Abstract
Background
The 10-valent conjugate vaccine (PCV10) was introduced into the Extended Program on Immunization in Madagascar. We assessed the impact of PCV10 on the targeted pneumococcal ...serotypes among children < 5 years of age at Centre Hospitalier Universitaire Mère Enfant Tsaralalàna.
Method
Between 2012 and December 2018, cerebrospinal fluid (CSF) samples were collected and tested for S. pneumoniae by culture, and antigen tests. The Sentinel Site Laboratory (SSL) referred available CSF samples to the Regional Reference Laboratory (RRL) for real-time polymerase chain reaction confirmatory testing and serotyping.
Results
In total, 3616 CSF specimens were collected. The SSL referred 2716 to the RRL; 125 were positive for S. pneumoniae. At the RRL, 115 samples that tested positive for S. pneumoniae were serotyped; PCV10 serotypes accounted for 20%. Compared to the pre-PCV period, the proportion of S. pneumoniae detected declined from 22% to 6.6%, (P < .05), the proportion of PCV10 serotypes as the cause of pneumococcal meningitis cases declined by 26% following vaccine introduction.
Conclusions
In our findings, PCV10 introduction resulted in a decline of meningitis caused by S. pneumoniae and PCV10 vaccine serotypes.
Following a recommendation by the World Health Organization, Madagascar introduced rotavirus vaccine in 2014. Though national rotavirus vaccine coverage has remained <80%, rotavirus hospitalizations ...declined by 78%. Gavi, the Vaccine Alliance, has provided financial support for rotavirus vaccine, however the Malagasy government has increasing responsibility for the financial cost.
In this evaluation, we describe the direct medical, direct non-medical, and indirect cost of illness due to diarrhea among children <5 years old at a public pediatric referral hospital. A 3-part structured questionnaire was administered during and following the hospitalization and the child’s hospital record was reviewed.
In total, 96 children were included in this analysis. The median total cost of the illness was $156.00 (IQR: 104.00, 210.86) and the median direct medical cost was $107.22. Service delivery costs represented a median of 44% of the inpatient costs; medications and diagnostic tests represented a median of 28% and 20% of the total costs of the hospitalization, respectively. The median percentage of the total illness costs paid by the household was 67%. Among households with income of <$61/month, the median costs of the illness paid by the household were $78.55, representing a median of 168% of the household’s monthly expenses. Among households earning >$303/month, the median costs paid by the household were $147.30, representing a median of 53% of the household’s monthly expenses. Among all household income levels, caregivers commonly paid these bills from savings, borrowed money, and donations.
Our findings will be useful in assessing the cost-effectiveness of rotavirus vaccine by decisionmakers. These results may also help hospital administrators and healthcare providers better understand the financial constraints of families.
Abstract
Background
The 10-valent pneumococcal conjugate vaccine (PCV10) was introduced in Madagascar in 2012. The objective of this study was to determine the impact of PCV10 on bacterial meningitis ...in hospitalized children <5 years of age.
Methods
During 2010–2017, data from the hospital admission logbook were recorded for bacterial meningitis and pneumonia hospitalizations in children <5 years of age. Between April 2011 and December 2017, 3312 cerebrospinal fluid (CSF) samples collected from children who fulfilled the World Health Organization case definition of suspected bacterial meningitis were analyzed at the sentinel site laboratory (SSL) by microscopy, culture, and antigen detection tests. A total of 2065 CSF samples were referred to the regional reference laboratory for real-time polymerase chain reaction (RT-PCR) analysis. 2010–2011 was defined as the prevaccine period, 2012 as vaccine introduction year, and 2013–2017 the postvaccine period. The number of cases, causative agent, and pneumonia hospitalizations were compared before and after PCV10 introduction.
Results
In the prevaccine period, bacterial meningitis and pneumonia hospitalizations accounted for 4.5% and 24.5% of all hospitalizations while there were 2.6% and 19%, respectively, in the postvaccine period (P < .001). In samples tested at the SSL, 154 were positive with 80% Streptococcus pneumoniae and 20% other bacteria. Pneumococcal meningitis diagnosed by RT-PCR declined from 14% in 2012 to 3% in 2017. Also, 14% of children with pneumococcal meningitis died.
