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Background: The severity of COVID-19 outbreaks is disproportionate across settings (e.g., long-term care facilities (LTCF), schools) across Canada. Few studies have examined factors associated with outbreak severity to inform prevention and response. Our study objective was to assess how outbreak severity, as measured using outbreak intensity and defined as number of outbreak-associated cases divided by outbreak duration, differed by setting and factors known to influence SARS-CoV-2 transmission. Methods: We described outbreak intensity trends in 2021 using data from the Canadian COVID-19 Outbreak Surveillance System from seven provinces/territories, representing 93% of the Canadian population. A negative binomial fixed-effects model was used to assess for associations between the outcome, outbreak intensity, and characteristics of outbreaks: setting type, median age of cases, number at risk, and vaccination coverage of at least 1 dose. Also included were variables previously reported to influence SARS-CoV-2 transmission: stringency of non-pharmaceutical interventions (NPI) and the predominant SARS-CoV-2 variant detected by surveillance. Results: The longest outbreaks occurred in LTCF (mean = 25.4 days) and correctional facilities (mean = 20.6 days) which also reported the largest outbreaks (mean = 29.6 cases per outbreak). Model results indicated that outbreak intensity was highest in correctional facilities. Relative to correctional facilities (referent), the second highest adjusted intensity ratio was in childcare centres (intensity ratio = 0.58 [95% CI: 0.51–0.66]), followed by LTCF (0.56 [95% CI: 0.51–0.66]). Schools had the lowest adjusted intensity ratio (0.46 [95% CI: 0.40–0.53]) despite having the highest proportion of outbreaks (37.5%). An increase in outbreak intensity was associated with increases in median age, the number at risk, and stringency of NPI. Greater vaccination coverage with at least 1 dose was associated with reduced outbreak intensity. Conclusion: Descriptive and multivariable model results indicated that in Canada during 2021, outbreak intensity was greatest in closed congregate living facilities: correctional facilities and LTCF. Findings from this study support the importance of vaccination in reducing outbreak intensity when vaccines are effective against infection with circulating variants, which is especially important for closed congregate living facilities where NPIs are more challenging to implement. [ABSTRACT FROM AUTHOR]

In 2015, the United Nations (UN) proposed the 2030 Agenda, a resolution that outlines the global goals for sustainable development. This report focuses on promoting health and well-being, emphasizing the importance of primary healthcare (PHC). However, Brazil faces challenges in managing its healthcare system, exacerbated by fiscal policy changes that have reduced public sector expenditures after 2015. This study was motivated by these recent changes in Brazil's fiscal policy. We evaluated potential fluctuations in total factor productivity (TFP) in 5,524 Brazilian municipalities' primary healthcare from 2015 to 2019. TFP, a measure of efficiency and production technology in PHC, was computed using the bootstrapping Malmquist productivity index (MPI) derived from the Data Envelopment Analysis (DEA) algorithm. This study focused on the economic recession and austerity measures initiated in 2015. Moreover, it's essential to highlight that the SARS-CoV-2 pandemic in Brazil in 2020 brought significant changes to the country's economic, social, and health dynamics. Therefore, this research intentionally concentrated on the pre-pandemic period. Our results revealed that TFP in the PHC sector in Brazil decreased between 2015 and 2019. It was possible to note that three out of every four Brazilian municipalities experienced either stagnation or a decline in the TFP of primary healthcare, with more pronounced challenges in the Midwest and Northeast regions. Looking at the TFP elements, we could see a continuous drop in technical efficiency everywhere in the country, markedly in the Midwest and Northeast. Conversely, there was a considerable uptick in Brazil's technological component. These results implied that there might have been advancements in PHC's technological infrastructure, preventing even less favorable outcomes in the TFP indicator. We concluded that the productivity of primary healthcare in Brazil declined when the 2015 fiscal ceiling was implemented. This decrease in performance was evident in the sluggish growth rate of primary healthcare inputs, a diminution in vaccination coverage indicators, and an increase in hospitalizations for preventable causes. Given that health is a crucial component of social well-being, it is vital to highlight the need for comprehensive efforts to guarantee the effective operation and advancement of primary healthcare services, even during economic downturns. [ABSTRACT FROM AUTHOR]

Background: The effect of nirmatrelvir/ritonavir on preventing post-COVID condition (PCC) in the BA4, BA5, and XBB Omicron predominant periods is not well understood. The purpose of this study was to assess how nirmatrelvir/ritonavir treatment affected both PCC and health-related quality of life. Methods: This retrospective cohort study enrolled 2,524 adults aged 18 years and older who were eligible for nirmatrelvir/ritonavir between July 14 to November 14, 2022. All outcomes were observed from the patient's first visit to the primary health clinic, 1 week, 1 month, 3 months, and 6 months after testing positive for COVID-19. The primary outcome was the presence of PCC. Secondary outcomes included the effects on health-related quality of life, such as walking, bathing and dressing, activities, cause adverse emotions or signs that prevent individuals from leading normal lives over a 180-day observation period. Results: There were no significant differences observed between the nirmatrelvir/ritonavir and those not administered (control group) in terms of PCC symptoms at 3 months (OR 0.71 95% CI 0.31, 1.64) and 6 months (OR 1.30 95% CI 0.76, 2.21). At 3 months, the use of nirmatrelvir/ritonavir was associated with a 26% reduction in symptoms causing negative emotions (OR 0.74 95% CI 0.60, 0.92) and an increased likelihood of symptoms limiting walking (OR 1.58 95% CI 1.10, 2.27). However, there were no significant differences between the nirmatrelvir/ritonavir and the control group in terms of the impact of PCC on health-related quality of life at 6 months. Conclusions: Our study indicates that the administration of nirmatrelvir/ritonavir does not significantly reduce PCC after 3 months and 6 months in a population with high vaccination coverage. [ABSTRACT FROM AUTHOR]

Bacillus Calmette-Guerin (BCG) vaccination and tuberculosis (TB) incidence in children under 1 year of age are critical public health indicators in Brazil. The coronavirus disease 2019 pandemic disrupted vaccination coverage (VC), potentially impacting TB incidence. Understanding regional disparities in VC and TB incidence can inform targeted interventions. We conducted an observational and ecological study using BCG vaccination data (2019–21) and TB incidence (2020–22) for all births in Brazil. Data were collected from public health databases, stratified by state, and analyzed using descriptive and analytical statistics to explore VC and TB incidence. Between 2019 and 2021, average BCG VC was 79.59%, with significant variation among states (P  < .001). Only four states achieved minimum recommended coverage (>90%). TB incidence varied significantly among states (P  = .003). There was a notable decline in VC from 2019 (90.72%) to 2021 (78.67%) (P  < .001). This study highlights regional disparities in BCG VC and TB incidence among Brazilian states. Lower VC post-pandemic may increase TB incidence, requiring targeted interventions in states with inadequate coverage. The findings underscore the importance of sustaining vaccination programs amidst public health crises and implementing strategies to enhance access and uptake. [ABSTRACT FROM AUTHOR]

Objective: To assess the evolution of the COVID-19 pandemic in Brazil and its macro-regions, considering disease incidence and mortality rates, as well as identifying territories with still rising disease indices and evaluating vaccine coverage and population adherence to COVID-19 immunization. Methods: An ecological study conducted in Brazil with COVID-19 cases and deaths reported between February 2020 and April 2024, obtained through the Coronavirus Panel. Historical series were constructed from incidence and mortality rates to assess the pandemic's evolution, and temporal trends were estimated using the Seasonal Trend Decomposition using Loess (STL) method. The Spatial Variation in Temporal Trends (SVTT) technique was employed to identify clusters with significant variations in temporal trends. Vaccination was analyzed considering the percentage of vaccinated and unvaccinated population in each municipality of the country. Results: Brazil recorded a total of 38,795,966 cases and 712,038 deaths from COVID-19 during the study period. Incidence and mortality rates showed three waves of the disease, with a fourth wave of smaller amplitude. Four clusters with significant case growth and two with increased deaths were identified. Vaccine coverage varied among municipalities, with some regions showing low vaccination rates and others with high immunization adherence. Conclusion: The study provided a comprehensive overview of coronavirus behavior in Brazil, and its results highlight the ongoing importance of vaccination and the need to direct efforts and resources to areas of higher risk. [ABSTRACT FROM AUTHOR]

