Success in vaccination programming through community health workers: a qualitative analysis of interviews and focus group discussions from Nepal, Senegal and Zambia.

OBJECTIVES: Community health workers are essential to front-line health outreach throughout low-income and middle-income countries, including programming for early childhood immunisation. Understanding how community health workers are engaged for successful early childhood vaccination among countries who showed success in immunisation coverage would support evidence-based policy guidance across contexts. DESIGN: We employed a multiple case study design using qualitative research methods. SETTING: We conducted research in Nepal, Senegal and Zambia. PARTICIPANTS: We conducted 207 interviews and 71 focus group discussions with 678 participants at the national, regional, district, health facility and community levels of the health systems of Nepal, Senegal and Zambia, from October 2019 to April 2021. We used thematic analysis to investigate contributing factors of community health worker programming that supported early childhood immunisation within each country and across contexts. RESULTS: Implementation of vaccination programming relied principally on the (1) organisation, (2) motivation and (3) trust of community health workers. Organisation was accomplished by expanding cadres of community health workers to carry out their roles and responsibilities related to vaccination. Motivation was supported by intrinsic and extrinsic incentives. Trust was expressed by communities due to community health worker respect and value placed on their work. CONCLUSION: Improvements in immunisation coverage was facilitated by community health worker organisation, motivation and trust. With the continued projection of health worker shortages, especially in low-income countries, community health workers bridged the equity gap in access to vaccination services by enabling wider reach to underserved populations. Although improvements in vaccination programming were seen in all three countries-including government commitment to addressing human resource deficits, training and remuneration; workload, inconsistency in compensation, training duration and scope, and supervision remain major challenges to immunisation programming. Health decision-makers should consider organisation, motivation and trust of community health workers to improve the implementation of immunisation programming.

Strategies for expanding childhood vaccination in the Americas following the COVID-19 pandemic.

Objective: To provide an overview of the status of the childhood vaccination schedule in the Americas, outline program structures, and identify updated implementation strategies to improve vaccination coverage following the COVID-19 pandemic. Methods: A group of experts in pediatrics, epidemiology, vaccines, and global and public health discussed the current status of the childhood vaccination schedule in the Americas, describing the program structure and identifying new implementation strategies that have the potential to improve vaccination coverage in the post-pandemic context, after the challenges COVID-19 presented for more than two years. Results: The Americas currently face a high risk of resurgence of diseases that were previously controlled or eliminated. Therefore, it is important to find new strategies to educate citizens on the risks associated with lower vaccination rates, especially in children. Conclusions: New strategies along with strong mobilization of the population and advocacy by citizens are necessary to prevent antivaccination groups from gaining a stronger presence in the region and jeopardizing the credibility of the Expanded Program on Immunization.

[Eradication of poliomyelitis in Spain: What has happened in the last decade?] / Erradicación de la poliomielitis en España: ¿qué ha pasado en la última década?

On the 60th anniversary of the initiation of the polio vaccination campaign in Spain, the significant milestone in achieving disease control is highlighted. There has been a shift from an incidence of over 2,000 yearly cases in the 1960s to a sustained absence of wild poliovirus (WPV) since 1988. Despite the observed negative impact on polio vaccination coverage at the onset of the COVID-19 pandemic, these rates gradually recovered, reaching 98.2% in primary vaccination in 2022. Over the past decade, two essential elements have been identified to maintain the goal of polio elimination and that reinforces the importance of sustaining high vaccination coverage: robust epidemiological surveillance systems and a swift response to alerts to protect the vulnerable population and prevent virus reintroduction. In order to achieve eradication, it is crucial to interrupt international transmission and maintain continuous high-quality surveillance and effective coordination across different levels in response to any detection of PV, wild or vaccine derived. This article aimed to provide a comprehensive view of the polio eradication situation in Spain, focusing on the key events that occurred in the last decade and the present and future challenges.

hito en el control de la enfermedad que ha supuesto el cambio desde una incidencia de más de 2.000 casos anuales en la década de los 60 a una ausencia mantenida de poliovirus (PV) salvaje desde 1988. A pesar del impacto negativo observado en las coberturas de vacunación de poliomielitis al inicio de la pandemia de la COVID-19, estas se fueron recuperando, alcanzando un 98,2% en la primovacunación en 2022. En la última década se han identificado dos elementos esenciales para mantener el objetivo de eliminación de la poliomielitis y que, además, refuerzan la importancia de mantener altas coberturas de vacunación: los sistemas de vigilancia epidemiológica robustos y la respuesta rápida a las alertas para proteger a la población vulnerable y evitar la circulación del virus. Es crucial interrumpir la transmisión a nivel internacional para lograr la erradicación, manteniendo una vigilancia continua de alta calidad y una coordinación efectiva entre los diferentes niveles frente a cualquier detección de PV, ya sea salvaje o derivado de la vacuna. Este artículo tuvo como objetivo proporcionar una visión integral sobre la situación de erradicación de la poliomielitis en España, centrándose en los eventos clave ocurridos en la última década y en los retos presentes y futuros.

Utilization of Mobile Reminders in Improving the Completeness and Timeliness of Routine Childhood Immunization in Kano Metropolis, Nigeria: A Randomized Controlled Trial.