Conclusions
Following PCV10 introduction, pneumococcal meningitis, bacterial meningitis, and pneumonia hospitalizations declined. Surveillance should continue to monitor the impact of PCV10.
We found a decline in pneumococcal meningitis, bacterial meningitis, and pneumonia hospitalizations after the introduction of pneumococcal conjugate vaccine (PCV). It is essential to continue conducting such sentinel surveillance to monitor the long-term impact of 10-valent PCV.
Data from the WHO and UNICEF Estimates of National Immunization Coverage (WUENIC) 2022 revision were analyzed to assess the status of routine immunization in the WHO African Region disrupted by the ...COVID-19 pandemic. In 2022, coverage for the first and third doses of the diphtheria-tetanus-pertussis-containing vaccine (DTP1 and DTP3, respectively) and the first dose of the measles-containing vaccine (MCV1) in the region was estimated at 80%, 72% and 69%, respectively (all below the 2019 level). Only 13 of the 47 countries (28%) achieved the global target coverage of 90% or above with DTP3 in 2022. From 2019 to 2022, 28.7 million zero-dose children were recorded (19.0% of the target population). Ten countries in the region accounted for 80.3% of all zero-dose children, including the four most populated countries. Reported administrative coverage greater than WUENIC-reported coverage was found in 19 countries, highlighting routine immunization data quality issues. The WHO African Region has not yet recovered from COVID-19 disruptions to routine immunization. It is critical for governments to ensure that processes are in place to prioritize investments for restoring immunization services, catching up on the vaccination of zero-dose and under-vaccinated children and improving data quality.
The context of the outbreak Since 2004, the number of measles cases reported in Madagascar had plummeted from tens of thousands of annual cases to fewer than 20 confirmed cases per year.4 This drop ...in cases followed a successful expansion of the immunisation programme (figure 1A) in which consistent (although low) routine measles vaccination coverage (between 55% and 85%) was combined with vaccination campaigns targeting ages from 9 months to 14 years (in 2004) or 9 months to 4 years (in 2007, 2010, 2013, 2016).5 The combination of low incidence and the potential for incomplete vaccination coverage over a number of years suggested that Madagascar might have a large susceptible population distributed across a wide age range, yielding potential for a wide age range, fast-growing outbreak. Historical context of measles in Madagascar and the recent outbreak (A) measles first dose vaccination coverage estimates from UNICEF (y-axis, top) and measles incidence from who (y-axis, log scale, bottom) from 1980 to 2018 (x-axis), showing a sharp decline in cases in 2005 with 10 or less cases in each years following 2005 until the start of the focal outbreak in 2018 when more than 21 000 cases reported; (B) time series of suspected cases (y-axis) against time (indicated epidemic week starting in 2018, thin vertical line shows the separation between 2018 and 2019) from the 2018 to 2019 line-list data in each of the 22 regions, coloured by the timing of the peaks (orange is earliest, grey intermediate, and brown latest); dashed vertical lines indicate the approximate timing of the three waves of vaccination (different districts were targeted in each wave, see text); inset shows the regions of Madagascar coloured as for the time series (orange is the earliest peaks, grey intermediate and brown the latest). (A) Measles vaccination coverage at 5 years in each of the 22 regions estimated from Madagascar’s 2009 Demographic and Health Survey (x-axis) plotted against (A) the median age distribution of cases (y-axis) and (B) the R E of the outbreak in each region (y-axis). The outbreak response In October 2018, rapidly growing case numbers in the Analamanga region (where the capital city of Antananarivo is located) prompted deployment of a vaccination campaign across a limited spatial extent (four health districts of the urban community of Antananarivo) targeting children up to 5 years of age.
Vaccination coverage of the first dose of diphtheria-tetanus-pertussis-hepatitis B-
type b (pentavalent) vaccine for the City-Province of Kinshasain the years 2012 - 2014 wasbelow the national ...objective of 92%, with coverage less than 80% reported in 12 of the 35 health zones (HZ). The purpose of this study was to discern potential contributing factors to low vaccination coverage in Kinshasa.