Objectives: To assess the association between socioeconomic status (SES) and selfreported adherence to preventive measures in Switzerland during the COVID-19 pandemic. Methods: 4,299 participants from a digital cohort were followed between September 2020 and November 2021. Baseline equivalised disposable income and education were used as SES proxies. Adherence was assessed over time. We investigated the association between SES and adherence using multivariable mixed logistic regression, stratifying by age (below/above 65 years) and two periods (before/after June 2021, to account for changes in vaccine coverage and epidemiological situation). Results: Adherence was high across all SES strata before June 2021. After, participants with higher equivalised disposable income were less likely to adhere to preventive measures compared to participants in the first (low) quartile [second (Adj.OR, 95% CI) (0.56, 0.37-0.85), third (0.38, 0.23-0.64), fourth (0.60, 0.36-0.98)]. We observed similar results for education. Conclusion: No differences by SES were found during the period with high SARS-CoV-2 incidence rates and stringent measures. Following the broad availability of vaccines, lower incidence, and eased measures, differences by SES started to emerge. Our study highlights the need for contextual interpretation when assessing SES impact on adherence to preventive measures. [ABSTRACT FROM AUTHOR]

Background: The early stages of the COVID-19 pandemic overwhelmed general hospitals in Spain. In response, a dedicated hospital for COVID-19 care, the Hospital de Emergencias Enfermera Isabel Zendal (HEEIZ), was established. This study aimed to compare clinical outcomes of COVID-19 patients treated at the specialized HEEIZ with those at conventional general hospitals (CGHs) in Madrid, Spain. Methods: The study was a prospective, observational cohort study including COVID-19 patients admitted to the HEEIZ and 14 CGHs (December 2020 to August 2021). Patients were assigned based on hospital preference. Clinical data were collected and analyzed using multivariate regression to assess primary and secondary outcomes, including hospital mortality, need of invasive mechanical ventilation (IMV), and pharmacological treatments. Results: The HEEIZ cohort (n = 2997) was younger and had lower Charlson comorbidity scores than the CGH cohort (n = 1526). Adjusted HEEIZ hospital mortality was not significantly higher compared with CGHs (OR: 1.274; 95% CI: 0.781–2.079; p = 0.332). Conclusions: During the study period, patients admitted to the HEEIZ showed no significant differences in clinical outcomes, compared with patients admitted at CGHs. These results might support the use of specialized centers in managing pandemic surges, allowing CGHs to handle other needs. [ABSTRACT FROM AUTHOR]

The U.S. Virgin Islands (USVI) receives an updated population count once every 10 years and used 2010 decennial census population counts to estimate COVID-19 vaccination coverage during the COVID-19 emergency response. We investigated whether using outdated (2010) or modeled (2020 international database [IDB]) population counts biased vaccination coverage estimates used to inform public health priorities during the 2020–2022 COVID-19 response. We estimated percentage of USVI residents with a completed primary COVID-19 vaccination series during December 16, 2020–September 20, 2022. Vaccination coverage was calculated as number of persons who completed the vaccination series divided by 2010 and 2020 decennial census population counts and 2020 IDB intercensal estimate. COVID-19 vaccination coverage using the 2020 population count was 12 % points higher than coverage using 2010 denominator (2010 denominator: 51 %; 2020 denominator: 63 %). Vaccination coverage estimated using 2020 IDB was approximately equal with the 2010 decennial census estimate (52 %). Using 2010 and modeled population counts underestimated 2020 USVI COVID-19 vaccination coverage given the 18 % population decline during 2010–2020, potentially limiting USVI's ability to assess vaccination progress. Identifying mechanisms for more reliable population enumeration or improved estimate modeling are essential for accurately guiding USVI public health decision-making. [ABSTRACT FROM AUTHOR]

The coronavirus infectious disease-2019 (COVID-19) in Bangladesh is a paradigm for how one of the most densely populated countries in the world, with 1270 people per square kilometer, managed to cope with the COVID-19 pandemic under extraordinary circumstances. This review highlights the SARS-CoV-2 variants in Bangladesh and the timeline of their detection in the context of the global experience with the management of vaccination and natural SARS-CoV-2 infection. The motivation to overcome the COVID-19 vaccine dilemma and track Bangladeshi SARS-CoV-2 sub-variants underscores the potential for a low-income country to excel in international medical science, despite having stressed health care services and limited availability of resources for SARS-CoV-2 testing and gene sequencing. [ABSTRACT FROM AUTHOR]

Objectives: To assess the impact of COVID-19 on immunization coverage and delayed vaccination among tribal children in the Khordha district of Odisha state. Methods: A cross-sectional rapid epidemiological survey was conducted using a standard WHO (30 × 7) cluster survey with 30 tribal villages under the Community Health Centre (CHC), Mendhasala, Odisha, as clusters and seven children from each cluster. A total of 14 children from each cluster; seven each born in 2019 (2019 cohort) and 2020 (2020 cohort), amounting to 420 children were included. The dates of vaccination and related details were obtained from the mother and child protection cards alongside a pretested, semi-structured questionnaires administered to the mothers or primary caregivers. Immunization coverage and delayed vaccination rates were compared between the two cohorts. Results: Full immunization coverage was 81.9% and 77.6% in the 2019 and 2020 cohorts, respectively. A significant decline in full immunization coverage was seen for 14 weeks (Pentavalent-3) vaccine in 2020 cohort (P = 0.01). The proportion of delayed vaccination for scheduled vaccines at birth, 6 weeks, 10 weeks, 14 weeks, and 9–12 months for 2019 cohort and 2020 cohort were 8.6%, 6.7%, 18.1%, 19.5%, 22.4%, and 21.9%, 26.7%, 30.5%, 19%, 16.2%, respectively. However, delayed vaccination rates among the 2019 and 2020 cohorts were not statistically significant. Conclusion: Our study findings showed a little decline in immunization coverage in tribal areas during the pandemic. [ABSTRACT FROM AUTHOR]

We aimed to use the digital platform maintained by the local health service providers in Southeast Sweden for integrated monitoring of disparities in vaccination and morbidity during the COVID-19 pandemic. The monitoring was performed in the adult population of two counties (n = 657,926) between 1 February 2020 and 15 February 2022. The disparities monitored were relocated (internationally displaced), substance users, and suffering from a psychotic disorder. The outcomes monitored were COVID-19 vaccination, SARS-CoV-2 test results, and hospitalization with COVID-19. Relocated residents displayed an increased likelihood of remaining unvaccinated and a decreased likelihood of testing as well as increased risks of primary SARS-CoV-2 infection and hospitalization compared with the general population. Suffering from a major psychiatric disease was associated with an increased risk of remaining unvaccinated and an increased risk of hospitalization but a decreased risk of SARS-CoV-2 infection. From the digital monitoring, we concluded that the relocated minority received insufficient protection during the pandemic, suggesting the necessity for comprehensive promotion of overall social integration. Persons with major psychiatric diseases underused vaccination, while they benefitted from proactively provided testing, implying a need for active encouragement of vaccination. Further research is warranted on legal and ethical frameworks for digital monitoring in vaccination programs. [ABSTRACT FROM AUTHOR]

Copyright of Revista Foco (Interdisciplinary Studies Journal) is the property of Revista Foco and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This article examines vaccination coverage in Balkan and Eastern European countries, focusing on the impact of the COVID-19 pandemic. It analyzes data on the percentage of infants vaccinated against polio, rubella, and measles to assess vaccination achievements and predict coverage until 2025. The study emphasizes the importance of primary healthcare organization and high-quality vaccines for achieving universal health coverage. The data shows variations in vaccination coverage among countries, with Russia and Belarus having the highest median indicators for measles vaccination and Bosnia and Herzegovina and Serbia having the lowest. The study also discusses the challenges faced by some countries in maintaining high vaccination rates during the pandemic. The article includes references to relevant sources such as the World Health Organization's publications on universal health coverage and immunization agenda for 2030, as well as an article on infodemics and infodemiology. [Extracted from the article]

