Client views,perception and satisfaction with immunisation services at Primary Health Care Facilities in Calabar,South-South Nigeria

Objective:To determine the degree of client satisfaction with immunisation services at Primary Health facilities in Calabar,Cross River State,Nigeria.Method:A semi-structured questionnaire was administered on 402 caregivers who were selected using systematic random sampling from four primary health centres.The four centres were randomly selected from the 19 health centres using the table of random numbers.Data obtained were analysed using Epi-Info s of tware version 2002.Results:The majority of clients were dissatisfied with most aspects of care given at the Health Care Centres including long waiting time,accessibility of immunisation services,poor respect for clients’ rights,especially to their dignity,health information and counseling on their medical needs.Conclusions:The study concludes that client satisfaction with immunization service in Calabar was low due to poor attitude of health care providers,long waiting time and lack of respect for clients’ rights.

Influence of Maternal and Larval Immunisation against <i>Lactococcus garviae</i>Infection in Rainbow Trout <i>Oncorhynchus mykiss</i>(Walaum) Lysozyme Activity and IgM Level

This study evaluated efficacy of maternal and larval immunisation against Lactococcus garviae infection and on the lysozyme and immunoglobulin (IgM) levels in rainbow trout Oncorhynchus mykiss (Walaum). Forty-eight-day-old larvae (mean weight 96 mg) originating from injected weekly with letrozole and immunised, only immunised and non-immunised parents were experimentally infected with the L. garvieae, and the mortality rate was recorded daily. Larvae were vaccinated by immersion at 58 days post hatch with live L. garvieae (109 cells/mL) for 15 min. Every third day post larvae vaccination, two larvae from each group were collected for analysis lysozyme (by a method based on the ability of lysozyme to lyse the bacterium Micrococcus lysodeikticus) and IgM (by enzyme-linked immunosorbent assay (ELISA)) parameters. Vaccinated and control larvae were tested for protection against L. garvieae 30 days post larvae immunization when the larvae were 88 days old. Larvae were challenged by bath exposure with live L. garvieae (109 cells/mL) for 2 min and monitored for mortality for at least 10 days following challenge. The challenge experiment with L. garvieae showed a significant reduction in larvae from immunised (54.44% ± 0.64%) and injected weekly with letrozole and immunised fish (52.96% ± 0.97%) compared to larvae from control fish (62.96% ± 2.22%). Vaccinated larvae originated from injected weekly with letrozole and immunised parents showed significantly higher lysozyme activity compared to other fish groups. Vaccinated larvae showed significantly less mortality compared to controls. The relative percent survival (RPS) values of larvae from only immunised, injected weekly with letrozole and immunised and non-immunised parents vaccinated with L. garvieae were 67.36% ± 0.9%, 68.05% ± 0.66% and 48.27% ± 2.79% respectively. The results indicate that the effect of maternal immunization rainbow trout against L. garvieae infection by eliciting the immune responses as indicated by an increase in the IgM level and lysozyme activity.

Prevalence of recent immunisation in children with febrile convulsions

AIM:To determine the prevalence of recent immunisation amongst children under 7 years of age presenting for febrile convulsions.METHODS:This is a retrospective study of all children under the age of seven presenting with febrile convulsions to a tertiary referral hospital in Sydney.A total of 78 cases occurred in the period January 2011 to July 2012 and were included in the study.Data was extracted from medical records to provide a retrospective review of the convulsions.RESULTS:Of the 78 total cases,there were five medical records which contained information on whether or not immunisation had been administered in the preceding 48 h to presentation to the emergency department.Of these five patients only one patient(1.28%of the study population) was confirmed to have received a vaccination with Infanrix,Prevnar and Rotavirus.The majority of cases reported a current infection as a likely precipitant to the febrile convulsion.CONCLUSION:This study found a very low prevalence of recent immunisation amongst children with febrile convulsions presenting to an emergency department at a tertiary referral hospital in Sydney.This finding,however,may have been distorted by underreporting of vaccination history.

