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Introducción: La inmunización es unade las intervenciones de salud más exitosas y costo-efectivas, por medio de la cual se pueden prevenir entre dos y tres millo-nes de muertes cada año en el mundo, sigue siendo considerada como una inter-vención eficaz que salva vidas y evita el sufrimiento; beneficia a los niños porque mejora la salud y la esperanza de vida, también por su impacto social y econó-mico a escala mundial. Objetivo: Validar los instrumentos cuantitativo y cualitativo para determinar los factores sociodemo-gráficos que inciden en la accesibilidad al servicio de inmunizaciones en niños menores de 24 meses. Metodología: El presente estudio es de enfoque mixto (cuanti – cualitativo) de corte transver-sal, exploratorio de tipo descriptivo y de campo, con un enfoque cualitativo feno-menológico diseñado por 3 categorías y codificado de acuerdo al número de par-ticipantes. La población como muestra de la investigación es de 100 personas, de las cuales se hizo un estudio piloto de 15 personas para la encuesta y 1 persona para la entrevista a profundidad. Resul-tados: Al aplicar el criterio de los juicios de expertos, se obtuvieron los siguientes resultados: en el instrumento cuantitativo se obtuvo un promedio de 96 y en el ins-trumento cualitativo logrando un prome-dio de 95, ambos resultados equivalentes a muy confiable. Conclusión: El plan pi-loto da a entender que los instrumentos tienen propiedades buenas para determi-nar los factores sociodemográficos que incidan a la accesibilidad del servicio de inmunizaciones.

This study investigated sociodemographic factors for immunization care use and the relationship between trust in physician (TIP) and immunization service use in older Chinese Americans. Data were collected through the Population Study of Chinese Elderly, including survey information of 3,157 older adults in the Greater Chicago area. Regression results showed that the odds of getting vaccinated were higher for those who were older, female, and had higher education and income. After adjusting for the covariates, higher TIP was associated with greater immunization service use. The highest tertile of TIP was associated with higher odds of using immunization service ( OR 2.19, 95% CI [1.76, 2.72]), especially for flu and pneumonia vaccines. Findings suggests that immunization service use may be increased by improving TIP and promoting targeted health care management plans for racial/ethnic minorities, which is highly relevant to increase the vaccination rate and contain the pandemic as the COVID-19 vaccine is available.

