Last data update: Jun 03, 2024. (Total: 46935 publications since 2009)
Records 1-14 (of 14 Records) |
Query Trace: Meyer SA [original query] |
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Challenges and opportunities during the COVID-19 vaccination efforts in long-term care
Stone ND , Parker Fiebelkorn A , Guo A , Mothershed E , Moccia L , Bell J , Yassanye D , Hall E , Duggar C , Srinivasan A , Meyer SA , Link-Gelles R . Vaccine 2024 From December 2020 through March 2023, the COVID-19 vaccination efforts in long-term care (LTC) settings, identified many gaps and opportunities to improve public health capacity to support vaccine distribution, education, and documentation of COVID-19 vaccines administered to LTC residents and staff. Partner engagement at the local, state, and federal levels helped establish pathways for dissemination of information, improve access and delivery of vaccines, and expand reporting of vaccine administration data to monitor the impact of COVID-19 vaccination in LTC settings. Sustaining the improvements to the vaccine infrastructure in LTC settings that were created or enhanced during the COVID-19 vaccination efforts is critical for the protection of residents and staff against COVID-19 and other vaccine preventable respiratory outbreaks in the future. |
Risk factors for serogroup B meningococcal disease among college students
Weil LM , Crowe SJ , Rubis AB , Soeters HM , Meyer SA , Hariri S , McNamara LA . Open Forum Infect Dis 2023 10 (12) ofad607 BACKGROUND: College students are at increased risk for invasive meningococcal disease, but which students are most at risk is unclear. METHODS: US meningococcal disease cases in persons aged 18-24 years during 2014-2017 were included. Patients were classified as undergraduate students or other persons. Incidence in different student and non-student populations was compared. RESULTS: During 2014-2017, 229 meningococcal disease cases were reported in persons aged 18-24 years; 120 were in undergraduate students. Serogroup B accounted for 74% of cases in students. Serogroup B disease incidence was 4-fold higher in undergraduate students, 11.8-fold higher among first-year undergraduate students, and 8.6-fold higher among residence hall residents versus non-undergraduates. During outbreaks, students affiliated with Greek life had a 9.8-fold higher risk of disease compared to other students. A significantly higher party school ranking was observed for schools with sporadic or outbreak cases when compared to schools with no cases. CONCLUSIONS: The findings of increased disease risk among first-year students and those living on campus or affiliated with Greek life can inform shared clinical decision-making for serogroup B vaccines to prevent this rare but serious disease. These data also can inform school serogroup B vaccination policies and outbreak response measures. |
A summary of the Advisory Committee for Immunization Practices (ACIP) use of a benefit-risk assessment framework during the first year of COVID-19 vaccine administration in the United States
Wallace M , Rosenblum HG , Moulia DL , Broder KR , Shimabukuro TT , Taylor CA , Havers FP , Meyer SA , Dooling K , Oliver SE , Hadler SC , Gargano JW . Vaccine 2023 41 (44) 6456-6467 To inform Advisory Committee for Immunization Practices (ACIP) COVID-19 vaccine policy decisions, we developed a benefit-risk assessment framework that directly compared the estimated benefits of COVID-19 vaccination to individuals (e.g., prevention of COVID-19-associated hospitalization) with risks associated with COVID-19 vaccines. This assessment framework originated following the identification of thrombosis with thrombocytopenia syndrome (TTS) after Janssen COVID-19 vaccination in April 2021. We adapted the benefit-risk assessment framework for use in subsequent policy decisions, including the adverse events of myocarditis and Guillain-Barre syndrome (GBS) following mRNA and Janssen COVID-19 vaccination respectively, expansion of COVID-19 vaccine approvals or authorizations to new age groups, and use of booster doses. Over the first year of COVID-19 vaccine administration in the United States (December 2020-December 2021), we used the benefit-risk assessment framework to inform seven different ACIP policy decisions. This framework allowed for rapid and direct comparison of the benefits and potential harms of vaccination, which may be helpful in informing other vaccine policy decisions. The assessments were a useful tool for decision-making but required reliable and granular data to stratify analyses and appropriately focus on populations most at risk for a specific adverse event. Additionally, careful decision-making was needed on parameters for data inputs. Sensitivity analyses were used where data were limited or uncertain; adjustments in the methodology were made over time to ensure the assessments remained relevant and applicable to the policy questions under consideration. |
Meningococcal carriage among a university student population - United States, 2015.
Breakwell L , Whaley M , Khan UI , Bandy U , Alexander-Scott N , Dupont L , Vanner C , Chang HY , Vuong JT , Martin S , MacNeil JR , Wang X , Meyer SA . Vaccine 2017 36 (1) 29-35 OBJECTIVES: Several outbreaks of serogroup B meningococcal disease have occurred among university students in recent years. In the setting of high coverage of the quadrivalent meningococcal conjugate vaccine and prior to widespread use of serogroup B meningococcal vaccines among adolescents, we conducted surveys to characterize the prevalence and molecular characteristics of meningococcal carriage among university students. METHODS: Two cross-sectional oropharyngeal carriage surveys were conducted among undergraduates at a Rhode Island university. Isolates were characterized using slide agglutination, real-time polymerase chain reaction (rt-PCR), and whole genome sequencing. Adjusted prevalence ratios and 95% confidence intervals were calculated using Poisson regression to determine risk factors for carriage. RESULTS: A total of 1837 oropharyngeal specimens were obtained from 1478 unique participants. Overall carriage prevalence was 12.7-14.6% during the two survey rounds, with 1.8-2.6% for capsular genotype B, 0.9-1.0% for capsular genotypes C, W, or Y, and 9.9-10.8% for nongroupable strains by rt-PCR. Meningococcal carriage was associated with being male, smoking, party or club attendance, recent antibiotic use (inverse correlation), and recent respiratory infections. CONCLUSIONS: In this university setting, the majority of meningococcal carriage was due to nongroupable strains, followed by serogroup B. Further evaluation is needed to understand the dynamics of serogroup B carriage and disease among university students. |
Tdap vaccination among healthcare personnel - 21 states, 2013
O'Halloran AC , Lu PJ , Meyer SA , Williams WW , Schumacher PK , Sussell AL , Birdsey JE , Boal WL , Sweeney MH , Luckhaupt SE , Black CL , