BACKGROUND: Integrating Routine Immunization (RI) into COVID-19 vaccination implies that COVID-19 vaccination is the primary focus, with RI services added to the effort. During COVID-19 vaccination campaigns in Nigeria, healthcare workers also provided routine vaccines such as measles and polio to individuals who came for their COVID-19 shots. This paper aims to demonstrate that integrating RI into COVID-19 vaccination increases overall vaccine coverage but may introduce equity issues. METHODOLOGY: The data used in this study consist of COVID-19 immunization records (first, second, and booster doses) from 23 local government areas (LGAs) in Niger State, Nigeria. The project aimed to vaccinate the remaining 30% of the population who had not received any COVID-19 vaccine doses. Two LGAs were excluded due to security concerns. Routine immunizations (RIs) provided alongside COVID-19 vaccinations included the inactivated polio vaccine (IPV), oral polio vaccine (OPV), pentavalent polio vaccine (PENTA), and other vaccines based on specific needs, primarily targeting zero-dose children. The primary outcome was vaccine coverage, measured as the percentage of targeted individuals who received at least one dose of the COVID-19 vaccine. Secondary outcomes included the uptake of routine immunization during COVID-19 vaccination campaigns and a gender equity analysis to assess disparities in vaccination rates between males and females. RESULTS: A total of 436,598 individuals were vaccinated, with a daily average of 3,898. Among those vaccinated, 49.78% were male, while 50.22% were female, achieving a percentage coverage of 101%. Of the vaccinated individuals, 76% received a single dose, 5.1% received a second dose, and 18.3% received a booster dose. Among those who received a single dose, 49.9% were male and 50.1% were female. Among those who received the second dose, 47.4% were male and 52.6% were female. Among those who received the booster dose, 49.8% were male and 50.2% were female. No significant mean differences were found between males and females for those who received the first and booster doses. Similarly, there were no significant mean differences between the targeted and achieved vaccinations, despite variations in coverage across the 23 LGAs. Additionally, 60,373 routine immunizations were administered alongside COVID-19 vaccinations. A breakdown of the RI distribution showed that 17.6% of recipients received PENTA, 18.3% received OPV, 17.6% received IPV, and 46.5% received other vaccines. A significant mean difference was observed between males and females when RI was integrated into COVID-19 vaccinations, suggesting a gender disparity. CONCLUSION: Although integrating RI into COVID-19 vaccination efforts increased overall immunization coverage, the data suggest potential inequities, as a higher proportion of RI doses were administered to females. This finding highlights differences in vaccine access between males and females. Further research is needed to understand the impact of gender differences in RI integration and to promote equitable vaccination access for all.

BACKGROUND: Hepatitis B virus (HBV) and neonatal tetanus infections remain endemic in Nigeria despite the availability of safe, effective vaccines. We aimed to determine health facilities' capacity for hepatitis B vaccine birth dose (HepB-BD) and maternal tetanus-diphtheria (Td) vaccination and to assess knowledge, attitudes, and practices of HepB-BD and maternal Td vaccine administration among health facility staff in Nigeria. MATERIALS AND METHODS: This was a cross-sectional study assessing public primary and secondary health facilities in Adamawa and Enugu States. A multistage sampling approach was used to select 40 facilities and 79 health-care workers (HCWs) from each state. A structured facility assessment tool and standardized questionnaire evaluated facility characteristics and HCW knowledge, attitudes, and practices related to HepB-BD and maternal Td vaccination. Frequencies and proportions were reported as descriptive statistics. RESULTS: The survey of 80 facilities revealed that 73.8% implemented HepB-BD and maternal Td vaccination policies. HepB-BD was administered within 24 h of birth at 61.3% of facilities and at all times at 57.5%. However, administration seldom occurred in labor and delivery (35%) or maternity wards (16.3%). Nearly half of the facilities (46.3%) had HCWs believing there were contraindications to HepB-BD vaccination. Among 158 HCWs, 26.5% believed tetanus could be transmitted through unprotected sex, prevented by vaccination at birth (46.1%), or by avoiding sharing food and utensils. 65% of HCWs knew HBV infection had the worst outcome for newborns. CONCLUSIONS: The limited implementation of national policies on HepB-BD and maternal Td vaccination, coupled with knowledge gaps among HCWs, pose significant challenges to timely vaccination, necessitating interventions to address these gaps.

