Who is protected? Determinants of hepatitis B infant vaccination completion among a prospective cohort of migrant workers in Thailand during the COVID-19 pandemic

Abstract

Background Hepatitis B causes significant disease and death globally, despite the availability of effective vaccination. Migration likewise affects hundreds of millions of people annually, many of whom are women and children, and increases risks for poor vaccine completion and mother to child transmission of hepatitis B. In the neighbouring countries of Thailand and Myanmar, vaccine campaigns have made progress but little is known about the reach of these programs into migrant worker communities from Myanmar living in Thailand. Methods A cohort of 253 postpartum women (53 urban migrants in Chiang Mai and 200 rural migrants in Tak Province) were surveyed about their Hepatitis B knowledge and willingness to vaccinate their children between September 10, 2019 and March 30, 2019. They were subsequently followed to determine vaccine completion. When records of vaccination were unavailable at the birth facility, or visits were late, families were contacted and interviewed about vaccination elsewhere, and reasons for late or missed vaccines. Results Though women in Tak province displayed better knowledge of Hepatitis B and equal intention to vaccinate, they were 14 times less likely to complete Hepatitis B vaccination for their children compared to migrants in Chiang Mai. Tak women were largely undocumented, had private (non-profit) insurance and had more transient residence. In Chiang Mai migrant women were mostly documented and had full access to the Thai national health services. Though minor individual and facility-level differences may have contributed, the major driver of the disparity seems to be the place of migrants within local socio-political-economic systems. The COVID-19 pandemic further disproportionately affected Tak province migrants who faced severe travel restrictions hampering vaccination. Sixty percent of families who were lost to vaccine follow-up in Tak province could not be contacted by phone or home visit. Chiang Mai migrants, with 86.8% vaccine completion, nearly reached the target of 90%. Conclusions Achievement of high levels of hepatitis B vaccination in migrant communities is important and feasible, and requires inclusive policies that integrate migrants into national health and social services. This is more urgent than ever during the COVID-19 era.

Born too soon in a resource-limited setting: A 10-year mixed methods review of a special care baby unit for refugees and migrants on the Myanmar-Thailand border

“…Given the experience of the nurses and medics who have been working in SMRU SCBUs since their establishment, their reflections captured in FGDs lend a historical perspective to the qualitative findings. The narratives from women receiving SCBU care may be limited due to when they were collected, but they align with many of the issues related to coverage, acceptability, adoption, feasibility, and fidelity for maternal, neonatal, and infant care documented previously in this setting ( 23 , 46 , 76 , 78 ). Given that the original mixed methods design was intended to inform best SCBU practices for this setting, the qualitative findings have been kept as a valuable contribution to the continuous improvement process for SCBU care.…”

“…b Culturally adapted swaddling ( 22 ). c Facility-based vaccination program in place and provides infant immunizations, but poor follow up restricts coverage rates in the first year of life ( 23 , 24 ). d Risk factor-based screening for gestational diabetes mellitus with treatment over the antenatal period ( 25 ).…”

Impact of COVID-19 on essential service provision for reproductive, maternal, neonatal, and child health in the Southeast Asia region: a systematic review

“…While Thailand may have emerged as a country with minimal service disruption during the period assessed, recent evidence suggests that migrant populations may have experienced disruptions in vaccination services. 64 Such information on differential impacts across population subgroups and sexes has rarely been reported and requires further analysis to shed light on the equity dimensions of service disruption.…”