INTRODUCTION: This study examined the effectiveness of mobile phone reminders in improving the completeness and timeliness of childhood immunization. METHOD: We conducted a parallel arm cluster randomized controlled trial in four primary health care facilities in Nigeria. Reminders were sent to eligible participants in the intervention group at specific intervals when their children were scheduled to receive the vaccines administered at the sixth, 10, and 14 weeks after birth. Immunization records of all participants' children were then tracked to assess their immunization status. RESULTS: The immunization status of the intervention (n = 275) and control (n = 261) arms was analyzed. Completeness and timeliness of the vaccine series were significantly higher (p < .001) among children of participants in the intervention (n = 169, 61.5% and n = 138, 50.2%) than those in the control group (n = 35, 13.4% and n = 13, 5%) arm. DISCUSSION: Mobile phone reminders were established to be effective in increasing the completeness and timeliness of childhood immunization.

Health system barriers to the first dose of measles immunization in Ethiopia: a qualitative study.

BACKGROUND: Ethiopia has made considerable progress toward measles elimination. Despite ongoing efforts, the country remains among those with the highest number of children missing their initial dose of measles vaccine, and the disease continues to be a public health emergency. The barriers within the health system that hinder the first dose of measles immunization have not been thoroughly investigated. This study aims to identify these barriers within the Ethiopian context. METHODS: Qualitative research, using purposive expert sampling to select key informants from health organizations in Addis Ababa, Ethiopia was employed. We conducted in-depth face-to-face interviews using a semi-structured interview guide. A thematic analysis based on the World Health Organization's health systems building blocks framework was conducted. RESULTS: The study uncovered substantial health system barriers to the uptake of the first dose of the measles vaccine in Ethiopia. These barriers include; restricted availability of immunization services, vaccine stockouts, shortage of cold chain technologies, data inaccuracy resulting from deliberate data falsification or accidental manipulation of data, as well as data incompleteness. CONCLUSION: Our research highlighted significant health system barriers to MCV1 immunization, contributing to unmet EPI targets in Ethiopia. Our results suggest that to accelerate the country towards measles elimination, there is an urgent need to improve the health systems components such as service delivery, information systems, as well as access to vaccine and cold chain technologies.

Landscaping analysis of immunization progress and program structures in selected middle income Southeast Asian countries.

This study examined the performance and structures of national immunization program in five middle-income Southeast Asian countries - Malaysia, Thailand, Philippines, Viet Nam, and Myanmar, and analyzed how the different structures relate to the difference in program performance to identify effective strategies in the study countries that facilitated good immunization performance. Data were derived from published literature, and WHO/UNICEF/Gavi databases, with 2010 as the baseline year. UMICs Malaysia and Thailand maintained ≥90 % coverage from 2010 to 2020 and even during the COVID-19 pandemic in 2021. LMICs Viet Nam and donor-supported Myanmar also achieved 80-90 % coverage for most routine vaccines in 2020. The Philippines have not reached ≥90 % coverage since 2010, with the maximum only 72 % (MCV1 and Polio3) in 2020. All study countries prioritize immunization and increased government financing since 2010 by minimum 91 % in Malaysia and 1897 % in Myanmar. However, Myanmar still largely depended on donor support with government financing only 32 % of immunization costs in 2021. The Philippines funds 100 % of immunization costs and ensures sustainable financing for the NIP through earmarked "sin tax" revenues from alcohol and tobacco. Donor support influenced new vaccine introductions among the study countries, with Gavi countries Myanmar and Viet Nam introducing more new vaccines, compared to Gavi-ineligible Malaysia and Thailand. The Philippines reported vaccine stock-outs every year amounting to 28 stock-outs events from 2010 to 2019, compared to only 1-4 stockouts in the other study countries. Donor support, innovative financing, and domestic vaccine manufacturing all play an important role in the efficient delivery of immunization services as demonstrated by the several new vaccine introductions and high immunization rates in Myanmar though Gavi and UNICEF support, additional annual $1.2 billion budget for health and immunization from "sin taxes" in the Philippines, and lack of stockouts for vaccines sourced at affordable prices from domestic manufacturers in Viet Nam.

Erradicación de la poliomielitis en España: ¿qué ha pasado en la última década? / Eradication of poliomyelitis in Spain: What has happened in the last decade?

Al cumplirse sesenta años desde el inicio de la campaña de vacunación frente a la poliomielitis en España, se destaca el importante hito en el control de la enfermedad que ha supuesto el cambio desde una incidencia de más de 2.000 casos anuales en la década de los 60 a una ausencia mantenida de poliovirus (PV) salvaje desde 1988. A pesar del impacto negativo observado en las coberturas de vacunación de poliomielitis al inicio de la pandemia de COVID-19, estas se fueron recuperando, alcanzando un 98,2% en la primovacunación en 2022. En la última década, se han identificado dos elementos esenciales para mantener el objetivo de eliminación de la poliomielitis y que, además, refuerzan la importancia de mantener altas coberturas de vacunación: los sistemas de vigilancia epidemiológica robustos y la respuesta rápida a las alertas para proteger a la población vulnerable y evitar la circulación del virus. Es crucial interrumpir la transmisión a nivel internacional para lograr la erradicación, manteniendo una vigilancia continua de alta calidad y una coordinación efectiva entre los diferentes niveles frente a cualquier detección de PV, ya sea salvaje o derivado de la vacuna.(AU)

