Lower Coverage Rates of Full Rotavirus Vaccine Series in Libyan Children: A Prospective Cross-Sectional Study, 2016
Background: There are little data on the current condition of national immunization programme (NIP) in Libya. In 2013, pentavalent rotavirus vaccines were added to the NIP. Incomplete rotavirus vaccine series may result in lower vaccine effectiveness. The study aimed to assess timeliness and coverage rates of routine NIP vaccinations including the newly introduced rotavirus vaccine in Libya.
Methods: A prospective cross-sectional study of children aged 0 to 18 months was carried out in vaccination centers of two north-western cities. Data were collected during Nov-Dec 2016 from vaccination cards of children. Child age and doses received in previous visits were documented.
Results: Overall, we included 1023 children assessed in 29 visits at six vaccination centers. In children aged 18 months, coverage rates for all doses of BCG, OPV, HepB, pneumococcal, Meningococcal and MMR vaccines exceeded 95%. Coverage rates for second and third doses of rotavirus vaccines were 89% and 68%, respectively. Most (75%) children who missed the third dose of rotavirus vaccine were aged >8 months when at the time of appointment for the third dose.
Conclusion: Overall, the coverage rate for routine vaccination in children assessed at immunization centers in northwest Libya was high. Lower coverage of full pentavalent rotavirus vaccine series may have been the result of exceeding the age restriction. Measures to improve timeliness of vaccination appointments should be assessed. Lifting the age restriction on rotavirus vaccines should be considered for at-risk population.
2. PATH (2014). 10 reasons vaccines are the best protector of human life. global health organization, the US. Available from: https://www.path.org/articles/10-reasons-vaccines-are-the-best-protector-of-human-life/
3. Murray CJ, Shengelia B, Gupta N et al (2003). Validity of reported vaccination coverage in 45 countries. Lancet, 362:1022-1027.
4. Cortese MM, Parashar UD, Centers for Disease C, Prevention (2009). Prevention of rotavirus gastroenteritis among infants and children: recommendations of the Advisory Committee on Immunization Practices (ACIP). ed. Dept. of Health & Human Services, Centers for Disease Control and Prevention.
5. Ruiz-Palacios GM, Perez-Schael I, Velazquez FR et al (2006). Safety and efficacy of an attenuated vaccine against severe rotavirus gastroenteritis. N Engl J Med, 354:11-22.
6. Vesikari T, Matson DO, Dennehy P et al (2006). Safety and efficacy of a pentavalent human-bovine (WC3) reassortant rotavirus vaccine. New England Journal of Medicine, 354:23-33.
7. WHO (2008). Generic protocol for monitoring impact of rotavirus vaccination on gastroenteritis disease burden and viral strains. Department of Immunization, Vaccines and Biologicals.
8. WHO (2009). Rotavirus vaccines. Weekly epidemiological record, 51-52:533–540.
9. Patel MM, Steele D, Gentsch JR et al (2011). Real-world impact of rotavirus vaccination. Pediatr Infect Dis J, 30:S1-5.
10. Jiang V, Jiang B, Tate J, Parashar UD, Patel MM (2010). Performance of rotavirus vaccines in developed and developing countries. Hum Vaccin, 6:532-542.
11. Burnett E, Jonesteller CL, Tate JE, Yen C, Parashar UD (2017). Global impact of rotavirus vaccination on childhood hospitalizations and mortality from diarrhea. J Infect Dis, 215:1666-1672.
12. Jonesteller CL, Burnett E, Yen C et al (2017). Effectiveness of Rotavirus Vaccination: A systematic review of the first decade of global post-licensure data, 2006-2016 Effectiveness of Rotavirus Vaccination. Clin Infect Dis, 65(5):840-850.
13. Leshem E, Givon-Lavi N, Tate JE et al (2016). Real-World Effectiveness of Pentavalent Rotavirus Vaccine Among Bedouin and Jewish Children in Southern Israel. Clin Infect Dis, 2:S155-60.
14. Leshem E, Tate JE, Steiner CA et al (2015). Acute gastroenteritis hospitalizations among US children following implementation of the rotavirus vaccine. JAMA, 313:2282-2284.
