BACKGROUND Patients with diabetes mellitus(DM)are predisposed to an increased risk of infection signifying the importance of vaccination to protect against its potentially severe complications.The Centers for Disease ...BACKGROUND Patients with diabetes mellitus(DM)are predisposed to an increased risk of infection signifying the importance of vaccination to protect against its potentially severe complications.The Centers for Disease Control and Prevention/Advisory Committee on Immunization Practices(CDC/ACIP)issued immunization recommendations to protect this patient population.AIM To assess the adherence of patients with DM to the CDC/ACIP immunization recommendations in Saudi Arabia and to identify the factors associated with the vaccine adherence rate.METHODS An observational retrospective study conducted in 2023 was used to collect data on the vaccination records from 13 diabetes care centers in Saudi Arabia with 1000 eligible patients in phase I with data collected through chart review and 709 patients in phase II through online survey.RESULTS Among participants,10.01%(n=71)had never received any vaccine,while 85.89%(n=609)received at least one dose of the coronavirus disease 2019(COVID-19)vaccine,and 34.83%(n=247)had received the annual influenza vaccine.Only 2.96%(n=21),2.11%(n=15),and 1.12%(n=8)received herpes zoster,tetanus,diphtheria,and pertussis(Tdap),and human papillomavirus(HPV)vaccines,respectively.For patients with DM in Saudi Arabia,the rate of vaccination for annual influenza and COVID-19 vaccines was higher compared to other vaccinations such as herpes zoster,Tdap,pneumococcal,and HPV.Factors such as vaccine recommendations provided by family physicians or specialists,site of care,income level,DM-related hospitalization history,residency site,hemoglobin A1c(HbA1c)level,and health sector type can significantly influence the vaccination rate in patients with DM.Among non-vaccinated patients with DM,the most reported barriers were lack of knowledge and fear of side effects.This signifies the need for large-scale research in this area to identify additional factors that might facilitate adherence to CDC/ACIP vaccine recommendations in patients with DM.CONCLUSION In Saudi Arabia,patients with DM showed higher vaccination rates for annual influenza and COVID-19 vaccines compared to other vaccinations such as herpes zoster,Tdap,pneumococcal,and HPV.Factors such as vaccine recommendations provided by family physicians or specialists,the site of care,income level,DM-related hospitalization history,residency site,HbA1c level,and health sector type can significantly influence the vaccination rate in patients with DM.展开更多
Introduction: As new vaccines become available, countries must assess the relevance to introduce them into their vaccination schedules. Malawi has recently introduced several new vaccines and plans to introduce more. ...Introduction: As new vaccines become available, countries must assess the relevance to introduce them into their vaccination schedules. Malawi has recently introduced several new vaccines and plans to introduce more. This study was conducted to identify key factors that need to be considered when deciding to introduce a new vaccine and current challenges faced by low and middle income countries using Malawi as an example. Methodology: The study employed a desk review approach, examining published literature from various sources such as PubMed, Medline, and Google Scholar. Policy documents from organizations like the World Health Organization, GAVI the Alliance, and the Ministry of Health for Malawi were also included. A total of 99 articles and documents on new vaccine introduction, challenges of immunization, policy documents in immunization and health systems strengthening were included. The review focused on addressing five key areas critical to new vaccine introduction namely: the need for a vaccine, availability of the vaccine, safety and effectiveness of the vaccine, demand for the vaccine, and the prudent use of public or private funds. Results: Malawi considered the burden of cervical cancer and the significance of malaria in the country when introducing the HPV and malaria vaccines. The country opted for vaccines that can be handled by the cold chain capacity and available human resources. Despite that malaria vaccine and Typhoid Conjugate Vaccine trials were done in country, there are limited vaccine safety and efficacy trials conducted in Malawi, leading to a reliance on WHO-prequalified vaccines. Demand for newly introduced vaccines varied, with high demand for Oral Cholera Vaccine during a cholera outbreak, while demand for COVID-19 vaccines decreased over time. Although cost-effectiveness studies were limited in the country, 2 studies indicated that Typhoid Conjugate Vaccine and malaria vaccine would be cost effective. All these have been implemented despite having challenges like lack of accurate surveillance data, inadequate cold chain capacity, limited safety and efficacy vaccine clinical trials, political influence, and limited funding. Conclusion: Despite several challenges Malawi set a good example of the careful considerations required before introducing a new vaccine. The process involves data review, priority setting, precise planning, and consultation with stakeholders. Low-income countries should invest in vaccine safety, efficacy, and cost-effectiveness trials.展开更多
