An Insight into the Immunization Coverage for Combined Vaccines in Albania

We aim to Provide facts about the vaccination coverage for combined vaccines such as MMR (Measles, Mumps and Rubella) and DTP (Diphtheria, Tetanus, Pertussis) containing vaccines in use in Albania during the last 10 years, in order to confirm the stability of immunization program. One of the reasons for coverage improvement is the use of one or two-dose vials for the administration of MMR vaccine, enabling the vaccination of children at any time, without the need of gathering them on certain days when the multi-dose vaccine vials are opened. In the last three years, according to WHO recommendations, it was noted that vaccination coverage with three doses containing DTP is at sustainable levels, always above 95%, but for our country this value goes sometimes above 98%. As for the use of pentavalent vaccine, from 2008, DTP-HepB-Hib, also the coverage of Hepatitis b vaccine is always at upper levels due to its use on 5 in 1 combination. The application of this vaccine was associated with the use of one dose vial administration, therefore one vaccine to a child. Immunization coverage for vaccines with measles component remains at very high levels for both doses of vaccine, more then 95%. Immunization coverage for vaccines with DTP component exceeds 95% rate at country level, for each district it exceeds 95% and it reaches the value of 98.5% for the last two years. During the last years the vaccine coverage is increased significantly as a result of using combined vaccine of DTP-HepB -Hib. The use of one dose vials has played an important role on sustaininig and increasing vaccination coverage

Factors associated with adverse events following immunization in Albanian children: An analysis of the national database of adverse events after immunization

Background: Adverse events following immunization are a major concern which is influencing vaccination coverage all over the world. It is therefore important to evaluate the reporting of this events and factors associated with their occurrence in order to prevent them. Methods: The national database of adverse events following immunization in Albanian children was de-identified and transferred to the IBM® SPSS version 21. (SPSS Inc, USA). Every medical information was re-entered using the Medical Dictionary for Regulatory Activities (MedDRA) terms. The dose-based reporting rates are calculated always taking in consideration the number of administered vaccines instead of the number of distributed ones, which is an advantage of the Albanian reporting system Results: During a thirteen year period (2003-2015) there have been 307 AEFI cases reported for a total of 7,713,325 doses of vaccines administered. That regarded 106 females and 134 males. Most of the events have been reported during 2004. Most of thecases were non-serious (78,8%). Most of the cases were treated at ambulatory setting (72.55), followed by hospital treatment (24.3%) and no treatment (2.6%). Most of the cases were recorded in infants aged < 4 months. Conclusion: During the 13 year period, there were no severe events. The completeness and accuracy of information in the Albanian vaccine safety surveillance system still need to improve.&nbsp

Adverse Events Following Administration of DTwP Containing Vaccines in Albanian Children from 2003 to 2015

The Albanian vaccination program started in 1960. DTwP vaccine was introduced to the immunization schedule since the beginning and was produced in the country until the establishment of EPI (Expanded Program on Immunization – EPI) in 1993, at the Department of Epidemiology of the Institute of Public Health (IPH). From that time the vaccines were procured by UNICEF. Until 2003, the reporting of adverse events after vaccination was not made through a standard reporting form. The adverse events reporting system was implemented in 2003 through the introduction of individual reporting forms to the primary health care centers. Although the surveillance system was a passive one, the collection of data by IPH was made on monthly base and when a signal was detected further investigations were undertaken. The pertussis component of Diphtheria, Tetanus, Pertussis (DTwP) vaccine is the whole inactivated cell of Bordetella Pertussis. The aim of this study is to analyze the rate of adverse events following DTwP administration in Albanian children from 2003 to 2015

Trends in prevalence of hepatitis B virus infection among Albanian blood donors, 1999-2009

<p>Abstract</p> <p>Background</p> <p>Hepatitis B virus (HBV) was among the first virus known to be transmitted by blood and blood productions. The objective of this study is to determine the trend of hepatitis B virus in blood donors.</p> <p>Materials and methods</p> <p>In this study 79274 blood donors were retrospectively evaluated for HBsAg. The donors were selected using personal questionnaire, physical examination and testing blood before donation. Blood banks records are used as source of information. The blood donors samples were analyzed for the presence of hepatitis B surface antigen (HBsAg) by commercial available kits ELISA method, third generation (from Abbott laboratory, Germany). A sample was considered as HBsAg positive when found twice repeatedly reactive. Reactive samples were not confirmed with addition tests.</p> <p>Results</p> <p>In the evaluation data, we found out that from 79274 of the total healthy blood donors, 15983 were voluntary donors, 52876 were family replacement donors and 10424 commercial blood donors. The prevalence of HBsAg in blood donors was 7.9%. It was increased steadily from 5.9% in 1999 to 9.1% in 2006 and decreased in 7.9% in 2009. According to blood donors status the HBsAg prevalence was 10.5% in commercial blood donors, 8.1% in voluntary donors and 8.6% in family replacement donors. The prevalence of anti-HBc in blood donors was 59.1%.</p> <p>Conclusion</p> <p>The prevalence of HBsAg was lower in voluntary non remunerate blood donors than commercial donors and family replacement blood donors. In FDs the prevalence was higher than VDs but lower than CDs. So, it is important to encourage the voluntary blood donors to become regularly blood donors.</p