The purpose of this study is to understand the impact of community mobilization initiatives on citizens' health-seeking behavior through the lens of COVID-19 vaccination in the state of Madhya Pradesh, India. This study follows a case study approach to understand community mobilization initiatives that led to increased COVID-19 vaccination uptake. The study delineates the process to increase community mobilization to improve the uptake of COVID-19 vaccination. It highlights the key components of community mobilization that were adopted: the involvement of local leadership (at district, block, and village level), support of vaccination/mobilizer team, the role of in-person communication, involvement of influential community heads and social workers, localized strategies and IEC materials, and support from the state administration. Additionally, the key communication themes that played a crucial role in increasing COVID-19 vaccination coverage are identified. The findings of this study will help the policymakers and practitioners in the domains of Health and Medical Humanities, Health Policy and Services, and Social Sciences to clarify the roles of community mobilization activities and initiatives in increasing vaccination coverage. Furthermore, the study provides evidence for the adaptation, integration, and enhancement of these activities based on the four case studies discussed. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the effects of the COVID-19 pandemic on childhood immunisation programmes in West African Countries. Design: The study was a systematic review of available evidence of the impact of the COVID-19 pandemic on childhood immunisation programmes in West Africa Setting: An online literature search was conducted using PubMed, Embase, Scopus and Web of Science for all peer-reviewed longitudinal, descriptive, observational, prospective and retrospective studies on childhood immunisation programmes in West Africa published between January 2020 and May 2022 Participants: All West African childhood immunisation programmes. Interventions: None Main Outcome Measures: Change in immunisation volumes during the COVID-19 pandemic Results: 353 studies were identified during the literature search, and eight were included in this review. The studies comprised six quantitative studies, one mixed-method (quantitative/qualitative) study and one qualitative study. Changes to immunisation services ranged between 53% and 52% for MCV and Penta3 vaccines in Guinea, lasting longer than August 2020, to 0.3% and 1% in Liberia for BCG and MCV vaccines lasting no longer than May 2020. Factors contributing to the observed disruptions in vaccine coverage during the pandemic included the fear of contracting the virus expressed by caregivers and healthcare workers and general misinformation about the COVID-19 virus. Conclusion: While the changes were greater than 50% and lasted longer in some countries, they were brief and short-lived in others, emphasising that the COVID-19 pandemic's effect in each country differed. [ABSTRACT FROM AUTHOR]

Following the World Health Organization's declaration of the new coronavirus as a pandemic, nations had to act swiftly to draft effective strategies for the prevention and containment of COVID-19. International literature highlights a range of approaches taken by countries, with varying degrees of success, as measured by the quality and responsiveness of their public health systems. This brief perspective proposes a critical-gerontological reflection on the Central American countries, highlighting the divergent regional approaches to the pandemic that resulted in unequal figures between nations. Despite the intention to face the health challenge collectively, varying governmental positions had a direct impact on the health of the older population. Costa Rica and Panama responded similarly to the crisis, showcasing their better social and health scenarios compared to their peers. The Central American approach to public health was tailored to the political ideology of each country, rather than adhering to the common objectives set by the regional integration scheme in place. Despite the pandemic posing a challenge, the region remains committed to building universal, equitable, and comprehensive public health for older people. [ABSTRACT FROM AUTHOR]

Amid the COVID-19 pandemic, understanding the spatial and temporal dynamics of the disease is crucial for effective public health interventions. This study aims to analyze COVID-19 data in Peru using a Bayesian spatio-temporal generalized linear model to elucidate mortality patterns and assess the impact of vaccination efforts. Leveraging data from 194 provinces over 651 days, our analysis reveals heterogeneous spatial and temporal patterns in COVID-19 mortality rates. Higher vaccination coverage is associated with reduced mortality rates, emphasizing the importance of vaccination in mitigating the pandemic's impact. The findings underscore the value of spatio-temporal data analysis in understanding disease dynamics and guiding targeted public health interventions. [ABSTRACT FROM AUTHOR]

Introduction. From a coronavirus disease (COVID-19) pandemic perspective, Aotearoa New Zealand (NZ) rural residents formed an at-risk population, and disparities between rural and urban COVID-19 vaccination coverage have been found. Aim. To gain insight into factors contributing to the urban-rural COVID-19 vaccination disparity by exploring NZ rural health providers' experiences of the vaccine rollout and pandemic response in rural Māori and Pasifika communities. Methods. Rural health providers at four sites participated in individual or focus group semi-structured interviews exploring their views of the COVID-19 vaccine rollout. Thematic analysis was undertaken using a framework-guided rapid analysis method. Results. Twenty interviews with 42 participants were conducted. Five themes were identified: Pre COVID-19 rural situation, fragile yet resilient; Centrally imposed structures, policies and solutions - urban-centric and Pakehā focused; Multiple logistical challenges - poor/no consideration of rural context in planning stages resulting in wasted resource and time; Taking ownership - rural providers found geographically tailored, culturally anchored and locally driven solutions; Future directions - sustained investment in rural health services, including funding long-term integrated (rather than 'by activity') health services, would ensure success in future vaccine rollouts and other health initiatives for rural communities. Discussion. In providing rural health provider perspectives from rural areas serving Māori and Pasifika communities during the NZ COVID-19 vaccine rollout, the importance of the rural context is highlighted. Findings provide a platform on which to build further research regarding models of rural health care to ensure services are designed for rural NZ contexts and capable of meeting the needs of diverse rural communities. [ABSTRACT FROM AUTHOR]

Global measles cases are on the rise following disruptions to routine immunisation programs during the COVID-19 pandemic, with devastating consequences. According to the World Health Organization, the behavioural and social drivers of vaccination include what people think and feel about vaccines, social processes, motivation to vaccinate and practical barriers to vaccination. However, the drivers of measles vaccine uptake are not necessarily the same as those for other childhood vaccines, and we lack data on how these drivers specifically have changed during and since the COVID-19 pandemic. Without accurately measuring the behavioural and social drivers for measles vaccination, and ideally measuring them serially over time, countries cannot design, target and implement interventions that effectively increase and sustain measles vaccine coverage. This paper outlines what is and is not known about the behavioural and social drivers of measles vaccination and provides recommendations for improving their post-pandemic assessment. [ABSTRACT FROM AUTHOR]

Due to the COVID-19 pandemic, many children missed their routine vaccinations globally. There is insufficient evidence on the trends in vaccination coverage in the private healthcare sector in South Africa. This study explored the changes in childhood vaccination patterns (non-COVID vaccines) in the private healthcare sector in South Africa using medicine claim data. Using the information on medication claims from a South African pharmaceutical benefit management (PBM) company, we performed a quantitative cross-sectional analysis comparing the period before (2018–2019) and during the COVID-19 pandemic (2020–2021). All patients who made claims within the study period were included. This study included 67,830 children aged two years and younger. In particular, from 2018 to 2021, boys (52%) outnumbered girls (48%). Pharmacists consistently held the predominant prescriber role before and during the COVID-19 pandemic. The proportion of children receiving non-COVID-19 vaccines was higher before the pandemic (60%) than during the pandemic (55%). Furthermore, there was a notable decline of 5% in measles vaccination rates during the children's first year of life, while a notable increase was observed for measles (5%), hepatitis A (7.7%), and the pentavalent vaccine (5%) during the second year of life. Governments and private healthcare providers must take action to enhance vaccination coverage rates for children in their first year of life to prevent a resurgence of vaccine-preventable diseases. The results obtained in this study underscore the significance of implementing vaccine catch-up campaigns to address missed vaccination opportunities arising from the impact of the COVID-19 pandemic. Moreover, pharmacists emerged as the predominant healthcare providers responsible for administering vaccinations within the private healthcare sector in South Africa, both prior and during the COVID-19 pandemic. Their pivotal role in the vaccination process warrants due recognition and should not be underestimated. [ABSTRACT FROM AUTHOR]

Objective: Brazil was strongly affected by the COVID-19 pandemic. Its continental dimension and socio-demographic characteristics pose challenges to distribution and accessibility, making vaccination programs challenging. The objectives of the study were to describe the clinical and demographic characteristics of the general population vaccinated against COVID-19 by October 2021 and analyze the strategies implemented during the vaccination program. Study design and setting: A retrospective nationwide study that analyzed data from the OpenDataSUS platform of the Informatics Department of the Brazilian Ministry of Health (DataSUS), which contains information from all individuals in Brazil who have received at least one dose of any vaccine against COVID-19 approved by the National Health Agency (ANVISA) from 17 January to 3 October 2021. Results: Until 3 October, a total of 146,254,578 persons (68.6 per 100 inhabitants) received at least one dose of a vaccine in Brazil. The north and northeast regions had the lowest vaccination rates compared with the remaining regions (North: 56.8, Northeast: 62.0, South: 74.4, and Southeast: 73.2 per 100 inhabitants). Elderly individuals had the highest vaccination rates, particularly those above 70 years old. Heterologous dosing regimens were administered to 1,063,079 individuals (0.7% of those receiving the first dose). Conclusions: The COVID-19 vaccination program reached more than two-thirds of the population in Brazil by 9 months after its start, but the vaccination coverage was heterogeneous, reflecting the country's geographic and socio-demographic characteristics. Establishing priority groups for vaccination was a main characteristic of the vaccination strategy. In addition, technology transfer agreements have played an important role in increasing vaccine accessibility. [ABSTRACT FROM AUTHOR]