BACKGROUND Immunization is a key component of primary health care and an indisputable human right.Vaccines are critical to the prevention and control of infectious disease outbreaks.The coronavirus disease 2019(COVID-...BACKGROUND Immunization is a key component of primary health care and an indisputable human right.Vaccines are critical to the prevention and control of infectious disease outbreaks.The coronavirus disease 2019(COVID-19)pandemic and associated disruptions over the past two years have strained the health systems,with many children missing out on essential childhood vaccines.AIM To evaluate the immunization coverage among 12-23-month-old children in the rural areas of Community Health Centre(CHC)Dighal and to determine the factors influencing the existing immunization coverage.METHODS A coverage evaluation survey was conducted according to the 30-cluster sampling technique,which is the standard methodology for such surveys devised by World Health Organization.A total of 300 children aged 12-23 months were included,whose immunization details were noted from their immunization cards.RESULTS Full immunization rate was noted in 86.7%of the children,with partial and non-immunized children accounting for 9%and 4.3%respectively.The full immunization dropout rate was 4.2%.The common reasons for partial or non-immunization were family problem including illness of mother,vaccine not being available and child being ill.Place of birth(P=0.014)and availability of immunization card(P<0.001)were significant predictors of the immunization status.Since the study was conducted in 2020/2021,health services were disrupted due to the COVID-19 lockdown.CONCLUSION Due to the coverage being higher than the national average,it was concluded that the immunization coverage was optimal and not affected by the COVID-19 pandemic.展开更多
Objective:To explore the changes in the epidemiological characteristics of varicella before and after implementing the two-dose varicella vaccine(VarV)immunization program in the Banan District of Chongqing and to pro...Objective:To explore the changes in the epidemiological characteristics of varicella before and after implementing the two-dose varicella vaccine(VarV)immunization program in the Banan District of Chongqing and to provide a reference for future epidemic prevention and control.Methods:The data of reported varicella cases in Banan District from 2014 to 2023 were collected and analyzed using the China Disease Prevention and Control Information System.Descriptive epidemiological methods were employed to assess the changes in the reported incidence of varicella before(2014-2018)and after(2019-2023)the implementation of the two-dose VarV immunization program.Results:The average annual reported incidence rate of varicella in Banan District from 2014 to 2023 was 81.53 per 100,000.From 2014 to 2018,the reported incidence rate showed an upward trend year by year(trend x2=223.96,P<0.05).However,the reported incidence rate decreased from 2019 to 2023(trend x?=189.51,P<0.05).Before and after the adjustment of the immunization program,the reported incidence rate for the 5-9 years old group was 774.62 per 100,000 and 476.98 per 100,000,respectively,with a statistically significant difference(x2=161.26,P<0.05).The onset of varicella showed a bimodal distribution,with peak incidence periods in May-June and October-December.From 2014 to 2023,a total of 155,181 doses of VarV were administered in Banan District.The estimated annual vaccination rate for the first varicella vaccine(VarV1)from 2019 to 2023 was 86.28%,and for the second dose(VarV2)was 59.18%.The primary vaccination targets were the 5-9-year-old group,accounting for 64.21%.Conclusion:After implementing the two-dose VarV immunization program in Banan District,the vaccination rate increased yearly,and the reported incidence of varicella showed a downward trend.The incidence rate of varicella in children aged 5-9 years reduced significantly,but the overall downward trend for the entire population was not as pronounced.Therefore,it is necessary to increase the vaccination rate of VarV2.展开更多