Socioeconomic Factors of Full Immunisation Coverage in India

The following article has been retracted due to the investigation of complaints received against it. The Editorial Board found that substantial portions of the text came from other published papers. The scientific community takes a very strong view on this matter, and the Health treats all unethical behavior such as plagiarism seriously. This paper published in Vol.3 No. 3,102-110?pages, 2013, has been removed from this site.

Immunisation Status of Children Born with Orofacial Clefts Who Visited the Komfo Anokye Teaching Hospital (KATH) Multidisciplinary Cleft Clinic

Background: The Ghana Expanded Programme on Immunisation recommends that children receive Bacillus Calmette-Guerin (BCG) and Oral Polio Vaccine (OPV) at birth;three doses of Penta vaccine and OPV at 6, 10 and 14 weeks of age;and measles vaccine at 9 months of age. Aim/Objective: To evaluate the immunisation status of children born with orofacial clefts who visited the KATH multidisciplinary Cleft clinic. Methodology/Statistics: The study was a descriptive study with a cross-sectional design. The methodology consisted of in-person interviews of mothers of children born with cleft lip and palate reporting at KATH Cleft clinic. Interview guides were used for mothers who could not read. Mothers who were literate and as such could answer the questions directly were given questionnaires to fill. Result: It was reported that of the 83 children included, 47 (57%) had been fully vaccinated and on time, 24 (29%) had been fully vaccinated but delayed and 12 (14%) had not been vaccinated at all. Children with isolated cleft palate and macrostomia were fully vaccinated on time (77.3% and 100%, respectively) as compared to those with combined cleft lip and palate (43.3%) and isolated cleft lip (50.0%). The majority (77%) of the mothers who either had not vaccinated their children or had delayed in vaccinating them attributed stigmatisation as the main cause. Most of the mothers (95%) had knowledge of immunisation. About two-thirds of the mothers (65%) agreed that establishing an immunisation centre at the cleft clinic is the best way to improve immunisation rate among children with orofacial clefts. Conclusion: The study showed that the percentage of children with orofacial cleft who visited the KATH Cleft Clinic and were vaccinated on time was above the national average. Cleft palates were more vaccinated and on time than cleft lips. According to the children’s mothers, lack of timely vaccination was mainly due to the stigma associated with clefts in their societies.

Health and immunisation services for the urban poor in selected countries of Asia

Background:Asia is a region that is rapidly urbanising.While overall urban health is above rural health standards,there are also pockets of deep health and social disadvantage within urban slum and peri-urban areas that represent increased public health risk.With a focus on vaccine preventable disease and immunisation coverage,this commentary describes and analyses strengths and weaknesses of existing urban health and immunisation strategy,with a view to recommending strategic directions for improving access to immunisation and related maternal and child health services in urban areas across the region.The themes discussed in this commentary are based on the findings of country case studies published by the United Nations Childrens Fund(UNICEF)on the topic of immunisation and related health services for the urban poor in Cambodia,Indonesia,Mongolia,Myanmar,the Philippines,and Vietnam.Main body:Although overall urban coverage is higher than rural coverage in selected countries of Asia,there are also wide disparities in coverage between socio economic groups within urban areas.Consistent with these coverage gaps,there is emerging evidence of outbreaks of vaccine preventable diseases in urban areas.In response to this elevated public health risk,there have been some promising innovations in operational strategy in urban settings,although most of these initiatives are project related and externally funded.Critical issues for attention for urban health services access include reaching consensus on accountability for management and resourcing of the strategy,and inclusion of an urban poor approach within the planning and budgeting procedures of Ministries of Health and local governments.Advancement of local partnership and community engagement strategies to inform operational approaches for socially marginalised populations are also urgently required.Such developments will be reliant on development of municipal models of primary health care that have clear delegations of authority,adequate resources and institutional capabilities to implement.Conclusions:The development of urban health systems and immunisation strategy is required regionally and nationally,to respond to rapid demographic change,social transition,and increased epidemiological risk。

Effects of Good Practices for Catch-Up Vaccinations: Assessment with a Quasi-Experimental Study in Democratic Republic of Congo

