Introduction: As new vaccines become available, countries must assess the relevance to introduce them into their vaccination schedules. Malawi has recently introduced several new vaccines and plans to introduce more. ...Introduction: As new vaccines become available, countries must assess the relevance to introduce them into their vaccination schedules. Malawi has recently introduced several new vaccines and plans to introduce more. This study was conducted to identify key factors that need to be considered when deciding to introduce a new vaccine and current challenges faced by low and middle income countries using Malawi as an example. Methodology: The study employed a desk review approach, examining published literature from various sources such as PubMed, Medline, and Google Scholar. Policy documents from organizations like the World Health Organization, GAVI the Alliance, and the Ministry of Health for Malawi were also included. A total of 99 articles and documents on new vaccine introduction, challenges of immunization, policy documents in immunization and health systems strengthening were included. The review focused on addressing five key areas critical to new vaccine introduction namely: the need for a vaccine, availability of the vaccine, safety and effectiveness of the vaccine, demand for the vaccine, and the prudent use of public or private funds. Results: Malawi considered the burden of cervical cancer and the significance of malaria in the country when introducing the HPV and malaria vaccines. The country opted for vaccines that can be handled by the cold chain capacity and available human resources. Despite that malaria vaccine and Typhoid Conjugate Vaccine trials were done in country, there are limited vaccine safety and efficacy trials conducted in Malawi, leading to a reliance on WHO-prequalified vaccines. Demand for newly introduced vaccines varied, with high demand for Oral Cholera Vaccine during a cholera outbreak, while demand for COVID-19 vaccines decreased over time. Although cost-effectiveness studies were limited in the country, 2 studies indicated that Typhoid Conjugate Vaccine and malaria vaccine would be cost effective. All these have been implemented despite having challenges like lack of accurate surveillance data, inadequate cold chain capacity, limited safety and efficacy vaccine clinical trials, political influence, and limited funding. Conclusion: Despite several challenges Malawi set a good example of the careful considerations required before introducing a new vaccine. The process involves data review, priority setting, precise planning, and consultation with stakeholders. Low-income countries should invest in vaccine safety, efficacy, and cost-effectiveness trials.展开更多
目的评估甲型肝炎(简称甲肝)疫苗(hepatitis A vaccine,HepA)试点(1996年)以及2008年被纳入国家扩大免疫规划(expanded program on immunization,EPI)前后,对上海市甲肝发病率的影响,为上海市甲肝的防控效果评价提供科学依据。方法利用...目的评估甲型肝炎(简称甲肝)疫苗(hepatitis A vaccine,HepA)试点(1996年)以及2008年被纳入国家扩大免疫规划(expanded program on immunization,EPI)前后,对上海市甲肝发病率的影响,为上海市甲肝的防控效果评价提供科学依据。方法利用国家人口健康科学数据中心和《中国卫生年鉴》获取甲肝报告发病资料(1990—2019年),选中断时间序列(interrupted time series,ITS)方法构建中断线性回归模型,模拟HepA试点和HepA纳入EPI前后甲肝的发病率水平和斜率改变情况,利用t检验行模型系数检验、灰色模型(grey model,GM)拟合2008年后甲肝的发病数据,采用Mantel-Haenszelχ^(2)检验行甲肝发病率线性趋势分析。结果1990—2019年上海市甲肝年均发病率为5.24/10万,发病率呈线性下降趋势(χ^(2)_(趋势)=17.92,P<0.001)。HepA试点前发病率为13.95/10万,下降斜率为3.21/10万,试点后发病率为4.95/10万,下降斜率为0.26/10万。HepA纳入EPI前发病率为8.22/10万,下降斜率为1.22/10万,纳入EPI后发病率为4.13/10万,斜率为0.25/10万。结论甲肝发病率在HepA试点后呈下降趋势,HepA纳入EPI后甲肝发病率虽有小范围波动,但平均发病率较HepA纳入EPI前低,整体上甲肝发病率维持在较低水平,HepA试点和HepA纳入EPI对降低上海市甲肝发病率发挥重要作用。展开更多