Silkworm pupa is a nourishing food with high nutritional value,but its consumption has been greatly limited given its allergenicity.Enzyme hydrolytic technique is recognized as an effective method to reduce the allerg...Silkworm pupa is a nourishing food with high nutritional value,but its consumption has been greatly limited given its allergenicity.Enzyme hydrolytic technique is recognized as an effective method to reduce the allergenicity of protein.In this study,we aimed to investigate the effect of enzymolysis on the allergenicity of silkworm pupa.Crude silkworm pupa protein was extracted through alkali extraction and acid precipitation,which included 5 proteins with the molecular weights ranging from 34 kDa to 76 kDa,and silkworm pupa were then hydrolyzed by alkaline protease.The allergenicity of silkworm pupa protein and its enzymatic hydrolysates was evaluated by establishing BALB/c mice model,and the mice were immunized via intragastric gavage and intraperitoneal injection,respectively.The results indicated that the intraperitoneal inj ection immunization route induced more by detecting with antibodies,histamine and Th2-related cytokines.Moreover,mice treated with silkworm pupa protein peptide displayed no obvious allergic symptoms,indicating that enzyme hydrolytic technique could significantly reduce the allergenicity of silkworm pupa.展开更多
Objective:To access the level of knowledge,perceptions,and practice towards adverse events following immunization(AEFI)surveillance among vaccination workers in Zhejiang province,China.Methods:This was a cross-section...Objective:To access the level of knowledge,perceptions,and practice towards adverse events following immunization(AEFI)surveillance among vaccination workers in Zhejiang province,China.Methods:This was a cross-sectional survey involving 768 vaccination workers.Data were collected using self-administered questionnaires and analyzed by using SAS 9.3 software.Knowledge,perceptions,and practice on AEFI surveillance were summarized using frequency tables.The mean±SD value was used as the cut-off for defining good(values≥mean)and poor(values<mean)knowledge,perceptions or practice.Binary logistic regression analysis was used to determine sociodemographic variables associated with knowledge,perceptions,and practice towards AEFI.Results:The proportions of good knowledge,perceptions and practice on AEFI surveillance were 78.13%,57.81%and 66.15%,respectively.Having a higher education background,longer years of experience,previous training on AEFI and≥30 years of age were factors associated with good knowledge,perceptions and practice on AEFI surveillance among vaccination workers.Conclusions:Over half of the respondents had good knowledge,perceptions and practice on AEFI surveillance work.Interventions on improving the vaccination workers’knowledge,perceptions and practice on AEFI surveillance should be considered in order to develop a more effective surveillance system.展开更多
Background: the hepatitis B virus infection remains a major public health problem worldwide. It can lead to a liver cirrhosis and/or hepatocellular carcinoma. The World Health Organisation (WHO) has recommended the im...Background: the hepatitis B virus infection remains a major public health problem worldwide. It can lead to a liver cirrhosis and/or hepatocellular carcinoma. The World Health Organisation (WHO) has recommended the implementation of generalised vaccination programs against hepatitis B. In Cameroon, this vaccine was introduced in the expanded program on immunization (EPI) in 2005, but few studies have assessed the immune response. Objective: the general objective of this study was to identify factors associated with antibody levels among children aged from 15 to 59 months vaccinated against hepatitis B during the EPI in Cameroon. Method: this was a cross-sectional study carried out from December 2021 to June 2022 in a paediatric centre of Yaoundé (Cameroon). We analysed the antibody level in children vaccinated against hepatitis B within the framework of the EPI. We enrolled children who had received a series of 3 intramuscular doses of hepatitis B vaccine at 6, 10 and 14 weeks after birth. Some children could receive a 4<sup>th</sup> booster dose between 12 months. The antibody level was assessed by measuring the anti-HBs in such children, aged 15 - 59 months. A good immunization was defined as a serum level of anti-HBs antibody level above 100 IU/mL;a poor immunization, for an anti-HBs antibody level between 10 and 100 IU/mL;and a non-immunization, for an anti-HBs antibody level < 10 IU/mL. Association between explored factors and poor or non-immunization was evaluated through the Chi square test. The significance threshold was defined at p < 0.05. Results: sixty subjects were included in the study with a slight female majority: 31 cases (52%). The average age was 38.5 ± 15.7 months (range 15 - 59 months). We found 32 (53%) cases of good immunization;21 (35%) of poor immunization;and 7 children (12%) with a non-immunization. The only factor associated with poor or non-immunization was the age between 37 - 59 months (p = 0.016). Conclusion: Anti HBs Antibody levels in children vaccinated against hepatitis B virus were globally satisfactory in our series. Results show an association between low antibody levels with older age (over 36 months), suggesting a circulating antibodies levels decrease over time, yet deemed protecting until 59 months.展开更多