In Mozambique, the Expanded Program on Immunization (EPI) was implemented in 1979 with the objective of reducing child mortality and morbidity through the provision of immunization services. This study aims to describe the characteristics of the EPI and review the available information related to immunization service in Mozambique, its accomplishments and perspectives. A narrative review of the literature was carried out and the electronic databases accessed were VHL, Google Scholar, and PubMed between 1979 and 2019, using descriptors related to the theme. A total of 28 articles and other relevant sources have been consulted for the review. The national immunization coverage in Mozambique between 1997 (47%) and 2015 (66%) improved 19 percentual points; also immunization coverage of children under 12 months has increased from 44.3% (1997) to 57% (2015). The 2015 survey showed that out of the 11 provinces, only the southern and Cabo Delgado province could reach the 80% recommended goal at the provincial level. Zambézia, Nampula, and Tete provinces have been reporting low coverage over the years and Cabo Delgado presents coverage oscillation. The BCG, DPT3, Polio 3, and measles have reached 80% of coverage goal from 1997 to 2015. Our analysis have shown important improvements in national immunization, characterized by an overall increase in the national and provincial coverage and a decrease in the number of children that did not receive any vaccine. Despite these improvements, some provinces have lower coverages than expected and it is necessary to understand the determinants of dropout in children to retain them and provide timely and full immunization. Em Moçambique, o Programa Alargado de Vacinação (PAV) foi implementado em 1979 com o compromisso de reduzir a morbimortalidade na população infantil através dos serviços de imunização. O presente estudo tem como objetivo descrever as características do PAV e revisar as informações disponíveis relacionadas aos serviços de imunização em Moçambique, os avanços e perspectivas. Foi realizada uma revisão narrativa da literatura, e as bases de dados acessadas foram BVS, Google Scholar e PubMed, entre 1979 e 2019, usando descritores relacionados ao tema. A revisão acessou um total de 28 artigos científicos, além de outras fontes relevantes. A cobertura nacional de vacinação em Moçambique entre 1997 (47%) e 2015 (66%) aumentou 19 pontos percentuais, e a cobertura de vacinação em crianças abaixo de 12 meses de idade aumentou de 44,3% (1997) para 57% (2015). De acordo com os dados de 2015, das 11 províncias, apenas as do Sul e a de Cabo Delgado atingiram a meta de cobertura recomendada de 80%. As províncias de Zambézia, Nampula e Tete mostraram baixas coberturas ao longo dos anos, enquanto Cabo Delgado mostrou oscilação na cobertura. As vacinas BCG, DPT3, Polio 3 e sarampo atingiram a meta de cobertura de 80% entre 1997 e 2015. Nossa análise mostrou avanços importantes na vacinação nacional, caracterizados por um aumento geral nas coberturas nacional e provinciais e uma queda no número de crianças que não receberam nenhuma vacina. Apesar desses avanços, algumas províncias tiveram coberturas aquém das metas, o que reforça a necessidade de entender os determinantes do abandono da imunização nas crianças, para retê-las e assegurar a imunização oportuna e completa. En Mozambique, el Programa de Inmunización Expandido (EPI por sus siglas en inglés) fue implementado en 1979, con el compromiso de reducir la mortalidad infantil y la morbilidad a través de la provisión de servicios de inmunización. El objetivo del presente estudio es describir las características del EPI y revisar la información disponible, relacionada con el servicio de inmunización en Mozambique, así como sus logros y perspectivas. Se llevó a cabo una revisión narrativa de la literatura y se accedió a las siguientes bases de datos electrónicas: BVS, Google Scholar y PubMed para el período de 1979 a 2019, usando descriptores relacionados con el tema. Se tuvo acceso a un total de 28 artículos y otras fuentes relevantes para la revisión. La cobertura nacional de inmunización en Mozambique de 1997 (47%) a 2015 (66%) mejoró 19 puntos porcentuales y la cobertura de inmunización de los niños con menos de 12 meses se incrementó de un 44,3% (1997) a un 57% (2015). La encuesta de 2015 mostró que, de las 11 provincias, solamente la provincia del sur y la provincia de Cabo Delgado podrían alcanzar el 80% de la meta recomendada a nivel provincial. Las provincias de Zambézia, Nampula, y Tete han estado informando de baja cobertura a largo de estos años y Cabo Delgado tiene oscilaciones en la cobertura. BCG, DPT3, Polio 3 y sarampión han alcanzado un 80% de la meta de la cobertura de 1997-2015. Nuestro análisis ha mostrado importantes mejoras en la inmunización nacional, caracterizada por un aumento en general en la cobertura nacional y provincial, así como un decremento en el número de niños que no recibieron ninguna vacuna. A pesar de estas mejoras, algunas provincias tienen coberturas más bajas que las esperadas y existe una necesidad para entender los determinantes del abandono en niños para retenerlos y proporcionarles a tiempo una completa inmunización.

Background Routine childhood immunization coverage in Pakistan remains sub-par, in part, due to the poor quality of service delivery. This study aims to summarize the quality of immunization centers throughout the Sindh province, Pakistan, by assessing all Government vaccination facilities and their associated health workers. Methods A health facility and worker assessment survey adapted from tools developed by BASICS and EPI-Sindh was used to record facility infrastructure, processes, and human resources. Using expert panel ranking, we developed critical criteria to indicate items immunization centers need to be operational (vaccinator, a cold box or refrigerator, and vaccine supplies) as well as high, low, and moderate function requirements and their respective scores. Results Out of 1396 centers assessed, 1236 (88.5%) were operational, while 1209 (86.6%) offered immunization services. Only 793 (66.0%) of the functional immunization facilities met the critical criteria. The average scores for high, moderate, and low function requirements were significantly lower for centers that did not meet the critical criteria. Of 2,153 healthcare workers interviewed, 1874 (87.1%) were vaccinators. 1805 (96.3%), 1655 (88.3%), and 1387 (74.0%) were trained in vaccination, cold chain, and inventory, respectively. Discussion One out of three immunization centers in Sindh lack the critical components essential for quality vaccination services. Health workers have adequate training and experience, suggesting that sub-optimal vaccination center quality is due to inadequate infrastructure and inefficient processes. Our study presents innovative and critical research findings with high-impact policy implications for identifying and addressing gaps to improve vaccination uptake within an LMIC setting. Key messages Every 2 out of 5 facilities in Sindh Province lacked essential equipment for immunizations such as vaccines, vaccinator and cold box for vaccination. In all health facilities, the health workers appear sufficiently trained, indicating that poor quality may be due to missing infrastructure and inefficient processes in resource-constrained settings.