On the 60th anniversary of the initiation of the polio vaccination campaign in Spain, the significant milestone in achieving disease control is highlighted. There has been a shift from an incidence of over 2,000 yearly cases in the 1960s to a sustained absence of wild poliovirus (WPV) since 1988. Despite the observed negative impact on polio vaccination coverage at the onset of the COVID-19 pan-demic, these rates gradually recovered, reaching 98.2% in primary vaccination in 2022. Over the past decade, two essential elements have been identified to maintain the goal of polio elimination and that reinforces the importance of sustaining high vaccination co-verage: robust epidemiological surveillance systems and a swift response to alerts to protect the vulnerable population and prevent virus reintroduction. In order to achieve eradication, it is crucial to interrupt international transmission and maintain continuous high-quality surveillance and effective coordination across different levels in response to any detection of PV, wild or vaccine derived.This article aimed to provide a comprehensive view of the polio eradication situation in Spain, focusing on the key events that occu-rred in the last decade and the present and future challenges.(AU)

Serosurvey of anti-rubella and anti-measles IgG antibodies in young females in Jahrom, southern west Iran in 2012: A review of literature of the serological profile in Iran.

Background: Rubella and measles are two highly contagious viral childhood diseases. However, the high possibility of brutal effects of both microorganisms during pregnancy has kept them emerging as a major public health issue. The current study aimed to investigate the seroprevalence of rubella and measles among 15-25-year-old females in southwest Iran. Method: This descriptive study was performed in Jahrom, southern west Iran during 2012. Serum samples from female individuals with an age of 15-25 years visiting main laboratories in our study location were collected and evaluated by a commercial ELISA kit for anti-rubella and measles IgG antibodies. Results: Among the 179 participants, regarding anti-rubella antibodies, 171 (95.0%) were positive, 3 (1.7%) were negative, and 6 (3.3%) were borderline. Regarding anti-measles antibodies, 166 (92.2%) of the subjects were positive, 1 (5.6%) was negative, and 13 (17.2%) were borderline. By assuming a positive value for the borderline cases, the ultimate findings demonstrated that 98.3% and 99.4% of the participants were immune against rubella and measles, respectively. There was no statistically significant association between measles and rubella immunity with age or the use of immunosuppressor medication. Conclusion: Implementation of vaccine program has obtained significant immunity level in inhabitants, particularly women of childbearing age who play a more important role in herd immunity. Therefore, maintaining the national immune screening against rubella and measles is needed to take into consideration to maintain the current satisfactory level of immunization.

[Ranking of immunization programs in Latin America, 2020Ranking dos programas de vacinação na América Latina, 2020]. / Ranking de los programas de vacunación en América Latina, 2020.

Objective: Construct a ranking of national immunization programs in Latin America in 2020 and compare it with the previous year. Methods: Eighteen national immunization programs were evaluated on the basis of public information obtained from official sites of the countries' ministries of health, the World Health Organization, the Pan American Health Organization, the United Nations Children's Fund, and local sources. The ranking was based on the 2020 vaccination schedule for different life stages, special situations, vaccination against influenza, 2019 vaccination coverage, and programmatic aspects. Results: Vaccination coverage decreased in most countries. The average regional declined in 2020, as did the scores for most countries, except Chile and Colombia. Chile leads the ranking, followed by Uruguay, Panama, and Costa Rica. Chile stands out for its full calendar, higher vaccination coverage rates, and programmatic achievements. Conclusions: The lower overall score in 2020 highlights the need to recover the Region's vaccination coverage rates. This analysis seeks to motivate countries to address pending challenges.

Objetivo: Construir e comparar o ranking dos programas nacionais de imunização (PNIs) na América Latina em 2020 com o ano anterior. Métodos: Foram avaliados 18 PNIs com base em informações públicas obtidas de sites oficiais dos ministérios da Saúde dos países, da Organização Mundial da Saúde, da Organização Pan-Americana da Saúde, do Fundo das Nações Unidas para a Infância e de fontes locais. O ranking foi compilado com base no calendário de vacinação de 2020 para diferentes fases da vida, situações especiais, vacinação contra a gripe, cobertura vacinal (CV) de 2019 e aspectos programáticos. Resultados: As CVs diminuíram na maioria dos países. A pontuação média regional e a pontuação da maioria dos países também caíram em 2020, exceto no Chile e na Colômbia. O Chile lidera o ranking, seguido do Uruguai, do Panamá e da Costa Rica, e se destaca por ter um calendário completo, maiores CVs e êxitos programáticos. Conclusões: A pontuação global mais baixa em 2020 destaca a necessidade de recuperar a CV da região. Esta análise busca motivar os países a enfrentar os desafios pendentes.

Key Learnings from the Development and Early Use of Global Guidance on the Integration of COVID-19 Vaccination into Broader Health Systems.