Sirmaur district in the state of Himachal Pradesh in India is a hard-to-reach area situated in the western Himalayas having an extreme landscape with snow-laden mountains and extensive river systems that makes the del...Sirmaur district in the state of Himachal Pradesh in India is a hard-to-reach area situated in the western Himalayas having an extreme landscape with snow-laden mountains and extensive river systems that makes the delivery of immunization services extremely challenging. Vaccinators needed a long walk through the hilly terrain to reach outreach sites. Community mobilizers were unable to go house to house to inform the caregivers to bring children to the site for vaccination. Caregivers were unaware when the vaccinators arrive at the site. As a result, many children missed vaccination or were not vaccinated timely. Age-appropriate vaccination coverage (according to national immunization schedule) in the Sirmaur district was the lowest in the state. Thinking out-of-box to address the communication barriers with the caregivers, the traditional drum beating was used, for the first time in India, in two blocks of the Sirmaur district (Rajpura and Shillai). The initiative was planned and implemented by the district health system with the support of the local community leaders. An exit interview was conducted to know the reach of the drum beating to caregivers, and a baseline and end line household survey was conducted to know the outcome of the initiative on age-appropriate vaccination coverage. Analysis of exit interviews data indicated a very high reach of a drum beating to the caregivers;more than 97% of caregivers in Rajpura and 100% in Shillai heard drum beating, and almost 95% of caregivers in Rajpura and 98% in Shillai knew the purpose of drum beating. Analysis of immunization data from baseline and end line surveys showed improvement in age-appropriate vaccination coverage for all vaccines in Rajpura (by 2.2% for BCG, 15.3% for Pentavalent 1, 14.9% for Pentavalent 2, 14.1% for Pentavalent 3, and 6.5% for Measles/MR). In Shillai, age-appropriate vaccination coverage improved for Pentavalent 1 (by 3.4%), Pentavalent 2 (by 5%) and Measles/MR (by 1.7%). In addition, dropout rates were reduced in both the blocks, particularly in Rajpura Pentavalent 1 to Measles dropout rate was reduced by 13.5%. Both health workers and community leaders had positive perceptions of the drum beating initiative. However, another important lesson learned from the initiative was that both the access and demand-side barriers need to be addressed for the desired improvement of age-appropriate immunization coverage. In Shillai, there was lower coverage improvement and a reduction in dropout rates attributed to vacant positions of vaccinators that caused an issue with access to immunization services to people.展开更多
文摘BACKGROUND Patients with diabetes mellitus(DM)are predisposed to an increased risk of infection signifying the importance of vaccination to protect against its potentially severe complications.The Centers for Disease Control and Prevention/Advisory Committee on Immunization Practices(CDC/ACIP)issued immunization recommendations to protect this patient population.AIM To assess the adherence of patients with DM to the CDC/ACIP immunization recommendations in Saudi Arabia and to identify the factors associated with the vaccine adherence rate.METHODS An observational retrospective study conducted in 2023 was used to collect data on the vaccination records from 13 diabetes care centers in Saudi Arabia with 1000 eligible patients in phase I with data collected through chart review and 709 patients in phase II through online survey.RESULTS Among participants,10.01%(n=71)had never received any vaccine,while 85.89%(n=609)received at least one dose of the coronavirus disease 2019(COVID-19)vaccine,and 34.83%(n=247)had received the annual influenza vaccine.Only 2.96%(n=21),2.11%(n=15),and 1.12%(n=8)received herpes zoster,tetanus,diphtheria,and pertussis(Tdap),and human papillomavirus(HPV)vaccines,respectively.For patients with DM in Saudi Arabia,the rate of vaccination for annual influenza and COVID-19 vaccines was higher compared to other vaccinations such as herpes zoster,Tdap,pneumococcal,and HPV.Factors such as vaccine recommendations provided by family physicians or specialists,site of care,income level,DM-related hospitalization history,residency site,hemoglobin A1c(HbA1c)level,and health sector type can significantly influence the vaccination rate in patients with DM.Among non-vaccinated patients with DM,the most reported barriers were lack of knowledge and fear of side effects.This signifies the need for large-scale research in this area to identify additional factors that might facilitate adherence to CDC/ACIP vaccine recommendations in patients with DM.CONCLUSION In Saudi Arabia,patients with DM showed higher vaccination rates for annual influenza and COVID-19 vaccines compared to other vaccinations such as herpes zoster,Tdap,pneumococcal,and HPV.Factors such as vaccine recommendations provided by family physicians or specialists,the site of care,income level,DM-related hospitalization history,residency site,HbA1c level,and health sector type can significantly influence the vaccination rate in patients with DM.
