COVID-19 Vaccine Perspective Among University Lecturers and Students: A Qualitative Study of Pre Implementation of Vaccination.

Background: The determinants of vaccine preferences and hesitancy varied by time and place. Objective: The aim of this study was to assess the perspective of a COVID-19 vaccine among university-based groups. Methodology: This qualitative research involved lecturers and students, and a selection of online focused group discussion was conducted based on the following criteria, including representatives of the health and non-health faculties, with at least 8 attendees in lecturer groups, and 8 participants in student groups. Results: This study is described in 8 themes covering various issues about COVID-19 vaccine, such as views on COVID-19 vaccine, fake news, vaccine implementation by government. Conclusion: The assessment of vaccine perspective shows that although awaited by some people, it also creates contradictions. This is due to the massive amount of information available regarding the vaccine descriptions. The role of the government as the main policy maker is to provide the right information and to make the right decisions about vaccines and vaccination implementation.

COVID-19 Vaccine Acceptance among University Students and Lecturers in Different Provinces of Indonesia: A Cross-Sectional Study.

The coronavirus disease 2019 (COVID-19) pandemic imposed a pressing global threat. Vaccines against COVID-19 are a key tool to control the ongoing pandemic. The success of COVID-19 vaccination programs will largely depend on public willingness to receive the vaccine. This study aimed to evaluate the acceptability of COVID-19 vaccines among university students and lecturers in four different provinces of Indonesia. An anonymous, cross-sectional study was conducted online among university students and lecturers in Indonesia between 23 December 2020 and 15 February 2021. Of 3433 respondents, 50.3% stated that they would accept COVID-19 vaccination, while 10.7% expressed unwillingness and 39% were not sure about receiving the vaccine. Concern regarding the side effects after COVID-19 vaccination was the main reason among the participants for not willing to receive the vaccine. Being male, associated with the health sector, having a higher monthly expenditure and having health insurance could increase the acceptability of the COVID-19 vaccine. Low trust in the government and low confidence towards vaccine safety and efficacy could hinder participants' decision to be vaccinated. Simple, clear and fact-based information from trusted sources on a regular basis will be important for building confidence towards the COVID-19 vaccination program in Indonesia.

Cancer treatment data available in European cancer registries: Where are we and where are we going?

Population-based cancer registries are responsible for collecting incidence and survival data on all reportable neoplasms within a defined geographical area. During the last decades, the role of cancer registries has evolved beyond monitoring epidemiological indicators, as they are expanding their activities to studies on cancer aetiology, prevention, and quality of care. This expansion relies also on the collection of additional clinical data, such as stage at diagnosis and cancer treatment. While the collection of data on stage, according to international reference classification, is consolidated almost everywhere, data collection on treatment is still very heterogeneous in Europe. This article combines data from a literature review and conference proceedings together with data from 125 European cancer registries contributing to the 2015 ENCR-JRC data call to provide an overview of the status of using and reporting treatment data in population-based cancer registries. The literature review shows that there is an increase in published data on cancer treatment by population-based cancer registries over the years. In addition, the review indicates that treatment data are most often collected for breast cancer, the most frequent cancer in women in Europe, followed by colorectal, prostate and lung cancers, which are also more common. Treatment data are increasingly being reported by cancer registries, though further improvements are required to ensure their complete and harmonised collection. Sufficient financial and human resources are needed to collect and analyse treatment data. Clear registration guidelines are to be made available to increase the availability of real-world treatment data in a harmonised way across Europe.

Report of the 2nd workshop of the International Collaboration on advanced vaccinology training.