More than 13.5 billion COVID-19 vaccine doses were delivered between 2021 and 2023 through a mix of delivery platforms, with mass vaccination campaigns being the main approach. In 2022, with the continued circulation of SARS-CoV2 and the need for periodic boosters being most likely, countries were required to plan for more sustainable approaches to provide COVID-19 vaccinations. In this context of uncertainty, a global tool for integrating COVID-19 vaccines into immunization programs and as part of broader health systems was published jointly by the WHO and UNICEF to respond to country needs. This paper summarizes the approach to, and lessons learned during, the development of a global guidance document and describes some examples of its early use in low- and middle-income countries (LMICs). The guidance leveraged existing health system frameworks, proposed four steps for planning and implementing the COVID-19 vaccination integration journey, and identified investment areas. The development process maximized robust global stakeholder and country engagement, and the timeframe was aligned with donor funding windows to support countries with the integration of COVID-19 vaccination. The rapid dissemination of the guidance document allowed countries to ascertain their readiness for integrating COVID-19 vaccination and inform the development of national plans and funding applications. While progress has been made in specific areas (e.g., optimizing cold chain and logistics leveraging COVID-19 vaccination), in the context of decreasing demand for COVID-19 vaccines, reaching adult COVID-19 vaccine high-priority-use groups and engaging and coordinating with other health programs (beyond immunization) remain challenges, particularly in LMICs. We share the learning that despite the uncertainties of a pandemic, guidance documents can be developed and used within a short timeframe. Working in partnership with stakeholders within and beyond immunization towards a common objective is powerful and can allow progress to be made in terms of integrating health services and better preparing for future pandemics.

Using community-based, participatory qualitative research to identify determinants of routine vaccination drop-out for children under 2 in Lilongwe and Mzimba North Districts, Malawi.

OBJECTIVE: In recent years, full childhood routine immunisation coverage has fallen by 5% to levels not seen since 2008; between 2019 and 2021, 67 million children were undervaccinated. We aimed to identify and describe the determinants of vaccination drop-out from the perspectives of caregivers and health workers in Malawi. DESIGN: We used a community-based participatory research approach to collect data through photo elicitation, short message service exchanges, in-depth interviews and observations. We used a team-based approach for thematic analysis, guided by the Behavioural and Social Drivers of Vaccination framework. SETTING: The study was conducted in Lilongwe and Mzimba North Districts in Malawi, representing urban and rural settings, respectively. PARTICIPANTS: Participants included caregivers of partially vaccinated (n=38) and fully vaccinated (n=12) children between 25 and 34 months and Community Health Workers (n=20) who deliver vaccines. Caregiver participants were identified through health facility vaccination registers and with the assistance of community health volunteers. RESULTS: We identified five principal drivers of routine vaccination drop-out: (1) poor caregiver knowledge of the vaccine schedule and how many vaccines are needed for full vaccination; (2) caregivers' fear of repercussions after not following vaccination guidelines; (3) rumours and concerns if vaccines are repeated or new ones are introduced; (4) high opportunity cost of health facility visits, exacerbated by wait times, stockouts and missed opportunities and (5) limited family support and vaccination burden placed largely on mothers. Key differences between rural and urban settings related to practices around health cards and vaccine wastage, wait times, migrant and tenant communities, and social support systems. CONCLUSIONS: Immunisation interventions should be tailored to address drivers of drop-out in the community, the health facility and beyond. Service quality, timeliness and reliability need to be improved, and tailored messaging and education are needed, especially in response to COVID-19-related misinformation and introductions of new, routine vaccines.

Invasive meningococcal disease in South-Eastern European countries: Do we need to revise vaccination strategies?

Invasive meningococcal disease (IMD) is an acute life-threatening infection caused by the gram-negative bacterium, Neisseria meningitidis. Globally, there are approximately half a million cases of IMD each year, with incidence varying across geographical regions. Vaccination has proven to be successful against IMD, as part of controlling outbreaks, and when incorporated into national immunization programs. The South-Eastern Europe Meningococcal Advocacy Group (including representatives from Croatia, the Czech Republic, Greece, Hungary, Poland, Romania, Serbia, Slovenia and Ukraine) was formed in order to discuss the potential challenges of IMD faced in the region. The incidence of IMD across Europe has been relatively low over the past decade; of the countries that came together for the South-Eastern Meningococcal Advocacy Group, the notification rates were lower than the European average for some country. The age distribution of IMD cases was highest in infants and children, and most countries also had a further peak in adolescents and young adults. Across the nine included countries between 2010 and 2020, the largest contributors to IMD were serogroups B and C; however, each individual country had distinct patterns for serogroup distribution. Along with the variations in epidemiology of IMD between the included countries, vaccination policies also differ.

Factors associated with COVID-19 autumn 2022 booster uptake in the Netherlands among older adults aged ≥ 60 years and younger adults with chronic conditions.