文摘Introduction: As new vaccines become available, countries must assess the relevance to introduce them into their vaccination schedules. Malawi has recently introduced several new vaccines and plans to introduce more. This study was conducted to identify key factors that need to be considered when deciding to introduce a new vaccine and current challenges faced by low and middle income countries using Malawi as an example. Methodology: The study employed a desk review approach, examining published literature from various sources such as PubMed, Medline, and Google Scholar. Policy documents from organizations like the World Health Organization, GAVI the Alliance, and the Ministry of Health for Malawi were also included. A total of 99 articles and documents on new vaccine introduction, challenges of immunization, policy documents in immunization and health systems strengthening were included. The review focused on addressing five key areas critical to new vaccine introduction namely: the need for a vaccine, availability of the vaccine, safety and effectiveness of the vaccine, demand for the vaccine, and the prudent use of public or private funds. Results: Malawi considered the burden of cervical cancer and the significance of malaria in the country when introducing the HPV and malaria vaccines. The country opted for vaccines that can be handled by the cold chain capacity and available human resources. Despite that malaria vaccine and Typhoid Conjugate Vaccine trials were done in country, there are limited vaccine safety and efficacy trials conducted in Malawi, leading to a reliance on WHO-prequalified vaccines. Demand for newly introduced vaccines varied, with high demand for Oral Cholera Vaccine during a cholera outbreak, while demand for COVID-19 vaccines decreased over time. Although cost-effectiveness studies were limited in the country, 2 studies indicated that Typhoid Conjugate Vaccine and malaria vaccine would be cost effective. All these have been implemented despite having challenges like lack of accurate surveillance data, inadequate cold chain capacity, limited safety and efficacy vaccine clinical trials, political influence, and limited funding. Conclusion: Despite several challenges Malawi set a good example of the careful considerations required before introducing a new vaccine. The process involves data review, priority setting, precise planning, and consultation with stakeholders. Low-income countries should invest in vaccine safety, efficacy, and cost-effectiveness trials.
文摘BACKGROUND Immunization is a key component of primary health care and an indisputable human right.Vaccines are critical to the prevention and control of infectious disease outbreaks.The coronavirus disease 2019(COVID-19)pandemic and associated disruptions over the past two years have strained the health systems,with many children missing out on essential childhood vaccines.AIM To evaluate the immunization coverage among 12-23-month-old children in the rural areas of Community Health Centre(CHC)Dighal and to determine the factors influencing the existing immunization coverage.METHODS A coverage evaluation survey was conducted according to the 30-cluster sampling technique,which is the standard methodology for such surveys devised by World Health Organization.A total of 300 children aged 12-23 months were included,whose immunization details were noted from their immunization cards.RESULTS Full immunization rate was noted in 86.7%of the children,with partial and non-immunized children accounting for 9%and 4.3%respectively.The full immunization dropout rate was 4.2%.The common reasons for partial or non-immunization were family problem including illness of mother,vaccine not being available and child being ill.Place of birth(P=0.014)and availability of immunization card(P<0.001)were significant predictors of the immunization status.Since the study was conducted in 2020/2021,health services were disrupted due to the COVID-19 lockdown.CONCLUSION Due to the coverage being higher than the national average,it was concluded that the immunization coverage was optimal and not affected by the COVID-19 pandemic.