At a workshop on 22-24 March 2022, leaders of 33 advanced vaccinology courses were invited to meet with partners to further the aims of the International Collaboration on Advanced Vaccinology Training (ICAVT) initiated in 2018 to assist courses in addressing challenges in priority areas and facilitate interactions and exchange of information. This included: an update to the landscape analysis of advanced vaccinology courses conducted in 2018, sharing experiences and good practices in the implementation of virtual training, reviewing the training needs of target audiences, informing courses of the principles, challenges, and added value of accreditation, discussing course evaluations and measurement of course impact, reviewing principles and support needed for quality cascade training, reviewing COVID-19 impact on training and identifying remaining related training needs, and identifying solutions to facilitate refresher courses and ways to facilitate networking of courses' alumni (particularly for virtual courses). The aims were to identify needs and impediments and implement necessary actions to facilitate sharing of information and resources between courses, to identify need for further developments of the e-Portal of the Collaboration (icavt.org) established to facilitate communication between the different courses and assist future course participants identify the most suitable course for them, and to discuss the formalization of the Collaboration. During the workshop, participants looked at several reports of surveys completed by courses and courses' alumni or partners. The COVID-19 pandemic impacted the delivery of some vaccinology courses leading to postponement, delivery online or hybrid training events. Lack of sustainable funding remained a major constraint for advanced vaccinology training and needs to be addressed. The Collaboration was consolidated with responsibilities and benefits for the members better defined. There was strong support for the Collaboration to continue with the organization of educational sessions at future workshops. The meeting re-enforced the view that there was much enthusiasm and commitment for the Global Collaboration and its core values.

Advanced vaccinology training globally: Update and impact of the COVID-19 crisis.

The rapid development of innovations and new technologies, the focus on the life-course approach to immunization and equity, and the prevalent hesitancy towards vaccines requires immunization staff to be well-trained and updated regularly in order to deliver quality immunization services to the public. The need for advanced vaccinology training is therefore paramount. In preparation for a second Global Workshop on Advanced Vaccinology Training that took place in March 2022, this paper presents the results of a survey aiming to provide a thorough update of a landscape analysis on advanced vaccinology courses conducted in 2018 and a look at the impact of the COVID-19 crisis. Thirty-three course organizers responded to a survey to provide information on their respective course. Of those, 17 courses are short courses, 11 post-graduate courses and 5 are Master level courses. Most courses are organized on an annual basis. Even though some courses were not sustained overtime, the number of courses has been increasing during the last few years, and at least one vaccinology course is now being offered in each WHO region. Although the training capacity has increased tremendously, the need still exceeds the capacity and many courses have way more applicants than they can select. The most frequent challenges reported included sustainable funding and identifying faculty. The COVID-19 pandemic impacted the delivery of several vaccinology courses, which have been postponed or reformatted to an online or hybrid training event. An e-portal of the global collaboration has been established to facilitate communication between the different courses and to assist future course participants to identify the most suitable course for their needs.

Assessing COVID-19 Vaccine's Acceptability Amongst Health Care Workers in Oman: A cross-sectional study.

BACKGROUND: COVID-19 vaccines are considered to be a vital tool in controlling the pandemic. Hesitation with COVID-19 immunization has been reported worldwide. The acceptability of the COVID-19 vaccine among health care workers (HCWs) is an important step in determining the success of any new vaccination program. This study aims to estimate the acceptability of COVID-19 vaccines among HCWs in Oman. METHODS: A cross-sectional study using a self- administered questionnaire was conducted among HCWs in December 2020. Data were analyzed using a bivariate level to identify the statistical association with acceptability using the Chi-squared test. At the multivariate level, we determined the socio-demographic and knowledge factors associated with vaccine acceptability. RESULTS: A total of 608 out of 700 HCWs participated (response rate 87 %), of which 64.8 % were Oman citizens and 53.8 % were aged between 30 and 39 years. The majority of the participants were female (62.8 %) and married (87.0 %), while 48.5 % of the respondents were doctors. Only 43 % of the participants were willing to be vaccinated against COVID-19, while 57 % were either uncertain 35 % or unwilling 22 % to be vaccinated. The main reason for not being willing to receive the vaccine was their perceived adverse events after vaccination. The male participants (OR: 1.96 95 % CI 1.22-3.13) and those with a positive attitude towards the vaccine (OR: 9.17(95 %) CI-1.78-47.07) were more willing to receive the COVID-19 vaccine. Similarly, trust in the government (OR: 2.41 95 % CI 1.57-3.71) and having sound knowledge of the COVID-19 vaccine (OR: 15.91 95 % CI 9.81-25.88) improved the acceptability to vaccinate among the HCWs. In contrast, having a previous experience with SARS-CoV-2 (OR: 1.65, 95 % CI: 1.08-2.54), was associated with a significant decrease in COVID-19 vaccine acceptability. CONCLUSION: 50 % of HCWs reported being uncertain or unwilling to be vaccinated against the COVID-19 vaccine. Male gender, positive attitude towards the vaccines, trust in government and knowledge of COVID-19 vaccine as key factors that determine improved vaccine acceptability among HCWs. Therefore, to facilitate herd immunity among the population, it is necessary to initiate effective communication strategies among HCWs in order to sensitize them towards the acceptability of the COVID-19 vaccine.

