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State health departments commonly use quality improvement coaching as an implementation strategy for improving low human papillomavirus (HPV) vaccination coverage, but such coaching can be resource intensive. To explore opportunities for improving efficiency, we compared in-person and webinar delivery of coaching sessions on implementation outcomes, including reach, acceptability, and delivery cost. In 2015, we randomly assigned 148 high-volume primary care clinics in Illinois, Michigan, and Washington State to receive either in-person or webinar coaching. Coaching sessions lasted about 1 hr and used our Immunization Report Card to facilitate assessment and feedback. Clinics served over 213,000 patients ages 11-17. We used provider surveys and delivery cost assessment to collect implementation data. This report is focused exclusively on the implementation aspects of the intervention. More providers attended in-person than webinar coaching sessions (mean 9 vs. 5 providers per clinic, respectively, p = .004). More providers shared the Immunization Report Card at clinic staff meetings in the in-person than webinar arm (49% vs. 20%; p = .029). In both arms, providers' belief that their clinics' HPV vaccination coverage was too low increased, as did their self-efficacy to help their clinics improve (p < .05). Providers rated coaching sessions in the two arms equally highly on acceptability. Delivery cost per clinic was$733 for in-person coaching versus $ 461 for webinar coaching. In-person and webinar coaching were well received and yielded improvements in provider beliefs and self-efficacy regarding HPV vaccine quality improvement. In summary, in-person coaching cost more than webinar coaching per clinic reached, but reached more providers. Further implementation research is needed to understand how and for whom webinar coaching may be appropriate. Keywords HPV vaccine, Immunization programs, Quality improvement coaching, Primary care, State health departments, Assessment and feedback

Background Immunization quality improvement programs are often limited by the cost and inconvenience associated with delivering face-to-face consultations to primary care providers. To investigate a more efficient mode of intervention delivery, we conducted a process evaluation that compared in-person consultations to those delivered via interactive webinar. Methods The Centers for Disease Control and Prevention’s Assessment, Feedback, Incentives, and eXchange (AFIX) Program is an immunization quality improvement program implemented in all 50 states. In 2011, we randomly assigned 61 high-volume primary care clinics in North Carolina to receive an in-person or webinar AFIX consultation focused on adolescent immunization. We used surveys of participating vaccine providers and expense tracking logs to evaluate delivery modes on participation, satisfaction, and cost. Clinics served 71,874 patients, ages 11 to 18. Results Clinics that received in-person and webinar consultations reported similar levels of participation on key programmatic activities with one exception: more webinar clinics reported improving documentation of previously administered, ‘historical’ vaccine doses. Both in-person and webinar clinics showed sustained improvement in confidence to use reminder/recall systems (both p  < 0.05). Participants rated delivery modes equally highly on satisfaction measures such as convenience (mean = 4.6 of 5.0). Delivery cost per clinic was $152 for in-person consultations versus $100 for webinar consultations. Conclusions In-person and webinar delivery modes were both well received, but webinar AFIX consultations cost substantially less. Interactive webinar delivery shows promise for considerably extending the reach of immunization quality improvement programs. Trial registration Clinicaltrials.gov, NCT01544764

This article presents the World Health Organization’s (WHO) recommendations on the use of human papillomavirus (HPV) vaccines excerpted from the WHO position paper on Human papillomavirus vaccines: WHO position paper, May 2017, published in the Weekly Epidemiological Record [1]. This position paper replaces the 2014 WHO position paper on HPV vaccines [2]. The position paper focuses primarily on the prevention of cervical cancer, but also considers the broader spectrum of cancers and other diseases preventable by HPV vaccination. It incorporates recent developments concerning HPV vaccines, including the licensure of a nonavalent (9-valent) vaccine and recent data on vaccine effectiveness, and provides guidance on the choice of vaccine. New recommendations are proposed regarding vaccination strategies targeting girls only or both girls and boys, and vaccination of multiple birth cohorts [3]. Footnotes to this paper provide a number of core references including references to grading tables that assess the quality of the scientific evidence, and to the evidence-to-recommendation table. In accordance with its mandate to provide guidance to Member States on health policy matters, WHO issues a series of regularly updated position papers on vaccines and combinations of vaccines against diseases that have an international public health impact. These papers are concerned primarily with the use of vaccines in large-scale immunization programmes; they summarize essential background information on diseases and vaccines, and conclude with WHO's current position on the use of vaccines in the global context. Recommendations on the use of HPV vaccines were discussed by SAGE in October 2016; evidence presented at these meetings can be accessed at: www.who.int/immunization/sage/meetings/2016/october/presentations_background_docs/en/.