Introduction: Despite the enormous resources deployed and the success achieved in vaccination, reducing the number of children who remain unvaccinated remains a major operational challenge in certain countries. In 2014, the Kalemie Expanded Program of Immunization outpost in the Democratic Republic of the Congo was faced with a high number of unvaccinated children. They instituted a “token” catch-up system based on a collaborative approach with community health workers. This study aims to document the effects of this strategy on vaccination coverage. Methods: This study was a comparative quasi-experimental test/control study. The “test” health area was Undugu where the catch-up strategy was implemented and the “control” health area was Kanunka. A vaccination coverage survey was conducted according to the WHO method in both health areas, examining children aged 12 to 23 months. The proportions were compared using a Pearson chi-square test and the odds ratios were estimated. Results: Vaccine coverage was significantly higher in the “test” health area for all the antigens. Full vaccination coverage was 69.4% in the “test” health area versus 31% in the “control” health area, with a 4.7 times greater chance of being fully vaccinated in the “test” health area (OR: 4.7;CI 95% [3.1 - 7.2];p = 0.0001). Conclusion: This study demonstrates the value of a strategy that can increase access to vaccination and use of vaccination services, leading to a reduction in inequality in this area. However, this is linked to adapting the collaborative model on which it is based. This must be taken into consideration in plans to reproduce the findings.

Recent Developments in the Nasal Immunization against Anthrax

Bacillus anthracis is the causative agent of anthrax, a bacterial infection with a high mortality rate [1-3]. Although anthrax infection can be cutaneous, gastrointestinal or pulmonary, the pulmonary form is the most deadly [2,3]. Thus, the release of Bacillus anthracis spores that can be inhaled represents a potent bioterrorism threat;the capacity of B. anthracis spores to act as a bioterrorism weapon was demonstrated in 2001, with the intentional infection of 22 persons in the U.S.A. [2,4]. Until recently, the available vaccines were developed to confer protection against cutaneous infection;despite this, these vaccines demonstrated experimental efficacy against pulmonary infection in multiple animal models [1,2]. Nevertheless, there are many limitations for these vaccines to be considered successful and effective vaccine, including the intensity of the required vaccination schedule, the administration route and the presence of local adverse effects experienced after vaccination [1,3,5,6]. To develop more efficient vaccines against pulmonary anthrax, intranasal formulations with adjuvant have been studied. These formulations have advantages because they are easy to administer and because they are expected to induce both systemic and respiratory tract mucosal immune responses. Therefore, the main goal of this review is to compare the different experimental adjuvants used with anthrax antigens and the different approaches regarding the vaccination schedule and consecutive boosters.

Tetanus in a post operative patient—A case report

Tetanus is a preventable disease which commonly occurs with puncture or penetrating wounds, or contamination of cutaneous wounds. It may be secondary to surgical procedures such as gastrointestinal surgery on rare occasions. This article reports a fatal case of tetanus in a post operative patient in which the source of infection could not be ascertained. Active immunization of all persons against tetanus, adequate sterilization of surgical equipment and consumables as well as the operating rooms is advocated.

Reinfection, recontamination and revaccination for SARS-CoV-2

The reports on coronavirus disease 2019(COVID-19)describe the pandemic in waves.Similar to the ocean’s waves,the frequency and amplitude of the number of new cases and the number of deaths were globally quite regular;nevertheless,they showed important regional irregularities and the direction of spread has been generally rather unpredictable for COVID-19.One of the major reasons for the repeated outbreaks is the mutating capacity of the severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)that allows the virus to infect persons who have natural immunity or have been vaccinated.Vaccination began in vast campaigns from the second year of the pandemic that was supposed to decrease the magnitude of the waves.Although it reduced the complications,the expected attenuation of the disease expansion has not yet been met.This paper provides a short overview of the most recent data on the rate of reinfection in vaccinated and non-vaccinated individuals.It points out that testing positive for a second time for SARS-CoV-2 does not necessarily mean a reinfection;it can also be interpreted as recontamination.The symptom free outcome as well as the rapid reconversion of the polymerase chain reaction test may help to determine the difference between reinfection and recontamination.Awareness of this phenomenon may be valuable in times of human resource difficulties.The available evidence may suggest that the protective value of a prior infection could be better considered for vaccine distribution in the future.