Background: Cholera is a considerable health burden in developing country settings including Bangladesh. The oral cholera vaccine (OCV) is a preventative tool to control the disease. The objective of this study was to describe whether the International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), could provide the OCV to rural communities using existing government infrastructure. Methods: The study was conducted in rural sub-district Keraniganj, 20 km from the capital city Dhaka. All listed participants one year and above in age (excluding pregnant women) were offered two doses of OCV at a 14 day interval. Existing government facilities were used to deliver and also maintain the cold chain required for the vaccine. All events related to vaccination were recorded at the 17 vaccination sites to evaluate the coverage and feasibility of OCV program. Results: A total of 29,029 individuals received the 1st dose (90% of target) and 26,611 individuals received the 2nd dose (83% of target and 92% of 1st dose individuals) of OCV. The highest vaccination coverage was in younger children (1–9 years) and the lowest was amongst 18–29-year age group. Somewhat better coverage was seen amongst the female participants than males (92% vs. 88% for the 1st dose and 93% vs. 90% for the 2nd dose). The cost of vaccine cost was calculated as US$1.00 per dose plus freight, insurance, and transportation and the total vaccine delivery cost was US$70,957. Conclusion: This was a project undertaken using existing public health program resources to collect empirical evidence on the use of a mass OCV campaign in the rural setting. Mass vaccination with the OCV is feasible in the rural setting using existing governmental vaccine delivery systems in Bangladesh.

Background Immunizations are considered the most successful and cost-effective public health interventions employed today. While immunization coverage in India has improved dramatically in the last decade, areas of very low coverage persist. The University of Michigan School of Public Health and the Indian Institute of Public Health Gandhinagar collaborated to document strengths and weaknesses of immunization service delivery in two districts in India. Methods This report describes a qualitative assessment of clinic level immunization service delivery in ten primary health centers (PHCs) located in two districts of Gujarat, India. Assessment criteria were derived from the Reaching Every District (RED) strategy that is intended to provide a framework for delivering childhood immunizations. Staff from the PHCs were interviewed in April 2013. Results Interviews revealed several barriers to immunization service delivery including: 1) Vaccine and supply stockouts; 2) Hard to reach communities; 3) Unreliable Internet access; 4) Cold chain equipment malfunctions; 5) Inconsistently maintained and utilized immunization records and registries. Conclusions Immunization service delivery is a complex process that can encounter barriers at many stages. A RED-based evaluation of the vaccine delivery system in Gujarat, India identified several points where the system was performing sub-optimally and possible solutions to successfully address these challenges.

Context: Inimitable among the trio of recommended immunizations administered to newborns at delivery centers of institutions is hepatitis B. While it is necessary for hepatitis B to be given within 24 hours of birth, the same cannot be said for Bacillus Calmette-Guérin (BCG) and zero-dose oral polio vaccine (OPV). Objective: To assess the impact of rescheduling of BCG vaccination from the current twice weekly to daily to cover newborn vaccinations at the Government Medical College, Patiala, India. Materials And Methods: Until 2015, the delivery of BCG vaccine was restricted to twice a week, but from the year 2015, the schedule was changed from twice weekly to daily. Records for the 2 years, 2014 and 2015, were obtained, i.e., before and after the change. Data on 7065 babies born from January 2014 to December 2015 were statistically analyzed for the coverage of birth dose of hepatitis B, BCG, and OPV using Microsoft Excel. Chi-square test was applied, and p < 0.05 was considered significant. Results: Rescheduling of BCG dose, from twice weekly to daily, the coverage of BCG and OPV zero dose increased from 54% (in 2014) to 78% (in 2015), and a marked increase from 8.2% to 42.9% was noted for the birth dose of hepatitis B. By rescheduling BCG (twice weekly to daily), the vaccine wastage increased from 21.5% to 26.2%, the difference found to be statistically insignificant. Conclusions: Modification in the delivery of immunization service from twice a week to daily has had a good impact on the vaccination of newborns though the goal of achieving the ideal 100% coverage is yet to be reached. Apart from the immunization of newborns, improving parental awareness, better coordination between immunization staff and maternal health staff, improved communication, and clear delineation of responsibility and answerability in the immunization service delivery will have a good impact on the vaccination of newborns.

Background: Missed opportunities for immunization (MOI) is considered as the most important preventable reason for underimmunization. Health-care workers stand beyond more than half the children's missed opportunities due to gaps in their knowledge, attitudes, and practices (KAP) regarding immunization. Objectives: This study assessed immunization staff at primary health-care centers in Baghdad/Al-Karkh for KAP that may lead to MOI. Materials and Methods: KAP survey was conducted on field immunization service providers at primary health-care centers in Baghdad/Al-Karkh. Barriers are considered to present whenever scores found

Objectives To discuss how pharmacists are prepared to deliver vaccines that require multiple doses in a series. Summary Influenza, pneumococcal, and zoster vaccines are the most common vaccines that are administered in pharmacies. Routine recommendations often identify these vaccines to be administered 1 year apart. Other vaccines, and potential new vaccines, may require more immediate follow-up to complete a series. This article discusses if the reminder systems used by pharmacists are adequate for vaccine follow-up dosing. The Standards for Adult Immunization Practices and the Immunization Neighborhood discuss these issues. Medication synchronization policies may address a similar situation but may need to be refined to be applicable to immunizations. Conclusion Pharmacists need to anticipate an expanded immunization service. An ideal reminder system would be minimally different from current workflow but will ensure appropriate and timely follow-up for vaccine doses.