Knowledge, Attitude, and Acceptability of COVID-19 Vaccine in Oman: A Cross-sectional Study.

Objectives: To evaluate the knowledge, attitude, and acceptance of COVID-19 vaccine among the general population of Oman, on the eve of the rollout of vaccination program in the country. Methods: A cross-sectional study was conducted using a structured and validated online questionnaire. Adults residing in Oman were invited to participate in the study between 22 and 24 December 2020. Logistic regression analysis was used to identify the factors associated with COVID-19 vaccine acceptability. Results: Of the total of 966 participants, the majority (612; 63.4%) were women. Most participants were younger than 40 years (572; 59.3%). Participants displayed good awareness about COVID-19 (946; 97.9%) and the global vaccine development initiatives (831; 86.0%). Only 265 (27.4%) participants were willing to get themselves vaccinated. The majority were either uncertain 365 (37.8%) or unwilling 336 (34.8%). The main driver of vaccine acceptance was to protect oneself and others (186/265; 70.0%). The main reasons given for vaccination hesitation/refusal were concerns over possible side-effects (505/701; 72.0%), safety concerns (386/701; 55.0%), and ineffectiveness of the vaccine (107/701; 15.3%). Conclusions: On the eve of the first-ever rollout of COVID-19 vaccine in Oman in December 2020, the surveyed residents of the country expressed significant hesitancy to get themselves vaccinated. Participants' perceptions of risk of contracting COVID-19, their trust in vaccines, government, and their health system were important predictors of vaccine acceptance. These results enabled development of strategies to address such concerns to facilitate vaccine acceptance among the residents of Oman. The results of this study can be used by researchers to conduct comparative research in future, with more emphasis on Omani youth (< 40 years).

Vaccine Hesitancy Drives Low Human Papillomavirus Vaccination Coverage in Girls Attending Public Schools in South Africa.

Girls aged ≥9 years attending South African public sector schools are provided with free human papillomavirus (HPV) vaccination, through a schools-based programme. HPV vaccine misinformation spread via social media in 2014, was identified as a barrier to obtaining parental informed consent in some districts, including Sedibeng District, which subsequently had the lowest HPV vaccination coverage in Gauteng Province in 2018. This study investigated vaccine hesitancy in caregivers of girls in Grade 4 to 7 aged ≥9 years attending public schools in Sedibeng District. A cross-sectional survey using a self-administered questionnaire was conducted among caregivers of age-eligible girls attending all public schools in Sedibeng District with first dose HPV vaccination coverage of <70%. The questionnaire included demographics; HPV vaccination status of girls; reasons for not being vaccinated; and a 5-item tool measuring the determinants of vaccine hesitancy (5C scale), using a 7-point Likert scale. Data were coded and captured on Microsoft Excel®. Except for collective responsibility which was reverse scored, the other 5C items (confidence, complacency, constraints, and calculation) were captured as follows: 1 = strongly disagree, 2 = moderately disagree, 3 = slightly disagree, 4 = neutral, 5 = slightly agree, 6 = moderately agree and 7 = strongly agree. Descriptive and inferential statistical analyses were conducted using Epi InfoTM. Of the principals of all schools with <70% HPV vaccination coverage, 69.6% (32/46) gave permission. The response rate from caregivers of girls present on the day of data collection was 36.8% (1,782/4,838), with 67.1% (1,196/1,782) of respondents reporting that their daughters had received ≥1 dose of HPV vaccine. Only 63.1% (370/586) of respondents with unvaccinated daughters answered the question on reasons, with 49.2% (182/370) reporting reasons related to vaccine hesitancy. Statistically significant differences between caregivers of vaccinated and unvaccinated daughters were identified for four of the five determinants of vaccine hesitancy: confidence (vaccinated group higher), complacency (unvaccinated group higher), constraints (unvaccinated group higher) and collective responsibility (vaccinated group higher). This is the first South African study to (a) report results of the 5C scale, which was found to be very useful for predicting vaccination uptake; and (b) confirm that the relatively low HPV vaccination coverage in Sedibeng District is largely driven by reasons related to vaccine hesitancy.