文摘Objective:To explore the changes in the epidemiological characteristics of varicella before and after implementing the two-dose varicella vaccine(VarV)immunization program in the Banan District of Chongqing and to provide a reference for future epidemic prevention and control.Methods:The data of reported varicella cases in Banan District from 2014 to 2023 were collected and analyzed using the China Disease Prevention and Control Information System.Descriptive epidemiological methods were employed to assess the changes in the reported incidence of varicella before(2014-2018)and after(2019-2023)the implementation of the two-dose VarV immunization program.Results:The average annual reported incidence rate of varicella in Banan District from 2014 to 2023 was 81.53 per 100,000.From 2014 to 2018,the reported incidence rate showed an upward trend year by year(trend x2=223.96,P<0.05).However,the reported incidence rate decreased from 2019 to 2023(trend x?=189.51,P<0.05).Before and after the adjustment of the immunization program,the reported incidence rate for the 5-9 years old group was 774.62 per 100,000 and 476.98 per 100,000,respectively,with a statistically significant difference(x2=161.26,P<0.05).The onset of varicella showed a bimodal distribution,with peak incidence periods in May-June and October-December.From 2014 to 2023,a total of 155,181 doses of VarV were administered in Banan District.The estimated annual vaccination rate for the first varicella vaccine(VarV1)from 2019 to 2023 was 86.28%,and for the second dose(VarV2)was 59.18%.The primary vaccination targets were the 5-9-year-old group,accounting for 64.21%.Conclusion:After implementing the two-dose VarV immunization program in Banan District,the vaccination rate increased yearly,and the reported incidence of varicella showed a downward trend.The incidence rate of varicella in children aged 5-9 years reduced significantly,but the overall downward trend for the entire population was not as pronounced.Therefore,it is necessary to increase the vaccination rate of VarV2.
基金supported by Special Project on the Integration of Industry,Education and Research of Guangdong Provine(2013B090600060)National Key R&D Program of China(2018YFC1604205)National Natural Science Foundation of China(31760431)。
文摘Silkworm pupa is a nourishing food with high nutritional value,but its consumption has been greatly limited given its allergenicity.Enzyme hydrolytic technique is recognized as an effective method to reduce the allergenicity of protein.In this study,we aimed to investigate the effect of enzymolysis on the allergenicity of silkworm pupa.Crude silkworm pupa protein was extracted through alkali extraction and acid precipitation,which included 5 proteins with the molecular weights ranging from 34 kDa to 76 kDa,and silkworm pupa were then hydrolyzed by alkaline protease.The allergenicity of silkworm pupa protein and its enzymatic hydrolysates was evaluated by establishing BALB/c mice model,and the mice were immunized via intragastric gavage and intraperitoneal injection,respectively.The results indicated that the intraperitoneal inj ection immunization route induced more by detecting with antibodies,histamine and Th2-related cytokines.Moreover,mice treated with silkworm pupa protein peptide displayed no obvious allergic symptoms,indicating that enzyme hydrolytic technique could significantly reduce the allergenicity of silkworm pupa.
基金funded by medical and health science and technology project of Zhejiang province (Grant number:2023KY633)
文摘Objective:To access the level of knowledge,perceptions,and practice towards adverse events following immunization(AEFI)surveillance among vaccination workers in Zhejiang province,China.Methods:This was a cross-sectional survey involving 768 vaccination workers.Data were collected using self-administered questionnaires and analyzed by using SAS 9.3 software.Knowledge,perceptions,and practice on AEFI surveillance were summarized using frequency tables.The mean±SD value was used as the cut-off for defining good(values≥mean)and poor(values<mean)knowledge,perceptions or practice.Binary logistic regression analysis was used to determine sociodemographic variables associated with knowledge,perceptions,and practice towards AEFI.Results:The proportions of good knowledge,perceptions and practice on AEFI surveillance were 78.13%,57.81%and 66.15%,respectively.Having a higher education background,longer years of experience,previous training on AEFI and≥30 years of age were factors associated with good knowledge,perceptions and practice on AEFI surveillance among vaccination workers.Conclusions:Over half of the respondents had good knowledge,perceptions and practice on AEFI surveillance work.Interventions on improving the vaccination workers’knowledge,perceptions and practice on AEFI surveillance should be considered in order to develop a more effective surveillance system.
