Population and sub-national (district) level diversity in missed and dropout of different doses of hepatitis-B vaccine among Indian children aged 12–59 months

Abstract

Initiating with a birth dose and a full immunization against hepatitis-B is crucial during early childhood in a country like India where maternal screening of hepatitis-B surface antigen is almost negligible and there is a considerable risk of vertical transmission among children. It is also evident that coverage of hepatitis-B is lowest among all other vaccine doses included in the universal immunization program. In addition, the major challenge is posed by the missed and drop-out of different doses of hepatitis-B among Indian children. In this context, this study examined the population and sub-national level diversity in missed and dropout of different doses of hepatitis-B vaccine in India. We analysed a large dataset of 196,654 children aged 12–59 months from a nationally representative cross-sectional survey, the National Family Health Survey (NFHS), 2015–16. Bivariate cross tabulation was used to estimate the prevalence and the dropout rates. Multivariable-adjusted logistic regression was applied to assess the likelihood of the study events. Within a Bayesian framework, a district-level spatial analysis was conducted employing the Besag-York-Mollie (BYM) Model and the Leroux Model. During 2016, 38% of the children missed the birth dose nationally and 45% of the children did not complete full immunization of hepatitis-B. Findings suggest, presence of socio-economic and demographic gradients in missed and drop-out of different doses of hepatitis-B at national level. The sub-national level spatial analysis identifies more than 280 (out of 640) districts with substantially higher risk (Posterior Median Risk>1) in terms of missed and drop-out of different doses. Most of these districts are scattered across the North-Eastern and Northern part of India. The findings hint the existence of a population and sub-national level diversity in India’s missed out and dropout of hepatitis-B doses. Identifying high risk population sub-groups and the districts with children at higher risk of missing the birth and consecutive doses informs the existing knowledge base and helps in formulating community-oriented policies and programs.

COVID‐19 vaccines reduce mortality in hospitalized patients with oxygen requirements: Differences between vaccine subtypes. A multicontinental cohort study

“…The AF is the proportion of the risk among exposed that is attributable to the exposure, and the PAR estimates the portion of the risk in a population that is attributable to the exposure. 29 In the present study, AF shows the reduction in the risk of death among vaccinated that is attributable to the COVID-19 vaccine, and the PAR shows the proportion of deaths in the unvaccinated patients that would be avoided if they had been vaccinated.…”

“…Additionally, we studied the attributable fraction (AF) and the population attributable risk (PAR) to quantify the contribution of the COVID‐19 vaccine on death reduction after the confounder's adjustment. The AF is the proportion of the risk among exposed that is attributable to the exposure, and the PAR estimates the portion of the risk in a population that is attributable to the exposure 29 …”