Knowledge synthesis of benefits and adverse effects of measles vaccination: the Lasbela balance sheet

Abstract

BackgroundIn preparation for a cluster-randomized controlled trial of a community intervention to increase the demand for measles vaccination in Lasbela district of Pakistan, a balance sheet summarized published evidence on benefits and possible adverse effects of measles vaccination.MethodsThe balance sheet listed: 1) major health conditions associated with measles; 2) the risk among the unvaccinated who contract measles; 3) the risk among the vaccinated; 4) the risk difference between vaccinated and unvaccinated; and 5) the likely net gain from vaccination for each condition.ResultsTwo models revealed very different projections of net gain from measles vaccine. A Lasbela-specific combination of low period prevalence of measles among the unvaccinated, medium vaccination coverage and low vaccine efficacy rate, as revealed by the baseline survey, resulted in less-than-expected gains attributable to vaccination. Modelled on estimates where the vaccine had greater efficacy, the gains from vaccination would be more substantial.ConclusionSpecific local conditions probably explain the low rates among the unvaccinated while the high vaccine failure rate is likely due to weaknesses in the vaccination delivery system. Community perception of these realities may have had some role in household decisions about whether to vaccinate, although the major discouraging factor was inadequate access. The balance sheet may be useful as a communication tool in other circumstances, applied to up-to-date local evidence.

Community perception regarding childhood vaccinations and its implications for effectiveness: a qualitative study in rural Burkina Faso

“…Health workers have to remind women every time on their appointments so that they bring their children for immunization. Moreover, the possibility of side effects significantly influence the behavior of mothers, which supports similar observations in other populations [ 43 – 45 ]. Finally, mobility of respondents was also shown to be a serious barrier to vaccination, supporting similar observations from other studies [ 46 ].…”

Benefit-Risk Assessment of Vaccines. Part II: Proposal Towards Consolidated Standards of Reporting Quantitative Benefit-Risk Models Applied to Vaccines (BRIVAC)

“…The views expressed are those of the authors and do not necessarily reflect the views of IDRC. (Example based on Ledogar et al [71]).…”

The fallacy of coverage: uncovering disparities to improve immunization rates through evidence. Results from the Canadian International Immunization Initiative Phase 2 - Operational Research Grants

“…Mitchell et al [8] provide evidence on how poor access and mother's education (in urban areas only) were the key equity factors obstructing measles vaccination uptake in the Lasbela district of Pakistan. In the Nouna district of Burkina Faso, Sanou et al [12] provide evidence for how the education of both parents along with the economic conditions of households affected immunization coverage. The authors did note, however, that the influence of economic conditions is complex as immunization services are free of charge, thus pointing to the importance of communication about the free services to avoid potential abuses by providers.…”

“…Through the use of qualitative methods, their results suggest that interpretation of religious principles by church-going populations is primary in explaining reticence and that the solutions lie in creating an open dialogue among all actors : reticent parents, their religious leaders and health authorities. Such an intervention is also alluded to by the work in Burkina Faso by Sanou et al [12] and national EPI teams have used the results of the study.…”

“…The Pakistan study thus provides evidence on how to improve the demand side of vaccination uptake at a relatively low cost (US$9 per child). Interestingly, the work in Mali by Koumaré et al [19] and in Burkina Faso by Sanou et al [12] similarly underscore the need to give priority to providing information to communities on the goals of immunization as well as the importance of tailoring interventions to local realities to improve immunization uptake.…”