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Challenges Addressing Inequalities in Measles Vaccine Coverage in Zambia through a Measles–Rubella Supplementary Immunization Activity during the COVID-19 Pandemic

Background: Measles–rubella supplementary immunization activities (MR-SIAs) are conducted to address inequalities in coverage and fill population immunity gaps when routine immunization services fail to reach all children with two doses of a measles-containing vaccine (MCV). We used data from a post...

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Autores principales: Yang, Yangyupei, Kostandova, Natalya, Mwansa, Francis Dien, Nakazwe, Chola, Namukoko, Harriet, Sakala, Constance, Bobo, Patricia, Masumbu, Penelope Kalesha, Nachinga, Bertha, Ngula, David, Carcelen, Andrea C., Prosperi, Christine, Winter, Amy K., Moss, William J., Mutembo, Simon
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10059977/
https://www.ncbi.nlm.nih.gov/pubmed/36992192
http://dx.doi.org/10.3390/vaccines11030608
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author Yang, Yangyupei
Kostandova, Natalya
Mwansa, Francis Dien
Nakazwe, Chola
Namukoko, Harriet
Sakala, Constance
Bobo, Patricia
Masumbu, Penelope Kalesha
Nachinga, Bertha
Ngula, David
Carcelen, Andrea C.
Prosperi, Christine
Winter, Amy K.
Moss, William J.
Mutembo, Simon
author_facet Yang, Yangyupei
Kostandova, Natalya
Mwansa, Francis Dien
Nakazwe, Chola
Namukoko, Harriet
Sakala, Constance
Bobo, Patricia
Masumbu, Penelope Kalesha
Nachinga, Bertha
Ngula, David
Carcelen, Andrea C.
Prosperi, Christine
Winter, Amy K.
Moss, William J.
Mutembo, Simon
author_sort Yang, Yangyupei
collection PubMed
description Background: Measles–rubella supplementary immunization activities (MR-SIAs) are conducted to address inequalities in coverage and fill population immunity gaps when routine immunization services fail to reach all children with two doses of a measles-containing vaccine (MCV). We used data from a post-campaign coverage survey in Zambia to measure the proportion of measles zero-dose and under-immunized children who were reached by the 2020 MR-SIA and identified reasons associated with persistent inequalities following the MR-SIA. Methods: Children between 9 and 59 months were enrolled in a nationally representative, cross-sectional, multistage stratified cluster survey in October 2021 to estimate vaccination coverage during the November 2020 MR-SIA. Vaccination status was determined by immunization card or through caregivers’ recall. MR-SIA coverage and the proportion of measles zero-dose and under-immunized children reached by MR-SIA were estimated. Log-binomial models were used to assess risk factors for missing the MR-SIA dose. Results: Overall, 4640 children were enrolled in the nationwide coverage survey. Only 68.6% (95% CI: 66.7%, 70.6%) received MCV during the MR-SIA. The MR-SIA provided MCV1 to 4.2% (95% CI: 0.9%, 4.6%) and MCV2 to 6.3% (95% CI: 5.6%, 7.1%) of enrolled children, but 58.1% (95% CI: 59.8%, 62.8%) of children receiving the MR-SIA dose had received at least two prior MCV doses. Furthermore, 27.8% of measles zero-dose children were vaccinated through the MR-SIA. The MR-SIA reduced the proportion of measles zero-dose children from 15.1% (95% CI: 13.6%, 16.7%) to 10.9% (95% CI: 9.7%, 12.3%). Zero-dose and under-immunized children were more likely to miss MR-SIA doses (prevalence ratio (PR): 2.81; 95% CI: 1.80, 4.41 and 2.22; 95% CI: 1.21 and 4.07) compared to fully vaccinated children. Conclusions: The MR-SIA reached more under-immunized children with MCV2 than measles zero-dose children with MCV1. However, improvement is needed to reach the remaining measles zero-dose children after SIA. One possible solution to address the inequalities in vaccination is to transition from nationwide non-selective SIAs to more targeted and selective strategies.
