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Impact of an Intervention to Use a Measles, Rubella, and Polio Mass Vaccination Campaign to Strengthen Routine Immunization Services in Nepal.

Abstract The potential to strengthen routine immunization (RI) services through supplementary immunization activities (SIAs) is an important benefit of global measles and rubella elimination and polio eradication strategies. However, little evidence exists on how best to use SIAs to strengthen RI. As part the 2012 Nepal measles-rubella and polio SIA, we developed an intervention package designed to improve RI processes and evaluated its effect on specific RI process measures.
PMID
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Authors

Mayor MeshTerms
Keywords

immunization systems

measles

polio

supplementary immunization activities

Journal Title the journal of infectious diseases
Publication Year Start




PMID- 28838201
OWN - NLM
STAT- MEDLINE
DA  - 20170825
DCOM- 20170905
LR  - 20170906
IS  - 1537-6613 (Electronic)
IS  - 0022-1899 (Linking)
VI  - 216
IP  - suppl_1
DP  - 2017 Jul 01
TI  - Impact of an Intervention to Use a Measles, Rubella, and Polio Mass Vaccination
      Campaign to Strengthen Routine Immunization Services in Nepal.
PG  - S280-S286
LID - 10.1093/infdis/jix164 [doi]
AB  - Background: The potential to strengthen routine immunization (RI) services
      through supplementary immunization activities (SIAs) is an important benefit of
      global measles and rubella elimination and polio eradication strategies. However,
      little evidence exists on how best to use SIAs to strengthen RI. As part the 2012
      Nepal measles-rubella and polio SIA, we developed an intervention package
      designed to improve RI processes and evaluated its effect on specific RI process 
      measures. Methods: The intervention package was incorporated into existing SIA
      activities and materials to improve healthcare providers' RI knowledge and
      practices throughout Nepal. In 1 region (Central Region) we surveyed the same 100
      randomly selected health facilities before and after the SIA and evaluated the
      following RI process measures: vaccine safety, RI planning, RI service delivery, 
      vaccine supply chain, and RI data recording practices. Data collection included
      observations of vaccination sessions, interviews with the primary healthcare
      provider who administered vaccines at each facility, and administrative record
      reviews. Pair-matched analytical methods were used to determine whether
      statistically significant changes in the selected RI process measures occurred
      over time. Results: After the SIA, significant positive changes were measured in 
      healthcare provider knowledge of adverse events following immunization (11%
      increase), availability of RI microplans (+17%) and maps (+12%), and awareness of
      how long a reconstituted measles vial can be used before it must be discarded
      (+14%). For the SIA, 42% of providers created an SIA high-risk villages list, and
      >50% incorporated this information into RI outreach session site planning.
      Significant negative changes occurred in correct knowledge of measles vaccination
      contraindications (-11%), correct definition for a measles outbreak (-21%), and
      how to treat a child with a severe adverse event following immunization (-10%).
      Twenty percent of providers reported cancelling >/=1 RI sessions during the SIA. 
      Many RI process measures were at high proportions (>90%) before the SIA and
      remained high afterward, including proper vaccine administration techniques,
      proper vaccine waste management, and availability of vaccine carriers and vaccine
      registers. Conclusions: Focusing on activities that are easily linked between
      SIAs and RI services, such as using SIA high-risk village list to strengthen RI
      microplanning and examining ways to minimize the impact of an SIA on RI session
      scheduling, should be prioritized when implementing SIAs.
FAU - Wallace, Aaron S
AU  - Wallace AS
AD  - Global Immunization Division, Centers for Disease Control and Prevention,
      Atlanta, Georgia.
FAU - Bohara, Rajendra
AU  - Bohara R
AD  - World Health Organization Nepal.
FAU - Stewart, Steven
AU  - Stewart S
AD  - Global Immunization Division, Centers for Disease Control and Prevention,
      Atlanta, Georgia.
FAU - Subedi, Giri
AU  - Subedi G
AD  - Ministry of Health.
FAU - Anand, Abhijeet
AU  - Anand A
AD  - Global Immunization Division, Centers for Disease Control and Prevention,
      Atlanta, Georgia.
FAU - Burnett, Eleanor
AU  - Burnett E
AD  - Global Immunization Division, Centers for Disease Control and Prevention,
      Atlanta, Georgia.
FAU - Giri, Jagat
AU  - Giri J
AD  - Ministry of Health.
FAU - Shrestha, Jagat
AU  - Shrestha J
AD  - Ministry of Health.
FAU - Gurau, Suraj
AU  - Gurau S
AD  - World Health Organization Nepal.
FAU - Dixit, Sameer
AU  - Dixit S
AD  - Center for Molecular Development Network, Kathamandu, Nepal.
FAU - Rajbhandari, Rajesh
AU  - Rajbhandari R
AD  - Center for Molecular Development Network, Kathamandu, Nepal.
FAU - Schluter, W William
AU  - Schluter WW
AD  - World Health Organization Nepal.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - J Infect Dis
JT  - The Journal of infectious diseases
JID - 0413675
RN  - 0 (Vaccines)
SB  - AIM
SB  - IM
MH  - Health Knowledge, Attitudes, Practice
MH  - Health Personnel
MH  - Humans
MH  - Immunization Programs/*standards
MH  - Mass Vaccination/*standards
MH  - Measles/*prevention & control
MH  - Nepal
MH  - Poliomyelitis/*prevention & control
MH  - Rubella/*prevention & control
MH  - Vaccines/administration & dosage/adverse effects/supply & distribution
OTO - NOTNLM
OT  - immunization systems
OT  - measles
OT  - polio
OT  - supplementary immunization activities
EDAT- 2017/08/26 06:00
MHDA- 2017/09/07 06:00
CRDT- 2017/08/26 06:00
AID - 3935079 [pii]
AID - 10.1093/infdis/jix164 [doi]
PST - ppublish
SO  - J Infect Dis. 2017 Jul 1;216(suppl_1):S280-S286. doi: 10.1093/infdis/jix164.