Hemanthi

Article above by Minal K Patel and Walter A Oreinstein - available here: https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(18)30492-3/fulltext

Summary

Background Despite improvements in reported coverage of measles-containing vaccine (MCV) and progress towards elimination of measles, 172 939 measles cases were reported worldwide in 2017. Questions have been raised about whether measles cases are due to failure of immunisation programmes or vaccine policy failure, which might require changes to vaccination schedules or number of doses.

Methods This retrospective review of global surveillance data analysed case-based data for cases of measles occurring during 2013–17 submitted to WHO by its member states. Cases were classified as programmatically preventable(ie, did not receive the age-appropriate number of doses for that country) or programmatically non-preventable(ie, appropriately vaccinated as per national programme) on the basis of age at onset, year of birth, vaccination status,and eligibility for MCV doses in the country reporting the case. We grouped reasons why cases were non-preventableinto four categories as follows: (1) received at least two doses of MCV; (2) too young for first dose; (3) received one dose but was too young to receive the second; or (4) was only eligible for one dose according to the national schedule. We analysed numbers and proportions of preventable and non-preventable cases of measles by region and year, reasons for non-preventable cases by year, preventable cases by age group, and preventable and non-preventable cases,including reasons for non-preventable cases, by measles elimination status of countries.

Findings Between Jan 1, 2013, and Dec 31, 2017, 634 139 measles cases were reported; 7850 (1%) cases were excluded because they did not provide age at onset, so 626 289 were included in our analysis. 191 333 (31%) of these cases had unknown vaccination status. 275 754 (63%) of the 434 956 cases with available vaccination data were categorised as programmatically preventable, 213 461 (77%) of whom were aged 1 year to less than 15 years. 156 384 (36%) cases were categorised as non-preventable, of whom 38 677 (25%) were two-dose vaccine recipients, 74 438 (48%) were too young to receive their first MCV dose, 11 914 (8%) received their first dose and were too young to receive their second dose,and 31 355 (20%), mostly in the Africa region, were non-preventable because they were only eligible for one dose onthe basis of the national immunisation programme.

Interpretation Most measles cases during 2013–17 were programmatically preventable, highlighting the need for improving the effectiveness of immunisation programmes that already exist. Individual countries should do similar analyses to establish the changes needed in their country to decrease numbers of measles cases.

PAHO has released a new Article: Improving immunization data quality in Peru and Mexico: Two case studies highlighting challenges and lessons learned. Available here: https://www.sciencedirect.com/science/article/pii/S0264410X18314701?via%3Dihub

Abstract

Introduction

The Global Vaccine Action Plan and the Regional Immunization Action Plan of the Americas call for countries to improve immunization data quality. Immunization information systems, particularly electronic immunization registries (EIRs), can help to facilitate program management and increase coverage. However, little is known about efforts to develop and implement such systems in low- and middle-income countries. We present the experiences of Mexico and Peru in implementing EIRs.

Methods

We conducted case studies of an EIR in Mexico and of a population registry in Peru. Information was gathered from technical documents, stakeholder focus groups, site visits, and semi-structured interviews of national stakeholders. We organized findings into narratives that emphasized challenges and lessons learned.

Results

Mexico built one of the world’s first EIRs, incorporating novel features such as local-level tracking of patients; however, insufficient resources and poor data registration practices led to the system’s discontinuation. Peru created an information system to improve affiliation to social programs, including the immunization program and quality of demographic data. Mexico’s experience highlights lessons in failed sustainability of an EIR and a laudable effort to reform a country’s information system. Peru’s demonstrates that attempts to improve health and other data may strengthen health systems, including immunization data. Major challenges in information system implementation and sustainability in Peru and Mexico related to funding, clear governance structures, and resistance among health workers.

Discussion

These case studies reinforce the need for countries to ensure adequate funding, plans for sustainability, and health worker capacity-building activities before implementing EIRs. They also suggest new approaches to implementation, including economic incentives for sub-national administrative levels and opportunities to link efforts to improve immunization data with other health and political priorities. More information on best practices is needed to ensure the successful adoption and sustainability of immunization registries in low- and middle-income countries.

Keywords

• Electronic immunization registries
• Immunization information systems
• Immunization data
• National immunization programs
• Global vaccine action plan