While paper-based immunization registries are the prevalent form of documenting individual-level immunization service delivery in Africa, some countries are interested in transitioning to electronic immunization registries (EIRs) which have the potential to transform immunization data into useable information for decision making to optimize the performance of immunization programs. This report discusses opportunities and challenges in the adoption of EIRs in the African continent.

Objetivou-se analisar o acesso às salas de vacinas nas Estratégias Saúde da Família de um município de Minas Gerais/Brasil. Trata-se de um estudo de caso único, qualitativo, realizado no ano de 2015. As salas de vacinas foram as unidades de análise do estudo. Realizadas entrevistas semiestruturadas com 49 usuários e 30 profissionais de saúde e observação da rotina de atendimento em sala de vacina. Procedeu-se a técnica de análise de conteúdo temática, com as categorias pré-estabelecidas. Os dados demonstraram que o acesso às salas de vacina na atenção primária à saúde apresentam entraves, implicando na exclusão de usuários ao serviço de imunização, por isso a importância de conhecer as dificuldades do acesso ao serviço, a fim de reorganizá-lo de forma a abranger a vacinação a todo público-alvo do Programa Nacional de Imunização.

Objective: Patients' satisfaction is a useful measure of the quality of service. An expression of satisfaction or dissatisfaction is also the patients' judgment on the quality of service in all its aspects. This study examined the effect of health workers sensitization on mothers' satisfaction with immunization service provided in health care facilities in a state in North Central Nigeria.Methods: This is a quasi-experimental study involving sensitization of health workers on quality health service provision at the study site, Alanamu Health Centre, Ilorin. The control group was at Okelele Health Centre, Ilorin. One hundred and fifty mothers were recruited from each of the facilities and the total population of mothers bringing their children (0-14 weeks old) for immunization was recruited consecutively for the study.Results: Less than 80% of respondents in the study group and the control group (73.3% and 77.3% respectively) were satisfied with the waiting time at the pre-intervention stage. At post-intervention, there was a significant increase in the proportion of mothers in the study group that were satisfied with the waiting time, seat provision and information received on immunization (p0.05). Age and level of education had significant influence on mothers' satisfaction (p

Immunization has made significant contribution to public health in the African Region, including elimination, eradication and control of life threatening diseases. Hospitalization due to vaccine preventable diseases has been drastically reduced due to introduction of new effective vaccines. However, optimizing the benefits of immunization by achieving high universal coverage has met with many challenges. The Regional immunization coverage, though raised from its low 57% in 2000 to 76% in 2015 has remained below expected target. Worse still, it has stagnated around 70% for a prolonged period. Cases of inequity in access to immunization service continue to exist in the region. This paper therefore explored the different challenges to immunization in the African Region. Some of the challenges it identifies and discusses include issues of sustainable funding and resources for immunization, vaccine stock-outs, and logistics. Others include data issues and laboratory infrastructure. The paper also attempted some possible solutions.

Climate change and solar ultraviolet radiation may affect vaccine-preventable infectious diseases (VPID), the human immune response process and the immunization service delivery system. We systematically reviewed the scientific literature and identified 37 relevant publications. Our study shows that climate variability and ultraviolet radiation may potentially affect VPID and the immunization delivery system through modulating vector reproduction and vaccination effectiveness, possibly influencing human immune response systems to the vaccination, and disturbing immunization service delivery. Further research is needed to determine these affects on climate-sensitive VPID and on human immune response to common vaccines. Such research will facilitate the development and delivery of optimal vaccination programs for target populations, to meet the goal of disease control and elimination.

There is a healthcare program in Indonesia called Pos Pelayanan Terpadu (Posyandu). Services such as nutritional counselling, immunization service, health education and birth preparedness are conducted in the program. All the information collected form such program is still in paper-based document, called Kartu Menuju Sehat (KMS). A development of an electronic KMS (e-KMS) is proposed. This paper presents several related works on e-KMS for Indonesia. This paper derives requirements towards the most workable features for e-KMS based on the literatures. © 2019 Institute of Physics Publishing. All rights reserved.