目的了解孕妇对未来子女非免疫规划疫苗(expanded program on immunization,EPI)的接种意愿及其影响因素,为提高儿童非EPI接种率提供参考。方法采用便利抽样的方法,选取山西省妇幼保健院438名产检孕妇为研究对象进行问卷调查。利用独立...目的了解孕妇对未来子女非免疫规划疫苗(expanded program on immunization,EPI)的接种意愿及其影响因素,为提高儿童非EPI接种率提供参考。方法采用便利抽样的方法,选取山西省妇幼保健院438名产检孕妇为研究对象进行问卷调查。利用独立样本t检验、方差分析和多重线性回归模型分析个人社会经济因素、疫苗倾向和疫苗信息获取渠道对孕妇为未来子女接种非EPI意愿的影响,并基于计划行为理论构建结构方程模型分析孕妇对子女非EPI接种的态度、主观规范、知觉行为控制对接种意愿的影响。结果98.4%调查对象愿意为子女接种非EPI。与倾向于接种进口疫苗的群体相比,有接种国产疫苗倾向的群体(β=0.119)为子女接种非EPI的意愿更强,有接触媒体宣传较没有接触的群体子女非EPI接种意愿更强(β=0.099),有接触社区医院和疾病预防控制中心的宣传册和活动讲座的群体较没有接触的群体子女非EPI接种意愿更强(β=0.119)。结构方程模型结果显示影响接种意愿强度的因素从大到小依次为知觉行为控制、行为态度、主观规范(路径系数分别为0.73,0.13,0.12)。结论孕妇对未来子女非EPI的接种意愿水平较高。加强非EPI接种宣传教育,改变孕妇对非EPI的知觉行为控制和态度,能够帮助提高儿童非EPI接种率。展开更多
目的评估南昌市将甲型肝炎减毒活疫苗(live attenuated hepatitis A vaccine,Hep A-L)纳入扩大免疫规划(Expanded Program on Immunization,EPI)接种策略的效果及效益。方法采用净现值法计算净效益和成本效益比,进行成本-效益分析。结果...目的评估南昌市将甲型肝炎减毒活疫苗(live attenuated hepatitis A vaccine,Hep A-L)纳入扩大免疫规划(Expanded Program on Immunization,EPI)接种策略的效果及效益。方法采用净现值法计算净效益和成本效益比,进行成本-效益分析。结果 2008~2016年,南昌市将Hep A-L纳入EPI投入成本1 865.36万元,减少甲型肝炎(简称甲肝)病例9 297例,即每投入2 006.41元,减少1例甲肝病例。产生净效益13 708.73万元,成本效益比为8.35∶1。结论南昌市将Hep A-L纳入EPI接种策略可获得较高的成本效果比和成本效益比。展开更多
文摘Introduction: As new vaccines become available, countries must assess the relevance to introduce them into their vaccination schedules. Malawi has recently introduced several new vaccines and plans to introduce more. This study was conducted to identify key factors that need to be considered when deciding to introduce a new vaccine and current challenges faced by low and middle income countries using Malawi as an example. Methodology: The study employed a desk review approach, examining published literature from various sources such as PubMed, Medline, and Google Scholar. Policy documents from organizations like the World Health Organization, GAVI the Alliance, and the Ministry of Health for Malawi were also included. A total of 99 articles and documents on new vaccine introduction, challenges of immunization, policy documents in immunization and health systems strengthening were included. The review focused on addressing five key areas critical to new vaccine introduction namely: the need for a vaccine, availability of the vaccine, safety and effectiveness of the vaccine, demand for the vaccine, and the prudent use of public or private funds. Results: Malawi considered the burden of cervical cancer and the significance of malaria in the country when introducing the HPV and malaria vaccines. The country opted for vaccines that can be handled by the cold chain capacity and available human resources. Despite that malaria vaccine and Typhoid Conjugate Vaccine trials were done in country, there are limited vaccine safety and efficacy trials conducted in Malawi, leading to a reliance on WHO-prequalified vaccines. Demand for newly introduced vaccines varied, with high demand for Oral Cholera Vaccine during a cholera outbreak, while demand for COVID-19 vaccines decreased over time. Although cost-effectiveness studies were limited in the country, 2 studies indicated that Typhoid Conjugate Vaccine and malaria vaccine would be cost effective. All these have been implemented despite having challenges like lack of accurate surveillance data, inadequate cold chain capacity, limited safety and efficacy vaccine clinical trials, political influence, and limited funding. Conclusion: Despite several challenges Malawi set a good example of the careful considerations required before introducing a new vaccine. The process involves data review, priority setting, precise planning, and consultation with stakeholders. Low-income countries should invest in vaccine safety, efficacy, and cost-effectiveness trials.
