Explore the vast range of titles available.

Objective: To determine immunization status of children residing in urban slums of Rawalpindi and identify the barriers to immunization. Study Design: Cross sectional study. Place and Duration of Study: Slums of Takht Pari, Rawalpindi Pakistan, from Jan to Mar 2020. Methodology: Children, aged 12-23 months, residing at Takht Pari were enrolled. Two sessions of a free medical camp were arranged at Takht Pari by Department of Community Medicine, Foundation University, Islamabad. Data was collected from parents visiting the medical camp with the mother labelled as the primary respondent. Immunization cards and mother’s recall were used to assess the immunization status of children. Results: Two hundred ninety-one (72.9%) children were completely immunized, partially immunized were 106(26.6%) while 2(0.5%) were unimmunized. Three hundred eighty-eight (97.2%) children were vaccinated through government centers while those who received vaccination through private clinics were 9(2.3%). Factors associated with incomplete immunization were education of parents (p<0.001), number of children (p<0.001), gender of child (p=0.001), access to TV or Radio (p<0.001), and site of immunization (government/private) (p<0.001). Conclusion: Immunization status of 73% shows that unremitting efforts are essential for attaining universal coverage of immunization with extra attention to underprivileged areas. Planning and placement of public facilities for preventive services needs to be an urgent priority improving service utilization and enhancing coverage as people tend to follow ease of accessibility for using immunization services.  

•One out of two children missed routine immunizations during COVID-19 lockdown in Sindh.•COVID-19 lockdown disproportionately affected coverage rates across the districts.•Drop in the number of immunizations was higher in rural areas followed by urban slums.•Expanding pool of un-immunized children is bringing down herd immunity and raising the risk of vaccine-preventable disease outbreaks. COVID-19 pandemic has affected routine immunization globally. Impact will likely be higher in low and middle-income countries with limited healthcare resources and fragile health systems. We quantified the impact, spatial heterogeneity, and determinants for childhood immunizations of 48 million population affected in the Sindh province of Pakistan. We extracted individual immunization records from real-time provincial Electronic Immunization Registry from September 23, 2019, to July 11, 2020. Comparing baseline (6 months preceding the lockdown) and the COVID-19 lockdown period, we analyzed the impact on daily immunization coverage rate for each antigen by geographical area. We used multivariable logistic regression to explore the predictors associated with immunizations during the lockdown. There was a 52.5% decline in the daily average total number of vaccinations administered during lockdown compared to baseline. The highest decline was seen for Bacille Cal­mette Guérin (BCG) (40.6% (958/2360) immunization at fixed sites. Around 8438 children/day were missing immunization during the lockdown. Enrollments declined furthest in rural districts, urban sub-districts with large slums, and polio-endemic super high-risk sub-districts. Pentavalent-3 (penta-3) immunization rates were higher in infants born in hospitals (RR: 1.09; 95% CI: 1.04–1.15) and those with mothers having higher education (RR: 1.19–1.50; 95% CI: 1.13–1.65). Likelihood of penta-3 immunization was reduced by 5% for each week of delayed enrollment into the immunization program. One out of every two children in Sindh province has missed their routine vaccinations during the provincial COVID-19 lockdown. The pool of un-immunized children is expanding during lockdown, leaving them susceptible to vaccine-preventable diseases. There is a need for tailored interventions to promote immunization visits and safe service delivery. Higher maternal education, facility-based births, and early enrollment into the immunization program continue to show a positive association with immunization uptake, even during a challenging lockdown.