BACKGROUND: A booster with bivalent COVID-19 vaccine was offered in the Netherlands in autumn, 2022. We aimed to investigate vaccine uptake during the autumn 2022 booster round among the population subgroups at risk for severe COVID-19 that were specifically targeted by this campaign: the medical risk group aged 18-59 years and individuals ≥ 60 years. We calculated booster uptake in both populations and analyzed determinants of booster uptake among those who had received at least one prior COVID-19 vaccination. METHODS: Having had an autumn 2022 booster dose was defined as having received a COVID-19 vaccination between 19 September 2022 and 7 March 2023. The study population included individuals who received at least one previous COVID-19 vaccination. National registries of sociodemographic determinants and COVID-19 vaccination were linked by a unique person identifier. Voting proportions for political parties were included at neighborhood level. Determinants of COVID-19 vaccine autumn booster uptake were ranked by importance by random forest analyses. RESULTS: Booster uptake was 68 % among those aged ≥ 60 and 30 % among those aged 18-59 years with a medical risk factor for severe disease. For both target groups the most important determinant for booster uptake was age (15 % in 18-29 years to 72 % in 80 + years). Voting proportions for progressive liberal political parties ranked second in the random forest analysis in both groups, with an increasing proportion of votes associated with higher uptake. In the 60 + group, household type ranked third, with highest vaccine uptake among married couples without children (72 %) and the lowest uptake among unmarried couples with children (47 %). In the medical risk group, migration status ranked third. Migrants with two parents born abroad had the lowest uptake (18 %), whereas migrants with both parents born in the Netherlands had the highest uptake (35 %). CONCLUSION: The target group of people aged ≥ 60 years was much better reached than the target group of people with a medical risk aged 18-59 years. Uptake varied considerably among subgroups in both target groups. The findings of this study can be used in future vaccination strategies as well as for further research to better understand the drivers and barriers of vaccine uptake among the subgroups with notably low uptake.

Hesitação vacinal infantil e COVID-19: uma análise a partir da percepção dos profissionais de saúde / Childhood vaccine hesitancy and COVID-19: an analysis based on the perception of health professionals / La reticencia vacunal infantil y la COVID-19: un análisis a partir de la percepción de los profesionales de la salud

Resumo: Este artigo apresenta os resultados de uma pesquisa sobre a percepção dos profissionais de saúde sobre a hesitação vacinal infantil relacionada à COVID-19. Baseado no constructo teórico da hesitação vacinal, foi realizada uma pesquisa qualitativa com 86 trabalhadores da atenção primária à saúde (APS) em quatro municípios de quatro estados brasileiros e no Distrito Federal. A análise temática foi realizada e obtiveram-se três categorias: medo, desinformação em vacina e papel dos profissionais de saúde. O medo como motivo de hesitação vacinal gerou reflexões sobre a condução da pandemia pelo Governo Federal, principalmente no que tange à governabilidade por meio desse afeto, e sobre as consequências do uso das plataformas digitais na população. O medo relacionou-se ao fato de a vacina ainda ser percebida como experimental; às possíveis reações adversas; à ausência de estudos de longo prazo; à falsa percepção de risco reduzido da COVID-19 em crianças; e às condutas do Governo Federal geradoras de insegurança nos efeitos da vacina. A desinformação em vacina relacionou-se às fake news sobre a vacina e suas reações; ao fenômeno da infodemia e desinformação; e à ausência de orientação e conhecimento sobre vacinas. Por fim, o trabalho discute o papel fundamental dos profissionais de saúde da APS no aumento da cobertura vacinal devido à confiabilidade perante a população e à proximidade com os territórios, fatores que possibilitam reverter o medo e a desinformação diante das vacinas. Ao longo do trabalho, buscou-se apresentar as convergências entre o conteúdo dos temas delineados e os determinantes da hesitação vacinal e refletir sobre possibilidades para a reconstrução da alta adesão às vacinas infantis.

Abstract: This article presents the results of a study on health professionals' perceptions of childhood vaccine hesitancy related to COVID-19. Based on the theoretical construct of vaccine hesitancy, a qualitative study was conducted with 86 primary health care (PHC) workers in four municipalities in four Brazilian states and in the Federal District. A thematic analysis was performed and three categories were obtained: fear, misinformation about vaccines, and the role of health professionals. Fear as a reason for vaccine hesitancy has led to reflections on the Brazilian Federal Government's management of the pandemic, especially regarding governability and the consequences of the use of digital platforms on the population. Fear was related to the vaccine still being perceived as experimental; to the adverse reactions it may cause; to the lack of long-term studies; to the false perception of reduced risk of COVID-19 in children; and to the Federal Government's behavior, which creates uncertainty about the effects of the vaccine. Vaccine misinformation was related to fake news about the vaccine and its reactions; the phenomenon of infodemic and misinformation; and the lack of guidance and knowledge about vaccines. Finally, the article discusses the fundamental role of PHC workers in increasing vaccination coverage due to the trust among the population and proximity to the territories, factors that enable the reversal of fear and misinformation about vaccines. Throughout the study, authors' sought to show the convergences between the content of the themes outlined and the determinants of vaccine hesitancy and to consider possibilities for rebuilding high adherence to childhood vaccines.

