Search

To eliminate the risk for vaccine-related paralysis, live attenuated Sabin-strain oral poliovirus vaccine type 2 was withdrawn from routine use in a globally coordinated manner in 2016. However, because of [...]

Background: Pneumococcal meningitis, a vaccine-preventable disease caused by Streptococcus pneumoniae (Spn) is the leading bacterial meningitis in under five children. In April 2014, Uganda introduced routine immunization with 10-valent Pneumococcal Conjugate Vaccine (PCV10) for infants. The target coverage for herd immunity is ≥ 90% with three doses (PCV10-dose 3). We assessed the effect of PCV10 introduction and coverage on the trends of pneumococcal meningitis in under five children. Methods: We analyzed laboratory-confirmed pediatric bacterial meningitis (PBM) data at two high-volume WHO-accredited sentinel surveillance hospitals in Kampala City and Gulu District, from 2003 to 2022. We used confirmed cases to estimate the minimum incidence of pneumococcal meningitis in the host districts and calculated annual incidence of pneumococcal meningitis per one million populations, and the proportion of confirmed PBM attributable to Spn. We divided the study period into 2003–2013 (pre-PCV10) and 2014–2022 (post-PCV10), and conducted interrupted time series analysis using autoregressive integrated moving average models for the effect of PCV10 on trends of pneumococcal meningitis and PBM attributable to Spn. We analyzed reported PCV10 data in DHIS2 from 2014 to 2022 for annual PCV10-dose 3 coverage. Results: Among the 534 confirmed PBM cases, 331(62%) were pneumococcal meningitis; 227(69%) from Gulu District and 104(31%) from Kampala City. The majority (95%) of the isolates were not serotyped. The majority (57%) were male and unimmunized (98%); median age = 14(IQR = 6–27) months with most (55%) aged ≥ 12 months. The case-fatality rate was 9%. During Pre-PCV10 period, the overall incidence of pneumococcal meningitis in the host districts increased; slope change = 1.0 (95%CI = 0.99999, 1.00001) but declined in post-PCV10 period (2014–2022) by 92% from 86 cases /1,000,000 in 2014 to 7/1,000,000 in 2022, slope change= -1.00006 (95%CI=-1.00033, -0.99979). Whereas there was an immediate decline in the proportion of confirmed PBM attributable to Spn in the host districts, level change=-1.84611(95%CI=-1.98365,-1.70856), an upward trend was recorded from 2016 to 2022, slope change = 1.0 (95%CI = 0.99997, 1.00003). During 2015–2022, PCV10-dose 3 coverage was largely > 90% for Gulu District and 52–72% for Kampala City. Conclusion: The PCV10 routine immunization program reduced the incidence of pneumococcal meningitis in Kampala City and Gulu District. There was no effect on the confirmed PBM proportionately attributable to Spn. Kampala City persistently recorded PCV10-dose3 coverage < 90%. We recommend enhancing serotyping and periodic nasopharyngeal carriage surveys to ascertain the maximum vaccine effectiveness and monitor Spn serotypes, and strengthening routine immunization in Kampala City. [ABSTRACT FROM AUTHOR]

