Implementation and adherence of routine pertussis vaccination (DTP) in a low-resource urban birth cohort

Introduction Reliable information on rates of up-to-date coverage and timely administration of routine childhood immunisations are critical for guiding public health efforts worldwide, yet prospective observation of vaccination programmes within individual communities is rare. Here, we provide a lon...

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Autores principales:	Christian E Gunning, Lawrence Mwananyanda, William B MacLeod, Magdalene Mwale, Donald M Thea, Rachel C Pieciak, Pejman Rohani, Christopher J Gill
Formato:	article
Lenguaje:	EN
Publicado:	BMJ Publishing Group 2020
Materias:	Medicine R
Acceso en línea:	https://doaj.org/article/86af50bab42943478b0aa49f8effffce
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spelling	oai:doaj.org-article:86af50bab42943478b0aa49f8effffce2021-11-19T09:00:06ZImplementation and adherence of routine pertussis vaccination (DTP) in a low-resource urban birth cohort10.1136/bmjopen-2020-0411982044-6055https://doaj.org/article/86af50bab42943478b0aa49f8effffce2020-12-01T00:00:00Zhttps://bmjopen.bmj.com/content/10/12/e041198.fullhttps://doaj.org/toc/2044-6055Introduction Reliable information on rates of up-to-date coverage and timely administration of routine childhood immunisations are critical for guiding public health efforts worldwide, yet prospective observation of vaccination programmes within individual communities is rare. Here, we provide a longitudinal analysis of the directly observed administration of a three-dose primary vaccination series to infants in a low-resource community in Lusaka, Zambia.Methods Throughout 2015, we recruited a longitudinal birth cohort of mother/infant pairs (initial enrolment, 1981 pairs; attending, 1497 pairs) from the periurban informal settlement of Chawama compound, located in Lusaka, Zambia. We prospectively monitored the administration of scheduled diphtheria–tetanus–pertussis (DTP) vaccinations across the first 14–18 weeks of life. We analysed study attendance and vaccine coverage, both overall and stratified by age group. We employed Kaplan-Meier analyses to estimate delays in age-appropriate administration of vaccine doses. We also assessed schedule timing violations, including early and compressed dose administration.Results At study completion, first dose (DTP1) rates were high (92.9% of attending), whereas third dose completion (DTP3) rates were far lower (61.9%). Missed vaccinations and study dropout both contributed to the low DTP3 completion rates. DTP1 was administered very late (at or after 10 weeks) to 61 infants (4.1%). DTP1 was administered too early to 64 infants (4.3%), and 77 (5.1%) received consecutive doses below the minimum recommended spacing of 28 days.Conclusions We observe substantial individual variation in the timing of early childhood DTP doses, though following this birth cohort proved challenging. Our results indicate that timely administration of both DTP1 and DTP3 remains a challenge in this community. These directly-observed, individual-based results provide an important counterpoint to more course-grained, survey-based national and province estimates of up-to-date vaccine coverage. This study also highlights the challenges of vaccine hesitancy and suboptimal utilisation of (no-cost) healthcare services in a low-resource urban setting.Christian E GunningLawrence MwananyandaWilliam B MacLeodMagdalene MwaleDonald M TheaRachel C PieciakPejman RohaniChristopher J GillBMJ Publishing GrouparticleMedicineRENBMJ Open, Vol 10, Iss 12 (2020)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R
spellingShingle	Medicine R Christian E Gunning Lawrence Mwananyanda William B MacLeod Magdalene Mwale Donald M Thea Rachel C Pieciak Pejman Rohani Christopher J Gill Implementation and adherence of routine pertussis vaccination (DTP) in a low-resource urban birth cohort
description	Introduction Reliable information on rates of up-to-date coverage and timely administration of routine childhood immunisations are critical for guiding public health efforts worldwide, yet prospective observation of vaccination programmes within individual communities is rare. Here, we provide a longitudinal analysis of the directly observed administration of a three-dose primary vaccination series to infants in a low-resource community in Lusaka, Zambia.Methods Throughout 2015, we recruited a longitudinal birth cohort of mother/infant pairs (initial enrolment, 1981 pairs; attending, 1497 pairs) from the periurban informal settlement of Chawama compound, located in Lusaka, Zambia. We prospectively monitored the administration of scheduled diphtheria–tetanus–pertussis (DTP) vaccinations across the first 14–18 weeks of life. We analysed study attendance and vaccine coverage, both overall and stratified by age group. We employed Kaplan-Meier analyses to estimate delays in age-appropriate administration of vaccine doses. We also assessed schedule timing violations, including early and compressed dose administration.Results At study completion, first dose (DTP1) rates were high (92.9% of attending), whereas third dose completion (DTP3) rates were far lower (61.9%). Missed vaccinations and study dropout both contributed to the low DTP3 completion rates. DTP1 was administered very late (at or after 10 weeks) to 61 infants (4.1%). DTP1 was administered too early to 64 infants (4.3%), and 77 (5.1%) received consecutive doses below the minimum recommended spacing of 28 days.Conclusions We observe substantial individual variation in the timing of early childhood DTP doses, though following this birth cohort proved challenging. Our results indicate that timely administration of both DTP1 and DTP3 remains a challenge in this community. These directly-observed, individual-based results provide an important counterpoint to more course-grained, survey-based national and province estimates of up-to-date vaccine coverage. This study also highlights the challenges of vaccine hesitancy and suboptimal utilisation of (no-cost) healthcare services in a low-resource urban setting.
format	article
author	Christian E Gunning Lawrence Mwananyanda William B MacLeod Magdalene Mwale Donald M Thea Rachel C Pieciak Pejman Rohani Christopher J Gill
author_facet	Christian E Gunning Lawrence Mwananyanda William B MacLeod Magdalene Mwale Donald M Thea Rachel C Pieciak Pejman Rohani Christopher J Gill
author_sort	Christian E Gunning
title	Implementation and adherence of routine pertussis vaccination (DTP) in a low-resource urban birth cohort
title_short	Implementation and adherence of routine pertussis vaccination (DTP) in a low-resource urban birth cohort
title_full	Implementation and adherence of routine pertussis vaccination (DTP) in a low-resource urban birth cohort
title_fullStr	Implementation and adherence of routine pertussis vaccination (DTP) in a low-resource urban birth cohort
title_full_unstemmed	Implementation and adherence of routine pertussis vaccination (DTP) in a low-resource urban birth cohort
title_sort	implementation and adherence of routine pertussis vaccination (dtp) in a low-resource urban birth cohort
publisher	BMJ Publishing Group
publishDate	2020
url	https://doaj.org/article/86af50bab42943478b0aa49f8effffce
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Implementation and adherence of routine pertussis vaccination (DTP) in a low-resource urban birth cohort

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