Resumen: Este artículo presenta los resultados de una encuesta sobre la percepción de los profesionales de la salud acerca de la reticencia vacunal infantil relacionada con la COVID-19. Con base en el constructo teórico de la reticencia vacunal, se realizó una encuesta cualitativa con 86 trabajadores de la atención primaria de salud (APS) en 4 municipios de 4 estados brasileños y en el Distrito Federal. Se realizó un análisis temático y se obtuvieron tres categorías: miedo, desinformación sobre vacunas y papel de los profesionales de la salud. El miedo como motivo de reticencia vacunal dio lugar a reflexiones sobre el manejo de la pandemia por parte del Gobierno Federal, sobre todo en lo que respecta a la gobernabilidad por medio de esta afección y las consecuencias del uso de plataformas digitales en la población. El temor se relacionó con el hecho de que la vacuna todavía se percibe como experimental; con las reacciones adversas que puedan provocar; con la ausencia de estudios a largo plazo; con la falsa percepción de riesgo reducido de COVID-19 en niños y con las conductas del Gobierno Federal que generan inseguridad sobre los efectos de la vacuna. La desinformación sobre las vacunas se relacionó con noticias falsas sobre la vacuna y sus reacciones; el fenómeno de la infodemia y la desinformación; y la ausencia de orientación y conocimiento sobre las vacunas. Finalmente, el trabajo discute el papel fundamental de los profesionales de la salud de la APS en el aumento de la cobertura vacunal debido a su confiabilidad entre la población y cercanía a los territorios, factores que permiten revertir el miedo y la desinformación respecto a las vacunas. A lo largo del trabajo, se buscó presentar las convergencias entre el contenido de los temas delineados y los determinantes de la reticencia vacunal y reflexionar sobre las posibilidades para la reconstrucción de una alta adhesión a las vacunas infantiles.

Temporal trends in vaccination coverage in the first year of life in Brazil / Tendência temporal das coberturas vacinais no primeiro ano de vida no Brasil

ABSTRACT Objective: The aim of this study was to analyze the temporal trends in vaccination coverage (VC) during the first year of life of children in Brazil. Methods: Data on VC for the first year of life from 2011 to 2020 for Bacille Calmette-Guerin (BCG), hepatitis B, polio, pentavalent, and triple viral vaccines at the national, regional, and state levels were obtained from the Information System of the National Immunization Program. Trends were analyzed using Prais-Winsten generalized linear regression models and average annual percent change (APC) estimates. Results: Decreasing trends were observed for the BCG (APC −3.58%; p<0.05), pentavalent (APC −4.10%; p<0.05), polio (APC −2.76%; p<0.05), and triple viral (APC −2.56%; p<0.05) vaccines in the country. Hepatitis B vaccine was the only vaccine that displayed stationary behavior (APC −4.22%; p>0.05). During the study period, no increasing trends were observed in any territory or vaccine. Conclusions: This study shows a recent significant reduction and decreasing trends in VC during the first year of life of children in Brazil, indicating the need for interventions to curb this ongoing phenomenon and to recover acceptable VC rates in the country.

RESUMO Objetivo: Analisar a tendência temporal da cobertura vacinal (CV) em crianças com idade menor ou igual a um ano no Brasil. Métodos: Foram empregados dados da CV no primeiro ano de vida de 2011 a 2020 referentes às vacinas BCG, hepatite B, poliomielite, pentavalente e tríplice viral, obtidos do Sistema de Informação do Programa Nacional de Imunizações (SI-PNI). Os dados estão agregados em nível nacional, regional e estadual. Para a análise de tendência foi utilizado o modelo de regressão linear generalizado de Prais-Winsten e foi calculada a variação percentual média anual (APC). Resultados: As tendências de CV para as vacinas BCG (APC −3,58%; p<0,05), pentavalente (APC −4,10%; p<0,05), poliomielite (APC −2,76%; p<0,05) e tríplice viral (APC −2,56%; p<0,05) foram decrescentes no país. Apenas para a CV da vacina contra hepatite B foi identificado comportamento estacionário (APC −4,22%; p>0,05). Nenhum território ou vacina apresentou tendência crescente para cobertura vacinal no período estudado no Brasil. Conclusões: Este estudo alerta sobre a redução expressiva das CV no primeiro ano de vida nos últimos anos no Brasil e sua tendência decrescente, sendo imperativa a adoção de intervenções com o fim de frear o fenômeno em curso e de resgatar níveis aceitáveis de CV no país.

Ranking de los programas de vacunación en América Latina, 2020 / Ranking of immunization programs in Latin America, 2020 / Ranking dos programas de vacinação na América Latina, 2020

RESUMEN Objetivo. Construir y comparar el ranking de los programas nacionales de inmunizaciones (PNI) de América Latina del año 2020 con el año anterior. Métodos. Se evaluaron 18 PNI con base en la información pública obtenida de sitios oficiales de los ministerios de salud de los países, la Organización Mundial de la Salud, la Organización Panamericana de la Salud, el Fondo de las Naciones Unidas para la Infancia y referentes locales. El ranking se elaboró con base en el calendario de vacunación del año 2020 en distintas etapas de la vida, situaciones especiales, vacunación antigripal, coberturas vacunales (CV) del 2019 y aspectos programáticos. Resultados. Las CV disminuyeron en la mayoría de los países. El puntaje promedio regional y de la mayoría de los países también bajó en el 2020 excepto en Chile y Colombia. Chile lidera el ranking, seguido por Uruguay, Panamá y Costa Rica, y se destaca por su calendario completo, mayores CV y logros programáticos. Conclusiones. El menor puntaje global del 2020 resalta que es necesario recuperar la CV en la Región. Este análisis busca motivar a los países a abordar los desafíos pendientes.