BACKGROUND: In 2022, the U.S. Centers for Disease Control and Prevention collaborated with implementing partners, African Field Epidemiology Network and Sydani Group, to support COVID-19 vaccination efforts in Nigeria. To characterize the costs of COVID-19 vaccination, this study evaluated financial costs per dose for activities implemented to support the intensification campaign for COVID-19 vaccination. METHODS: This retrospective evaluation collected secondary data from existing expenditure and programmatic records on resource utilization to roll out COVID-19 vaccination during 2022. The study included incremental financial costs of the activities implemented to support an intensification campaign for COVID-19 vaccination across nine states and six administrative levels in Nigeria from the perspective of the external donor (U.S. Government). Costs for vaccines and injection supplies, transport of vaccines, and any economic costs, including government in-kind contributions, were not included. All costs were converted from Nigerian Naira to 2022 U.S. Dollars (US$). RESULTS: The estimated financial delivery cost of the COVID-19 vaccination intensification campaign was US$0.84 per dose (total expenditure of US$6.29 million to administer 7,461,971 doses). Most of the financial resources were used for fieldwork activities (86%), followed by monitoring and supervision activities (8%), coordination activities (5%), and training-related activities (1%). Labor (58%) and travel (37%) were the resource inputs that accounted for the majority of the cost, while shares of other resource inputs were marginal (1% for each). Most labor costs (79%) were spent on payments for mass vaccination campaign teams, including pay-for-performance incentives. By administrative level, the largest share of costs (46%) was for pay-for-performance incentives at the community, health facility, or campus levels combined, followed by local government area level (24%), community level only (15%), state level (9%), national level (3%), campus level only (1%), and health facility level only (< 1%). CONCLUSIONS: Findings from the evaluation can help to inform resources needed for vaccination activities to respond to future outbreaks and pandemics in resource-limited settings, particularly to reach new target populations not regularly included in routine childhood immunization delivery.

BACKGROUND: Nigeria has the largest number of children infected with hepatitis B virus (HBV) globally and has not yet achieved maternal and neonatal tetanus elimination. In Nigeria, maternal tetanus diphtheria (Td) vaccination is part of antenatal care and hepatitis B birth dose (HepB-BD) vaccination for newborns has been offered since 2004. We implemented interventions targeting healthcare workers (HCWs), community volunteers, and pregnant women attending antenatal care with the goal of improving timely (within 24 hours) HepB-BD vaccination among newborns and Td vaccination coverage among pregnant women. METHODS: We selected 80 public health facilities in Adamawa and Enugu states, with half intervention facilities and half control. Interventions included HCW and community volunteer trainings, engagement of pregnant women, and supportive supervision at facilities. Timely HepB-BD coverage and at least two doses of Td (Td2+) coverage were assessed at baseline before project implementation (January-June 2021) and at endline, one year after implementation (January-June 2022). We held focus group discussions at intervention facilities to discuss intervention strengths, challenges, and improvement opportunities. RESULTS: Compared to baseline, endline median vaccination coverage increased for timely HepB-BD from 2.6% to 61.8% and for Td2+ from 20.4% to 26.9% in intervention facilities (p < 0.05). In comparison, at endline in control facilities median vaccination coverage for timely HepB-BD was 7.9% (p < 0.0001) and Td2+ coverage was 22.2% (p = 0.14). Focus group discussions revealed that HCWs felt empowered to administer vaccination due to increased knowledge on hepatitis B and tetanus, pregnant women had increased knowledge that led to improved health seeking behaviors including Td vaccination, and transportation support was needed to reach those in far communities. CONCLUSION: Targeted interventions significantly increased timely HepB-BD and Td vaccination rates in intervention facilities. Continued support of these successful interventions could help Nigeria reach hepatitis B and maternal and neonatal tetanus elimination goals.