15. Madhi SA, Cunliffe NA, Steele D et al (2011). Effect of human rotavirus vaccine on severe diarrhea in African infants. N Engl J Med, 362:289-298.
16. Patel M, Pedreira C, De Oliveira LH et al (2009). Association between pentavalent rotavirus vaccine and severe rotavirus diarrhea among children in Nicaragua. JAMA, 301(21):2243-2251.
17. Parashar UD, Johnson H, Steele AD,Tate JE (2016). Health impact of rotavirus vaccination in developing countries: progress and way forward. Clin Infect Dis, 62:S91-S95.
18. Leshem E, Lopman B, Glass R et al (2014). Distribution of rotavirus strains and strain-specific effectiveness of the rotavirus vaccine after its introduction: a systematic review and meta-analysis. Lancet Infect Dis, 14:847-56.
19. National Network for Immunization Information (2010). Rotavirus. the Infectious Diseases Society of America, the US. http://www.immunizationinfo.org/vaccines/rotavirus/
20. Patel NC, Hertel PM, Estes MK, et al (2010). Vaccine-acquired rotavirus in infants with severe combined immunodeficiency. N Engl J Med, 362:314-319.
21. CDC (2010). Rotavirus vaccine. National Immunization Program, U.S. Department of health and human service, Atlanta.
22. Patel MM, Clark AD, Sanderson CF, Tate J, Parashar UD (2012). Removing the age restrictions for rotavirus vaccination: a benefit-risk modeling analysis. PLoS Med, 9:e1001330.
23. Mvula H, Heinsbroek E, Chihana M et al (2016). Predictors of Uptake and Timeliness of Newly Introduced Pneumococcal and Rotavirus Vaccines, and of Measles Vaccine in Rural Malawi: A Population Cohort Study. PLoS One, 11:e0154997.
24. NCDC (2009). Annual report for infectious disease in Libya. Surveillance department at NCDC.
25. WHO (2013) WHO vaccine-preventable diseases: monitoring system. 2013 global summary. WHO, the Switzerland. Available from: http://apps.who.int/immunization_monitoring/globalsummary/countries?countrycriteria[country]=LBY&commit=OK
26. MoH (2013). National immunization program guideline. Primary Health Care, Khoms. Libya
27. MoH (2016). Vaccination card. Vaccination department, NCDC. Libya.
28. WHO (2007). Health Systems Profile - Libya. Eastern Mediterranean Regional Health Systems Observatory WHO.
29. Alkoshi S, Leshem E, Parashar UD, Dahlui M (2015). Anticipating rotavirus vaccines--a pre-vaccine assessment of incidence and economic burden of rotavirus hospitalizations among children < 5 year of age in Libya, 2012-13. BMC Public Health, 15:26.
30. Panozzo CA, Becker-Dreps S, Pate V (2013). Patterns of rotavirus vaccine uptake and use in privately-insured US infants, 2006–2010. PLoS One, 8:e73825.
31. Givon-Lavi N, Ben-Shimol S, Cohen R, Greenberg D,Dagan R (2015). Rapid impact of rotavirus vaccine introduction to the National Immunization plan in southern Israel: comparison between 2 distinct populations. Vaccine, 33:1934-40.
32. CDC (2017). Rotavirus Vaccination. https://www.cdc.gov/rotavirus/surveillance.html
33. Flannery B, Samad S, de Moraes JC et al (2013). Uptake of oral rotavirus vaccine and timeliness of routine immunization in Brazil's National Immunization Program. Vaccine, 31:1523-1528.
34. Salamanca BV, Hagerup-Jenssen ME, Flem E (2016). Uptake and timeliness of rotavirus vaccination in Norway: The first year post-introduction. Vaccine, 34:4684-4689.
35. Suárez-Castaneda E, Pezzoli L, Elas M et al (2014). Routine childhood vaccination programme coverage, El Salvador, 2011—In search of timeliness. Vaccine, 32:437-444.
36. NCDC (2015). Coverage rate report. National immunization report.