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In response to the COVID-19 pandemic caused by SARS-CoV-2, governments have adopted a wide range of non-pharmaceutical interventions (NPI). These include stringent measures such as strict lockdowns, closing schools, bars and restaurants, curfews, and barrier gestures such as mask-wearing and social distancing. Deciphering the effectiveness of each NPI is critical to responding to future waves and outbreaks. To this end, we first develop a dynamic model of the French COVID-19 epidemics over a one-year period. We rely on a global extended Susceptible-Infectious-Recovered (SIR) mechanistic model of infection that includes a dynamic transmission rate over time. Multilevel data across French regions are integrated using random effects on the parameters of the mechanistic model, boosting statistical power by multiplying integrated observation series. We estimate the parameters using a new population-based statistical approach based on a Kalman filter, used for the first time in analysing real-world data. We then fit the estimated time-varying transmission rate using a regression model that depends on the NPIs while accounting for vaccination coverage, the occurrence of variants of concern (VoC), and seasonal weather conditions. We show that all NPIs considered have an independent significant association with transmission rates. In addition, we show a strong association between weather conditions that reduces transmission in summer, and we also estimate increased transmissibility of VoC. [ABSTRACT FROM AUTHOR]

Background: Routine vaccination coverage in Latin America and the Caribbean declined prior to and during the coronavirus pandemic. We assessed the pandemic's impact on national coverage levels and analyzed whether financial and inequality indicators, immunization policies, and pandemic policies were associated with changes in national and regional coverage levels. Methodology: We compared first- and third-dose coverage of diphtheria–pertussis–tetanus-containing vaccine (DTPcv) with predicted coverages using time series forecast modeling for 39 LAC countries and territories. Data were from the PAHO/WHO/UNICEF Joint Reporting Form. A secondary analysis of factors hypothesized to affect coverages during the pandemic was also performed. Results: In total, 31 of 39 countries and territories (79%) had greater-than-predicted declines in DTPcv1 and DTPcv3 coverage during the pandemic, with 9 and 12 of these, respectively, falling outside the 95% confidence interval. Within-country income inequality (i.e., Gini coefficient) was associated with significant declines in DTPcv1 coverage, and cross-country income inequality was associated with declines in DTPcv1 and DTPcv3 coverages. Observed absolute and relative inequality gaps in DTPcv1 and DTPcv3 coverage between extreme country quintiles of income inequality (i.e., Q1 vs. Q5) were accentuated in 2021, as compared with the 2019 observed and 2021 predicted values. We also observed a trend between school closures and greater-than-predicted declines in DTPcv3 coverage that approached statistical significance (p = 0.06). Conclusion: The pandemic exposed vaccination inequities in LAC and significantly impacted coverage levels in many countries. New strategies are needed to reattain high coverage levels. [ABSTRACT FROM AUTHOR]

Copyright of European Policy Analysis is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Although the World Health Organization has declared that the COVID‐19 pandemic no longer qualifies as a global public health emergency, it still needs to explore the response of society to the COVID‐19 pandemic. Socio‐economic status (SES) was proven to be linearly associated with the COVID‐19 pandemic, although this relationship may be more complex due to regional differences. In the study, we analyzed and revealed the effects and mechanisms of SES on infections among low, lower‐middle, upper‐middle and high SES group (LSG, LMSG, UMSG, and HSG, respectively). The results showed that the relationship between SES and infections was inverted U‐shaped, especially in the first three phases. In Phase I, UMSG had the highest number of infections, with an average of 238.31/1M people (95%CI: 135.47–341.15/1M people). In Phases II and III, infections decreased insignificantly with increasing SES (r = −0.01, p = 0.92; r = −0.11, p = 0.22) and the highest number of infections were found in the LMSG. In Phase IV, SES was positively related to the number of infections (r = 0.54, p < 0.001). Furthermore, the nonlinear impact of multiple factors related to SES on the infections explains the complex relationships between SES and infections. SES affected infections mainly through medical resources, demographics and vaccination, and differed across the SES groups. Particularly, demographics could exert an impact on population mobility, subsequently influencing infections in LMSG, with an indirect effect of 0.01 (p < 0.05) in Phase II. This study argues for greater attention to countries with middle SES and the need for future targeted measures to cope with infectious diseases. Plain Language Summary: As the virulence of SARS‐CoV‐2 diminishes and vaccination coverage rises, countries around the world are gradually returning to normal development like the pre‐COVID‐19 period. However, the COVID‐19 pandemic crisis of the past three years calls for thoughtful reflection, presenting us with experiences and lessons to learn from. Previous studies suggested that the infections were linearly associated with socio‐economic status (SES). Nevertheless, SES was related with multiple factors (such as vaccination), leading to the complex relationship between infections and SES. Therefore, it still needs to analyze the impacts and mechanisms of SES on infections. Empirical results show the relationship between SES and infections was an inverted U‐shape in the progress of the COVID‐19 pandemic, and the infections in lower‐middle and upper‐middle SES countries was the highest in the first three phases. SES affected infections through multiple factors and the mechanisms differed across SES groups. This work emphasizes the need to be attentive to the further prevalence of infectious diseases in middle‐SES countries and implementing the target measures in different SES countries in the future. Key Points: The response of society to the COVID‐19 pandemic was exploredSocio‐economic status had an inverted U‐shaped relationship with infections during the COVID‐19 pandemicSES affected infections mainly through action time, demographics, medical resources and vaccination [ABSTRACT FROM AUTHOR]

Background: Since the emergence of SARS-CoV-2 (COVID-19), there have been multiple waves of infection and multiple rounds of vaccination rollouts. Both prior infection and vaccination can prevent future infection and reduce severity of outcomes, combining to form hybrid immunity against COVID-19 at the individual and population level. Here, we explore how different combinations of hybrid immunity affect the size and severity of near-future Omicron waves. Methods: To investigate the role of hybrid immunity, we use an agent-based model of COVID-19 transmission with waning immunity to simulate outbreaks in populations with varied past attack rates and past vaccine coverages, basing the demographics and past histories on the World Health Organization Western Pacific Region. Results: We find that if the past infection immunity is high but vaccination levels are low, then the secondary outbreak with the same variant can occur within a few months after the first outbreak; meanwhile, high vaccination levels can suppress near-term outbreaks and delay the second wave. Additionally, hybrid immunity has limited impact on future COVID-19 waves with immune-escape variants. Conclusions: Enhanced understanding of the interplay between infection and vaccine exposure can aid anticipation of future epidemic activity due to current and emergent variants, including the likely impact of responsive vaccine interventions. [ABSTRACT FROM AUTHOR]

There has been increasing recognition of vaccine access challenges in middle-income countries and the need for increased action, particularly in countries that are not eligible for or have transitioned out of Gavi, the Vaccine Alliance support. These countries' immunization systems are more vulnerable than ever as the COVID-19 pandemic exacerbates existing programme challenges, increasing the risk of delayed vaccine introductions, backsliding immunization coverage rates, and increased coverage inequity. The potential health and equity impact of improving immunization outcomes in middle-income countries is substantial. Modelling suggests that the introduction of pneumococcal conjugate vaccine and vaccines for rotavirus and human papillomavirus in this set of Gavi-transitioned and non-Gavieligible middle-income countries in 2020 could have saved an estimated 70,000 lives if 90 % coverage had been reached. Further, increasing coverage for already-introduced vaccines to 90 % could have saved an additional estimated 16,000 lives. Over the past decade, stakeholders have made considerable efforts to identify immunization challenges in middle-income countries as documented in the 2015 SAGE-endorsed Shared Partner Middle-Income Country Strategy. In the coming decade, new global platforms like Gavi 5.0 and the Immunization Agenda 2030 provide opportunities to align on MIC strategies and provide coordinated global support to middle-income countries. The international COVID-19 pandemic response has the potential to lay the foundation for long term support beyond the scope of COVID-19 to non-Gavi eligible middle-income countries. Meanwhile regional mechanisms to address immunization barriers in middle-income countries have grown in number and strength, offering sustainable platforms for cross-country collaboration and the provision of tailored technical support. To ensure that these opportunities are successfully acted upon and that middle-income countries achieve the Immunization Agenda 2030 goals, comprehensive, multi-stakeholder consultations were conducted to identify areas of action with the greatest potential to accelerate immunization progress. Stakeholders should work together to put these findings, highlighted in this paper, into action, adapting their approaches to specific country contexts and learning from and building on existing efforts. [ABSTRACT FROM AUTHOR]