In order to increase uptake of measles, mumps and rubella (MMR) vaccine, a domiciliary immunization service was established in Dudley primary care trust in England in 2010. Parents of unimmunized children were offered vaccines at home. Uptake of MMR vaccine among 2 year olds rose from 89% in 2007/08 to 96.9% in 2015. Children were also given any other outstanding immunizations. The domiciliary immunization service reached vulnerable unimmunized children who may otherwise have remained unprotected against life threatening childhood illnesses. Domiciliary immunization service was set up in 2010 to reduce inequalities in uptake of MMR vaccine among children aged between 2 and 5 years.

The African Regional Office of the World Health Organization (WHO AFRO) organized the annual regional conference on immunization (ARCI) from 10 to 12 December 2012 in Dar es Salaam, Tanzania, under the theme, “Innovations, access and the right of all to vaccines”. The meeting reviewed the status of immunization in the region and identified all innovations, strategies and technologies available and how these could be fully utilized to enhance the access and the rights of all to vaccines. Over 50 oral presentations were made in plenary and parallel sessions of the conference which was attended by over 200 participants drawn from national immunization programs, academia, public health experts and immunization partners. In addition there were 40 poster presentations. This manuscript summarizes of the meeting, highlighting the innovations in immunization being piloted or scaled-up, their impact and suggesting ways to further improve immunization service delivery for the eradication, elimination and control of vaccine-preventable diseases in the region.

Entre recém-nascidos de risco, a imunização torna-se relevante em virtude do caráter preventivo. A pesquisa objetivou analisar a situação vacinal dos recém-nascidos de risco de Cuiabá-MT, bem como a satisfação e dificuldades das mães em relação à imunização. Estudo descritivo, quantitativo, com 113 recém-nascidos de risco, selecionados pela Declaração de Nascido Vivo: 25,7% apresentaram atraso vacinal, sendo a falta de vacinas na Unidade de Saúde (50,0%) o motivo mais relatado. Das crianças em atraso, 65,5% tinham mais de uma vacina atrasada, 100% apresentavam peso abaixo do esperado, 75,9% eram acompanhados em seu crescimento e desenvolvimento pela Unidade de Saúde, 69,0% apresentaram episódio de doença nos seis primeiros meses de vida, 41,4% das mães eram menores de 18 anos. As mães relataram várias dificuldades quanto ao serviço de imunização. Destaca-se a importância de estratégias que visem melhorar a qualidade no atendimento, estrutura dos serviços de saúde, acolhimento e preparo dos profissionais. Among newborns at risk, immunization becomes relevant due to its preventive characteristic. The research aimed to analyze the vaccination status of newborns at risk of Cuiabá-MT, as well as satisfaction and difficulties of mothers regarding immunization. This is descriptive study, quantitative, with 113 newborns at risk, selected by the Statement of Live Birth: 25.7% had delayed immunization, being the lack of vaccine at the Health Unit (50.0%) the reason most often reported. Of the children with delayed immunization, 65.5% had more than one vaccine late, 100% had weight less than expected, 75.9% were accompanied in their growth and development by the Health Unit, 69.0% had an episode of illness in the six first months of life, 41.4% of mothers were under 18 years. The mothers reported more difficulties to the immunization service. We emphasize the importance of strategies to improve the quality of care, structure of health services, reception and professional preparation. Entre los recién nacidos en situación de riesgo, la inmunización se vuelve relevante debido a su característica preventiva. Esta investigación tuvo como objetivo analizar el estado de vacunación de los recién nacidos en riesgo de Cuiabá-MT, así como la satisfacción y las dificultades de las madres con respecto a la inmunización. Este estudio descriptivo, cuantitativo, con 113 recién nacidos en riesgo, seleccionados por la Declaración de Nacimiento: 25,7% había retrasado la vacunación, siendo la falta de vacuna en la Unidad de Salud (50,0%), la razón más frecuentemente reportado. De los niños con retraso en la vacunación, 65,5% tenían más de una vacuna retrasada; 100% tenían un peso inferior a lo esperado; 75,9% fueron acompañados en su crecimiento y desarrollo en la Unidad de Salud; 69,0% tuvo un episodio de la enfermedad en los seis primeros meses de vida; y 41,4% de las madres eran menores de 18 años. Las madres reportaron varias dificultades relativas al servicio de vacunación. Destacamos la necesidad y la importancia de estrategias que mejoren la calidad de la atención, la estructura de los servicios de salud, la recepción y la preparación profesional.

