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Objective To evaluate the consistency and quality of immunization monitoring systems in 27 countries during 2002-03 using standardized data quality audits (DQAs) that had been launched within the framework of the Global Alliance for Vaccines and Immunization. Methods The consistency of reporting systems was estimated by determining the proportion of third doses of diphtheria-tetanuspertussis (DTP-3) vaccine reported as being administered that could be verified by written documentation at health facilities and districts. The quality of monitoring systems was measured using quality indices for different components of the monitoring systems. These indices were applied to each level of the health service (health unit, district and national). Findings The proportion of verified DTP-3 doses was lower than 85% in 16 countries. Difficulties in verifying the doses administered often arose at the peripheral level of the health service, usually as the result of discrepancies in information between health units and their corresponding districts or because completed recording forms were not available from health units. All countries had weaknesses in their monitoring systems; these included the inconsistent use of monitoring charts; inadequate monitoring of vaccine stocks, injection supplies and adverse events; unsafe computer practices; and poor monitoring of completeness and timeliness of reporting. Conclusion Inconsistencies in immunization data occur in many countries, hampering their ability to manage their immunization programmes. Countries should use these findings to strengthen monitoring systems so that data can reliably guide programme activities. The DQA is an innovative tool that provides a way to independently assess the quality of immunization monitoring systems at all levels of a health service and serves as a point of entry to make improvements. It provides a useful example for other global health initiatives. Keywords Diphtheria-tetanus-pertussis vaccine/administration and dosage; Immunization programs/statistics; Data collection/ standards; Quality control (source: MeSH, NLM). Mots cles Vaccin diphterie-tetanos-coqueluche/administration et posologie; Programmes de vaccination/statistique; Collecte donnees/ normes; Controle qualite (source: MeSH, INSERM). Palabras dave Vacuna difteria-tetano-pertussis/administracion y dosificacion; Programas de inmunizacion/estadistica; Recoleccion de datos/normas; Control de calidad (fuente: DeCS, BIREME). Bulletin of the World Health Organization 2005;83:503-510., Introduction The Global Alliance for Vaccines and Immunization (GAVI) was launched in 2000, and since then it has provided annual financial support to improve childhood immunization services in 52 developing [...]

Background: Current WHO best infection control practices for injections do not address the use of hub cutters due to insufficient evidence on safety and efficacy. Objective: To assess the impact of the use of hub cutters on 1) the frequency of needle- stick injuries (NSIs) and other blood exposures among workers and 2) the volume of sharps waste in a mass vaccination campaign setting. Methods: During yellow fever vaccination in Ghana, we conducted a cohort study on the use of hub cutters. We compared two groups-one group using hub cutters and a control group- for the occurrences of NSIs and the volume of sharp waste produced. Results: In the control arm, vaccinators used 284 482 syringes in 825 vaccination sessions. In the group using hub cutter, vaccinators used 397 079 syringes in 1599 sessions. Among vaccinators, the rate of NSI was not significantly (p=0.14) different between the hub cutter users (0.15/10 000 syringes) and the control group (0.04/10 000). Factors such as workload, lack of organization and pressure seemed to have influence the occurrence of NSIs. With all the limitations of the work, the volume of sharp waste per 10 000 syringes was 0.24 m3 in the hub cutter users and 0.41 m3 in the control group-a reduction of 41.2%. Vaccinators found hub cutters easy to use and safe. Use of hub cutter was not associated with increased duration of work. Conclusion: The use of hub cutters did not increase the risk of NSIs. More training is needed to facilitate its implementation in mass campaign setting. [ABSTRACT FROM AUTHOR]