Human Papillomavirus Vaccine Hesitancy Highly Evident among Caregivers of Girls Attending South African Private Schools.

The viral spread of social media misinformation and disinformation regarding human papillomavirus (HPV) vaccination safety has resulted in widespread vaccine hesitancy and suboptimal HPV vaccination uptake. We previously reported that only 19.4% of age-eligible private school girls in South Africa in 2018 had received ≥1 HPV vaccine dose. Here, we report on reasons given by caregivers for why their daughters were unvaccinated. An online survey targeting caregivers of girls in grades 4-7 attending South African private schools was conducted. Caregivers of unvaccinated girls provided the most important reason for their daughter not being vaccinated by either selecting from a list of coded reasons or providing a free text reason. Free text reasons were analysed, coded and added to the list of coded reasons, which were categorised according to broad themes. Frequency distributions of reasons and categories were calculated. Most reasons were related to vaccine hesitancy (61.4%), followed by lack of access to the vaccine (21.3%) and lack of information (15.7%). HPV vaccination coverage among age-eligible girls can be improved by including private-sector schools in the South African HPV vaccination programme, training healthcare providers to advocate for HPV vaccination and extending HPV vaccination advocacy campaigns to include private-sector educators.

Strengthening pre-service training of healthcare workers on immunisation and effective vaccine management: the experience of Kenya Medical Training College.

Pre-service health training institutions have a key role in training qualified medical and nursing staff deployable in immunisation programmes, making them capable of addressing complex situations, sustaining routine immunisation and introducing new vaccines and technologies. The incorporation of immunisation-related content into nursing and midwifery education is essential to improve and strengthen immunisation service delivery, disease surveillance, logistics, communication and management practices. Clinical and public health training incorporating learning objectives on immunisation that are specific to the Expanded Programme on Immunisation (EPI), will enable students to develop a firm basis of core knowledge and skills in immunisation. To assist health training institutions in the African Region and to facilitate the systematic revision of EPI curricula, two prototype curricula, one for medical and one for nursing/midwifery schools, were developed by WHO/AFRO, NESI/University of Antwerp and other partners in 2006 and revised in 2015. Kenya Medical Training College (KMTC) has been at the forefront in revising and updating their institutional EPI curriculum for the pre-service Kenyan Registered Community Health Nursing programme based on the EPI prototype curriculum. Building on the successful strengthening of the EPI curriculum, KMTC will now embark on improving education and training for effective vaccine and cold chain management for selected training programmes. The different steps taken by KMTC to strengthen EPI teaching and learning can support other health training institutions who are willing to integrate the content of the EPI prototype curriculum in their own institutional curricula by adapting them to the local context.

Two decades of regional trends in vaccination completion and coverage among children aged 12-23 months: an analysis of the Uganda Demographic Health Survey data from 1995 to 2016.