We conducted a multi-stage cluster household study of children 6 - 11 months in households residing in their current neighborhood for at least 3 months in the 12 high risk HZ in Kinshasa. Additional information on vaccination status of the children was collected at the health facility.
Of the 1,513 households with a child 6-11 months old, 81% were eligible and participated. Among the 1224 children surveyed, 96% had received the first dose of pentavalent vaccine; 84% had received the third dose; and 71% had received all recommended vaccines for their age. Longer travel time to get to health facility (p=0.04) and shorter length of residence in the neighborhood (p=0.04) showed significant differences in relation to incomplete vaccination. Forty percent of children received their most recent vaccination in a facility outside of their HZ of residence.
This survey found vaccination coverage in 12 HZs in Kinshasa was higher than estimates derived from administrative reports. The large percentage of children vaccinated outside of their HZ of residence demonstrates the challenge to use of the Reaching Every District strategy in urban areas.
In October 4
, 2018, a measles outbreak was declared in Madagascar. This study describes the epidemiology of the outbreak and determines public health implications for measles elimination in ...Madagascar.
Data have been collected using line list developed for the outbreak. Serum samples were collected within 30 days of rash onset for laboratory testing; confirmation was made by detection of measles immunoglobulin M (IgM) antibody.
A total of 2,930 samples were analysed in the laboratory among which 1,086 (37%) were laboratory confirmed. Measles cases age ranged from a minimum of 1 month to a maximum of 88 years. The median and the mean were 7 years and 9 years respectively. Children between 1 to 9 years accounted for 50.6% of measles cases. Attack rate (39,014 per 1,000,000 inhabitants) and case fatality rate (1.2%) were highest among children aged 9-11 months. A total of 67.2% cases were unvaccinated. As of March 14
, 2019, all the 22 regions and 105 (92%) health districts out of 114 were affected by the measles outbreak in Madagascar.
Measles outbreak in Madagascar showed that the country is not on the track to achieve the goal of measles elimination by 2020.
on October 4
, 2018, a measles outbreak was declared in Madagascar. This study describes challenges related to resources mobilization for the outbreak response.
data were collected using minutes of ...coordination committee meetings, activities reports, operational action plans and situation reports.
the total cost of the outbreak response was estimated to US$ 11,281,381. Operational cost was the leading cost driver (42.45%) followed by vaccine cost (33.74%). Cases management, epidemiological surveillance, communication and social mobilization and routine immunization strengthening represented 23.81% of the total cost. The main funder of the outbreak response was the measles and rubella initiative.
good coordination, open dialogue, good use of financial resources and accountability of government and partners have enabled to gain the confidence of national and international donors.
Health facility (HF) and household (HH) data can complement each other to provide a better understanding of the factors that contribute to vaccination status. In 12 zones with low vaccination ...coverage within Kinshasa Province, Democratic Republic of Congo, we conducted 2 surveys: (1) a linked HH and HF survey among 6–11-month-old infants, and (2) a HH survey among 12–23-month-old children. Linked survey objectives were to identify factors associated with vaccination status and to explore methodological considerations for linked survey implementation. To provide linked HH and HF data, we enrolled 6–11-month-old infants in HH clusters in each zone and then surveyed HFs located within the 12 zones and cited by caregivers of the enrolled infants as the most recent HF visited for vaccination or curative care. To provide vaccination coverage estimates for the 12-zone area, we enrolled 12–23-month-old children in every fourth HH. Of the HHs with a child aged 6–23 months, 16% were ineligible because they had resided in the neighborhood for <3 months or were unavailable to be interviewed, 4% refused, and 80% were eligible and participated. Of 1224 enrolled infants 6–11 months of age, records of 879 (72%) were linked to one of the 182 surveyed HFs. For the coverage survey, 710 children aged 12–23 months participated. Home-based vaccination cards were available for 1210 of 1934 children (63%) surveyed. The surveys were successful in assessing HH information for 2 age groups, documenting written vaccination history for a large proportion of 6–23-month-old children, linking the majority of infants with their most recently visited HF, and surveying identified HFs. The implementation of the individually linked survey also highlighted the need for a comprehensive list of HFs and an analysis plan that addresses cross-classified clusters with only 1 child.
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