Background: Microarray patches (MAPs) are innovative, needle-free vaccine delivery systems, suitable for administration by minimally trained health care workers or trained community health workers. Their introduction may transform immunization programmes, particularly for vaccines where high coverage is required for population immunity, such as measles, and where vaccine delivery is challenging, such as in low- and middle-income countries. Recognizing the need to understand how best to tailor these products to reflect country priorities, workshops on measles and rubella MAPs (MR-MAPs) were conducted in multiple regions to collect insights on needs and preferences from relevant stakeholders at country level. Methods: The CAPACITI Innovation Framework was used to structure stakeholder discussions in nine countries in the period from August 2022 to July 2023. The discussions, building on the findings from a situation analysis on the barriers related to measles and rubella vaccine delivery, followed the four-step process outlined in the framework. Results: Key barriers hindering delivery of measles and rubella vaccines across the countries were in the categories of human resource management, service delivery, and demand generation. MR-MAP attributes that stakeholders believed would reduce or eliminate these barriers included ease of preparation and administration, improved thermostability, fewer (ancillary) components, and single-dose presentation. Some attributes such as the site of administration, wear time, and storage volume could exacerbate certain barriers. Based on an understanding of key barriers, product attributes, and underserved populations, stakeholders identified several potential use cases for MR-MAPs: (i) delivery at a fixed health post, (ii) delivery through outreach sessions conducted by health workers, and (iii) administration by community health workers. To enable robust national decision making about the introduction of MR-MAPs and successful implementation, global and national evidence on feasibility and acceptability of MR-MAPs should be generated. To prepare for the potential introduction of MR-MAPs, immunization programmes should evaluate their immunization policies based on their preferred use cases and modify them if needed, for example, to enable community health workers to administer vaccines, along with making programmatic adjustments to waste management and training. Conclusions: MR-MAPs have the potential to reduce key barriers to MR delivery. Yet, their future impact depends on the ability of global stakeholders to steer the development of MR-MAPs to be responsive to country needs and preferences. The generation of evidence to enable robust decision making, timely modification of vaccine policies, and addressing programmatic considerations will be key to successful uptake. [ABSTRACT FROM AUTHOR]

IntroductionHoima, one of the largest districts in mid- western Uganda, has persistently performed poorly with low immunization coverage, high immunization drop outs rates and repeated outbreaks of vaccine preventable diseases especially measles. The objectives of this study were to evaluate the state of immunization services and to identify the gaps in immunization health systems that contribute to low uptake and completion of immunization schedules in Hoima District.MethodsThis was a cross sectional mixed methods study, utilizing both qualitative and quantitative approaches. A situation analysis of the immunization services was carried out using in-depth interviews with vaccinators, focus group discussions and key informant interviews with ethno-videography. Secondary data was sourced from records at headquarters and vaccination centres within Hoima District. The quantitative component utilized cluster random sampling with sample size estimated using the World Health Organization's 30 cluster sampling technique.ResultsA total of 311 caretaker/child pairs were included in the study. Immunization completion among children of age at least 12 months was 95% for BCG, 96% for OPV0, 93% for DPT1, 84.5% for DPT2, 81% for DPT3 and 65.5% for measles vaccines. Access to immunization centres is difficult due to poor road terrain, which affects effectiveness of outreach program, support supervision, mentorship and timely delivery of immunization program support supplies especially refrigerator gas and vaccines. Some facilities are under-equipped to effectively support the program. Adverse Events Following Immunization (AEFI) identification, reporting and management is poorly understood.ConclusionImmunization services in Hoima District require urgent improvement in the following areas: vaccine supply, expanding service delivery points, more health workers, transport and tailored mechanisms to ensure adequate communication between health workers and caretakers.

In October 2002, Uganda implemented a 5-year (2002-2006) accelerated measles control strategy that began with a vigorous attempt to interrupt all chains of measles transmission by using a 5-day countrywide [...]