Knowledge, practice and approaches of health professionals to adverse events following immunization and their reporting in Albania

In Albania, the reporting of an adverse events following immunization (AEFI) is done not only by immunization providers but also from clinicians providing clinical treatment of AEFI in health posts, health centers and private or public hospitals. The AEFI reporting system in Albania has started in 2001 with the establishment of National Regulatory Authority of Vaccines in the Institute of Public Health. The most important problems of passive surveillance systems include underreporting, deficiency and inaccuracy of information. A structured questionnaire containing 68 questions constructed from immunization experts constituted the study tool. The questionnaire addressed health professionals working at child consultant’s facilities and primary health centers in the district of Tirana. There were a total of 102 health professional interviewed. The majority of the respondents working at health centers in the district of Tirana in general, had poor knowledge levels on AEFI surveillance. The lowest score were received in knowledge about the role of different stakeholders involved in AEFI surveillance. The number of years practicing the profession did not influence in the total score of “practice and attitude toward reporting and managing an AEFI”. Although the majority of health care professionals have encountered an AEFI during their practice (72/102, 70,5%), only half of them have never reported an AEFI (37/102, 36,2%). Barriers to reporting included lack of interest, unclear definition of AEFI and lack of awareness of what to report. Nevertheless, the main reason for not reporting was because a respondent thought he or she had not observed an AEFI in the last years (44,1%). Majority of the respondents did not have any training about AEFI (68,6%, 70/102). From this study it is concluded that it is necessary to develop training and educational programs in order to increase awareness of all health professionals involved in child health toward reporting of adverse events following immunization. It is necessary to build feedback systems to give information on AEFI. This study shows the influence of knowledge, perceptions and practices of health care workers in the surveillance of adverse events following immunization. Thus, information generated from this study might be valuable for the public health regulators to generate new guidelines about AEFI surveillance and update existing information

Cost-effectiveness of rotavirus vaccination in Albania.

BACKGROUND: Rotavirus vaccines have been introduced in several European countries but can represent a considerable cost, particularly for countries that do not qualify for any external financial support. This study aimed to evaluate the cost-effectiveness of introducing rotavirus vaccination into Albania's national immunization program and to inform national decision-making by improving national capacity to conduct economic evaluations of new vaccines. METHODS: The TRIVAC model was used to assess vaccine impact and cost-effectiveness. The model estimated health and economic outcomes attributed to 10 successive vaccinated birth cohorts (2013-2022) from a government and societal perspective. Epidemiological and economic data used in the model were based on national cost studies, and surveillance data, as well as estimates from the scientific literature. Cost-effectiveness was estimated for both the monovalent (RV1) and pentavalent vaccines (RV5). A multivariate scenario analysis (SA) was performed to evaluate the uncertainty around the incremental cost-effectiveness ratios (ICERs). RESULTS: With 3% discounting of costs and health benefits over the period 2013-2022, rotavirus vaccination in Albania could avert 51,172 outpatient visits, 14,200 hospitalizations, 27 deaths, 950 disability-adjusted life-years (DALYs), and gain 801 life-years. When both vaccines were compared to no vaccination, the discounted cost per DALY averted was US$2008 for RV1 and US$ 5047 for RV5 from a government perspective. From the societal perspective the values were US$517 and US$ 3556, respectively. CONCLUSION: From both the perspectives, the introduction of rotavirus vaccine to the Albanian immunization schedule is either cost-effective or highly cost-effective for a range of plausible scenarios. In most scenarios, including the base-case scenario, the discounted cost per DALY averted was less than three times the gross domestic product (GDP) per capita. However, rotavirus vaccination was not cost-effective when rotavirus cases and deaths were based on plausible minimum estimates. Introduction of RV1 would yield similar benefits at lower cost