Acceptance of the Administration of Multiple Injectable Vaccines in a Single Immunization Visit in Albania

Preza, Iria; Subaiya, Saleena; Harris, Jennifer B.; Ehlman, Daniel C.; Wannemuehler, Kathleen; Wallace, Aaron S.; Huseynov, Shahin; Hyde, Terri B.; Nelaj, Erida; Bino, Silvia; Hampton, Lee M.

doi:10.1093/infdis/jiw570

Cited by 9 publications

(9 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However, relevant studies from developing countries are lacking [ 9 ]. Our results from the Philippines, a populous lower-middle income country in Asia, were comparable to recently published assessments in other low and middle income countries [ 10 , 14 , 15 ] We observed HCPs and caregivers to be receptive to multiple injections, with acceptance increasing after HCPs and caregivers had experience with this practice. Furthermore, our study showed that attitudes do not always align with practices; for example, some caregivers stated that they were comfortable with their child receiving only 1–2 injections at a visit yet allowed their child to receive three.…”

Section: Discussionsupporting

confidence: 89%

Introduction of inactivated poliovirus vaccine in the Philippines: Effect on health care provider and infant caregiver attitudes and practices

Lopez

Harris

Raguindin

et al. 2018

Vaccine

Self Cite

View full text Add to dashboard Cite

Background: The introduction of inactivated poliovirus vaccine (IPV) to the Philippines’ national immunization schedule meant the addition of a third injectable vaccine at a child’s 14-week immunization visit. Although previous studies have shown that providing multiple vaccines at the same time affected neither the risk of severe adverse events nor vaccine efficacy, concerns were raised that providing three injections at a single visit, with two injections in one leg, might be unacceptable to health care providers (HCP) and infant caregivers. Methods: We conducted pre- and post-IPV introduction surveys on the acceptance and acceptability of the additional injectable vaccine in three of the Philippines’ 17 administrative regions. Regions 3 and 6 were included in the pre-introduction phase and Regions 3, 6 and 10 were included in the post-introduction phase. Thirty public health centers (PHCs) were randomly sampled from each region. HCPs and infant caregivers were interviewed. In addition, vaccination records from a minimum of 20 eligible children pre-introduction and 10 children post-introduction per PHC were reviewed. Results and discussion: We interviewed 89 HCPs and 286 infant caregivers during the pre-introduction phase and 137 HCPs and 455 caregivers during the post-introduction phase. Among 986 vaccination records reviewed post-introduction, 84% (n = 826) of children received all three recommended injections at one visit, with a range from 61% (209/342) in Region 10 to 100% (328/328) in Region 3. The proportion of HCPs reporting that they had administered three or more injectable vaccines and the proportion of caregivers that would be comfortable with their child receiving three or more injectable vaccines at one visit increased from pre- to post-introduction (p < 0.0001 for both). Eighty-seven percent of HCPs that had administered three or more injectable vaccines post-introduction reported being comfortable or very comfortable with the number of vaccines they had administered.

show abstract

Section: Discussionsupporting

confidence: 89%

Introduction of inactivated poliovirus vaccine in the Philippines: Effect on health care provider and infant caregiver attitudes and practices

Lopez

Harris

Raguindin

et al. 2018

Vaccine

Self Cite

View full text Add to dashboard Cite

show abstract

“…In the Gambia, all children with an immunization visit at 4 months of age received the recommended doses of IPV, PCV, and pentavalent vaccine when all 3 vaccines were in stock [ 42 ]. In Albania, 85% of children with immunization visits at 2 or 4 months of age received all of the recommended doses of IPV, PCV, and pentavalent vaccine at a single visit [ 43 ]. In these 2 cases and as previously found in South Africa, concerns about the addition of a new injectable vaccine dose for infants did not prevent high uptake of IPV, PCV, and pentavalent vaccine [ 44 ].…”

Section: Discussionmentioning

confidence: 99%

Administering Multiple Injectable Vaccines During a Single Visit—Summary of Findings From the Accelerated Introduction of Inactivated Polio Vaccine Globally