ABSTRACT Objective. Construct a ranking of national immunization programs in Latin America in 2020 and compare it with the previous year. Methods. Eighteen national immunization programs were evaluated on the basis of public information obtained from official sites of the countries' ministries of health, the World Health Organization, the Pan American Health Organization, the United Nations Children's Fund, and local sources. The ranking was based on the 2020 vaccination schedule for different life stages, special situations, vaccination against influenza, 2019 vaccination coverage, and programmatic aspects. Results. Vaccination coverage decreased in most countries. The average regional declined in 2020, as did the scores for most countries, except Chile and Colombia. Chile leads the ranking, followed by Uruguay, Panama, and Costa Rica. Chile stands out for its full calendar, higher vaccination coverage rates, and programmatic achievements. Conclusions. The lower overall score in 2020 highlights the need to recover the Region's vaccination coverage rates. This analysis seeks to motivate countries to address pending challenges.

RESUMO Objetivo. Construir e comparar o ranking dos programas nacionais de imunização (PNIs) na América Latina em 2020 com o ano anterior. Métodos. Foram avaliados 18 PNIs com base em informações públicas obtidas de sites oficiais dos ministérios da Saúde dos países, da Organização Mundial da Saúde, da Organização Pan-Americana da Saúde, do Fundo das Nações Unidas para a Infância e de fontes locais. O ranking foi compilado com base no calendário de vacinação de 2020 para diferentes fases da vida, situações especiais, vacinação contra a gripe, cobertura vacinal (CV) de 2019 e aspectos programáticos. Resultados. As CVs diminuíram na maioria dos países. A pontuação média regional e a pontuação da maioria dos países também caíram em 2020, exceto no Chile e na Colômbia. O Chile lidera o ranking, seguido do Uruguai, do Panamá e da Costa Rica, e se destaca por ter um calendário completo, maiores CVs e êxitos programáticos. Conclusões. A pontuação global mais baixa em 2020 destaca a necessidade de recuperar a CV da região. Esta análise busca motivar os países a enfrentar os desafios pendentes.

Meningococcal Disease in the Post-COVID-19 Era: A Time to Prepare.

The global invasive meningococcal disease (IMD) landscape changed considerably during the COVID-19 pandemic, as evidenced by decreased incidence rates due to COVID-19 mitigation measures, such as limited social contact, physical distancing, mask wearing, and hand washing. Vaccination rates were also lower during the pandemic relative to pre-pandemic levels. Although policymakers may have shifted their focus away from IMD vaccination programs to COVID-19 vaccination programs, strong arguments support implementation and prioritization of IMD vaccination programs; IMD cases have increased in some countries and IMD rates may even have exceeded pre-pandemic levels. Additional concerns include increased susceptibility due to vaccination coverage gaps, increased incidence of other respiratory pathogens, immunity debt from lockdown restrictions, and increased IMD epidemiologic variability. The full range of benefits of widely available and effective meningococcal vaccines needs to be considered, especially in health technology assessments, where the broad benefits of these vaccines are neither accurately quantified nor captured in implementation policy decisions. Importantly, implementation of meningococcal vaccination programs in the current IMD climate also appeals to broader healthcare principles, including preparedness rather than reactive approaches, generally accepted benefit-risk approaches to vaccination, historical precedent, and the World Health Organization's goal of defeating meningitis by 2030. Countries should therefore act swiftly to bolster existing meningococcal vaccination strategies to provide broad coverage across age groups and serogroups given the recent increases in IMD incidence.

Restoring High Vaccine Coverage in Brazil: Successes and Challenges

Facing the decline in vaccine coverage observed since 2016, the new Brazilian government committed to reversing this scenario. To achieve this, the Federal Government launched the National Vaccination Movement and the 'Health with Science' platform to combat vaccine misinformation, promoted Microplanning, providing tools for decision-making at the territorial level, allocated 30 million dollars to states and municipalities to implement innovative vaccination strategies, standardized the rules of the information systems for the registration of vaccine doses, and directed data to the National Health Data Network (RNDS). Reversing the declining trend of vaccination coverage in Brazil is challenging, but within just one year, it is possible to observe significant results from governmental actions. Out of the eight recommended vaccines by the age of one, seven showed an increase in vaccination coverage in 2023 compared to 2022: Most states showed improvements in vaccination coverage. Many challenges persist in advancing the vaccination agenda. However, there are reasons to celebrate the reversal of the declining trend in coverage of several vaccines in this first year of government and the increase in the number of municipalities that have fully achieved the vaccination coverage target. The National Vaccination Movement, with public opinion awareness, the resumption of regionalized communication campaigns, localized micro-planning actions including extramural vaccination strategies, and the integration of information systems, has been decisive in strengthening work in the territories and thus restoring a culture of immunization, a source of pride in the country and internationally recognized, throughout the 50 years of the National Immunization Program