Background The National Expanded Program on Immunization in the Democratic Republic of the Congo implemented a program in 9 Provinces to generate georeferenced immunization microplans to strengthen the planning and implementation of vaccination services. The intervention aimed to improve identification and immunization of zero-dose children and overall immunization coverage. Methods This study applies a mixed-methods design including survey tools, in-depth interviews and direct observation to document the uptake, use, and acceptance of the immunization microplans developed with geospatial data in two intervention provinces and one control province from February to June 2023. A total of 113 health facilities in 98 Health Areas in 15 Health Zones in the three provinces were included in the study sample. Select providers received training on gender-intentional approaches for the collection and use of geospatial data which was evaluated through a targeted qualitative study. A secondary analysis of immunization coverage survey data (2020–2022) was conducted to assess the associated effects on immunization coverage, especially changes in rates of zero dose children, defined as those aged 12–23 months who have not received a single dose of Pentavalent vaccine. Results This research study shows that georeferenced microplans are well received, utilized, and led to changes in routine immunization service planning and delivery. In addition, the gender intervention is perceived to have led to changes in the approaches taken to overcome sociocultural gender norms and engage communities to reach as many children as possible, leveraging the ability of women to engage more effectively to support vaccination services. The quantitative analyses showed that georeferenced microplans may have contributed to a dramatic and sustained trend of high immunization coverage in the intervention site of Haut-Lomami, which saw dramatic improvement in coverage for 3 antigens and little change in Pentavalent drop-out rate over three years of implementation. Conclusion The overall study identified positive contributions of the georeferenced data in the planning and delivery of routine immunization services. It is recommended to conduct further analyses in Kasai in 2024 and 2025 to evaluate the longer-term effects of the gender intervention on immunization coverage and equity outcomes. Trial registration The study was registered and given BMC Central International Standard. Randomised Controlled Trial Number ISRCTN65876428 on March 11, 2021.

There is widespread concern that disruption to health services during the COVID-19 pandemic has led to declines in immunization coverage among young children, but there is limited information on the magnitude of such impact. High immunization coverage is essential for reducing the risk of vaccine preventable diseases. We used data from two nationwide sources covering the whole of Brazil. Data from the Information System of the National Immunization Program (SIPNI) on the monthly number of vaccine doses administered to young children were analyzed. The second source was a survey in 133 large cities in the 27 states in the country, carried out from August 24–27. Respondents answered a question on whether children under the age of three years had missed any scheduled vaccinations during the pandemic, and available vaccination cards were photographed for later examination. SIPNI data showed that, relative to January and February 2020, there was a decline of about 20% in vaccines administered to children aged two months or older during March and April, when social distancing was at the highest level in the country. After May, vaccination levels returned to pre-pandemic values. Survey data, based on the interviews and on examination of the vaccine cards, showed that 19.0% (95% CI 17.0;21.1%) and 20.6% (95% CI 19.0;23.1%) of children, respectively, had missed immunizations. Missed doses were most common in the North (Amazon) region and least common in the South and Southeast, and also more common among children from poor than from wealthy families. Our results show that the pandemic was associated with a reduction of about 20% in child vaccinations, but this was reverted in recent months. Children from poor families and from the least developed regions of the country were most affected. There is an urgent need to booster immunization activities in the country to compensate for missed doses, and to reduce geographic and socioeconomic inequalities.

The COVID-19 pandemic has caused a disruption in childhood immunization coverage around the world. This study aimed to determine the change in immunization coverage for children under 2 years old in Ontario, Canada, comparing time periods pre-pandemic to during the first year of the pandemic. Observational retrospective open cohort study, using primary care electronic medical record data from the University of Toronto Practice-Based Research Network (UTOPIAN) database, from January 2019 to December 2020. Children under 2 years old who had at least 2 visits recorded in UTOPIAN were included. We measured up-to-date (UTD) immunization coverage rates, overall and by type of vaccine (DTaP-IPV-Hib, PCV13, Rota, Men-C-C, MMR, Var), and on-time immunization coverage rates by age milestone (2, 4, 6, 12, 15, 18 months). We compared average coverage rates over 3 periods of time: January 2019-March 2020 (T1); March-July 2020 (T2); and August-December 2020 (T3). 12,313 children were included. Overall UTD coverage for all children was 71.0% in T1, dropped by 5.7% (95% CI: −6.2, −5.1) in T2, slightly increased in T3 but remained lower than in T1. MMR vaccine UTD coverage slightly decreased in T2 and T3 by approximately 2%. The largest decreases were seen at ages 15-month and 18-month old, with drops in on-time coverage of 14.7% (95% CI: −18.7, −10.6) and 16.4% (95% CI: −20.0, −12.8) respectively during T2. When stratified by sociodemographic characteristics, no specific subgroup of children was found to have been differentially impacted by the pandemic. Childhood immunization coverage rates for children under 2 years in Ontario decreased significantly during the early period of the COVID-19 pandemic and only partially recovered during the rest of 2020. Public health and educational interventions for providers and parents are needed to ensure adequate catch-up of delayed/missed immunizations to prevent potential outbreaks of vaccine-preventable diseases.