Objective To guide immunization policy, we determined the public health benefit of introducing Haemophilus influenzae type b (Hib) vaccine in Uganda and estimated the vaccine effectiveness. Methods Surveillance data for acute bacterial meningitis among children aged 0-59 months were reviewed from three hospital sentinel sites, for July 2001 to June 2007, to determine the incidence of Hib meningitis, the effectiveness of Hib vaccine with a case-control design, and the number of vaccine-preventable cases and deaths of Hib disease in Uganda. Findings Of the 13 978 children from 17 districts with suspected bacterial meningitis, 269 had confirmed Hib meningitis, declining from 69 patients in the prevaccine year (2001-2002) to three in 2006-2007. Hib meningitis incidence dropped from 88 cases per 100 000 children aged < 5 years in the year before vaccine introduction to 13 within 4 years, and to near zero in the fifth year. Vaccine effectiveness for 2 or more doses was 93% (95% confidence interval, CI: 69-99) against confirmed Hib meningitis and 53% (95% CI: 11-68) against purulent meningitis of unknown cause. In Uganda, Hib vaccine prevents an estimated 28 000 cases of pneumonia and meningitis, 5000 deaths and 1000 severe meningitis sequelae each year. Conclusion Infant immunization with Hib vaccine has virtually eliminated Hib meningitis in Uganda within 5 years. Ensuring long-term benefits of Hib vaccine urgently requires sustainable vaccine financing, high-quality ongoing surveillance, and a health sector able to deliver a robust immunization programme. Objectif Pour guider la politique de vaccination, nous avons determine le benefice pour la sante publique de l&apos;introduction en Ouganda du vaccin contre Haemophilus influenzae type b (Hib) et estime l&apos;efficacite de ce vaccin. Methodes Des donnees de surveillance concernant la meningite bacterienne aigue chez les enfants de 0 a 59 mois, fournies par trois sites hospitaliers sentinelles entre juillet 2001 et juin 2007, ont ete examinees pour determiner l&apos;incidence de la meningite a Hib, l&apos;efficacite du vaccin anti-Hib par un controle cas-temoin et le nombre de cas et de deces dus a cette meningite evitables par la vaccination en Ouganda. Resultats Parmi les 13978 enfants de 17 districts suspectes de meningite bacterienne, 269 cas de meningite a Hib ont ete confirmes, le nombre de cas de cette maladie dans le groupe passant de 69 pendant l&apos;annee precedant l&apos;introduction de la vaccination (2001-2002) a trois pour la periode 2006-2007. L&apos;incidence de la meningite a Hib a chute de 88 cas pour 100 000 enfants de moins de 5 ans l&apos;annee precedant l&apos;introduction du vaccin a 13 en l&apos;espace de 4 ans, puis a une valeur quasi nulle pour la cinquieme annee. L&apos;efficacite de la vaccination en 2 doses ou plus etait de 93 % (intervalle de confiance, IC, a 95 % = 69-99) contre la meningite a Hib confirmee et de 53 % (IC a 95 % = 11-68) contre la meningite purulente de cause inconnue. En Ouganda, on estime que le vaccin anti-Hib previent chaque annee 28 000 cas de pneumonie et de meningite, 5 000 deces et 1 000 cas de sequelles graves de meningite. Conclusion En l&apos;espace de 5 ans, la vaccination infantile anti-Hib a presque elimine la meningite a Hib du territoire ougandais. Pour preserver a long terme les benefices de cette vaccination, on a besoin d&apos;urgence d&apos;un financement durable du vaccin, d&apos;une surveillance continue et de qualite et d&apos;une aptitude du secteur de la sante a delivrer un programme de vaccination energique. Objetivo A fin de racionalizar la politica de inmunizacion, determinamos los beneficios para la salud publica reportados por la introduccion de la vacuna contra Haemophilus influenzae tipo b (Hib) en Uganda y estimamos la eficacia de la vacuna. Metodos Se examinaron los datos de vigilancia de la meningitis bacteriana aguda entre los ninos de 0 a 59 meses en tres centros hospitalarios centinela entre julio de 2001 y junio de 2007, a fin de determinar la incidencia de meningitis por Hib, la eficacia de la vacuna contra Hib mediante un diseno de casos y controles, y el numero de casos y muertes por Hib prevenibles mediante vacunacion en Uganda. Resultados De los 13 978 ninos de 17 distritos con presunta meningitis bacteriana, se confirmo la meningitis por Hib en 269 casos, con una disminucion desde 69 pacientes en el ano anterior al comienzo de la vacunacion (2001-2002) hasta tres casos en 2006-2007. La incidencia de meningitis por Hib disminuyo de 88 casos por 100 000 menores de cinco anos en el ano anterior a la introduccion de la vacuna a 13 casos a los 4 anos, y a casi cero en el quinto ano. La eficacia de la vacuna en dos o mas dosis fue del 93% (intervalo de confianza del 95%, IC95%: 69-99) para la meningitis confirmada por Hib y del 53% (IC95%: 11-68) para la meningitis purulenta de causa desconocida. Se estima que en Uganda la vacuna contra Hib previene unos 28 000 casos de neumonia y meningitis, 5000 defunciones y 1000 casos de secuelas meningiticas graves cada ano. Conclusion La inmunizacion infantil con la vacuna anti-Hib casi ha permitido eliminar la meningitis por ese agente en Uganda en un plazo de 5 anos. Para garantizar los beneficios a largo plazo de la vacunacion contra Hib se requieren urgentemente mecanismos de financiacion sostenible de las vacunas, sistemas de vigilancia permanente de gran calidad y un sector de la salud capaz de sacar adelante un programa de vacunacion robusto., Introduction Haemophilus influenzae type b (Hib) is a leading cause of bacterial meningitis and pneumonia in children worldwide, resulting in at least 3 million severe illnesses and 386 000 deaths [...]