Background: Variations in primary care practices may explain some differences in health outcomes during the COVID-19 pandemic. We sought to evaluate the characteristics of primary care practices by the proportion of patients unvaccinated against SARS-CoV-2. Methods: We conducted a population-based, cross-sectional cohort study using linked administrative data sets in Ontario, Canada. We calculated the percentage of patients unvaccinated against SARS-CoV-2 enrolled with each comprehensive-care family physician, ranked physicians according to the proportion of patients unvaccinated, and identified physicians in the top 10% (v. the other 90%). We compared characteristics of family physicians and their patients in these 2 groups using standardized differences. Results: We analyzed 9060 family physicians with 10 837 909 enrolled patients. Family physicians with the largest proportion (top 10%) of unvaccinated patients (n = 906) were more likely to be male, to have trained outside of Canada, to be older, and to work in an enhanced fee-for-service model than those in the remaining 90%. Vaccine coverage (≥ 2 doses of SARS-CoV-2 vaccine) was 74% among patients of physicians with the largest proportion of unvaccinated patients, compared with 87% in the remaining patient population. Patients in the top 10% group tended to be younger and live in areas with higher levels of ethnic diversity and immigration and lower incomes. Interpretation: Primary care practices with the largest proportion of patients unvaccinated against SARS-CoV-2 served marginalized communities and were less likely to use team-based care models. These findings can guide resource planning and help tailor interventions to integrate public health priorities within primary care practices. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic changed the setting of education for many children in the U.S. Understanding COVID-19 vaccination coverage by educational setting is important for developing targeted messages, increasing parents' confidence in COVID-19 vaccines, and protecting all children from severe effects of COVID-19 infection. Using data from the Household Pulse Survey (n = 25,173) collected from December 9–19, 2022, January 4–16, 2023, and February 1–13, 2023, this study assessed factors associated with COVID-19 vaccination and reasons for non-vaccination among school-aged children 5–11 and adolescents 12–17 by educational setting. Among children 5–11 years, COVID-19 vaccination coverage was higher among those who received in-person instruction (53.7%) compared to those who were homeschooled (32.5%). Furthermore, among adolescents 12–17 years, COVID-19 vaccination coverage was higher among those who received in-person instruction (73.5%) or virtual/online instruction (70.1%) compared to those who were homeschooled (51.0%). Children and adolescents were more likely to be vaccinated if the parental respondent had been vaccinated compared to those who had not. Among children and adolescents who were homeschooled, main reasons for non-vaccination were concern about side effects (45.4–51.6%), lack of trust in COVID-19 vaccines (45.0–50.9%), and lack of trust in the government (32.7–39.2%). Children and adolescents who were home-schooled during the pandemic had lower vaccination coverage than those who attended school in person, and adolescents who were home-schooled had lower vaccination coverage than those who received virtual instruction. Based on the reasons for non-vaccination identified in this study, increasing parental confidence in vaccines, and reducing barriers to access are important for supporting COVID-19 vaccination for school-age children. [ABSTRACT FROM AUTHOR]

The coronavirus disease 2019 (COVID-19) pandemic is a global threat, challenging health services' provision and utilization. This study aimed to assess compulsory vaccination coverage in 12 Sub-Saharan African countries two years following the COVID-19 pandemic using the Health Belief Model. A cross-sectional survey was conducted from November 1 to December 15, 2022. Multivariate logistic regression was conducted to identify the determinants of vaccination coverage. Among the 5032 respondents, 73.1% reported that their children received compulsory vaccination. The lowest coverage was observed in Ghana (36.5%), while the highest was in Burkina Faso and Congo (92.0%). Factors associated with non-vaccination included older mothers (adjusted odds ratio (AOR) = 1.04, 95%CI: 1.03–1.05), lower mothers' education, older children (AOR = 0.76, 95%CI: 0.60–0.96), children with chronic illnesses (AOR = 0.55, 95%CI: 0.45–0.66), and difficult accessibility to healthcare facilities (AOR = 11.27, 95%CI: 9.48–13.44). Low perceived risk, in which non-vaccinated children were believed to be at no higher risk for infectious diseases and the disease severity would not worsen among non-vaccinated children, increased the likelihood of non-vaccination (AOR = 2.29, 95%CI: 1.75–2.99 and AOR = 2.12, 95%CI: 1.64–2.73, respectively). Perceiving vaccines as unnecessary, and needless for breastfed babies increased the probability of non-vaccination (AOR = 1.38, 95%CI: 1.10–1.73 and AOR = 1.69, 95%CI: 1.31–2.19, respectively). Higher odds of non-vaccination were found when the provision of vaccine information did not motivate parents to vaccinate their children (AOR = 4.29, 95%CI: 3.15–5.85). Conversely, believing that vaccines were safe for children decreased the odds of non-vaccination (AOR = 0.72, 95%CI: 0.58–0.88). Parental perceptions and concerns should be considered in interventions aiming to increase compulsory vaccine acceptance and coverage. [ABSTRACT FROM AUTHOR]

The component of human life that has been most significantly altered by the COVID-19 epidemic is travel. Due to the upheaval produced by the pandemic breakout, countries are becoming increasingly avaricious and are scrambling to stockpile vaccines. The world has been locked down to reduce/control the pandemic outbreak, driving countries to shut their doors to other people from countries. The recent pandemic has had a short-term, positive effect on the environment, but travel restrictions have caused problems for the common person and are expected to deteriorate more soon, necessitating longer quarantines, vaccination requirements, vaccine passports, and immunization certificates required by countries for safe travel. Thus, this study has three objectives. First, we investigate the impact of COVID-19 on travel and the environment, as well as the role that tourists play in the transmission of the virus. Second, we examine how countries are handling COVID-19 vaccines. Finally, we pinpoint differences in vaccination coverage. [ABSTRACT FROM AUTHOR]

Influenza is a health problem and vaccination is the most effective measure to prevent it. The objective of this study was to evaluate the impact of the COVID-19 pandemic on vaccination coverage (VC) against influenza in healthcare workers (HCWs). A cross-sectional study was conducted at the Dr. Balmis University General Hospital in the province of Alicante (Spain), in which vaccination data were collected retrospectively. Adverse effects (AEs) were detected via telephone call between 15 and 30 days after vaccination. The existence of significant changes in VC between the different seasons studied was evaluated using Chi square with a statistical significance level of p < 0.05. A total of 8403 HCWs vaccinated throughout the different seasons were studied. The vaccination coverage of HCWs for influenza pre-COVID-19 pandemic (2019/20 season) was 51.9%; increased during the pandemic to 67.9% (2020/21 season) and 65.5% (2021/22 season); and, after the pandemic, it decreased to 42.7% (2022/23 season) (p < 0.05). The most frequent reason for vaccination during the periods evaluated was "self-protection", followed by "protection of patients" and "protection of family members". Of all HCWs evaluated, 26.6% (1460/5493) reported at least one AE. During the COVID-19 pandemic, HCWs' influenza vaccination coverage fluctuated considerably. There has been an increase in VC during the most critical moments of the pandemic, both in the 2020/21 and 2021/22 seasons, which has, subsequently, decreased in the 2022/2023 season, to levels below pre-pandemic (2019/2020 season), which justifies implementing specific measures to recover VC in Spain. [ABSTRACT FROM AUTHOR]

This document provides a summary of various research articles on the impact of the COVID-19 pandemic on vaccine implementation strategies and routine immunization services in different countries. The articles highlight the importance of effective communication systems, multidisciplinary leadership structures, and patient-centered engagement strategies in vaccine implementation. They also discuss the Whole Family Approach in Nigeria, which aims to increase COVID-19 vaccine uptake by leveraging the demand for other primary health services. The articles address challenges such as vaccine scarcity, vaccine hesitancy, and disruptions to routine immunization services. They propose interventions such as tailored decision aids, social mobilization campaigns, and the involvement of politicians to improve vaccine acceptance and uptake. The research findings contribute to the evidence needed to inform immunization recovery strategies during and after the pandemic. [Extracted from the article]

