Evaluation of the Impact of Meningococcal Serogroup A Conjugate Vaccine Introduction on Second-Year-of-Life Vaccination Coverage in Burkina Faso

Abstract

Background After successful meningococcal serogroup A conjugate vaccine (MACV) campaigns since 2010, Burkina Faso introduced MACV in March 2017 into the routine Expanded Programme for Immunization schedule at age 15–18 months, concomitantly with second-dose measles-containing vaccine (MCV2). We examined MCV2 coverage in pre- and post-MACV introduction cohorts to describe observed changes regionally and nationally. Methods A nationwide household cluster survey of children 18–41 months of age was conducted 1 year after MACV introduction. Coverage was assessed by verification of vaccination cards or recall. Two age groups were included to compare MCV2 coverage pre-MACV introduction (30–41 months) versus post-MACV introduction (18–26 months). Results In total, 15 925 households were surveyed; 7796 children were enrolled, including 3684 30–41 months of age and 3091 18–26 months of age. Vaccination documentation was observed for 86% of children. The MACV routine coverage was 58% (95% confidence interval [CI], 56%–61%) with variation by region (41%–76%). The MCV2 coverage was 62% (95% CI, 59%–65%) pre-MACV introduction and 67% (95% CI, 64%–69%) post-MACV introduction, an increase of 4.5% (95% CI, 1.3%–7.7%). Among children who received routine MACV and MCV2, 93% (95% CI, 91%–94%) received both at the same visit. Lack of caregiver awareness about the 15- to 18-month visit and vaccine unavailability were common reported barriers to vaccination. Conclusions A small yet significant increase in national MCV2 coverage was observed 1 year post-MACV introduction. The MACV/MCV2 coadministration was common. Findings will help inform strategies to strengthen second-year-of-life immunization coverage, including to address the communication and vaccine availability barriers identified.

Assessment of missed opportunities for vaccination (MOV) in Burkina Faso using the World Health Organization’s revised MOV strategy: Findings and strategic considerations to improve routine childhood immunization coverage

“…Although administrative coverage was high for most antigens, these estimates are sourced from unstable population denominators. Subsequent coverage surveys reported lower coverage for the period 2016–17, with 86% and 62% for MR1 and MR2, respectively [4] , and 69% for fully immunized children [5] .…”

Health workers’ perceptions and challenges in implementing meningococcal serogroup a conjugate vaccine in the routine childhood immunization schedule in Burkina Faso

“…In a nationwide coverage survey one year after the introduction of MACV in the routine childhood immunization schedule, results suggest a small increase (almost 5%) in MCV2 coverage compared with the period before MACV introduction [18]. However, given the methodology of the survey, such an increase in coverage cannot be statistically attributed to MACV introduction.…”

“…Data collection took place during February and March 2018 and was conducted by teams comprised of an interviewer and a note-taker, all of whom were from Burkina Faso and had prior experience in qualitative methodologies. Three regional supervisors involved in the quantitative vaccination coverage survey performed quality control checks with the data collection teams [18]. Each team interviewed two respondents each day in their local language (or French in some instances) at their designated health facilities or office locations; on average, each interview lasted approximately between 45 and up to 90 min.…”

“…One-year following the introduction of MACV into the routine childhood immunization schedule, we aimed to qualitatively examine health workers' perceptions of MACV introduction, identify barriers to uptake, and explore opportunities to improve coverage. The qualitative assessment was conducted concurrently with a quantitative nationwide MACV/MCV vaccination coverage survey, which is reported elsewhere [18]. This paper focuses on the qualitative assessment conducted with health workers, from frontline healthcare providers to Expanded Program on Immunization (EPI) managers at the district and regional levels.…”

Future Directions for Meningitis Surveillance and Vaccine Evaluation in the Meningitis Belt of Sub-Saharan Africa

“…Five years after the establishment of MenAfriNet, this journal supplement provides an opportunity to describe the surveillance strategy, review performance, and highlight successes and challenges. Papers elsewhere in this supplement detail how MenAfriNet has improved surveillance performance and strengthened country capacity for laboratory confirmation [10–16], contributed to a greater understanding of current meningitis epidemiology in the meningitis belt [17, 18], and provided a platform for vaccine evaluation and research to inform existing and future bacterial meningitis vaccine policies [19–21]. This paper presents a look forward at priorities to control meningitis due to pathogens other than NmA, based on findings from MenAfriNet and other surveillance and research in the region, and at future directions for continuing MenAfriNet to ensure quality data are readily available to inform and evaluate future vaccination strategies for the meningitis belt in sub-Saharan Africa.…”