Routine immunization (RI) delivery was declared a public health concern in Nigeria in 2017 because of persistently low immunization coverage rates reported in independent surveys. However, administrative coverage rates remain high, suggesting serious data quality issues. We posit that a shorter timespan between service provision and data reporting can improve the monitoring of RI data, and developed a short message system (SMS) text reporting strategy to generate daily RI data points from health facilities (HFs). The goal was to assess whether daily data collection produces complete, reliable and internally consistent data points. The SMS reporting platform was piloted between December 2017 and April 2018 in two Local Government Areas (LGAs, equivalent to districts) of Nasarawa state, Nigeria. The 145 healthcare workers from 55 HFs received one mobile phone and pre-configured SIM card, and were trained to send data through predefined codes. Healthcare workers compiled the data after each vaccination session and transmitted them via SMS. We analyzed completeness, number of weekly sessions, and supportive supervision conducted. During the pilot phase, we received data from 85% (n = 47) of the 55 HFs. We expected 66 fixed-post sessions and 30 outreach sessions per week, but received data for 33 fixed-post and 8 outreach weekly session on average. More HFs reported on Tuesdays compared to other days of the week. When assessing internal consistency, we observed that the reported number of children vaccinated was sometimes higher than the number of doses available from opening a given number of vaccine vials. When found, this discrepancy was noted for all antigens during fixed-post and outreach vaccination sessions. Despite these initial discrepancies, transmitting RI data sessions via texting is feasible and can provide real-time updates to the performance of the RI services at the HF level.

•International collaboration produced standard competencies for immunization workers.•The innovative competencies design can be customized based on country needs.•The three-part competency framework links to immunization program objectives.•The framework describes immunization competencies for eight domains at four levels.•Methodical competency modeling is a useful tool for complex immunization systems. Despite global support for immunization as a core component of the human right to health and the maturity of immunization programs in low- and middle-income countries throughout the world, there is no comprehensive description of the standardized competencies needed for immunization programs at the national, multiple sub-national, and community levels. The lack of defined and standardized competencies means countries have few guidelines to help them address immunization workforce planning, program management, and performance monitoring. Potential consequences resulting from the lack of defined competencies include inadequate or inefficient distribution of resources to support the required functions and difficulties in adequately managing the health workforce. In 2015, an international multi-agency working group convened to define standardized competencies that national immunization programs could adapt for their own workforce planning needs. The working group used a stepwise approach to ensure that the competencies would align with immunization programs’ objectives. The first step defined the attributes of a successful immunization program. The group then defined the work functions needed to achieve those attributes. Based on the work functions, the working group defined specific competencies. This process resulted in three products: (1) Attributes of an immunization program described within eight technical domains at four levels within a health system: National, Provincial, District/Local, and Community; (2) 229 distinct functions within those eight domains at each of the four levels; and (3) 242 competencies, representing eight technical domains and two foundational domains (Management and Leadership and Vaccine Preventable Diseases and Program). Currently available as a working draft and being tested with immunization projects in several countries, the final document will be published by WHO as normative guidelines. Vertical immunization programs as well as integrated systems can customize the framework to suit their needs. Standardized competencies can support immunization program improvements and help strengthen effective health systems.

Background Immunization is a significant public health achievement for the whole world, although the population’s adherence to vaccination efforts remains a concern. To address this, Brazil’s Ministry of Health introduced the concept of operational microplanning (OM) for high-quality vaccination activities (HQVA) in 2023 to ensure excellence in routine service and campaigns. OM is defined by structured interventions using assertive techniques to enhance the likelihood of covering a broader population previously unprotected from vaccine-preventable diseases. Objective To assess the adherence of states and municipalities to OM for HQVA and examine the relationship between adherence levels and increased vaccination coverage in Brazil. Methods Adopting an epidemiological approach with an ecological design, this study analyzed data on the adherence of the 27 Brazilian federative units to HQVA, as reported through the REDCap electronic form in 2023, as per an agreement with the Ministry of Health. The criteria for assessing the states’ adherence to the OM included: (1) Formation of a coordination committee for the OM for HQVA; (2) Inclusion of representatives from Primary Care in the committee; (3) Inclusion of representatives from COSEMS in the committee; (4) Regular coordination meetings between health surveillance and primary care for vaccination actions; and (5) Utilization of a management tool for decision-making and strategic planning (e.g., SWOT). Adherence levels were categorized as: 0 = High adherence (responding positively to 4 or 5 criteria); 1 = Medium adherence (3 positive responses); 2 = Low adherence (2 or fewer positive responses). For municipalities, the adherence criteria were similar, excluding the COSEMS representation and focusing on the involvement of primary care representatives. Results The findings indicated that 45.75% of municipalities achieved full adherence, implementing all the evaluated actions. Despite declaring adherence to the OM, ~ 30.68% of municipalities executed two actions, 19.27% only one, and 4.30% none. Among the states, 37.04% showed full adherence by employing all evaluated actions, with 33.33% executing four actions. States with higher adherence levels to the OM also had greater vaccination coverage (VC), particularly in 2023. Municipalities with complete adherence to the OM met the VC objectives for polio (D3), 10-valent pneumococcal (D2), and triple viral (D1) vaccines in 2023. In states with full adherence to the OM, most municipalities achieved the VC targets for all evaluated vaccines in 2023, showing statistical significance for pentavalent (D3), polio (D3), and 10-valent pneumococcal (D2) vaccines. Conclusion The findings underscore the impact of OM on improving VC in Brazil, demonstrating that its effective implementation is correlated with meeting VC targets, especially in states and municipalities that enacted all recommended actions. Municipalities engaging in all OM actions met VC objectives for crucial vaccines, highlighting the OM’s positive influence on VC. Full adherence to the OM by states correlated with a notable rise in VC averages across all analyzed vaccines. This analysis suggests that higher adherence to OM improves VC outcomes, emphasizing the role of OM in these metrics and shows that comprehensive implementation of OM improves vaccination efforts and significantly boosts VC, particularly in states fully adhering to guidelines.

