Introduction The introduction of new vaccines highlights concerns about high vaccine wastage, knowledge of wastage policies and quality of stock management. However, an emphasis on minimizing wastage rates may cause confusion when recommendations are also being made to reduce missed opportunities to routinely vaccinate children. This concern is most relevant for lyophilized vaccines without preservatives [e.g. measles-containing vaccine (MCV)], which can be used for a limited time once reconstituted. Methods We sampled 54 health facilities within 11 local government areas (LGAs) in Nigeria and surveyed health sector personnel regarding routine vaccine usage and wastage-related knowledge and practices, conducted facility exit interviews with caregivers of children about missed opportunities for routine vaccination, and abstracted vaccine stock records and vaccination session data over a 6-month period to calculate wastage rates and vaccine vial usage patterns. Results Nearly half of facilities had incomplete vaccine stock data for calculating wastage rates. Among facilities with sufficient data, mean monthly facility-level wastage rates were between 18 and 35% across all reviewed vaccines, with little difference between lyophilized and liquid vaccines. Most (98%) vaccinators believed high wastage led to recent vaccine stockouts, yet only 55% were familiar with the multi-dose vial policy for minimizing wastage. On average, vaccinators reported that a minimum of six children must be present prior to opening a 10-dose MCV vial. Third dose of diphtheria-tetanus-pertussis vaccine (DTP3) was administered in 84% of sessions and MCV in 63%; however, the number of MCV and DTP3 doses administered were similar indicating the number of children vaccinated with DTP3 and MCV were similar despite less frequent MCV vaccination opportunities. Among caregivers, 30% reported being turned away for vaccination at least once; 53% of these children had not yet received the missed dose. Discussion Our findings show inadequate implementation of vaccine management guidelines, missed opportunities to vaccinate, and lyophilized vaccine wastage rates below expected rates. Missed opportunities for vaccination may occur due to how the health system’s contradicting policies may force health workers to prioritize reduced wastage rates over vaccine administration, particularly for multi-dose vials.

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HighlightsPolio seroprevalence surveys help measure progress towards polio eradication.Nigeria program conducted multiple seroprevalence surveys in northern states.This article covers seroprevalence survey in Kano Nigeria in 2013 and 2014.Data represents levels before and after the interruption of poliovirus transmission.Significant improvement in seroprevalence in 2014 over 2013, but gaps continue.Good participation even by vaccine refusers in this health facility based project.

Highlights Nigeria's immunization stakeholders cooperated on the 2016–17 MICS/NICS survey. Extra survey clusters were added in 20 states to improve outcome precision. Data from MICS & supplementary clusters were pooled after passing a statistical test. Combined results were used to guide policy, but not as precise as originally hoped. We explore organizational aspects of cooperation & technical aspects of pooled data.

Background. Childhood immunization remains one of the most cost-effective public health interventions. Globally, millions of children are not being reached with safe and effective vaccines and Nigeria has the highest number of unprotected children. Objective. The effects of locally adapted intervention on vaccination timeliness and completeness were studied amongst Fulani populations across six health facilities in two districts of Bauchi State, Nigeria. Methods. The intervention group consisted of newborns who received 5-colour-coded bracelets representing different immunization contacts, while the control group has no bracelets. Vaccination rates across contacts were followed for 11 months. In addition, mothers of children in the intervention group were voluntarily recruited as peer to peer mobilizers (PPM). Results. 435 children were studied. Vaccination completeness was higher in the intervention group compared to the control group at all contacts during follow-up. The difference was strongest at the 5th contact, with 158/256 (62%) children in the intervention group completing, compared to 73/179 (41%) in the control group (p<0.0001). Timeliness of vaccination was better in the intervention group compared to the control, which reached statistical significance at 2nd and 3rd vaccination contacts (p<0.05). 68% of women volunteered as PPM and recruited 82 additional children for vaccination. Conclusion. This study has demonstrated the feasibility of a composite intervention (bracelets & PPM) to increase the completeness and timeliness of childhood immunization and provided preliminary evidence for its efficacy amongst Fulani populations in Nigeria. Findings from this pilot study should be confirmed through a larger cluster randomized controlled trial.