Background: Improper handling has been identified as one of the major reasons for the decline in vaccine potency at the time of administration. Loss of potency becomes evident when immunised individuals contract the diseases the vaccines were meant to prevent. Objective: Assessing the factors associated with vaccine handling and storage practices. Methods: This was a cross-sectional study. Three-stage sampling was used to recruit 380 vaccine handlers from 273 health facilities from 11 Local Government areas in Ibadan. Data was analysed using SPSS version 16. Results: Seventy-three percent were aware of vaccine handling and storage guidelines with 68.4% having ever read such guidelines. Only 15.3% read a guideline less than 1 month prior to the study. About 65.0% had received training on vaccine management. Incorrect handling practices reported included storing injections with vaccines (13.7%) and maintaining vaccine temperature using ice blocks (7.6%). About 43.0% had good knowledge of vaccine management, while 66.1% had good vaccine management practices. Respondents who had good knowledge of vaccine handling and storage [OR=10.0, 95%CI (5.28 –18.94), p < 0.001] and had received formal training on vaccine management [OR=5.3, 95%CI (2.50 – 11.14), p< 0.001] were more likely to have good vaccine handling and storage practices. Conclusion: Regular training is recommended to enhance vaccine handling and storage practices. Keywords: Vaccine handling, storage practices, immunization, service providers, Ibadan, Nigeria

PURPOSE The BCG immunization has long been performed in Japan. Although the BCG immunization service is the responsibility of the municipality, the manner in which the BCG immunization is delivered differs from municipality to municipality. The purpose of this study was to clarify how the different manner of the BCG immunization delivery systems influenced the BCG immunization coverage. METHODS The study of BCG immunization coverage was conducted in the Tama area located in the western suburbs of Tokyo in 2004. The birth data and the immunization history by the age of 3 years were collected in the three-year-old health check-up from a total of 2,341 children residing in the Tama area. Based on the age at immunization for each child, the BCG immunization coverage was calculated according to the types of the BCG immunization delivery system. The immunization types were defined as follows; the BCG immunization given on the occasion of the mass health check-up (Group 1); the exclusive mass BCG immunization in a monthly service (Group 2); the exclusive mass BCG immunization in a bimonthly service (Group 3); the exclusive mass BCG immunization in services of fewer than every two months (Group 4); and the immunization given on an individual basis by a general practitioner (Group 5). A univariate analysis was performed to examine the relationship between the BCG immunization coverage by the age of 6 months and the difference among the BCG immunization delivery systems, followed by a multivariate regression analysis to adjust for the factors related to the demography, health care services and the socio-economic status of the municipalities. RESULTS Unadjusted odds ratios and adjusted odds ratios for BCG unimmunized children under the age of 6 months by the BCG immunization delivery manner groups were OR 1 reference, adj. OR 1 reference in Group 1; OR 1.42 CI 0.87-2.29, adj. OR 4.01 CI 2.24-7.11 in Group 2; OR 4.96 CI 3.66-6.82, adj. OR 15.59 CI 10.10-24.49 in Group 3;OR 18.60 CI 13.77-25.49, adj. OR 48.17 CI 29.62-79.75 in Group 4; and OR 4.24 CI 2.86-6.31, adj. OR 15.61 CI 9.05-27.26 in Group 5. The univariate analysis and multivariate regression analysis revealed an influence of the BCG immunization delivery manner on the BCG immunization coverage. CONCLUSION The choice of BCG immunization delivery manner is very important to raise the BCG immunization coverage. The BCG immunization given on the occasion of the mass health check-up and the high-frequent immunization service are thought to improve the BCG immunization coverage.

Against a background of new developments and updated clinical guidelines, health care professionals (HCPs) administering childhood and adolescent immunizations require access to expert advice and support when appropriate. The clinical records of all pediatric referrals seen at a UK-based facility-the Stockport Specialist Immunization Clinic (SS IC)-between 01/10/2006 and 31/03/2007 were reviewed to determine the stated reason(s) for referral to a specialist immunization service and the outcome of that process. During the 6 month audit period, 430 case notes were identified and 410 (95%) were audited. Reasons for referral were primarily due to the medical condition of the child [118/410 (29%)], the child having experienced a previous vaccine adverse event [86/410 (21%)], or preterm birth of the child [86/410 (21%)]. The majority of referrals were from primary care [234/410 (57%)]. A total of 351 (85.6%) cases were categorized as appropriate referrals and 36 (11.6%) and 23 (5.6%) were categorized as inappropriate and equivocal, respectively. Four hundred and eight children completed a primary program; for two children the parents declined the advice offered. National data show that a small number of children remain susceptible to vaccine preventable diseases because they fail to access or complete immunization programs through their General Practitioner (GP) and this may be in part because the HCP is unsure about vaccine indications/contra-indications. Clearly a number of referring HCP s in this audit had some level of uncertainty when immunizing children with a pre-existing medical condition or a previous history of vaccine associated AEFI in the child/family, and this may be indicative of a more general problem among HCPs. A consistent approach to providing expert advice and support to primary care professionals in the UK would therefore be expected to make a significant impact on the immunization service by building confidence for parents/guardian, professionals and organizations involved in delivering it. The authors recommend a dedicated specialist immunization clinical service be considered as one approach to achieving this.

