Journal Content Recommendation
01
UNICEF/WHO released data: Global childhood immunization levels stalled in 2023
Data released on July 15 by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) show that global childhood immunization coverage is stagnating in 2023, with an increase of “2.7 million additional children un- and under-vaccinated compared to pre-pandemic levels in 2019”. The WHO and UNICEF Estimates of National Immunization Coverage (WUENIC) provide the world’s largest dataset of vaccination trends, covering data on a total of 16 vaccines or antigenic ingredients, and the corresponding number of doses given in 195 WHO/UNICEF member countries.
The findings show that the number of children who have not received a single dose of diphtheria, tetanus, and pertussis (DTP) vaccine in 2023 will increase from 13.9 million in 2022 to 14.5 million in 2023, an important indicator of national immunization coverage. More than half of the unvaccinated children live in “31 countries with fragile, conflict-affected and vulnerable settings,” where children are particularly vulnerable to vaccine-preventable diseases due to “disruptions and lack of access to security, nutrition, and health services.” Data further show that vaccination rates against the deadly measles disease have stagnated, “leaving nearly 35 million children with no or only partial protection.” In the past five years, there have been measles outbreaks in 103 countries, which account for about three-quarters of all infants worldwide. Low vaccine coverage (less than 80%) is the primary cause of this situation.
02
Do Pregnant Persons Want Influenza Vaccines? Knowledge, Attitudes, Perceptions, and Practices Toward Influenza Vaccines in 8 Low- and Middle-Income Countries
This study was published in The Journal of Infectious Diseases. The World Health Organization (WHO) recommends pregnant women get vaccinated against seasonal influenza, but immunization rates remain low. This study investigated “knowledge, attitudes, perceptions, and practices (KAP) related to influenza and influenza vaccines” in pregnant women to recommend measures to increase vaccination rates in this priority population. The study analyzed cross-sectional survey data on attitudes toward seasonal influenza vaccine among 8,556 pregnant women from eight low- and middle-income countries during 2018-2019, stratified by country-level (presence of a national influenza vaccination program, country income group, geographic region) and individual-level factors.
The study showed that “Most pregnant persons (6323, 74%) were willing to receive influenza vaccine if it was offered for free” Willingness to vaccinate varied according to the existence of an influenza vaccination program; acceptance rates were higher in countries without an influenza vaccination program (2,383, 89%) and lower in countries with such a program (3,940, 67%, p<0.001). Nonetheless, in middle-income countries, most pregnant women are willing to receive the free influenza vaccine when offered, regardless of an influenza vaccination program. “National investments in influenza vaccination programs present an opportunity to avert illness both in pregnant persons themselves and in their newborn babies.” The team notes that, despite a lower willingness to vaccinate in countries with vaccination programs, optimizing existing vaccination programs and providing vaccines free of charge may still significantly increase vaccination rates.
https://doi.org/10.1093/infdis/jiae340
03
Essential childhood immunization in 43 low- and middle-income countries: Analysis of spatial trends and socioeconomic inequalities in vaccine coverage
This study, published in Plos Medicine, analyzes information on childhood vaccination in 43 low- and middle-income countries to reveal spatial trends and socioeconomic inequalities in basic childhood immunization in these countries and regions. Data on vaccination information from the latest Demographic and Health Surveys were used to “estimate essential immunization coverage at the national and subnational levels and quantify socioeconomic inequalities in such coverage using adjusted concentration indices.”
The findings suggest that national-level vaccination rates may mask “large gaps in child immunization” across “West and Central Africa and in South Asia, particularly in regions of Angola, Chad, Nigeria, Guinea, and Afghanistan, where less than 10% of children are fully immunized.” Children in these countries generally lack all four essential vaccines WHO recommends for young children. In addition, children from poorer households are less likely to be fully immunized than children from other households. These differences are largely due to large administrative divisions and different periods of survey data collection.