文摘目的评估甲型肝炎(简称甲肝)疫苗(hepatitis A vaccine,HepA)试点(1996年)以及2008年被纳入国家扩大免疫规划(expanded program on immunization,EPI)前后,对上海市甲肝发病率的影响,为上海市甲肝的防控效果评价提供科学依据。方法利用国家人口健康科学数据中心和《中国卫生年鉴》获取甲肝报告发病资料(1990—2019年),选中断时间序列(interrupted time series,ITS)方法构建中断线性回归模型,模拟HepA试点和HepA纳入EPI前后甲肝的发病率水平和斜率改变情况,利用t检验行模型系数检验、灰色模型(grey model,GM)拟合2008年后甲肝的发病数据,采用Mantel-Haenszelχ^(2)检验行甲肝发病率线性趋势分析。结果1990—2019年上海市甲肝年均发病率为5.24/10万,发病率呈线性下降趋势(χ^(2)_(趋势)=17.92,P<0.001)。HepA试点前发病率为13.95/10万,下降斜率为3.21/10万,试点后发病率为4.95/10万,下降斜率为0.26/10万。HepA纳入EPI前发病率为8.22/10万,下降斜率为1.22/10万,纳入EPI后发病率为4.13/10万,斜率为0.25/10万。结论甲肝发病率在HepA试点后呈下降趋势,HepA纳入EPI后甲肝发病率虽有小范围波动,但平均发病率较HepA纳入EPI前低,整体上甲肝发病率维持在较低水平,HepA试点和HepA纳入EPI对降低上海市甲肝发病率发挥重要作用。
文摘目的了解孕妇对未来子女非免疫规划疫苗(expanded program on immunization,EPI)的接种意愿及其影响因素,为提高儿童非EPI接种率提供参考。方法采用便利抽样的方法,选取山西省妇幼保健院438名产检孕妇为研究对象进行问卷调查。利用独立样本t检验、方差分析和多重线性回归模型分析个人社会经济因素、疫苗倾向和疫苗信息获取渠道对孕妇为未来子女接种非EPI意愿的影响,并基于计划行为理论构建结构方程模型分析孕妇对子女非EPI接种的态度、主观规范、知觉行为控制对接种意愿的影响。结果98.4%调查对象愿意为子女接种非EPI。与倾向于接种进口疫苗的群体相比,有接种国产疫苗倾向的群体(β=0.119)为子女接种非EPI的意愿更强,有接触媒体宣传较没有接触的群体子女非EPI接种意愿更强(β=0.099),有接触社区医院和疾病预防控制中心的宣传册和活动讲座的群体较没有接触的群体子女非EPI接种意愿更强(β=0.119)。结构方程模型结果显示影响接种意愿强度的因素从大到小依次为知觉行为控制、行为态度、主观规范(路径系数分别为0.73,0.13,0.12)。结论孕妇对未来子女非EPI的接种意愿水平较高。加强非EPI接种宣传教育,改变孕妇对非EPI的知觉行为控制和态度,能够帮助提高儿童非EPI接种率。