Background Concerns regarding vaccine safety are increasing along with lack of compliance to vaccination schedules. This study aimed to assess vaccination-related risks and the impact of a Special Immunization Service (SIS) at the Pediatric Emergency Department (PED) of Padua on vaccination compliance among participants. Materials and methods This retrospective cohort study included all children attending the SIS from January 1st 2002 to December 31st 2015. The Service is divided into a clinic (SIS-C) where all referred children undergo a pre-vaccination visit and an area within the Pediatric Emergency Department (SIS-PED) where children are vaccinated if indicated. During each SIS-C visit, age, gender, admission criteria and scheduled vaccinations were recorded, with any vaccine-related adverse events captured during SIS-PED visits. Follow-up was conducted to evaluate vaccination plan completion. Results 359 children received 560 vaccine administrations (41.3% MMR/MMRV, 17.5% hexavalent) at the SIS during the 14 year study. Admission criteria were adverse events after previous vaccination (immediate, IgE/not IgE mediated, and late) in 27.2% of cases, non-anaphylactic allergies (mostly egg allergy) in 42.7% and anaphylaxis in 10.3%. After vaccination, 15/560 (2.7%) mild adverse events were observed. 96.3% of children vaccinated at least once at the SIS-PED and available for follow-up completed their vaccination plan, in contrast to 55.5% of children referred to the SIS-C who were not vaccinated in SIS-PED. Conclusions For children referred to SIS-C and available for follow-up, vaccination in SIS-PED was associated with more frequent completion of vaccination plans, indicating a benefit of the service to vaccine coverage. The low number and mild severity of adverse events reported after vaccination of high-risk children in SIS-PED attest to the safety of the service.

Objectives An in-house immunization service in which staff pharmacists administer vaccines was conceptualized as an innovation. Prior to making adoption decisions, community pharmacies evaluated characteristics of in-house immunization services. This study examined the impact of three specific characteristics (perceived benefit, perceived compatibility and perceived complexity) of in-house immunization services on community pharmacies' adoption decisions. Methods A multi-stage mixed-mode survey design was used to collect data from key informants of community pharmacies in Washington State, USA. Key informants included pharmacy managers or pharmacists-on-duty who were able to answer questions related to immunization activities in their pharmacies. Perceived characteristics of in-house immunization services and pharmacy adoption decisions were measured in 2004 and in 2006–2007, respectively. Key findings Each perceived characteristic individually predicted adoption of in-house immunization services. When all three characteristics were included in logistic regression, perceived benefit was the only significant predictor of in-house immunization service adoption. Conclusions Appropriate strategies, particularly promoting the benefit of in-house immunization services, should be implemented. The proposed model and findings may be applicable to other pharmacy-based innovative practices or other public health initiatives. We recommend that organizational leaders, researchers and practitioners consider the impact of perceived benefit and incorporate it when they design strategies to foster adoption of innovative practices. Doing this may increase the number of adopters and also increase diffusion rates for innovative services.

To achieve maximal protection against vaccine-preventable diseases, a child should receive all immunizations within recommended intervals. Clinic records of 512 Nigerian children were evaluated for timeliness in receiving vaccines and the completion rates of the schedule. About 30% of the children presented after four weeks of age for their first immunization; 18.9-65% of the children were delayed in receiving various vaccines compared to the recommended ages for receiving the vaccines. Only 227 (44.3%) children were fully immunized. Health education and mass mobilization of the community and health workers are recommended to improve the uptake of vaccines and to encourage timely receipt of vaccines.

Financial sustainability plans (FSPs) were developed by over 50 of the world's poorest countries receiving funding support from the Global Alliance for Vaccines and Immunization (GAVI) to introduce new and underused vaccines, injection safety and immunization service support between 2000 and 2006. These plans were analysed with respect to the strategies selected to promote financial sustainability, allowing classification of FSP strategies in three areas: (1) mobilizing additional resources, (2) increasing the reliability of resources, and (3) improving program efficiency. Despite some country successes and the magnitude of planned financial sustainability strategies, huge funding gaps remain for these countries due to the initial underlying assumptions of the GAVI and financial sustainability plan model.