We report on airborne Differential Optical Absorption Spectroscopy (DOAS) measurements of NO2 tropospheric columns above South Asia, the Arabic peninsula, North Africa, and Italy in November and December 2009. The DOAS instrument was installed on an ultralight aircraft involved in the Earth Challenge project, an expedition of seven pilots flying on four ultralight aircraft between Australia and Belgium. The instrument recorded spectra in limb geometry with a large field of view, a set-up which provides a high sensitivity to the boundary layer NO2 while minimizing the uncertainties related to the attitude variations. We compare our measurements with OMI (Ozone Monitoring Instrument) and GOME-2 (Global Ozone Monitoring Experiment 2) tropospheric NO2 products when the latter are available. Above Rajasthan and the Po Valley, two areas where the NO2 field is homogeneous, data sets agree very well. Our measurements in these areas are 0.1 ± 0.1 to 3 ± 1 × 1015 molec cm−2 and 2.6 ± 0.8 × 1016 molec cm−2, respectively. Flying downwind of Riyadh, our NO2 measurements show the structure of the megacity's exhaust plume with a higher spatial resolution than OMI. Moreover, our measurements are larger (up to 40%) than those seen by satellites. We also derived tropospheric columns when no satellite data were available if it was possible to get information on the visibility from satellite measurements of aerosol optical thickness. This experiment also provides a confirmation for the recent finding of a soil signature above desert. [ABSTRACT FROM AUTHOR]

Objective To evaluate the consistency and quality of immunization monitoring systems in 27 countries during 2002-03 using standardized data quality audits (DQAs) that had been launched within the framework of the Global Alliance for Vaccines and Immunization. Methods The consistency of reporting systems was estimated by determining the proportion of third doses of diphtheria-tetanus-pertussis (DTP-3) vaccine reported as being administered that could be verified by written documentation at health facilities and districts. The quality of monitoring systems was measured using quality indices for different components of the monitoring systems. These indices were applied to each level of the health service (health unit, district and national). Findings The proportion of verified DTP-3 doses was lower than 85% in 16 countries. Difficulties in verifying the doses administered often arose at the peripheral level of the health service, usually as the result of discrepancies in information between health units and their corresponding districts or because completed recording forms were not available from health units. All countries had weaknesses in their monitoring systems; these included the inconsistent use of monitoring charts; inadequate monitoring of vaccine stocks, injection supplies and adverse events; unsafe computer practices; and poor monitoring of completeness and timeliness of reporting. Conclusion Inconsistencies in immunization data occur in many countries, hampering their ability to manage their immunization programmes. Countries should use these findings to strengthen monitoring systems so that data can reliably guide programme activities. The DQA is an innovative tool that provides a way to independently assess the quality of immunization monitoring systems at all levels of a health service and serves as a point of entry to make improvements. It provides a useful example for other global health initiatives. [ABSTRACT FROM AUTHOR]

Between 1991 and 1995 the Belgian National Program for Surveillance of Hospital Infections (NSIH) collected data on perioperative antibiotic prophylaxis in 72 acute care hospitals. From the costs of prophylactic antibiotics for six categories of surgical procedure and from discharge summaries for hospitalization episodes nationwide, annual drug costs were estimated for 73% of Belgian surgical activity. Costs of antibiotics used in these surgical activities were estimated at 386-410 million Belgian francs (Bf) per year (us$12.1-12.9 million). After agreeing recommendations for best practice, the hypothetical costs of `optimal' antimicrobial prophylaxis were calculated for the same selection of surgical procedures. It was calculated that savings of at least 194 million BF (US$6.1 million) could be made if recommendations were followed closely. Only the costs borne by the National Health Insurance Institute for reimbursement of the dispensed drugs were considered in this study. Other direct costs, such as those related to drug storage, dispensing and administration, were not included. [ABSTRACT FROM PUBLISHER]

Abstract Background In November 2009, Sierra Leone conducted a preventive yellow fever (YF) vaccination campaign targeting individuals aged nine months and older in six health districts. The campaign was integrated with a measles follow-up campaign throughout the country targeting children aged 9–59 months. For both campaigns, the operational objective was to reach 95% of the target population. During the campaign, we used clustered lot quality assurance sampling (C-LQAS) to identify areas of low coverage to recommend timely mop-up actions. Methods We divided the country in 20 non-overlapping lots. Twelve lots were targeted by both vaccinations, while eight only by measles. In each lot, five clusters of ten eligible individuals were selected for each vaccine. The upper threshold (UT) was set at 90% and the lower threshold (LT) at 75%. A lot was rejected for low vaccination coverage if more than 7 unvaccinated individuals (not presenting vaccination card) were found. After the campaign, we plotted the C-LQAS results against the post-campaign coverage estimations to assess if early interventions were successful enough to increase coverage in the lots that were at the level of rejection before the end of the campaign. Results During the last two days of campaign, based on card-confirmed vaccination status, five lots out of 20 (25.0%) failed for having low measles vaccination coverage and three lots out of 12 (25.0%) for low YF coverage. In one district, estimated post-campaign vaccination coverage for both vaccines was still not significantly above the minimum acceptable level (LT = 75%) even after vaccination mop-up activities. Conclusion C-LQAS during the vaccination campaign was informative to identify areas requiring mop-up activities to reach the coverage target prior to leaving the region. The only district where mop-up activities seemed to be unsuccessful might have had logistical difficulties that should be further investigated and resolved.