Modelo lógico-teórico como ferramenta de planejamento para melhoria da cobertura vacinal infantil no Rio Grande do Norte, Brasil / Theoretical-logic model as a planning tool to improve childhood vaccination coverage in Rio Grande do Norte, Brazil / Modelo teórico-lógico como herramienta de planificación para mejorar la cobertura de vacunación infantil en Rio Grande do Norte, Brasil

Introdução:A vacinação tem se apresentado como uma importante estratégia de proteção à saúde da população. A redução da cobertura vacinal é um alerta para o retorno de doenças imunopreveníveis que já haviam sido erradicadas.Objetivo:Mapear o cenário de cobertura vacinal de crianças menores de 2 anos no Rio Grande do Norte no período de 2012 a 2021, e propor um modelo teórico-lógico para o planejamento das ações. Metodologia:Trata-se de um estudo do tipo ecológico, acerca da cobertura vacinal no estado em questão. Os dados foram coletados a partir do Departamento de Informática do Sistema Único de Saúde (DATASUS), por meio das Informações em Saúde (TABNET). Para coleta dos dados, elegeu-se como variáveis o ano para compor a linha da tabela a ser gerada pelo sistema, o imunobiológico para compor a coluna e, como medida, foi selecionada a cobertura vacinal. O período analisado foi de 2012 a 2021. Resultados:Nacionalmente, os anos de 2020 e 2021 apresentaram queda com relação aos dois anos anteriores à pandemia do novo coronavírus (SARS-CoV-2). Foi identificada a mesma tendencia de queda na cobertura vacinal infantil no estado de interesse do estudo ao comparar a média de cobertura de 2018/2019 com a média de 2020/2021. O modelo lógico teórico apresentado neste estudocontribui para a otimizaçãodo planejamento e das ações do programa estadual de imunização. Conclusão:Este estudose mostrou relevante para direcionar as estratégias da Secretaria de Saúde Pública do Rio Grande do Norte,ao propor ummodelo teórico-lógicocomo ferramenta para melhoria dos indicadoresde cobertura vacinal infantil (AU).

Introduction:Vaccination has been presented as an important health protection strategy for the population. The reduction in vaccination coverage is an alert for the return of immune preventable diseases that had already been eradicated. Objective:To map the vaccination coverage scenario for children under 2 years old in Rio Grande do Norte from 2012 to 2021 and propose a theoretical-logical model for planning actions. Methodology:This is an ecological study on vaccination coveragein the state in question. Data were collected from the Department of Informatics of the Brazilian National Health System (DATASUS), through Health Information (TABNET). The variables chosen for data collection were the year, which formed the rows of the table generated by the system, the immunobiological vaccine, which formed the columns, and the vaccination coverage rate as the measure. The period analyzed was from 2012 to 2021. Results:Nationally, the years 2020 and 2021 showed a drop compared to the two years prior to thenew coronavirus pandemic (SARS-CoV-2). The same downward trend in childhood vaccination coverage was identified in the state of interest when comparing the average coverage of 2018/2019 with the average of 2020/2021. The theoretical logic model presented in this study contributes to optimizing the planning and actions of the state immunization program. Conclusion:This study proved to be relevant for directing the strategies of the Rio Grande do Norte Public Health Department, by proposing a theoretical-logical model as a tool for improving infant vaccination coverage indicators (AU).

Introducción:La vacunación se hapresentado como una importante estrategia para proteger la salud de la población. La reducción de la cobertura de vacunación es una alerta para el regreso de enfermedades inmunoprevenibles que ya habían sido erradicadas. Objetivo:Mapear el escenario de cobertura de vacunación para niños menores de 2 años en Rio Grande do Norte en el período de 2012 a 2021, y proponer un modelo lógico-teórico para la planificación de acciones. Metodología:Este es un estudio ecológico sobre la cobertura de vacunación enelEstado en cuestión. Los datos fueron recolectados del Departamento de Informática del Sistema Único de Salud (DATASUS), a través del Información en Salud (TABNET). Las variables seleccionadas para la recopilación de datos fueron el año, que conformó las filas de la tabla generada por el sistema, la vacuna inmunobiológica, que conformó las columnas, y la tasa de cobertura vacunal como medida. El período analizado fue de 2012 a 2021. Resultados:A nivel nacional, los años 2020 y 2021 mostraron un descenso encomparación con los dos años previos a la pandemia del nuevo coronavirus (SARS-CoV-2). La misma tendencia a la baja en la cobertura de vacunación infantil se identificó en el estado de interés al comparar la cobertura media de 2018/2019 con la media de 2020/2021. El modelo lógico teórico presentado en este estudio contribuye a optimizar la planificación y las acciones del programa estatal de inmunización. Conclusión:Este estudio demostró ser relevante para direccionar las estrategias de la Secretaría de Salud Pública de Rio Grande do Norte, al proponer un modelo teórico-lógico como herramienta para mejorar los indicadores de cobertura de vacunación infantil (AU).