Together with access, acceptance of vaccines affects human papillomavirus (HPV) vaccine coverage, yet little is known about media’s role. Our aim was to determine whether measures of information exposure derived from Twitter could be used to explain differences in coverage in the United States. We conducted an analysis of exposure to information about HPV vaccines on Twitter, derived from 273.8 million exposures to 258,418 tweets posted between 1 October 2013 and 30 October 2015. Tweets were classified by topic using machine learning methods. Proportional exposure to each topic was used to construct multivariable models for predicting state-level HPV vaccine coverage, and compared to multivariable models constructed using socioeconomic factors: poverty, education, and insurance. Outcome measures included correlations between coverage and the individual topics and socioeconomic factors; and differences in the predictive performance of the multivariable models. Topics corresponding to media controversies were most closely correlated with coverage (both positively and negatively); education and insurance were highest among socioeconomic indicators. Measures of information exposure explained 68% of the variance in one dose 2015 HPV vaccine coverage in females (males: 63%). In comparison, models based on socioeconomic factors explained 42% of the variance in females (males: 40%). Measures of information exposure derived from Twitter explained differences in coverage that were not explained by socioeconomic factors. Vaccine coverage was lower in states where safety concerns, misinformation, and conspiracies made up higher proportions of exposures, suggesting that negative representations of vaccines in the media may reflect or influence vaccine acceptance.

The operational definition of the Sustainable Development Goal (SDG) immunization indicator encompasses coverage with full courses of diphtheria-tetanus-pertussis (DPT3), pneumococcal (PCV3), measles (MCV2), and human papillomavirus (HPV) vaccines. We assessed the feasibility of using publicly available national survey data to measure this using a summary co-coverage indicator. Due to lack of data on adolescent HPV vaccine coverage, HPV was excluded from the indicator. While 88 national surveys provided data on child immunizations since 2015, only 33 were suitable for calculating co-coverage—the receipt of all three child vaccines (DPT3, PCV3, and MCV2) by 36 months of age. Co-coverage ranged widely from 6.1 % in Ethiopia to 90.2 % in Rwanda. Because co-coverage requires that children receive all three vaccines, its median level of 60.2 % was 16 percentage points lower than the median for the country-specific average of the same vaccines. Socioeconomic and urban-rural inequalities in co-coverage were observed in most countries, with wider inequalities associated with co-coverage than average coverage. Ecological analyses revealed a strong correlation between co-coverage and existing summary measures based on WHO and UNICEF estimates. These findings show a critical need for more frequent and comprehensive national surveys, particularly for adolescent populations, to enable accurate monitoring of immunization along the life-course as intended by the SDG framework. Given current funding constraints for population-based surveys, reliance on administrative data for coverage monitoring is likely to continue.

Immunization coverage across numerous African nations has, unfortunately, shown little improvement and, in some cases, has even decreased over the past decade, leaving millions of children vulnerable to vaccine-preventable diseases. While efforts to improve immunization performance have primarily focused on the health system, effective delivery of immunization services is intricately linked to a country's governance, which, in this context, reflects a government's ability to provide comprehensive services to its citizens. This study investigated the relationship between governance, measured using the Mo Ibrahim Index for African Governance, and the trajectory of immunization coverage for three vaccines in 54 African countries from 2012 to 2021. We conducted an ecological study utilizing publicly available datasets, the WHO/UNICEF estimates of National Immunization Coverage and the Ibrahim Index of African Governance score (IIAG). We described the trends in routine immunization performance, evaluated and assessed the impact of governance on immunization coverage across 54 African countries for the period 2012 to 2021, using linear mixed models and focusing on three vaccines provided through the Expanded Program on Immunization (DTPCV1, DTPCV3, and MCV1). Among the 54 African countries studied, 32 (59.3 %) witnessed an overall decrease (slope of change in immunization coverage over time < 0) in immunization coverage, with 16 (29.6 %) experiencing a significant decline (slope of change significantly different from zero (P < 0.05)) in coverage. For DTPCV3, 31 countries (57.4 %) demonstrated a decline in coverage, with 12 (22.2 %) being significant declines. Thirty-two countries (59.2 %) reported a decrease in MCV1 coverage over the analysis period, with 17 (31.5 %) significant. Across all three antigens, the IIAG overall score was positively associated with immunization coverage over time. One unit increase in the IIAG score correlated with an average annual increase of 0.64 (95 % CI: 0.35–0.93) percentage points in DTPCV1 coverage, 0.74 percentage points (95 % CI: 0.42–1.07) in DTPCV3 coverage, and 0.60 (95 % CI: 0.30–0.91) percentage points in MCV1 coverage. These findings suggest that an African country with an average IIAG score just one unit higher than their observed average value over the study period, would have achieved a 6.4 %, 7.4 %, and 6.0 % coverage for DTPCV1, DTPCV3, and MCV1, respectively, above its 2021 coverage levels. The Expanded Program on Immunization aspires to reach all eligible populations with life-saving vaccines, regardless of the context. We found that country governance may be an important determinant of immunization performance, potentially explaining the observed stagnation or decline in immunization performance and the heightened vulnerability of immunization programs to external shocks. Understanding the nexus between governance and service delivery suggests that immunization actors, funders, and other stakeholders may need to adjust their expectations of countries' immunization performance accordingly.