After the 2015 documentation of global eradication of wild poliovirus type 2,* Sabin type 2 oral poliovirus vaccine (OPV) was withdrawn from routine immunization (RI) in all OPV-using countries in 2016, in a global synchronized switch from trivalent OPV (containing vaccine virus serotypes 1, 2, and 3) to bivalent OPV (containing serotypes 1 and 3), to reduce the rare risks for type 2 vaccine-associated paralytic poliomyelitis. Concurrently, the Global Polio Eradication Initiative (GPEI) recommended that all OPV-using countries introduce ≥1 dose of inactivated poliovirus vaccine (IPV) into RI programs; IPV protects against paralysis caused by all three serotypes but cannot be transmitted from person to person or cause paralysis. Use of OPV, especially in areas with low vaccination coverage, is associated with low risk of emergence of vaccine-derived polioviruses (VDPVs). As susceptible persons in new birth cohorts accumulated after withdrawal of OPV type 2, population immunity against infection with serotype 2 declined (1), facilitating the emergence of circulating VDPV type 2 (cVDPV2). During the previous 7 years, cVDPV2 outbreaks required response supplementary immunization activities (SIAs) with monovalent type 2 OPV (mOPV2); however, if SIAs were not of sufficiently high quality and did not achieve high enough coverage, new emergences of cVDPV2 occurred.

Nigeria is estimated to have the largest number of children worldwide, living with chronic hepatitis B virus (HBV) infection, the leading cause of liver cancer. Up to 90% of children infected at birth develop chronic HBV infection. A birth dose of the hepatitis B vaccine (HepB-BD) followed by at least two additional vaccine doses is recommended for prevention. This study assessed barriers and facilitators of HepB-BD administration and uptake, using structured interviews with healthcare providers and pregnant women in Adamawa and Enugu States, Nigeria. The Consolidated Framework for Implementation Sciences Research (CFIR) guided data collection and analysis. We interviewed 87 key informants (40 healthcare providers and 47 pregnant women) and created a codebook for data analysis. Codes were developed by reviewing the literature and reading a subsample of queries line-by-line. The overarching themes identified as barriers among healthcare providers were: the lack of hepatitis B knowledge, limited availability of HepB-BD to vaccination days only, misconceptions about HepB-BD vaccination, challenges in health facility staffing capacity, costs associated with vaccine transportation, and concerns related to vaccine wastage. Facilitators of timely HepB-BD vaccination included: vaccine availability, storage, and hospital births occurring during immunization days. Overarching themes identified as barriers among pregnant women were lack of hepatitis B knowledge, limited understanding of HepB-BD importance, and limited access to vaccines for births occurring outside of a health facility. Facilitators were high vaccine acceptance and willingness for their infants to receive HepB-BD if recommended by providers. Findings indicate the need for enhanced HepB-BD vaccination training for HCWs, educating pregnant women on HBV and the importance of timely HepB-BD, updating policies to enable HepB-BD administration within 24 hours of birth, expanding HepB-BD availability in public and private hospital maternity wards for all facility births, and outreach activities to reach home births.

Nigeria began administering COVID-19 vaccines on 5 March 2021 and is working towards the WHO's African regional goal to fully vaccinate 70% of their eligible population by December 2022. Nigeria's COVID-19 vaccination information system includes a surveillance system for COVID-19 adverse events following immunisation (AEFI), but as of April 2021, AEFI data were being collected and managed by multiple groups and lacked routine analysis and use for action. To fill this gap in COVID-19 vaccine safety monitoring, between April 2021 and June 2022, the US Centers for Disease Control and Prevention, in collaboration with other implementing partners led by the Institute of Human Virology Nigeria, supported the Government of Nigeria to triangulate existing COVID-19 AEFI data. This paper describes the process of implementing published draft guidelines for data triangulation for COVID-19 AEFI data in Nigeria. Here, we focus on the process of implementing data triangulation rather than analysing the results and impacts of triangulation. Work began by mapping the flow of COVID-19 AEFI data, engaging stakeholders and building a data management system to intake and store all shared data. These datasets were used to create an online dashboard with key indicators selected based on existing WHO guidelines and national guidance. The dashboard went through an iterative review before dissemination to stakeholders. This case study highlights a successful example of implementing data triangulation for rapid use of AEFI data for decision-making and emphasises the importance of stakeholder engagement and strong data governance structures to make data triangulation successful.