Dolan

Patel

Hampton

et al. 2017

The Journal of Infectious Diseases

Self Cite

View full text Add to dashboard Cite

Background.In 2013, the World Health Organization’s (WHO’s) Strategic Advisory Group of Experts (SAGE) recommended that all 126 countries using only oral polio vaccine (OPV) introduce at least 1 dose of inactivated polio vaccine (IPV) into their routine immunization schedules by the end of 2015. In many countries, the addition of IPV would necessitate delivery of multiple injectable vaccines (hereafter, “multiple injections”) during a single visit, with infants receiving IPV alongside pentavalent vaccine (which covers diphtheria, tetanus, and whole-cell pertussis; hepatitis B; and Haemophilus influenzae type b) and pneumococcal vaccine. Unanticipated concerns emerged from countries over acceptability of multiple injections, sites of administration, and safety. We contextualized the issues surrounding multiple injections by documenting concerns associated with administration of ≥3 injections, existing evidence in the published literature, and findings of a systematic review on administration practices and techniques.Methods.Concerns associated with multiple-injection visits were documented from meetings and personal communications with immunization program managers. Published literature on the acceptability of multiple injections by providers and caregivers was summarized, and a systematic review of the literature on administration practices was completed on the following topics: spacing between injection sites (ie, vaccine spacing), site of injection, route of injection, and procedural preparedness. WHO and United Nations Children’s Fund data from 2013–2015 were used to assess multiple-injection visits included in national immunization schedules.Results.Healthcare provider and caregiver attitudes and practices indicated concerns about infant pain, potential adverse effects, and uncertainty about vaccine effectiveness with multiple-injection visits. Published literature reinforced the record of safety and acceptance of the recommended schedule of IPV by the SAGE, but the evidence was largely from developed countries. Parental acceptance of multiple injections was associated with a positive provider recommendation to the caregiver. Findings of the systematic review identified that the intramuscular route is preferred over the subcutaneous route for vaccine administration and that the vastus lateralis muscle is preferred over the deltoid muscle for intramuscular injections. Recommendations on vaccine spacing and procedural preparedness were based on practical necessities, but comparative evidence was not identified. During 2013–2015, 85 countries added IPV to their immunization schedules, 46 (55%) of which adopted a schedule resulting in 3 injectable vaccines being administered in a single visit.Conclusion.The multiple-injection experience identified gaps in guidance for future vaccine introductions. Global partner organizations quickly mobilized to assess, document, and communicate the existing global experience on multiple-injection visits. This evidence-based approach provided reassurance to opinion leade...

show abstract

“…The introduction of IPV in Uganda, like elsewhere, resulted in the delivery of multiple injections during a single visit, with infants receiving IPV alongside pentavalent vaccine (for diphtheria, tetanus and whole-cell pertussis; hepatitis B; Haemophilus influenza type b) and pneumococcal vaccine at 14 weeks ( Preza et al., 2017) . Infants also receive the third and final OPV dose at 14 weeks.…”

Section: Introductionmentioning

confidence: 99%

Factors associated with the utilization of inactivated polio vaccine among children aged 12 to 23 months in Kalungu District, Uganda

Faith

Juliet

Tumuhamye

et al. 2020

Health Policy and Planning

View full text Add to dashboard Cite

Uganda officially introduced the inactivated polio vaccine (IPV) in May 2016 as part of the polio eradication strategy and integrated it into its routine immunization programme in addition to the oral polio vaccine. The current coverage stands at 60% as of July 2017. We therefore aimed to determine factors associated with the uptake of IPV among children in Kalungu District so as to inform the implementation of the vaccine policy. A community-based cross-sectional study was conducted among caregivers of 406 eligible children aged 12–23 months through multi-stage systematic sampling and a standardized semi-structured questionnaire. Nine key informant interviews were conducted through purposive selection of health care providers and members of Village Health Teams (VHTs) based on their expertize. Modified Poisson regression and thematic content analysis were used to determine factors significant to IPV uptake among children. 71% of sampled children aged 12–23 months had received IPV in Kalungu District. The survey found that being encouraged by health workers and VHTs was significant to children’s uptake of IPV (Adjusted PR 1.24, 95% CI; 1.22–3.47). Distance to the immunization point (Adjusted PR 0.32,95% CI; 0.16–0.62) and caregiver’s education level (Adjusted PR 1.16,95% CI; 1.05–2.22) were also associated with IPV uptake. Qualitative findings from health workers and VHT members further confirmed the perception that distance to the immunization post was important, and VHTs also stated that being encouraged by health workers was critical to IPV uptake. The current prevalence of IPV uptake among children aged 12–23 months in Kalungu is 71%, higher than the last reported national coverage (60%), though still below the recommended national coverage of 95%. Efforts should be focused on sensitization of caregivers through health workers and VHTs. Immunization outreach should be strengthened so as to bring services closer to patients.

show abstract

Acceptance of the Administration of Multiple Injectable Vaccines in a Single Immunization Visit in Albania

Cited by 9 publications

References 6 publications

Introduction of inactivated poliovirus vaccine in the Philippines: Effect on health care provider and infant caregiver attitudes and practices

Introduction of inactivated poliovirus vaccine in the Philippines: Effect on health care provider and infant caregiver attitudes and practices

Administering Multiple Injectable Vaccines During a Single Visit—Summary of Findings From the Accelerated Introduction of Inactivated Polio Vaccine Globally

Factors associated with the utilization of inactivated polio vaccine among children aged 12 to 23 months in Kalungu District, Uganda

Contact Info

Product

Resources

About