BACKGROUND: Childhood vaccination is an important public health intervention but there is limited information on coverage, trends, and determinants of vaccination completion in Uganda at the regional level. We examined trends in regional vaccination coverage and established the determinants of vaccination completion among children aged 12-23 months in Uganda. METHODS: We analyzed data from the women's questionnaire for the 1995-2016 Uganda Demographic Health Survey (UDHS). Vaccine completion was defined as having received a dose of Bacillus-Calmette Guerin (BCG) vaccine; three doses of diphtheria, pertussis, and tetanus (DPT) vaccine; three doses of oral polio vaccine (OPV) (excluding OPV given at birth); and one dose of measles vaccine. We performed Chi-square tests to compare vaccination completion by socio-demographic factors stratified by 10 sub-regions: Eastern, East Central, Central 1, Central 2, Kampala, Karamoja, North, Western, West Nile, and Southwest. We performed logistic regression analysis for each of the regions to identify factors associated with vaccination completion at 5% level of statistical significance. RESULTS: Overall vaccination completion was 48.6% (95%CI, 47.2, 50.1) and ranged from 17.3% in Central 1 to 65.9% in Southwest. Vaccination completion rates declined significantly by 10.4% (95% confidence interval (CI), - 16.1, - 4.6) between 1995 and 2000, and increased significantly by 10.0% (95% CI, 4.6, 15.4) between 2000 and 2006, and by 5.4% (95% CI, 0.2, 10.6) between 2006 and 2011. Maternal education (secondary or higher level), receipt of tetanus toxoid (TT) during pregnancy, and possession of a child health card were associated with vaccination completion across all the sub-regions. Other factors like place of residence, religious affiliation, household wealth, maternal age, childbirth order, size of child at birth, and place of delivery were associated with vaccination completion but differed between the 10 sub-regions. CONCLUSION: Besides considerable regional variations, the vaccination completion rate among children aged 12-23 months in Uganda remains suboptimal despite the availability of vaccines. Maternal education, receipt of TT, and possession of a child health card are associated with a higher likelihood of vaccination completion among children aged 12-23 months in all the regions of Uganda. Interventions to improve the utilization of vaccination services in Uganda should consider these factors.

Immunisation program training needs in 9 countries in the African Region.

INTRODUCTION: regular in-service training of healthcare workers within the immunization program is critical to address the program needs created by the introduction of new vaccines and technologies, as well as the expanding scope of immunisation programmes beyond infant immunization and towards a life-course approach. National immunization programs conduct in-service training of health workers depending on program needs and particularly when new program elements are introduced. METHODS: we conducted a survey of national and provincial level immunization program staff in 9 countries in the World Health Organization (WHO) African Region to determine the perceived needs and preferred training methods for capacity building in immunisation. RESULTS: nearly all of the respondents (98.3%) stated that there are skill gaps at their respective levels in the immunization program which require training, with 88% indicating that mid-level program management (MLM) training was needed to train new program staff, while 78% indicated program performance gaps and 60% of the respondents stated that refresher training is needed. Program areas identified as top priorities for training included immunisation monitoring and data quality, sustainable immunization financing, adverse events monitoring and community mobilization. More than three quarters of the respondents (78%) think that online MLM training is adequate to address program gaps. Only four of the 9 immunization program managers indicated that they regularly monitor the number of MLM trained staff within their national program. CONCLUSION: there is a strong need for in-service training of immunization program officers in the countries surveyed, especially at the subnational levels. Program managers should conduct regular monitoring of the training status of staff, as well as conduct detailed training needs assessments in order to tailor the training approaches and topics. Online training provides an acceptable approach for capacity building of immunization program staff.

Knowledge, Attitude and Acceptability of the Human Papilloma Virus Vaccine and Vaccination Among University Students in Indonesia.

Introduction: Cervical cancer, a major consequence of persistent HPV infection, is the third most common cancer in women worldwide and has claimed around 311,000 women lives in 2018. The majority of these deaths took place in low- and middle-income countries (LMICs). In LMICs, where cervical cancer screening coverage is low, the HPV vaccine is a promising tool for preventing HPV infections and, thus, averting cervical cancer cases. In Indonesia, cervical cancer is the second most common cancer and HPV vaccination demonstration programs are underway in several provinces, but the HPV vaccine has not yet been introduced nationally. Since students are an important source of information for the community, and medical and nursing students are the future healthcare professionals, this study explored the knowledge, attitude, and acceptability of the HPV vaccine among University students in Indonesia. Methodology: A self-administered online questionnaire was used to assess the knowledge, attitude, and willingness of University students toward HPV vaccination. Result: A total of 433 students from Medical, Nursing, Social Sciences, and other faculties participated in the survey. It was identified that over 90% of the students were aware of cervical cancer and HPV, but only 68% knew about the HPV vaccine before participating in the study. Despite an average knowledge on the HPV vaccine, the students showed a strong willingness to receive the vaccine (95.8% acceptance rate). They believed that the HPV vaccine is safe and effective and that it will protect against HPV infection. The high cost and the lack of adequate information flow on HPV-related topics have been identified as potential barriers to the adoption of the HPV vaccine in Indonesia. Conclusion: Despite a high willingness for HPV vaccine uptake among students, there is a need to provide education on HPV vaccine-related topics to Indonesian students through awareness and training programs and improving the academic curriculum on vaccination for the long-term sustainability of the HPV vaccination program.

