiological cluster of 32 cases was found, of which 27 were laboratory confirmed, 24 were isolated and 20 died. Real-time viral sequencing on 12 cases demonstrated SL3 lineage viruses with sequences differing by one to three nt inside a single phylogenetic cluster. For isolated cases, the average time between symptom onset and ETC referral was 2.8 days (interquartile range (IQR): 1-4). The average time between sample collection and molecular results' availability was 3 days (IQR: 2-5). In an area with scarce resources, the genetic characterisation supported the outbreak investigations in real time, linking cases where epidemiological investigation was limited and reassuring that the responsible strain was already circulating in Guinea. We recommend coupling thorough epidemiological and genomic investigations to control EVD clusters.

Real-time, portable genome sequencing for Ebola surveillance.

The Ebola virus disease epidemic in West Africa is the largest on record, responsible for over 28,599 cases and more than 11,299 deaths. Genome sequencing in viral outbreaks is desirable to characterize the infectious agent and determine its evolutionary rate. Genome sequencing also allows the identification of signatures of host adaptation, identification and monitoring of diagnostic targets, and characterization of responses to vaccines and treatments. The Ebola virus (EBOV) genome substitution rate in the Makona strain has been estimated at between 0.87 × 10(-3) and 1.42 × 10(-3) mutations per site per year. This is equivalent to 16-27 mutations in each genome, meaning that sequences diverge rapidly enough to identify distinct sub-lineages during a prolonged epidemic. Genome sequencing provides a high-resolution view of pathogen evolution and is increasingly sought after for outbreak surveillance. Sequence data may be used to guide control measures, but only if the results are generated quickly enough to inform interventions. Genomic surveillance during the epidemic has been sporadic owing to a lack of local sequencing capacity coupled with practical difficulties transporting samples to remote sequencing facilities. To address this problem, here we devise a genomic surveillance system that utilizes a novel nanopore DNA sequencing instrument. In April 2015 this system was transported in standard airline luggage to Guinea and used for real-time genomic surveillance of the ongoing epidemic. We present sequence data and analysis of 142 EBOV samples collected during the period March to October 2015. We were able to generate results less than 24 h after receiving an Ebola-positive sample, with the sequencing process taking as little as 15-60 min. We show that real-time genomic surveillance is possible in resource-limited settings and can be established rapidly to monitor outbreaks.

Immunization coverage in young children: a study nested into a health and demographic surveillance system in Burkina Faso.

BACKGROUND: Reliable estimates of immunization coverage are the basis for rational policy making, program implementation and evaluation. Vaccination coverage is usually measured using administrative data or surveys, both having a number of methodological problems. METHODS: We estimated vaccination coverage using a data set of 11 906 children aged <5 years from an existing Health and Demographic Surveillance System (HDSS) in north-western Burkina Faso. Data were collected from September 2008 to December 2009. RESULTS: Vaccination coverage based on information from existing vaccination cards ranged from 80% (measles) to 94% (OPV1). When taking into consideration all information available (including BCG scars in children with and without vaccination card), full coverage in children aged 12-23 months was around 75%, with a significantly higher coverage in rural compared with urban areas. There were no differences in vaccination coverage between boys and girls. CONCLUSION: The study supports other studies that found vaccination coverage improvement in Burkina Faso recently. In addition, our study found slightly better vaccination coverage in rural compared with urban areas, which needs further consideration.