Studies have shown that basic immunization coverage of children varies widely within and between countries and socio-economic groups. “More efforts are needed to ensure equitable access to essential vaccines in LMICs, where infectious diseases are among the leading causes of child death.” Therefore, targeted, localized interventions should be designed and implemented to eliminate child suffering and death from existing and emerging vaccine-preventable diseases.
https://doi.org/10.1371/journal.pmed.1004166
04
Effect of Pneumococcal Conjugate Vaccine on Pneumonia Incidence Rates among Children 2–59 Months of Age, Mongolia, 2015–2021
This study was published in Emerging Infectious Diseases. Pneumonia is the leading cause of child mortality in Mongolia, where the PCV13 vaccine has been gradually integrated into the routine infant immunization program since 2016 in the context of expanding the pneumonia surveillance program to assess vaccine efficacy. The study collected “Blood samples, nasopharyngeal swab samples, and chest radiographs” from children 2–59 months of age who were admitted to 1 of 4 four participating district hospitals” in Ulaanbaatar, Mongolia, between April 2015 and June 2021 by conducting prospective hospital-based surveillance. The study analyzed changes in childhood pneumonia data before and after the introduction of the PCV13 vaccine, calculated incidence rates at different periods, and adjusted prevalence rates for pneumonia endpoints, using negative binomial regression and data modeling for comparison.
The results showed a significant decrease in the prevalence of pneumonia, very severe pneumonia, and suspected pneumococcal pneumonia after the introduction of PCV13, as well as a decrease in the proportion of children with severe and very severe pneumonia. There were differences between age groups, with the 24-59-month age group showing a slightly greater decline than other age groups. In the three districts where PCV13 vaccine catch-up was introduced, pneumonia cases showed a decreasing trend, while no significant decrease was seen in the one district where catch-up was not introduced. “After PCV13 introduction, vaccine-type pneumococcal carriage prevalence decreased by 44% and non-vaccine-type carriage increased by 49%.”
The introduction of PCV13 significantly reduced the incidence of pneumonia in Mongolian children, with particularly significant effects on the severe pneumonia endpoint and PCV13 Streptococcus pneumoniae colonization. Implementation of a catch-up vaccination strategy may further strengthen the vaccine effect. This study provides important reference data for evaluating the effectiveness of PCV in Asian countries and countries transitioning from Gavi funding to government financing. It is recommended that Mongolia continue to expand PCV coverage and consider implementing catch-up vaccination strategies during the vaccine introduction phase. In addition, “Other countries that have satisfactory PCV coverage can expect decreased severe pneumonia cases and vaccine-type carriage after vaccine introduction.”
https://doi.org/10.3201/eid3003.230864
05
Medical Costs of Respiratory Syncytial Virus–Associated Hospitalizations and Emergency Department Visits in Children Aged Younger Than 5 Years: Observational Findings from the New Vaccine Surveillance Network, 2016-2019
This study, published in The Journal of Pediatrics, was designed to assess the “direct medical costs from laboratory-confirmed RSV-associated hospitalizations (n = 2007) and ED visits (n = 1267) from 2016 through 2019 among children aged <5 years” in the New Vaccine Surveillance Network in the United States. The study used surveillance data from six pediatric health systems and included a total of 2,007 hospitalized children and 1,267 emergency department visits. Medical costs were grouped according to clinical categories of services and administrative charges. Descriptive and bivariate analyses were used to explore RSV-related medical costs across visit scenarios and to assess the association between known RSV risk factors and hospitalization costs and length of stay.
Results showed that the median cost per hospitalized child was $7,100 (interquartile spacing (IQR): $4,006-$13,355) and the median cost per emergency room visit was $503 (IQR: $387-$930.) Eighty percent of the children were younger than 2 years of age, and the younger the gestational age, the higher the median cost for hospitalized children (gestational age ≥37 weeks: $6,840 (IQR: $3,905-$12,450); gestational age 29-36 weeks: $7,721 (IQR: $4,362-$15,274); gestational age <29 weeks: $9,131 (IQR: $4,518-$19,924)). In the sample included in the study, full-term births accounted for 70% of total healthcare expenditures. “Almost three quarters of the health care dollars spent originated in children younger than 12 months of age, the primary age group targeted by recommended RSV prophylactics.”
Research suggests that “Reducing the cost burden for RSV-associated medical care in young children will require prevention of RSV in all young children, not just high-risk infants.” New supplies of maternal vaccines and immunoprophylactic products may significantly reduce RSV-related healthcare costs.
https://doi.org/10.1016/j.jpeds.2024.114045
Content Editor: Linjing(Grace) Zhang
Page Editor: Ziqi Liu