Misinformation Drives Low Human Papillomavirus Vaccination Coverage in South African Girls Attending Private Schools.

Background: Cervical cancer, caused by persistent human papillomavirus (HPV) infection, is the leading cause of female cancer deaths in South Africa. In 2014, the South African National Department of Health introduced a free public sector school-based HPV vaccination programme, targeting grade 4 girls aged ≥9 years. However, private sector school girls receive HPV vaccination through their healthcare providers at cost. This study investigated HPV vaccination knowledge, attitudes and practices of caregivers of girls aged ≥9 years in grades 4-7 attending South African private schools. Methods: A link to an online survey was circulated to caregivers via an email sent to school principals of all private schools in four provinces enrolling girls in grades 4-7. Following a poor post-reminder response, a paid Facebook survey-linked advert targeting South African Facebook users aged ≥25 years nationally was run for 4 days, and placed on the South African Vaccination and Immunisation Centre's Facebook page for 20 days. Results: Of 615 respondents, 413 provided HPV vaccination data and 455 completed the knowledge and attitudes tests. Most (76.5%) caregivers had good knowledge and 45.3% had positive attitudes. Of their daughters, 19.4% had received ≥1 dose of HPV vaccine. Of caregivers of unvaccinated girls, 44.3% and 41.1%, respectively were willing to vaccinate their daughters if vaccination was offered free and at their school. Caregivers of unvaccinated girls were more likely [odds ratio (OR): 3.8] to have been influenced by "other" influences (mainly online articles and anecdotal vaccine injury reports). Of caregivers influenced by their healthcare providers, caregivers of unvaccinated girls were more likely (OR: 0.2) to be influenced by alternative medical practitioners. Caregivers of vaccinated girls were more likely to have good knowledge (OR: 3.6) and positive attitudes (OR: 5.2). Having good knowledge strongly predicted (OR: 2.8) positive attitudes. Having negative attitudes strongly predicted (OR: 0.2) girls being unvaccinated. Conclusion: Providing free school-based HPV vaccination in the private sector may not increase HPV vaccination coverage to an optimal level. Since misinformation was the main driver of negative attitudes resulting in <20% of girls being vaccinated, an advocacy campaign targeting all stakeholders is urgently needed.

The World Health Organization African regional training course for mid-level immunization managers: lessons and future directions.

The World Health Organization (WHO) African regional training course for mid-level managers (MLM) of immunization programs launched in 2004, has undergone revisions across the years, to accommodate new developments in the field. In 2016, the WHO African regional office conducted a thorough review of the course materials and delivery methods to document lessons to help improve the course. Some of the gaps included inappropriate selection of trainees, inadequate focus on skills development, heavy reliance on text and presentations, as well as resource limitations to reach a critical mass of learners. The regional office worked with Bull City Learning to redesign the course materials along carefully crafted course objectives and curricula, and to assist facilitators to better deliver the course. In addition, the materials were converted into online learning tools. Within 10 months, a total of 3011 learners were enrolled in the online MLM training platform and earned a total of 9209 certificates. The MLM course will continue to be highly relevant as the immunization area of work expands significantly, with the addition of new vaccines, introduction of new technologies, and expanding opportunities for online learning.

Strengthening national teams of experts to support HPV vaccine introduction in Eastern Mediterranean countries: Lessons learnt and recommendations from an international workshop.

