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Implementation of the vaccination program in Guinea-Bissau: Coverage and missed opportunities for BCG at birth
Clara Emilie Hartvig Rasmussen1, Julie Odgaard Vedel2, Andreas Møller Jensen2
1Bandim Health Project, Bissau, Guinea-Bissau.
Insights
Most infants in Guinea-Bissau miss the Bacillus Calmette-Guérin (BCG) vaccine at birth, despite its early benefits. Improving vaccination at first health contact could significantly increase timely BCG coverage.
Area of Science:
- Immunization and Public Health
- Vaccinology
- Pediatric Infectious Diseases
Background:
- The Bacillus Calmette-Guérin (BCG) vaccine is recommended at birth in Guinea-Bissau to confer early protection against infections.
- Delayed BCG vaccination is common, masking low initial coverage in routine 12-month estimates.
- Early BCG administration is crucial for maximizing non-specific protective effects, including reduced neonatal mortality.
Purpose of the Study:
- To assess the timeliness of BCG vaccination in Guinea-Bissau.
- To identify missed opportunities for early BCG administration.
- To investigate factors associated with delayed BCG vaccination.
Main Methods:
- Utilized data from a health and demographic surveillance system in Guinea-Bissau (2013-2019).
- Assessed BCG coverage at birth (within 3 days), 1 month, and 12 months.
- Employed binomial regression to analyze factors linked to missed vaccination opportunities.
Main Results:
- Only 19% of infants received BCG at birth; coverage at 12 months reached 93%.
- Timeliness improved, with birth coverage rising from 16% to 25% and 1-month coverage from 63% to 75% (2013-2019).
- Utilizing all opportunities could have doubled birth coverage to 45%, but only 40% were used; region of residence was a significant factor.
Conclusions:
- 12-month coverage masks significant delays in early BCG administration.
- Early vaccination coverage can be substantially improved by capitalizing on initial health system contacts.
- Ensuring vaccination at the first health contact is key to maximizing BCG's benefits.
Background:
The Bacillus Calmette-Guérin (BCG) vaccine is recommended at birth in Guinea-Bissau but often given with delay. Delays are not evident in routine coverage estimates since coverage is measured by 12 months of age. Studies show that BCG protects against other infections than tuberculosis and lowers neonatal mortality. Hence, the timing of BCG is important since the children should benefit from these non-specific effects as early as possible.
Methods:
Using data from a nationally representative health and demographic surveillance system in Guinea-Bissau, we assessed BCG coverage at birth (within the first 3 days of life), 1 month, and 12 months for children born in 2013-19. We measured the proportion of children who had a documented health system contact within the first 3 days of life, thus an opportunity for BCG at birth, and whether the opportunities were utilized. In binomial regression models, we investigated factors associated with missed opportunities for vaccination.
Results:
Among the 22,178 children only 19 % were vaccinated at birth. By 1 month and 12 months, BCG coverages were 64 % and 93 %. The timeliness of BCG improved over time, with coverage at birth increasing from 16 % in 2013 to 25 % in 2019 and 1-month coverage from 63 % in 2013 to 75 % in 2019. If all vaccination opportunities had been utilized, the BCG coverage at birth could have reached 45 % (in the 1-month cohort) instead of the actual coverage of 19 %, as only 40 % of the vaccination opportunities were utilized. Region of residence was associated with having a missed opportunity for vaccination.
Conclusion:
The high coverage estimates at 12 months falsely imply that the vaccine is being administered according to the recommended schedule. Our findings suggest that early coverage could be markedly improved by ensuring that children are vaccinated at their first contact with the health system.
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