Donor assistance for immunization has remained resilient with increased resource mobilization efforts in recent years to achieve current global coverage targets. As a result, more countries continue to introduce new vaccines while optimizing coverage for traditional vaccines. Gavi the Vaccine Alliance has been at the forefront of immunization support specifically among low and middle income countries, alongside other channels of development assistance which continue to play a vital role in immunization. Using available recipient country level data from 1996 to 2016, we estimate the impact of Gavi support for vaccines and health systems strengthening on vaccine coverage for 3 dose DPT, 3 dose pneumococcal conjugate vaccine, 3 dose pentavalent, 2 dose measles and 2 dose rotavirus vaccines. We investigate the same effects of total aid for immunization from other channels of development assistance. Standard time series cross sectional analysis methods are applied to investigate the effects of vaccine support controlling for country income, governance and population, with robustness tests implemented using different model specifications. Double counting was eliminated and results are presented in real 2017 US dollars. We found significant positive effects of aid particularly among the newer vaccines. Using 2016 country specific disbursements and coverage levels as baseline, we estimated that among recipient countries below the universal target, additional DAH per capita required to reach 90%, ranged from 0.01USD to 4.33USD for PCV, 0.03USD to 9.06USD for pentavalent vaccine and 0.01USD to 2.57USD for rotavirus vaccine. The estimated number of children vaccinated through 2016, attributable to Gavi support totaled 46.6million, 75.2million and 12.3million for PCV, pentavalent and rotavirus vaccines respectively. Our analysis suggests substantial success both from a historical and prospective perspective in the implementation of global immunization initiatives thus far. As more vaccines are rolled out and countries transition from donor aid, strategies for fiscal sustainability and efficiency need to be strengthened in order to achieve universal immunization coverage.

Measles remains a leading vaccine-preventable killer in low- and middle-income countries (LMICs). Using the WHO/UNICEF Estimates of National Immunization Coverage (WUENIC) 2024 revisions, this article assesses measles-containing vaccine first-dose (MCV1) and second-dose (MCV2) coverage trends, inequities, and priority groups for targeted action. Data from 2019 to 2024 for 137 LMICs were analysed using descriptive statistics; Welch's t-tests and Wilcoxon rank-sum tests to compare fragile versus non-fragile states; Gini coefficients for inequality; k-means clustering (k = 4) on coverage, MCV1-to-MCV2 dropout, change, unvaccinated counts, and fragility; and bounded linear models to project MCV1 to 2030. In 2024, mean MCV1 coverage was 79.2% (95% CI: 76.8–81.6)—below the 95% threshold—with fragile LMICs at 68.5% versus 87.4% in non-fragile LMICs (difference − 18.1 percentage points; p < 0.001). MCV2 gaps were larger (−26.9 percentage points; p < 0.001). DTP1-based zero-dose prevalence was 20.8%, with 15.6 million children unvaccinated for MCV1 and 22.4 million for MCV2; West and Central Africa accounted for 7.2 million MCV1-unvaccinated (46.2%). Inequality rose (Gini 0.22 → 0.25, 2019–2024). Projections indicate MCV1 of 84.2% by 2030, with fragile LMICs off-track. Clustering identified four profiles: (1) very low coverage, high dropout, high fragility (22 countries); (2) high coverage, low dropout (44); (3) low coverage, severe dropout (31); and (4) low coverage, moderate dropout (40), each implying distinct priorities (conflict-adapted SIAs; sustaining gains; follow-up campaigns; expanding first-dose access). Persistent and widening measles immunization gaps—especially in fragile settings—threaten IA2030's 90% coverage targets. Pairing the 2024 WUENIC revision with fragility-sensitive clustering and bounded projections provides a practical framework to prioritize equity-focused funding and operational strategies where need is greatest.