Several countries have started to introduce the HPV vaccine into their national immunisation programme, with the majority of these countries being high or upper-middle income countries. Currently, 91 countries have introduced the HPV vaccine globally. One of the regions lagging behind in the introduction of the HPV vaccine is the Eastern Mediterranean Region, with currently only Libya and the United Arab Emirates having introduced the HPV vaccine. In order to support countries in the Eastern Mediterranean Region with their decision-making process for HPV vaccine introduction, a regional workshop was organised to explore the current status of HPV vaccine introduction plans in the Eastern Mediterranean countries, gaps in information about HPV disease burden in the region and the need for quality HPV data to make an informed decision to introduce the HPV vaccine, socio-cultural and religious challenges with HPV vaccine introduction, and the role of NITAGs in formulating recommendations for HPV vaccine introduction. Participating countries reflected on their respective status of decision making process about HPV vaccine introduction; they discussed any needs for operational research to support the decision-making process; and highlighed technical and financial support that might be required from partners to assist with HPV vaccine introduction. Recommendations were made on how to advance the decision-making process for HPV vaccine introduction. The workshop increased the awareness of the need of data on burden of disease and the associated benefits of HPV vaccination in Eastern Mediterranean countries. The importance of collaboration between different programmes including: immunisation, adolescent health, school health, sexual and reproductive health and cancer control programmes was clearly emphasized.

Impact of vaccine stock-outs on infant vaccination coverage: a hospital-based survey from South Africa.

Introduction: National population-based immunization coverage surveys provide data for validating official administrative coverage figures. However, these costly and logistically challenging surveys are conducted infrequently. This hospital-based records review determined coverage of birth-dose vaccines, fully immunized under 1-y-old coverage (FIC) of 12- to 59-mo-old children; and the reasons for missed vaccinations. Methods: Rotavirus surveillance in South Africa is based on under-5-y-old children being treated for diarrhoea, and includes photocopying the official vaccination document and collecting data on reasons for missed vaccinations. These data were captured from all 508 records collected from 2011 to 2014, and subjected to descriptive statistical analysis. Results: Bacille Calmette Guérin coverage was 99%; oral polio vaccine birth dose (OPV(0)) coverage was 99%. Coverage for 12- to 59-mo-olds ranged from 75% for the pneumococcal conjugate vaccine third dose to 99% for OPV(0). Several instances of subsequent doses being recorded without prior doses being received resulted in a FIC of 55%. In total, 207 vaccinations were missed by 88 children. Vaccine stock-outs were responsible for 62% of missed vaccinations. Conclusions: Efforts to improve vaccine stock management at facility and district levels should be implemented, and should include vaccinator training and supervision to eliminate vaccine stock-outs and missed vaccination opportunities.

Improving skills and institutional capacity to strengthen adolescent immunisation programmes and health systems in African countries through HPV vaccine introduction.

Several African countries have recently introduced or are currently introducing the HPV vaccine, either nationwide or through demonstration projects, while some countries are planning for introduction. A collaborative project was developed to strengthen country adolescent immunisation programmes and health systems in the African Region, addressing unique public health considerations of HPV vaccination: adolescents as the primary target group, delivery platforms (e.g. school-based and facility based), socio-behavioural issues, and the opportunity to deliver other health interventions alongside HPV vaccination. Following a successful "taking-stock" meeting, a training programme was drafted to assist countries to strengthen the integration of adolescent health interventions using HPV vaccination as an entry point. Two workshops were conducted in the Eastern and Southern African Regions. All countries reported on progress made during a final joint symposium. Of the 20 countries invited to participate in either of the workshops and/or final symposium, 17 countries participated: Angola, Botswana, Ethiopia, Kenya, Malawi, Mauritius, Mozambique, Namibia, Rwanda, Seychelles, South Africa, South Sudan, Swaziland, Tanzania, Uganda, Zambia and Zimbabwe. Countries that are currently implementing HPV vaccination programmes, either nationally or through demonstration projects, reported varying degrees of integration with other adolescent health interventions. The most commonly reported adolescent health interventions alongside HPV vaccination include health education (including sexually transmitted infections), deworming and delivering of other vaccines like tetanus toxoid (TT) or tetanus diphtheria (Td). The project has successfully (a) established an African-based network that will advocate for incorporating the HPV vaccine into national immunisation programmes; (b) created a platform for experience exchange and thereby contributed to novel ideas of revitalising and strengthening school-based health programmes as delivery platform of adolescent immunisation services and other adolescent health interventions, as well as identifying ways of reaching out-of-school girls through facility and community based programmes; and (c) laid a foundation for incorporating future adolescent vaccination programmes.