Wallace Aaron S, Bohara Rajendra, Stewart Steven, Subedi Giri, Anand Abhijeet, Burnett Eleanor, Giri Jagat, Shrestha Jagat, Gurau Suraj, Dixit Sameer, Rajbhandari Rajesh, Schluter W William
Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia.
World Health Organization Nepal.
J Infect Dis. 2017 Jul 1;216(suppl_1):S280-S286. doi: 10.1093/infdis/jix164.
The potential to strengthen routine immunization (RI) services through supplementary immunization activities (SIAs) is an important benefit of global measles and rubella elimination and polio eradication strategies. However, little evidence exists on how best to use SIAs to strengthen RI. As part the 2012 Nepal measles-rubella and polio SIA, we developed an intervention package designed to improve RI processes and evaluated its effect on specific RI process measures.
The intervention package was incorporated into existing SIA activities and materials to improve healthcare providers' RI knowledge and practices throughout Nepal. In 1 region (Central Region) we surveyed the same 100 randomly selected health facilities before and after the SIA and evaluated the following RI process measures: vaccine safety, RI planning, RI service delivery, vaccine supply chain, and RI data recording practices. Data collection included observations of vaccination sessions, interviews with the primary healthcare provider who administered vaccines at each facility, and administrative record reviews. Pair-matched analytical methods were used to determine whether statistically significant changes in the selected RI process measures occurred over time.
After the SIA, significant positive changes were measured in healthcare provider knowledge of adverse events following immunization (11% increase), availability of RI microplans (+17%) and maps (+12%), and awareness of how long a reconstituted measles vial can be used before it must be discarded (+14%). For the SIA, 42% of providers created an SIA high-risk villages list, and >50% incorporated this information into RI outreach session site planning. Significant negative changes occurred in correct knowledge of measles vaccination contraindications (-11%), correct definition for a measles outbreak (-21%), and how to treat a child with a severe adverse event following immunization (-10%). Twenty percent of providers reported cancelling ≥1 RI sessions during the SIA. Many RI process measures were at high proportions (>90%) before the SIA and remained high afterward, including proper vaccine administration techniques, proper vaccine waste management, and availability of vaccine carriers and vaccine registers.
Focusing on activities that are easily linked between SIAs and RI services, such as using SIA high-risk village list to strengthen RI microplanning and examining ways to minimize the impact of an SIA on RI session scheduling, should be prioritized when implementing SIAs.
通过补充免疫活动（SIAs）加强常规免疫（RI）服务的潜力是全球消除麻疹和风疹及根除脊髓灰质炎战略的一项重要益处。然而，关于如何最佳利用补充免疫活动来加强常规免疫的证据很少。作为2012年尼泊尔麻疹 - 风疹和脊髓灰质炎补充免疫活动的一部分，我们制定了一套旨在改善常规免疫流程的干预措施，并评估了其对特定常规免疫流程指标的影响。
将干预措施纳入现有的补充免疫活动和材料中，以提高尼泊尔各地医疗服务提供者的常规免疫知识和实践水平。在1个地区（中部地区），我们在补充免疫活动前后对100个随机选择的卫生设施进行了调查，并评估了以下常规免疫流程指标：疫苗安全性、常规免疫规划、常规免疫服务提供、疫苗供应链以及常规免疫数据记录实践。数据收集包括观察疫苗接种环节、采访每个设施中接种疫苗的初级医疗服务提供者以及审查行政记录。采用配对分析方法来确定所选常规免疫流程指标随时间是否发生了具有统计学意义的变化。
补充免疫活动后，在医疗服务提供者关于免疫后不良事件的知识（增加11%）、常规免疫微观规划的可用性（增加17%）和地图的可用性（增加12%）以及关于复溶麻疹疫苗小瓶在必须丢弃前可使用多长时间的知晓率（增加14%）方面，测量到了显著的积极变化。在补充免疫活动中，42%的提供者创建了补充免疫活动高风险村庄清单，超过50%的提供者将此信息纳入常规免疫外展活动地点规划。在麻疹疫苗接种禁忌症的正确知识（下降11%）、麻疹疫情的正确定义（下降21%）以及免疫后严重不良事件患儿的治疗方法（下降10%）方面出现了显著的消极变化。20%的提供者报告在补充免疫活动期间取消了≥1次常规免疫活动。许多常规免疫流程指标在补充免疫活动前的比例就很高（>90%），之后仍然很高，包括正确的疫苗接种技术、正确的疫苗废物管理以及疫苗运输工具和疫苗登记册的可用性。
在实施补充免疫活动时，应优先关注那些在补充免疫活动和常规免疫服务之间易于关联的活动，例如利用补充免疫活动高风险村庄清单来加强常规免疫微观规划，并研究如何尽量减少补充免疫活动对常规免疫活动安排的影响。