Abstract Background Uganda is currently implementing the International Health Regulations (IHR[2005]) within the context of Integrated Disease Surveillance and Response (IDSR). The IHR(2005) require countries to assess the ability of their national structures, capacities, and resources to meet the minimum requirements for surveillance and response. This report describes the results of the assessment undertaken in Uganda. Methods We conducted a descriptive cross-sectional assessment using the protocol developed by the World Health Organisation (WHO). The data collection tools were adapted locally and administered to a convenience sample of HR(2005) stakeholders, and frequency analyses were performed. Results Ugandan national laws relevant to the IHR(2005) existed, but they did not adequately support the full implementation of the IHR(2005). Correspondingly, there was a designated IHR National Focal Point (NFP), but surveillance activities and operational communications were limited to the health sector. All the districts (13/13) had designated disease surveillance offices, most had IDSR technical guidelines (92%, or 12/13), and all (13/13) had case definitions for infectious and zoonotic diseases surveillance. Surveillance guidelines were available at 57% (35/61) of the health facilities, while case definitions were available at 66% (40/61) of the health facilities. The priority diseases list, surveillance guidelines, case definitions and reporting tools were based on the IDSR strategy and hence lacked information on the IHR(2005). The rapid response teams at national and district levels lacked food safety, chemical and radio-nuclear experts. Similarly, there were no guidelines on the outbreak response to food, chemical and radio-nuclear hazards. Comprehensive preparedness plans incorporating IHR(2005) were lacking at national and district levels. A national laboratory policy existed and the strategic plan was being drafted. However, there were critical gaps hampering the efficient functioning of the national laboratory network. Finally, the points of entry for IHR(2005) implementation had not been designated. Conclusions The assessment highlighted critical gaps to guide the IHR(2005) planning process. The IHR(2005) action plan should therefore be developed to foster national and international public health security.

Rubella virus causes a mild disease; however, infection during the first trimester of pregnancy may lead to congenital rubella syndrome (CRS) in over 80% of affected pregnancies. Vaccination is recommended and has been shown to effectively reduce CRS incidence. Uganda plans to introduce routine rubella vaccination in 2019. The World Health Organization recommends assessing the disease burden and obtaining the baseline molecular virological data before vaccine introduction. Sera collected during case‐based measles surveillance from January 2005 to July 2018 were tested for rubella immunoglobulin M (IgM) antibodies. Sera from confirmed rubella outbreaks from January 2012 to August 2017 were screened using real‐time reverse‐transcription polymerase chain reaction (RT‐PCR); for positive samples, a region within the E1 glycoprotein coding region was amplified and sequenced. Of the 23 196 suspected measles cases serologically tested in parallel for measles and rubella, 5334 (23%) were rubella IgM‐positive of which 2710 (50.8%) cases were females with 2609 (96.3%) below 15 years of age. Rubella IgM‐positive cases were distributed throughout the country and the highest number was detected in April, August, and November. Eighteen (18%) of the 100 sera screened were real‐time RT‐PCR‐positive of which eight (44.4%) were successfully sequenced and genotypes 1G and 2B were identified. This study reports on the seroprevalence and molecular epidemiology of rubella. Increased knowledge of former and current rubella viruses circulating in Uganda will enhance efforts to monitor the impact of vaccination as Uganda moves toward control and elimination of rubella and CRS. [ABSTRACT FROM AUTHOR]