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spelling pubmed-100599772023-03-30 Challenges Addressing Inequalities in Measles Vaccine Coverage in Zambia through a Measles–Rubella Supplementary Immunization Activity during the COVID-19 Pandemic Yang, Yangyupei Kostandova, Natalya Mwansa, Francis Dien Nakazwe, Chola Namukoko, Harriet Sakala, Constance Bobo, Patricia Masumbu, Penelope Kalesha Nachinga, Bertha Ngula, David Carcelen, Andrea C. Prosperi, Christine Winter, Amy K. Moss, William J. Mutembo, Simon Vaccines (Basel) Article Background: Measles–rubella supplementary immunization activities (MR-SIAs) are conducted to address inequalities in coverage and fill population immunity gaps when routine immunization services fail to reach all children with two doses of a measles-containing vaccine (MCV). We used data from a post-campaign coverage survey in Zambia to measure the proportion of measles zero-dose and under-immunized children who were reached by the 2020 MR-SIA and identified reasons associated with persistent inequalities following the MR-SIA. Methods: Children between 9 and 59 months were enrolled in a nationally representative, cross-sectional, multistage stratified cluster survey in October 2021 to estimate vaccination coverage during the November 2020 MR-SIA. Vaccination status was determined by immunization card or through caregivers’ recall. MR-SIA coverage and the proportion of measles zero-dose and under-immunized children reached by MR-SIA were estimated. Log-binomial models were used to assess risk factors for missing the MR-SIA dose. Results: Overall, 4640 children were enrolled in the nationwide coverage survey. Only 68.6% (95% CI: 66.7%, 70.6%) received MCV during the MR-SIA. The MR-SIA provided MCV1 to 4.2% (95% CI: 0.9%, 4.6%) and MCV2 to 6.3% (95% CI: 5.6%, 7.1%) of enrolled children, but 58.1% (95% CI: 59.8%, 62.8%) of children receiving the MR-SIA dose had received at least two prior MCV doses. Furthermore, 27.8% of measles zero-dose children were vaccinated through the MR-SIA. The MR-SIA reduced the proportion of measles zero-dose children from 15.1% (95% CI: 13.6%, 16.7%) to 10.9% (95% CI: 9.7%, 12.3%). Zero-dose and under-immunized children were more likely to miss MR-SIA doses (prevalence ratio (PR): 2.81; 95% CI: 1.80, 4.41 and 2.22; 95% CI: 1.21 and 4.07) compared to fully vaccinated children. Conclusions: The MR-SIA reached more under-immunized children with MCV2 than measles zero-dose children with MCV1. However, improvement is needed to reach the remaining measles zero-dose children after SIA. One possible solution to address the inequalities in vaccination is to transition from nationwide non-selective SIAs to more targeted and selective strategies. MDPI 2023-03-07 /pmc/articles/PMC10059977/ /pubmed/36992192 http://dx.doi.org/10.3390/vaccines11030608 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Yang, Yangyupei
Kostandova, Natalya
Mwansa, Francis Dien
Nakazwe, Chola
Namukoko, Harriet
Sakala, Constance
Bobo, Patricia
Masumbu, Penelope Kalesha
Nachinga, Bertha
Ngula, David
Carcelen, Andrea C.
Prosperi, Christine
Winter, Amy K.
Moss, William J.
Mutembo, Simon
Challenges Addressing Inequalities in Measles Vaccine Coverage in Zambia through a Measles–Rubella Supplementary Immunization Activity during the COVID-19 Pandemic
title Challenges Addressing Inequalities in Measles Vaccine Coverage in Zambia through a Measles–Rubella Supplementary Immunization Activity during the COVID-19 Pandemic
title_full Challenges Addressing Inequalities in Measles Vaccine Coverage in Zambia through a Measles–Rubella Supplementary Immunization Activity during the COVID-19 Pandemic
title_fullStr Challenges Addressing Inequalities in Measles Vaccine Coverage in Zambia through a Measles–Rubella Supplementary Immunization Activity during the COVID-19 Pandemic
title_full_unstemmed Challenges Addressing Inequalities in Measles Vaccine Coverage in Zambia through a Measles–Rubella Supplementary Immunization Activity during the COVID-19 Pandemic
title_short Challenges Addressing Inequalities in Measles Vaccine Coverage in Zambia through a Measles–Rubella Supplementary Immunization Activity during the COVID-19 Pandemic
title_sort challenges addressing inequalities in measles vaccine coverage in zambia through a measles–rubella supplementary immunization activity during the covid-19 pandemic
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10059977/
https://www.ncbi.nlm.nih.gov/pubmed/36992192
http://dx.doi.org/10.3390/vaccines11030608
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