Antibody administration in experimental influenza increases survival and enhances the effect of oseltamivir

Anti-viral chemotherapy plays an important part in treating and preventing influenza illness. However, its effectiveness in severe infections can be debated and a reoccurring problem is the emergence of resistant virus. Passive immunisation has for a long time been and is still used for prophylaxis and treatment of a number of infectious diseases. In this experimental study anti-influenza antibodies were passively administrated to mice, subsequently they were infected with influenza virus and treated with oseltamivir. The aim was to investigate, if anti-influenza antibodies influenced the out come of oseltamivir treatment and development of resistance towards oseltamivir. We show, that oseltamivir alone was not able to effectively prevent a fatal outcome, but that oseltamivir administered together with a limited amount of antibodies, resulted in improvement of the clinical condition of the mice. The results also showed that a higher dosage of antibodies alone were able to protect the mice from a lethal dose of virus. These findings suggest that the effectiveness of oseltamivir depends on the host’s immune response to the influenza virus, and that that passive immunization is an option that should be considered in the in control of influenza.

Examining enablers of vaccine hesitancy toward routine childhood and adolescent vaccination in Malawi

Background:The contribution of vaccination to global public health and community wellbeing has been described as one of the greatest success stories of modern medicine.However,13.5 million children still miss at least one of their routine vaccinations,and this contributes to about 1.5 million deaths from vaccine-preventable diseases.One of the contributing factors has been associated with vaccine hesitancy.Vaccine hesitancy is the delay or refusal of vaccines despite their availability.The study explored factors from multiple perspectives that influence hesitancy among caregivers of children and adolescent girls eligible for childhood routine immunisation and the Human Papillomavirus vaccine in Malawi.Methods:The methodology used was qualitative such as key informant interviews and focus-group discussion.Information was obtained from caregivers,community and religious leaders,leaders of civil society groups,teachers in schools where Human Papillomavirus vaccine were piloted,healthcare workers,national and district-level officials of the expanded program on immunisation.There were 25 key informant interviews and two focus-group discussions,with 13 participants.The study was conducted between April to May 2020.The Interviews and discussions were audio-recorded,transcribed,and analysed using a thematic content approach.Results:Most vaccine-hesitancy drivers for routine immunisation were also relevant for the HPV vaccine.The drivers included inadequate awareness of the vaccination schedule,rumours and conspiracy theories exacerbated by religious beliefs,low literacy levels of caregivers,distance and transport to the vaccination clinic,gender role and a disconnect between community healthcare workers and community leaders.Conclusions:The study demonstrated that a network of factors determines vaccine hesitancy for childhood Routine Immunisation and Human Papillomavirus,and some of them are interrelated with one another.This has implications both for current levels of vaccine acceptance and the introduction of any new vaccine,such as those against Malaria,HIV/AIDS,HPV or COVID-19(coronavirus disease 2019).Therefore,strategies developed to address vaccine hesitancy must be multi-component and wide-ranging.

Coverage rates for diphtheria,tetanus,poliomyelitis,and pertussis age-specific booster recommendations in France:2018 update of the real-world cohort analysis

The French National Immunization Program was updated in 2013 for vaccination against diphtheria,tetanus,per-tussis,and poliomyelitis.Our previous findings on the evolution of age-specific booster vaccination coverage rates(VCRs)up to 2017 suggested suboptimal vaccination coverages due to the pre-2013 recommendation-residual vaccination practices.In the current analysis,we evaluated all age-specific booster VCR and distribution of age at vaccination visits in 2018.In this retrospective observational cohort study,the cumulative booster VCRs were updated at all vaccination visits up to 2018 among the people who were eligible for a booster vaccination,using a 1/97th random sample of French national healthcare reimbursement databases.The cumulative booster VCR for individuals from all age groups increased from 2017 to 2018,except for 85-years-old vaccination visit.Majority of the individuals from all age groups were vaccinated(boosted)with a vaccine containing the pertussis valence.In 2018,sharp peaks corresponding to the recommended ages for booster vaccination visits were observed for individuals aged 6,11 to 13,25,45,and 65 years.Our study reiterates suboptimal coverages in France and implies the need for booster vaccination throughout life for the protection of the population.