COVID-19 seriously impacted routine immunization (RI) in Iraq. Coverage declined to a 6-year low in 2021, and COVID-19 vaccination uptake was slow. In response, government implemented intensification of integrated immunization services (3IS), a nationwide approach comprising regular outreach sessions of COVID-19 vaccination and RI for children who had either missed doses or never commenced scheduled vaccination (zero-dose children). We describe the 3IS and its impact on vaccination coverage in Iraq. 3IS comprised new outreach sessions for urban and rural communities where administrative data suggested there were gaps in coverage. Groups of six personnel from each of 1,321 primary healthcare centres implemented six outreach sessions per month during February-November 2022. Community engagement was an integral component. We compared RI administrative data (2019–2022) and data reported during 3IS activities to assess its impact. In total 4,189,859 vaccine doses were administered during 72,495 3IS outreach sessions, over one-fifth of 19,106,849 vaccine doses administered in Iraq over these 10 months. Among them, 957,874 (22.9 %) were COVID-19 vaccines, adding slightly to national coverage, and 3,231,985 (77.1 %) were RI vaccines, dramatically reducing zero-dose children, adding 18 %, 25 %, 21 %, and 31 % to 2022 penta1, penta3, measles first-dose and MMR1 vaccine coverage, and contributing to national coverage of 102.2 %, 94.5 %, 91.8 % and 96.3 % for these vaccines during February-November, respectively. Moreover, 3IS sessions delivered 133,528 doses of tetanus toxoid, 16,353 doses of adult HepB vaccine, and 315,032 vitamin A doses to eligible individuals. In the context of global encouragement to integrate vaccination services, Iraq's 3IS approach enabled dramatic improvements in RI coverage, virtual elimination of zero-dose status among children born during the pandemic, and small improvements in COVID-19 and adult vaccination. Our findings provide lessons for future integrated primary care towards universal health coverage in Iraq, and for other countries yet to undertake integration. [ABSTRACT FROM AUTHOR]

Background: Conducting a study in rural pre-dominant areas will help to understand the penetration of the vaccination campaign during the COVID-19 health crisis. This study aimed to investigate vaccination coverage against COVID-19 among the rural adult population in India and to identify factors associated with vaccination coverage. Methods: A population-based cross-sectional study was conducted among the rural population in one district of north India from January to February 2023. A semi-structured questionnaire was designed on the SurveyMonkey digital platform for interviewing the participants, which consisted of questions related to socio-demographic profile, health problems, vaccination status, types of vaccine, re-infection after vaccination, and functional difficulties. The data regarding infection with COVID-19 was collected based on self-reported positive testing for SARS-CoV 2 on RT-PCR. Findings: A total of 3700 eligible individuals were enumerated for the survey, out of which 2954 (79.8%) were interviewed. The infection rate of past COVID-19 infection, based on self-report of testing positive, was 6.2% (95%CI: 5.3–7.1). Covishield vaccine was received by most participants (81.3%, 2380) followed by Covaxin (12.3%, 361) and Pfizer manufactured vaccine (0.03,1). The coverage for first, second, and booster doses of the vaccine was 98.2% (2902), 94.8% (2802), and 10.7% (315) respectively. The risk of reinfection at 12 months or more among participants with two doses of vaccine was 1.6% (46/2802, 95%CI: 1.2–2.1). The coverage among those with severe functional difficulties was lesser as compared to those with some or no difficulties. Interpretation: Vaccination coverage against COVID-19 in rural Haryana, India is not dependent on factors like gender or occupation but is dependent on age and education. Although the full and partial vaccination coverage is high, the booster dose coverage is poor. In addition, the presence of severe disability was significantly associated with reduced vaccination coverage. [ABSTRACT FROM AUTHOR]

Background: The terms syndemic and infodemic have both been applied to the COVID-19 pandemic, and emphasize concurrent socio-cultural dynamics that are distinct from the epidemiological outbreak itself. We argue that the COVID-19 pandemic has exposed yet another important socio-political dynamic that can best be captured by the concept of a quandemic – a portmanteau of "quantification" and "pandemic". Main text: The use of quantifiable metrics in policymaking and evaluation has increased throughout the last decades, and is driven by a synergetic relationship between increases in supply and advances in demand for data. In most regards this is a welcome development. However, a quandemic, refers to a situation where a small subset of quantifiable metrics dominate policymaking and the public debate, at the expense of more nuanced and multi-disciplinary discourse. We therefore pose that a quandemic reduces a complex pandemic to a few metrics that present an overly simplified picture. During COVID-19, these metrics were different iterations of case numbers, deaths, hospitalizations, diagnostic tests, bed occupancy rates, the R-number and vaccination coverage. These limited metrics came to constitute the internationally recognized benchmarks for effective pandemic management. Based on experience from the Nordic region, we propose four distinct dynamics that characterize a quandemic: 1) A limited number of metrics tend to dominate both political, expert, and public spheres and exhibit a great deal of rigidity over time. 2) These few metrics crowd-out other forms of evidence relevant to pandemic response. 3) The metrics tend to favour certain outcomes of pandemic management, such as reducing hospitalization rates, while not capturing potential adverse effects such as social isolation and loneliness. 4) Finally, the metrics are easily standardized across countries, and give rise to competitive dynamics based on international comparisons and benchmarking. Conclusion: A quandemic is not inevitable. While metrics are an indispensable part of evidence-informed policymaking, being attentive to quandemic dynamics also means identifying relevant evidence that might not be captured by these few but dominant metrics. Pandemic responses need to account for and consider multilayered vulnerabilities and risks, including socioeconomic inequities and comorbidities. [ABSTRACT FROM AUTHOR]

Background: Epidemiologic studies on coronavirus disease 2019 (COVID-19) in patients with multiple sclerosis (pwMS) have focused on the first waves of the pandemic until early 2021. Objectives: We aimed to extend these data from the onset of the pandemic to the global coverage by vaccination in summer 2022. Methods: This retrospective, multicenter observational study analyzed COVISEP registry data on reported COVID-19 cases in pwMS between January 2020 and July 2022. Severe COVID-19 was defined as hospitalization or higher severity. Results: Among 2584 pwMS with confirmed/highly suspected COVID-19, severe infection rates declined from 14.6% preomicron wave to 5.7% during omicron wave (p < 0.001). Multivariate analysis identified age (odds ratio (OR) = 1.43, 95% confidence interval (CI) = [1.25–1.64] per 10 years), male sex (OR = 2.01, 95% CI = [1.51–2.67]), obesity (OR = 2.36, 95% CI = [1.52–3.68]), cardiac comorbidities (OR = 2.36, 95% CI = [1.46–3.83]), higher Expanded Disability Status Scale (EDSS) scores (OR = 2.09, 95% CI = [1.43–3.06] for EDSS 3–5.5 and OR = 4.53, 95% CI = [3.04–6.75] for EDSS ⩾6), and anti-CD20 therapies (OR = 2.67, 95% CI = [1.85–3.87]) as risk factors for COVID-19 severity. Vaccinated individuals experienced less severe COVID-19, whether on (risk ratio (RR) = 0.64, 95% CI = [0.60–0.69]) or off (RR = 0.32, 95% CI = [0.30–0.33]) anti-CD20. Discussion: In pwMS, consistent risk factors were anti-CD20 therapies and neurological disability, emerging as vital drivers of COVID-19 severity regardless of wave, period, or vaccination status. [ABSTRACT FROM AUTHOR]

This study aims to assess the impact of the COVID-19 pandemic on childhood immunization programs in Indonesia, with a specific focus on performance disparities between rural and urban areas. It considers factors like access, utilization, and program workload. Methods: Data were collected from primary health cares (PHCs) in two regions in West Java Province, Indonesia, representing rural and urban areas. A descriptive analysis was conducted to compare vaccination coverage, drop-out rates, and the ratio of vaccinators per dose from 2019 to 2021 in 40 and 22 PHCs for rural and urban areas, respectively. A general linear model was employed to evaluate the differences in these parameters over the three consecutive years. Results: The results indicate fluctuations in vaccine coverage over the three years, with the most significant impact observed in 2020, particularly in rural areas. Statistical analysis revealed a significant difference in routine immunization coverage, drop-out rates, and vaccinator ratios between rural and urban areas from 2019 to 2021 (p< 0.05). In 2021, both rural and urban areas displayed significant differences in performance parameters for routine immunization and COVID-19 vaccination (p< 0.05), except in terms of coverage for IPV and COVID-19 vaccination. Conclusion: The study highlights a reduction in routine immunization coverage during the pandemic, a concerning issue that increases the risk of vaccine-preventable diseases, particularly in rural areas. [ABSTRACT FROM AUTHOR]