Randomized, controlled trials are not always possible to evaluate interventions targeting infectious disease. This is frequently the case when evaluating the population-level impact of vaccines or when evaluating interventions aiming to increase vaccine uptake. Under such circumstances, an array of quasi-experimental designs is increasingly being used to evaluate the effects of vaccines on a wide range of morbidity and health service outcomes. These studies can provide valuable information on the impact of vaccination programs and other related interventions in real-world settings. Nevertheless, not all quasi-experimental designs are equal, and it is important that authors and readers are aware of their relative strengths and potential sources of bias. In this paper, we discuss what a quasi-experimental design is, when they might be used for vaccine evaluation, their strengths and limitations, and examples of their application.

Background Many countries have recently expanded their childhood immunisation programmes. Schools are an increasingly attractive setting for delivery of these new immunisations because of their ability to reach large numbers of children in a short period of time. However, there are organisational challenges to delivery of large-scale vaccination programmes in schools. Understanding the facilitators and barriers is important for improving the delivery of future school-based vaccination programmes. Methods We undertook a systematic review of evidence on school-based vaccination programmes in order to understand the influence of organisational factors on the delivery of programmes. Our eligibility criteria were studies that (1) focused on childhood or adolescent vaccination programmes delivered in schools; (2) considered organisational factors that influenced the preparation or delivery of programmes; (3) were conducted in a developed or high-income country; and (4) had been peer reviewed. We searched for articles published in English between 2000 and 2015 using MEDLINE and HMIC electronic databases. Additional studies were identified by searching the Cochrane Library and bibliographies. We extracted data from the studies, assessed quality and the risk of bias, and categorised findings using a thematic framework of eight organisational factors. Results We found that most of the recent published literature is from the United States and is concerned with the delivery of pandemic or seasonal flu vaccination programmes at a regional (state) or local level. We found that the literature is largely descriptive and not informed by the use of theory. Despite this, we identified common factors that influence the implementation of programmes. These factors included programme leadership and governance, organisational models and institutional relationships, workforce capacity and roles particularly concerning the school nurse, communication with parents and students, including methods for obtaining consent, and clinic organisation and delivery. Conclusions This is the first time that information has been brought together on the organisational factors influencing the delivery of vaccination programmes in school-based settings. An understanding of these factors, underpinned by robust theory-informed research, may help policy-makers and managers design and deliver better programmes. We identified several gaps in the research literature to propose a future research agenda, informed by theories of implementation and organisational change.

The use of the first pneumococcal conjugate vaccine in children, the 7-valent pneumococcal conjugate vaccine (PCV7), resulted in an important decline in vaccine serotype invasive pneumococcal disease.1 However, due to serotype replacement by serotypes not included in PCV7, the introduction of this vaccine was associated with a subsequent increase in non-vaccine serotypes.1–3 New conjugate vaccines were developed, including a 10-valent conjugate vaccine, PCV10 (including PCV7 serotypes plus ST1, ST5, ST7F), and a 13-valent vaccine, PCV13 (including PCV10 serotypes plus ST3, ST19A, ST6A). The change was a result of the equally effective rating of PCV10 and PCV13 by the National Immunization Technical Advisory Groups (NITAG); therefore, only economic factors contributed to the decision. 2 years after this decision, in 2017, we report a significant increase in the number of invasive pneumococcal disease isolates received at the National Reference Centre originating from infants aged 0–2 years; from 121 isolates in 2015, before the switch to PCV10, to 154 in 2017 (χ2; p=0·0019). In 2015, only 2% (n=2) of invasive pneumococcal disease isolates in infants were ST19A by comparison with 37% (n=57) in 2011, when it was the most important serotype.7,8 Conversely, overall, ST19A was still the third most prevalent serotype (8·3% of overall invasive pneumococcal disease isolates) causing invasive pneumococcal disease.8 Especially worrying is the fact that ST19A is one of the most antibiotic-resistant serotypes. [...]it can be speculated, that taking into account herd immunity, this switch may have an impact on the burden of pneumococcal disease in the overall population.