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. 2024 Feb 7;12(2):168.
doi: 10.3390/vaccines12020168.

Status of Routine Immunization Coverage in the World Health Organization African Region Three Years into the COVID-19 Pandemic

Franck Mboussou  1 , Sarah Kada  2 , Maria Carolina Danovaro-Holliday  3 , Bridget Farham  1 , Marta Gacic-Dobo  3 , Jessica C Shearer  4 , Ado Bwaka  1 , Adidja Amani  1 , Roland Ngom  1 , Yolande Vuo-Masembe  1 , Charles Shey Wiysonge  1 , Benido Impouma  1
Affiliations

Status of Routine Immunization Coverage in the World Health Organization African Region Three Years into the COVID-19 Pandemic

Franck Mboussou et al. Vaccines (Basel). .

Abstract

Data from the WHO and UNICEF Estimates of National Immunization Coverage (WUENIC) 2022 revision were analyzed to assess the status of routine immunization in the WHO African Region disrupted by the COVID-19 pandemic. In 2022, coverage for the first and third doses of the diphtheria-tetanus-pertussis-containing vaccine (DTP1 and DTP3, respectively) and the first dose of the measles-containing vaccine (MCV1) in the region was estimated at 80%, 72% and 69%, respectively (all below the 2019 level). Only 13 of the 47 countries (28%) achieved the global target coverage of 90% or above with DTP3 in 2022. From 2019 to 2022, 28.7 million zero-dose children were recorded (19.0% of the target population). Ten countries in the region accounted for 80.3% of all zero-dose children, including the four most populated countries. Reported administrative coverage greater than WUENIC-reported coverage was found in 19 countries, highlighting routine immunization data quality issues. The WHO African Region has not yet recovered from COVID-19 disruptions to routine immunization. It is critical for governments to ensure that processes are in place to prioritize investments for restoring immunization services, catching up on the vaccination of zero-dose and under-vaccinated children and improving data quality.

Keywords: African Region; COVID-19; WUENIC; catch-up; routine immunization; vaccination coverage; zero-dose.

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Conflict of interest statement

Author Sarah Kada was employed by the company JSI. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Coverage of the BCG, DTP1, DTP3, HEPB3, HEPBB, HIB3, IPV1, POL3, MCV1, MCV2, PCV3, RCV1, ROTAC and YFV over time in the African Region. The horizontal dashed lines highlight the coverage of each antigen or combination of antigens in 2019 to allow for a comparison with 2022 coverage. Abbreviations: BCG: Bacille Calmette–Guérin vaccine; DTP1: first dose of diphtheria–tetanus–pertussis-containing vaccine; DTP3: third dose of diphtheria–tetanus–pertussis-containing vaccine; HEPBB: hepatitis B vaccine, birth dose; HEPB3: third dose of hepatitis B vaccine; HIB3: third dose of Haemophilus influenzae type b vaccine; POL3: third dose of oral poliovirus vaccine; IPV1: first dose of inactivated-poliovirus-containing vaccine; MCV1: first dose of measles-containing vaccine; MCV2: second dose of measles-containing vaccine; PCV3: third dose of pneumococcal conjugate vaccine; RCV1: first dose of rubella-containing vaccine; ROTAC: final dose of rotavirus vaccine; YFV: yellow fever vaccine.
Figure 2
Figure 2
DTP1, DTP3 and MCV1 coverage by country in 2022 in the WHO African Region. The horizontal dashed lines represent the target coverage of 90%. Abbreviations: DTP1: first dose of diphtheria–tetanus–pertussis-containing vaccine; DTP3: third dose of diphtheria–tetanus–pertussis-containing vaccine; MCV1: first dose of measles-containing vaccine; CAR: Central African Republic; DRC: Democratic Republic of Congo; Eq. Guinea: Equatorial Guinea; STP: Sao Tome and Principe.
Figure 3
Figure 3
Percent change in immunization compared to 2019 in the 47 countries of the WHO African Region. Abbreviations: CAR: Central African Republic; DRC: Democratic Republic of Congo; Eq. Guinea: Equatorial Guinea; STP: Sao Tome and Principe; NA: data not available. BCG: Bacille Calmette–Guérin vaccine; DTP1: first dose of diphtheria–tetanus–pertussis-containing vaccine; DTP3: third dose of diphtheria–tetanus–pertussis-containing vaccine; HEPBB: hepatitis B vaccine birth dose; HEPB3: third dose of hepatitis B vaccine; HIB3: third dose of Haemophilus influenzae type b vaccine; POL3: third dose of oral poliovirus vaccine; IPV1: first dose of inactivated-poliovirus-containing vaccine; MCV1: first dose of measles-containing vaccine; MCV2: second dose of measles-containing vaccine; PCV3: third dose of pneumococcal conjugate vaccine; RCV1: first dose of rubella-containing vaccine; ROTAC: final dose of rotavirus vaccine; YFV: yellow fever vaccine.
Figure 4
Figure 4
Geographical distribution of the (A) cumulative number of zero-dose children and (B) the cumulative number of zero-dose children per 1000 inhabitants in the WHO African Region during the pandemic period. The 2022 United Nations population estimates were used as the denominator [15].
Figure 5
Figure 5
Cumulative number of unvaccinated children from 2019 to 2022 for the diphtheria–tetanus–pertussis (DTP)-containing vaccine and measles-containing vaccine (MCV) in the 10 countries of the WHO African Region with the highest burden of unvaccinated children.
Figure 6
Figure 6
(A) The percentage of zero-dose children (i.e., children not immunized with the first dose of the diphtheria–tetanus–pertussis-containing vaccine (DTP1) in 2019 and 2022 and (B) the percentage of children not immunized with the first dose of the measles-containing vaccine (MCV1) in 2019 and 2022 by country in the WHO African Region. Abbreviations: CAR: Central African Republic; DRC: Democratic Republic of Congo; Eq. Guinea: Equatorial Guinea; STP: Sao Tome and Principe.
Figure 7
Figure 7
Percentage of change in the third dose of the diphtheria–tetanus–pertussis-containing vaccine (DTP3) coverage between the WUENIC and administrative reports in 2022 in 47 countries in the WHO African Region. Abbreviations: CAR: Central African Republic; DRC: Democratic Republic of Congo; STP: Sao Tome and Principe; Eq. Guinea: Equatorial Guinea; MZ: Mozambique.
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