The goal of the Data Quality Audit (DQA) is to assess whether the Global Alliance for Vaccines and Immunization-funded countries are adequately reporting the number of diphtheria-tetanus-pertussis immunizations given, on which the 'shares' are awarded. Given that this sampling design is a modified two-stage cluster sample (modified because a stratified, rather than a simple, random sample of health facilities is obtained from the selected clusters); the formula for the calculation of the standard error for the estimate is unknown. An approximated standard error has been proposed, and the first goal of this simulation is to assess the accuracy of the standard error. Results from the simulations based on hypothetical populations were found not to be representative of the actual DQAs that were conducted. Additional simulations were then conducted on the actual DQA data to better access the precision of the DQ with both the original and the increased sample sizes. [ABSTRACT FROM AUTHOR]

New lateral flow tests for the diagnosis of Neisseria meningitidis (Nm) (serogroups A, C, W, X, and Y), MeningoSpeed, and Streptococcus pneumoniae (Sp), PneumoSpeed, developed to support rapid outbreak detection in Africa, have shown good performance under laboratory conditions. We conducted an independent evaluation of both tests under field conditions in Burkina Faso and Niger, in 2018-2019. The tests were performed in the cerebrospinal fluid of suspected meningitis cases from health centers in alert districts and compared to reverse transcription polymerase chain reaction tests performed at national reference laboratories (NRLs). Health staff were interviewed about feasibility. A total of 327 cases were tested at the NRLs, with 26% confirmed Nm (NmC 63% and NmX 37%) and 8% Sp. Sensitivity and specificity were, respectively, 95% (95% CI: 89-99) and 90% (95% CI: 86-94) for Nm and 92% (95% CI: 75-99) and 99% (95% CI: 97-100) for Sp. Positive and negative predictive values were, respectively, 77% (95% CI: 68-85) and 98% (95% CI: 95-100) for Nm and 86% (95% CI: 67-96) and 99% (95% CI: 98-100) for Sp. Concordance showed 82% agreement for Nm and 97% for Sp. Interviewed staff evaluated the tests as easy to use and to interpret and were confident in their readings. Results suggest overall good performance of both tests and potential usefulness in meningitis outbreak detection.

Bacterial meningitis is a major global cause of morbidity and mortality. Rapid identification of the aetiological agent of meningitis is essential for clinical and public health management and disease prevention given the wide range of pathogens that cause the clinical syndrome and the availability of vaccines that protect against some, but not all, of these. Since microbiological culture is complex, slow, and often impacted by prior antimicrobial treatment of the patient, molecular diagnostic assays have been developed for bacterial detection. Distinguishing between meningitis caused by Neisseria meningitidis (meningococcus), Streptococcus pneumoniae (pneumococcus), Haemophilus influenzae, and Streptococcus agalactiae and identifying their polysaccharide capsules is especially important. Here, we review methods used in the identification of these bacteria, providing an up-to-date account of available assays, allowing clinicians and diagnostic laboratories to make informed decisions about which assays to use., Competing Interests: Declaration of Competing Interest The authors confirm there are no conflicts of interest., (Copyright © 2021 The Author(s). Published by Elsevier B.V. All rights reserved.)

Rapid diagnostic tests (RDTs) are increasingly recognized as valuable, transformative tools for the diagnosis of infectious diseases. Although there are a variety of meningitis RDTs currently available, certain product features restrict their use to specific levels of care and settings. For this reason, the development of meningitis RDTs for use at all levels of care, including those in low-resource settings, was included in the "Defeating Meningitis by 2030" roadmap. Here we address the limitations of available meningitis RDTs and present test options and specifications to consider when developing the next generation of meningitis RDTs., Competing Interests: Declaration of Competing Interest The authors do not have associations that might pose a conflict of interest., (Copyright © 2020 The British Infection Association. Published by Elsevier Ltd. All rights reserved.)