Vaccine implementation factors affecting maternal tetanus immunization in low- and middle-income countries: Results of the Maternal Immunization and Antenatal Care Situational Analysis (MIACSA) project

Abstract

Objectives To examine the characteristics of existing maternal tetanus immunization programmes for pregnant women in low- and middle-income countries (LMICs) and to identify and understand the challenges, barriers and facilitators associated with maternal vaccine service delivery that may impact the introduction and implementation of new maternal vaccines in the future. Design A mixed methods, cross sectional study with four data collection phases including a desk review, online survey, telephone and face-to-face interviews and in country visits. Setting LMICs. Results The majority of countries (84/95; 88%) had a maternal tetanus immunization policy. Countries with high protection at birth (PAB) were more likely to report tetanus toxoid-containing vaccine (TTCV) coverage targets > 90%. Less than half the countries included in this study had a TTCV coverage target of > 90%. Procurement and distribution of TTCV was nearly always the responsibility of the Expanded Programme on Immunization (EPI), however planning and management of maternal immunization was often shared between EPI and Maternal, Newborn and Child Health (MNCH) programmes. Receipt of TTCV at the same time as the antenatal care visit correlated with high PAB. Most countries (81/95; 85%) had an immunization safety surveillance system in place although only 11% could differentiate an adverse event following immunization (AEFI) in pregnant and non-pregnant women. Conclusions Recommendations arising from the MIACSA project to strengthen existing services currently delivering maternal tetanus immunization in LMICs include establishing and maintaining vaccination targets, clearly defining responsibilities and fostering collaborations between EPI and MNCH, investing in strengthening the health workforce, improving the design and use of existing record keeping for immunization, adjusting current AEFI reporting to differentiate pregnant women and endeavoring to integrate the provision of TTCV within ANC services where appropriate.

Associations Between Maternal Immunisation and Reduced Rates of Preterm Birth and Stillbirth: A Population Based Retrospective Cohort Study

“…In 2014, only 115 of 194 countries (59%) had a national influenza policy and, of these, fewer than half included pregnant women ( 30 ). The addition of maternal vaccines beyond tetanus toxoid containing vaccine in low- and middle-income countries has been slow ( 31 ). Likely reasons for this include the cost and/or challenges with prioritization over other healthcare expenses.…”

Optimizing next-generation RSV prevention in Mali: a cost-effectiveness analysis of pediatric vaccination, maternal vaccination, and extended half-life monoclonal antibody immunoprophylaxis

“…Finally, since RSV vaccination may have reduced performance if administered before six months of age compared to later in life [8], we used one-way sensitivity analyses to assess the optimal strategy choice across a wide range of efficacy values for pediatric vaccine administered at 10/14 weeks. In the first of these analyses, we identified the optimal strategy across vaccine efficacy changes regardless of whether other strategies were being deployed.…”

“…In most Sub-Saharan African countries, routine immunization schedules include vaccinations at birth, 6 weeks, 10 weeks, 14 weeks, and 9 months [7]. Alternatives to pediatric RSV vaccine strategies include maternal RSV vaccination, which would use antenatal care delivery platforms in need of strengthening in many LMICs [8], or extended half-life mAbs, a technology new to LMIC immunization programs. The most practical strategy for RSV prevention in LMICs would be pediatric RSV vaccination programs integrated into established routine immunization schedules, but there are also challenges to this approach [9].…”

The Fifth International Neonatal and Maternal Immunization Symposium (INMIS 2019): Securing Protection for the Next Generation

“…Philipp Lambach (World Health Organization [WHO], Switzerland) highlighted the efforts by the WHO to support maternal immunization platforms in LMICs, using tetanus vaccination in pregnancy as a proof of concept of this approach. The Maternal Immunization and Antenatal Care Situation Analysis (MIACSA) project, a collaborative effort between the WHO Departments of Immunization, Vaccines, and Biologicals (IVB) and Maternal, Newborn, Child, and Adolescent Health (MCA), was undertaken in 2016 to 2019 (6,7). MIACSA assessed maternal tetanus vaccine service delivery strategies and factors associated with effective delivery in low-resource settings, including collaborations between the immunization program and antenatal care clinic programs, human resources, finances, information systems, and surveillance.…”