Introduction: The present research highlights the promising factors that suggest the possible occurrence of the fourth COVID wave in India. India is among the major victim of this pandemic and has already witnessed the three dangerous COVID waves, and the lives of Indian people are put to a major setback. When it appears as the destruction caused by the third wave seems to getting over and people are trying to return to their normal lives, meanwhile with the mutation of the virus, the new COVID variants (COVID XBB 1.16 or Arcturus, XBB.1.5, and Delta Omicron) are again shaking our universe. Methods: Research studies and developed predictive models are suggesting the possible occurrence of the fourth COVID wave in the coming months. Considering the predictions and model developed, a critical insight is provided in the present study, which predicts the prospect of the fourth COVID wave in India. Results: Research proposed that the new COVID variants (COVID XBB 1.16, XBB.1.5, and Delta Omicron) are again leading to an increase in the number of active infected cases. Several factors, as mentioned in the research, are responsible for this spread of infection. Conclusions: Important factors are highlighted, which portray the probability of the fourth coronavirus wave in India. Important factors are presented in individuals, and an attempt is made to relate them with the occurrence or nonoccurrence of the fourth wave. [ABSTRACT FROM AUTHOR]

It is important to determine mothers’ perceptions of health care services during the pandemic to ensure equity in the provision of such services in the future. The objective: to determine the determinants of pregnant women’s perception of perinatal care services during the COVID-19 pandemic. Materials and methods. An original sociological study was conducted to assess the state of perinatal care during the COVID-19 pandemic using a questionnaire. 110 questionnaires were included in the analysis. Group 1 included 45 female respondents were sick with COVID-19 during pregnancy, group 2 – 65 women were not sick with COVID-19 during pregnancy. All questionnaires were analysed both in the general sample and in the section of COVID-19 during pregnancy. Results. Certain shortcomings in the provision of perinatal care during the COVID-19 pandemic at the ambulatory level were identified. Insufficient vaccination coverage of pregnant women (65.5% of respondents were vaccinated during pregnancy). 87.3% of patients considered insufficient information about vaccination of pregnant women. A negative attitude towards vaccination during pregnancy was expressed by 30.0% of respondents. 65.4% of respondents considered insufficient availability of perinatal care in the conditions of the COVID-19 pandemic. Remote counseling was received by less than half of patients (41.8%), and mainly those who were sick with COVID-19 (62.2%). A negative attitude towards remote counseling was expressed by 49.1% of women. More than half (56.4%) of the respondents considered the provided information about COVID-19, treatment and prevention to be insufficient. Only 9.1% of patients received full psychological support. Half of the patients were not satisfied with the qualifications of the medical staff, and 59.1% were not satisfied with the staff’s attitude. More than half (55.4%) of patients were not satisfied with the care provided at the outpatient stage in general, especially those who did not suffer from COVID-19, which may be due to a shift in the focus of attention on infected pregnant women. Conclusions. The following positions can be recommended to improve perinatal care: expansion of information provision of the population, in particular with the involvement of mass media; conducting explanatory work with patients on prevention, vaccination, treatment, possible complications during pregnancy; provision of remote counseling in possible cases; psychological support of the pregnant woman and her family at all stages of perinatal care. [ABSTRACT FROM AUTHOR]

The United Kingdom (UK) has a comprehensive national immunisation programme which comprises both routine and selective immunisation schedules (UK Health Security Agency [UKHSA], 2023). The routine programme includes those vaccines offered to the population, with eligibility predicated on age. For the last few years, vaccine coverage has been falling in the majority of children’s and young people’s immunisation programmes (UKHSA, 2022; UKHSA 2023a; UKHSA 2023b; UKHSA 2023c). The decline in coverage has been made worse by the Covid-19 pandemic and consequent lockdowns, illness among recipients, and confusion and hesitancy about vaccines in general. This article discusses the drop in coverage of the adolescent immunisation programmes in England, and the role that general practice nurses (GPNs) and primary care immunisers can play in ensuring that young people are offered missing vaccines. The benefit of this catch-up activity is seen in reduced risk of morbidity and mortality from vaccine preventable illness in both individuals and those around them. [ABSTRACT FROM AUTHOR]

Although immunization is one of the most successful and cost-effective interventions that prevents millions of infant and child deaths yearly, it has failed to achieve its intended goals in some low-income countries. Yemen is currently experiencing the most extreme humanitarian crisis globally, which has affected health and worsened its economy and political governance instability. There are few reports on Yemeni vaccination statuses. The present study aimed to investigate the effect of the public health emergency crises on childhood immunization in Yemen. A retrospective descriptive study was conducted in the Coastal Hadhramaut Governorate, Yemen. Secondary data from governorate annual reports for 2013–2020 were extracted. The assessment of the annual immunization coverage rate according to each vaccine was tabulated. The analysis revealed that the 2013–2019 vaccination coverage in Coastal Hadhramaut demonstrated an increasing trend. However, vaccination coverage decreased for all vaccines in 2015–2016 and 2020. Although all three doses of the pentavalent vaccine demonstrated >85% coverage in all years, the coverage of the first and second doses decreased in 2016, and the coverage of all doses decreased in 2020 during the COVID-19 pandemic. Public health emergencies negatively affected routine immunization coverage in Yemen. The trend correlated with the humanitarian crisis and other research findings in Yemen. The national response to public health threats during emergency crises must involve strengthening the program for monitoring and evaluating vaccine-preventable diseases. [ABSTRACT FROM AUTHOR]

Background: In the Americas, deaths by diseases avoidable with vaccines are a significant contributor to child mortality. An essential means of reducing this is through broad vaccine coverage. The COVID-19 pandemic has posed a potential disruption to vaccine coverage due to its effects on the healthcare system. Objectives: this study aims to evaluate the impact of the COVID-19 pandemic on DTP3 vaccination coverage in the Americas, investigating trends from 2012 to 2022 to identify significant changes, regional disparities, and the overall effect of the pandemic on progress towards global immunization targets. Methods: This study used the coverage data for the third dose of the diphtheria, tetanus, and pertussis vaccine (DTP3) pulled from UNICEF databases spanning 2012 to 2022. We conducted a Joinpoint regression to identify points of significant trend changes. The annual percentage change (APC) and 95% confidence intervals (95% CIs) were calculated for America and its regions. We also used segmented regression analysis. Using the Chi-square test, we compared DTP3 vaccination coverage for each country between 2019 and 2022. Results: Overall, America saw a decrease in vaccine coverage during this period, with an APC of −1.4 (95% CI −1.8; −1.0). This trend varied across regions. In North America, the decrease was negligible (−0.1% APC). South America showed the steepest decrease, with an APC of −2.5%. Central America also declined, with an APC of −1.3%. Our findings suggest a concerning trend of declining DTP-vaccination rates in the Americas, exacerbated in certain regions, in the wake of the COVID-19 pandemic. The absolute decrease in vaccine coverage in the Americas was −4% between 2019 and 2022, with the most important drop being in Central America (−7%). However, six countries reported increased vaccination rates post-COVID-19, led by Brazil, with a 7% increase. Conversely, twenty-two countries registered a decline in DTP3 vaccine coverage, with the average decrease being −7.37%. This decline poses an important challenge to achieving the WHO's target of 90% coverage for the third dose of DTP by 2030, as evidenced by the reduction in the number of countries meeting this target from 2019 to 2022. Conclusions: The COVID-19 pandemic has impacted vaccine coverage in America, leading to a decrease, especially across Central America. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic halted progress in global vaccine coverage and disrupted routine childhood vaccination practices worldwide. While there is ample evidence of the vaccination decline experienced during the pandemic, it is less clear how low-income countries were affected. We executed a systematic review to synthesize the current literature on the impacts of routine childhood vaccinations in low-income countries from 1 January 2020 to 8 February 2023. We collected data using an extraction form on Covidence and assessed the quality of studies included in the review using the Risk of Bias in Non-Randomized Studies of Interventions (ROBINS-I) tool. Effect estimates for changes in vaccination during the pandemic were reported and summarized. Factors that influenced changes were grouped into descriptive themes. Thirteen studies, encompassing 18 low-income countries and evaluating 15 vaccines at varying doses, were included in the final review. We found that routine childhood vaccinations during the COVID-19 pandemic varied considerably by vaccine type, location, and phase of the pandemic. Nine different themes were identified as factors that influenced changes in vaccination. Documenting past experiences and lessons learned is crucial for informing preparedness efforts in anticipation of future public health emergencies. Failure to effectively address these things in the next public health emergency could result in a recurrence of declining routine childhood vaccinations. [ABSTRACT FROM AUTHOR]