Background: Thousands of people die each year from vaccine-preventable diseases. Pharmacists can be a valuable resource in aiding the success of immunizations. Objective: To determine the barriers to implementing a program utilizing pharmacists as immunizers, as perceived by pharmacists, in a supermarket pharmacy chain. Methods: A 15 question survey regarding the perceived barriers to implementing a pharmacist-run immunization program was distributed to 60 pharmacists in a supermarket chain in northwestern Ohio. The responses were tabulated using a 5 point Likert scale. The data were analyzed utilizing the Statistical Package for Social Sciences. Results: Of the 60 pharmacists who received the survey, 43 completed the questionnaire (response rate 72.0%). A majority of the pharmacists surveyed believed that patient privacy was an issue in administering adult immunizations in a community pharmacy. The majority of pharmacists were concerned about the risk of adverse reactions to the vaccines and the need for a quick response to control these reactions. Twenty-five pharmacists believed that the prescription volume at their pharmacy limited them from having time to immunize. Twenty-one pharmacists cited cost as the main determining factor in a pharmacy immunization program. Conclusions: Many barriers to implementing a pharmacist-run immunization program exist. The future success of such an immunization program rests on overcoming the perceived barriers in a formal and timely manner.

Objective The literature demonstrates that conducting a stakeholder analysis to better understand the immunisation context and to involve the stakeholders in the assessment improves the quality and relevance of the assessment and increases the use of results by policy makers thereby ensuring that the programme provides efficient services. This stakeholder analysis is part of a study to assess the sustainability of the expansion of the expanded programme of immunisation in The Gambia. This paper reports and discusses the results of the study on the dimension of attaining high levels of technical efficiency of immunization programmes. Methods: The study was conducted on the Immunisation service of the Gambia in West Africa.Methods: The method used was a series of in-dept interviews with sixteen key stakeholders at the central, divisional and facility levels. A stakeholder analysis tool that incorporates key indicators of financial sustainability of the EPI was used in the interviews.Results: Results show that overall the majority of stakeholders strongly support the use of additional resources for implementing several actions (indicators) that can foster the financial sustainability of the EPI, including those that fall under the dimension of efficient immunisation services. Results further demonstrate that wastage is a very serious problem in the immunization system, which stakeholders generally felt is unacceptable. The causes could be grouped into four groups of factors: staff factors, resource factors, client factors and management/policy factors.Conclusion: Inefficiencies in the immunisation system, leading to, amomg other things, wastage of resources make expenditures in the EPI system unsustainable for a country that is experiencing slow economic growth and decreasing donor support. More intensified efforts to minimise the inefficiencies are needed to bring about more significant changes for the better

The immunization service delivery support (ISDS) model was initiated in Andhra Pradesh, India, in November 2003 with the aim of strengthening immunization services through supportive supervision. The ISDS model involves a well-established supervision system built upon the existing health infrastructure. The objectives of this approach are to: (1) identify areas of high performance and those that need improvement, (2) assist staff in identifying and correcting wrong practices, (3) improve staff skills, (4) motivate staff, and (5) initiate corrective actions at appropriate levels through information sharing. An evaluation of cost and effectiveness of ISDS in 16 districts that participated in the programme found that the incremental cost associated with three rounds of supportive supervision visits was approximately US$ 110 630 (US$ 36 877 per round). The performance of health centre and immunization sessions was evaluated using 43- and 28-point checklists, respectively, and demonstrated significant improvement during and following the two-year implementation of ISDS. The average percentage change in health centre performance scores from baseline to the fourth round of evaluation was approximately 36%, and immunization session performance scores increased by an average of 9%. The incremental costs per additional per cent increase in average health centre performance score and per additional per cent increase in average immunization session performance score over the evaluation period were estimated to be US$ 3091 and US$ 12 760, respectively. The incremental cost-effectiveness ratios are relatively sensitive to personnel and travel costs. Integration of ISDS into the Andhra Pradesh immunization system is projected to result in a 39% potential cost savings per round of supervision visit.

Home-based child vaccination records play an important role in documenting immunization services received by children. We report some of the results of a review of home-based vaccination records from 55 countries. In doing so, we categorize records into three groups (vaccination only cards, vaccination plus cards, child health books) and describe differences in characteristics related to the quality of data recorded on immunization. Moreover, we highlight areas of potential concern and areas in need of further research and investigation to improve our understanding of the home-based vaccination record form related to improved data quality from immunization service delivery.

The main British Airways Immunization Service in central London, open (since 1946) to any traveler, administers about 100000 vaccinations annually. The total vaccinations given during the 1st week of 1972 and the 1st week of 1987 happen to be virtually identical (see Table 1) but the range of vaccines used was quite different and provides an illustration of the changes over the last 15 years and the likely future trend as a more complete pre-travel medical service is developing.