文摘Background: the hepatitis B virus infection remains a major public health problem worldwide. It can lead to a liver cirrhosis and/or hepatocellular carcinoma. The World Health Organisation (WHO) has recommended the implementation of generalised vaccination programs against hepatitis B. In Cameroon, this vaccine was introduced in the expanded program on immunization (EPI) in 2005, but few studies have assessed the immune response. Objective: the general objective of this study was to identify factors associated with antibody levels among children aged from 15 to 59 months vaccinated against hepatitis B during the EPI in Cameroon. Method: this was a cross-sectional study carried out from December 2021 to June 2022 in a paediatric centre of Yaoundé (Cameroon). We analysed the antibody level in children vaccinated against hepatitis B within the framework of the EPI. We enrolled children who had received a series of 3 intramuscular doses of hepatitis B vaccine at 6, 10 and 14 weeks after birth. Some children could receive a 4<sup>th</sup> booster dose between 12 months. The antibody level was assessed by measuring the anti-HBs in such children, aged 15 - 59 months. A good immunization was defined as a serum level of anti-HBs antibody level above 100 IU/mL;a poor immunization, for an anti-HBs antibody level between 10 and 100 IU/mL;and a non-immunization, for an anti-HBs antibody level < 10 IU/mL. Association between explored factors and poor or non-immunization was evaluated through the Chi square test. The significance threshold was defined at p < 0.05. Results: sixty subjects were included in the study with a slight female majority: 31 cases (52%). The average age was 38.5 ± 15.7 months (range 15 - 59 months). We found 32 (53%) cases of good immunization;21 (35%) of poor immunization;and 7 children (12%) with a non-immunization. The only factor associated with poor or non-immunization was the age between 37 - 59 months (p = 0.016). Conclusion: Anti HBs Antibody levels in children vaccinated against hepatitis B virus were globally satisfactory in our series. Results show an association between low antibody levels with older age (over 36 months), suggesting a circulating antibodies levels decrease over time, yet deemed protecting until 59 months.
文摘Sirmaur district in the state of Himachal Pradesh in India is a hard-to-reach area situated in the western Himalayas having an extreme landscape with snow-laden mountains and extensive river systems that makes the delivery of immunization services extremely challenging. Vaccinators needed a long walk through the hilly terrain to reach outreach sites. Community mobilizers were unable to go house to house to inform the caregivers to bring children to the site for vaccination. Caregivers were unaware when the vaccinators arrive at the site. As a result, many children missed vaccination or were not vaccinated timely. Age-appropriate vaccination coverage (according to national immunization schedule) in the Sirmaur district was the lowest in the state. Thinking out-of-box to address the communication barriers with the caregivers, the traditional drum beating was used, for the first time in India, in two blocks of the Sirmaur district (Rajpura and Shillai). The initiative was planned and implemented by the district health system with the support of the local community leaders. An exit interview was conducted to know the reach of the drum beating to caregivers, and a baseline and end line household survey was conducted to know the outcome of the initiative on age-appropriate vaccination coverage. Analysis of exit interviews data indicated a very high reach of a drum beating to the caregivers;more than 97% of caregivers in Rajpura and 100% in Shillai heard drum beating, and almost 95% of caregivers in Rajpura and 98% in Shillai knew the purpose of drum beating. Analysis of immunization data from baseline and end line surveys showed improvement in age-appropriate vaccination coverage for all vaccines in Rajpura (by 2.2% for BCG, 15.3% for Pentavalent 1, 14.9% for Pentavalent 2, 14.1% for Pentavalent 3, and 6.5% for Measles/MR). In Shillai, age-appropriate vaccination coverage improved for Pentavalent 1 (by 3.4%), Pentavalent 2 (by 5%) and Measles/MR (by 1.7%). In addition, dropout rates were reduced in both the blocks, particularly in Rajpura Pentavalent 1 to Measles dropout rate was reduced by 13.5%. Both health workers and community leaders had positive perceptions of the drum beating initiative. However, another important lesson learned from the initiative was that both the access and demand-side barriers need to be addressed for the desired improvement of age-appropriate immunization coverage. In Shillai, there was lower coverage improvement and a reduction in dropout rates attributed to vacant positions of vaccinators that caused an issue with access to immunization services to people.