In this study, we modelled the incidence of COVID-19 cases and hospitalisations by basic health areas (ABS) in Catalonia. Spatial, temporal and spatio-temporal incidence trends were described using estimation methods that allow to borrow strength from neighbouring areas and time points. Specifically, we used Bayesian hierarchical spatio-temporal models estimated with Integrated Nested Laplace Approximation (INLA). An exploratory analysis was conducted to identify potential ABS factors associated with the incidence of cases and hospitalisations. High heterogeneity in cases and hospitalisation incidence was found between ABS and along the waves of the pandemic. Urban areas were found to have a higher incidence of COVID-19 cases and hospitalisations than rural areas, while socio-economic deprivation of the area was associated with a higher incidence of hospitalisations. In addition, full vaccination coverage in each ABS showed a protective effect on the risk of COVID-19 cases and hospitalisations. [ABSTRACT FROM AUTHOR]

While vaccines are pivotal in combating COVID-19, concerns about side effects and complex procedures have hindered complete vaccination. Prior studies suggest that individuals defaulted to opt-out exhibit higher COVID-19 vaccination rates compared to those in opt-in systems. However, these studies were conducted in countries with a tolerant attitude towards vaccination and default changes, targeting specific age groups, and did not address potential deterrents like the increase in cancellation rates on the day, discomfort towards changing defaults, or the possibility of the opt-out effect being a one-time occurrence. Under the hypothesis that the default nature of the COVID-19 vaccination system influences attitudes towards vaccination even in countries conservative about vaccination and default changes like in Japan, we aimed to examine the differences in the first and second dose vaccination rates, cancellation rates, and the number of complaints between the opt-in and opt-out systems for COVID-19 vaccination. An email survey was conducted in 10 cities in A Prefecture, Japan. The results showed not only higher COVID-19 vaccination rates across all comparable age groups in the opt-out group but also a notably smaller decrease in the second-dose vaccination rate compared to the opt-in group, all achieved without any complaints about the system's introduction. Consequently, it can be inferred that the potential inhibiting factors were largely overcome. Despite some limitations, such as regional specificity, the study suggests that opt-out systems might increase COVID-19 vaccination coverage without leading to significant cancellations or complaints, presenting a promising strategy to facilitate vaccination efforts. [ABSTRACT FROM AUTHOR]

• Health on Wheels (HoW) increased access to COVID-19 vaccination in rural Guatemala. • 1st, 2nd, and 3rd dose administration was over 2 times higher in intervened communities. • 1st, 2nd, and 3rd dose administration increased by 20 % post intervention. • The increase in 1st and 2nd dose administration was higher in communities with vaccine hesitancy. In April 2022, after a year of COVID-19 vaccination, there were large differences in coverage between urban and rural areas in Guatemala. To address barriers in rural communities, the "Health on Wheels" (HoW) strategy was implemented. The strategy deployed mobile brigades with a dedicated team of health workers and a culturally sensitive health promotion plan in selected communities in 15 districts in Alta Verapaz, a health area with low COVID-19 vaccination uptake and a high-level of COVID-19 vaccine hesitancy. This study evaluates the impact of the HoW strategy. We measured the relative increase in COVID-19 doses administered prior and during the HoW implementation period in the 190 intervened communities and compared to 188 communities without the intervention. Communities were grouped by health district and the impact analyses were stratified by number of COVID-19 vaccine dose (1st, 2nd, and 3rd doses) and history of vaccine hesitancy. The increase in 1st, 2nd, and 3rd dose-COVID-19 vaccination coverage between before and during HoW implementation was 2.4, 2.2 and 2.6 times higher in intervened communities (20 %, 21 % and 37 % increase in 1st, 2nd and 3rd dose, respectively) than in non-intervened communities (8 %, 10 % and 14 % increase in 1st, 2nd and 3rd dose respectively). For the 1st dose, increase in dose administration was 2.9 times higher in intervened communities (n = 24) with hesitancy (24 % increase) compared to non-intervened communities (n = 188) without hesitancy (8 % increase). The deployment of mobile brigades with a dedicated team of vaccinators and culturally sensitive health promotion through the HoW strategy successfully accelerated the increase in COVID-19 vaccination coverage in rural communities in Guatemala. [ABSTRACT FROM AUTHOR]

• Boot Camp Translation was studied for promoting rural adolescent vaccination. • Rural counties were randomized in a study conducted during the COVID pandemic. • 11–12-year-old vaccination decreased slightly; 13–17-year old coverage increased. • Vaccination outcomes did not differ between intervention and control counties. • Effect of BCT on vaccination is difficult to know due to influence of the pandemic. Routine vaccination coverage for adolescents living in the rural US is lower than adolescents living in urban areas. We sought to measure the effect of Boot Camp Translation (BCT), a community-based participatory intervention, on rural adolescent vaccination coverage. A cluster randomized controlled trial was performed September 2018-November 2021 involving 16 rural Colorado counties. Intervention county community members engaged in BCT to develop interventions to improve adolescent vaccination locally. Adolescent vaccination coverage was measured using the Colorado Immunization Information System. For 11–12-year-olds, HPV initiation, HPV up-to-date, MenACWY, and Tdap vaccination coverage was lower post- versus pre-intervention in the control and intervention groups. For 11–12-year-olds in the intervention group, there was no significant difference post- versus pre-intervention in the odds of HPV vaccine initiation (adjusted ratio of odds ratios [aROR] = 0.93, 95 %: 0.85–1.02, p = 0.10) or up-to-date HPV vaccination (aROR: 1.10, 95 % CI: 0.98–1.23, p = 0.11) compared with the control group. Among 11–12-year-olds, the decrease in the proportion vaccinated with MenACWY and Tdap in the intervention group was significantly greater than the control group. Among 13–17-year-olds, there were significant increases in HPV initiation, HPV up-to-date, MenACWY, and Tdap vaccination coverage from pre- to post-intervention for both groups, with no significant differences between groups. 11–12-year-old vaccination coverage decreased slightly from pre- to post-intervention while 13–17-year-old vaccination coverage increased. We saw no effect from the BCT intervention. Our findings about the effectiveness of BCT for improving vaccine uptake may not be generalizable because the study coincided with the COVID-19 pandemic. Clinical Trial Registry: This study was registered with ClinicalTrials.gov , NCT03955757. [ABSTRACT FROM AUTHOR]

Background: Recurring COVID-19 waves highlight the need for tools able to quantify transmission risk, and identify geographical areas at risk of outbreaks. Local outbreak risk depends on complex immunity patterns resulting from previous infections, vaccination, waning and immune escape, alongside other factors (population density, social contact patterns). Immunity patterns are spatially and demographically heterogeneous, and are challenging to capture in country-level forecast models. Methods: We used a spatiotemporal regression model to forecast subnational case and death counts and applied it to three EU countries as test cases: France, Czechia, and Italy. Cases in local regions arise from importations or local transmission. Our model produces age-stratified forecasts given age-stratified data, and links reported case counts to routinely collected covariates (e.g. test number, vaccine coverage). We assessed the predictive performance of our model up to four weeks ahead using proper scoring rules and compared it to the European COVID-19 Forecast Hub ensemble model. Using simulations, we evaluated the impact of variations in transmission on the forecasts. We developed an open-source RShiny App to visualise the forecasts and scenarios. Results: At a national level, the median relative difference between our median weekly case forecasts and the data up to four weeks ahead was 25% (IQR: 12–50%) over the prediction period. The accuracy decreased as the forecast horizon increased (on average 24% increase in the median ranked probability score per added week), while the accuracy of death forecasts was more stable. Beyond two weeks, the model generated a narrow range of likely transmission dynamics. The median national case forecasts showed similar accuracy to forecasts from the European COVID-19 Forecast Hub ensemble model, but the prediction interval was narrower in our model. Generating forecasts under alternative transmission scenarios was therefore key to capturing the range of possible short-term transmission dynamics. Discussion: Our model captures changes in local COVID-19 outbreak dynamics, and enables quantification of short-term transmission risk at a subnational level. The outputs of the model improve our ability to identify areas where outbreaks are most likely, and are available to a wide range of public health professionals through the Shiny App we developed. [ABSTRACT FROM AUTHOR]