Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States; The U.S. Public Health Service Commissioned Corps, Atlanta, Georgia, United States.
Hepatitis B Foundation, Doylestown, Pennsylvania, United States.
Vaccine. 2024 Oct 24;42(24):126222. doi: 10.1016/j.vaccine.2024.126222. Epub 2024 Aug 27.
Nigeria has the largest number of children infected with hepatitis B virus (HBV) globally and has not yet achieved maternal and neonatal tetanus elimination. In Nigeria, maternal tetanus diphtheria (Td) vaccination is part of antenatal care and hepatitis B birth dose (HepB-BD) vaccination for newborns has been offered since 2004. We implemented interventions targeting healthcare workers (HCWs), community volunteers, and pregnant women attending antenatal care with the goal of improving timely (within 24 hours) HepB-BD vaccination among newborns and Td vaccination coverage among pregnant women.
We selected 80 public health facilities in Adamawa and Enugu states, with half intervention facilities and half control. Interventions included HCW and community volunteer trainings, engagement of pregnant women, and supportive supervision at facilities. Timely HepB-BD coverage and at least two doses of Td (Td2+) coverage were assessed at baseline before project implementation (January-June 2021) and at endline, one year after implementation (January-June 2022). We held focus group discussions at intervention facilities to discuss intervention strengths, challenges, and improvement opportunities.
Compared to baseline, endline median vaccination coverage increased for timely HepB-BD from 2.6% to 61.8% and for Td2+ from 20.4% to 26.9% in intervention facilities (p < 0.05). In comparison, at endline in control facilities median vaccination coverage for timely HepB-BD was 7.9% (p < 0.0001) and Td2+ coverage was 22.2% (p = 0.14). Focus group discussions revealed that HCWs felt empowered to administer vaccination due to increased knowledge on hepatitis B and tetanus, pregnant women had increased knowledge that led to improved health seeking behaviors including Td vaccination, and transportation support was needed to reach those in far communities.
Targeted interventions significantly increased timely HepB-BD and Td vaccination rates in intervention facilities. Continued support of these successful interventions could help Nigeria reach hepatitis B and maternal and neonatal tetanus elimination goals.
尼日利亚是全球感染乙型肝炎病毒（HBV）的儿童人数最多的国家，尚未实现孕产妇和新生儿破伤风消除。在尼日利亚，孕产妇破伤风类毒素（Td）疫苗接种是产前护理的一部分，自 2004 年以来，已为新生儿提供乙型肝炎出生剂量（HepB-BD）疫苗接种。我们针对医护人员（HCWs）、社区志愿者和接受产前护理的孕妇实施了干预措施，目标是提高新生儿及时（24 小时内）接种 HepB-BD 疫苗和孕妇接种 Td 疫苗（Td2+）的覆盖率。
我们在阿达马瓦州和埃努古州选择了 80 家公共卫生机构，其中一半为干预设施，一半为对照设施。干预措施包括 HCW 和社区志愿者培训、孕妇参与以及设施的支持性监督。在项目实施前（2021 年 1 月至 6 月）和实施一年后（2022 年 1 月至 6 月）的基线评估了及时接种 HepB-BD 的覆盖率和至少两剂 Td（Td2+）的覆盖率。我们在干预设施举行了焦点小组讨论，讨论干预措施的优势、挑战和改进机会。
与基线相比，干预设施及时接种 HepB-BD 的疫苗接种覆盖率从 2.6%增加到 61.8%，Td2+的疫苗接种覆盖率从 20.4%增加到 26.9%（p<0.05）。相比之下，在对照设施，及时接种 HepB-BD 的疫苗接种覆盖率在基线时为 7.9%（p<0.0001），而 Td2+的疫苗接种覆盖率为 22.2%（p=0.14）。焦点小组讨论显示，由于对乙型肝炎和破伤风的知识增加，医护人员有能力接种疫苗，孕妇的知识增加，导致改善了寻求包括 Td 疫苗接种在内的卫生服务的行为，并且需要交通支持来帮助那些偏远社区的人。
有针对性的干预措施显著提高了干预设施及时接种 HepB-BD 和 Td 的疫苗接种率。继续支持这些成功的干预措施可能有助于尼日利亚实现乙型肝炎和孕产妇及新生儿破伤风消除目标。
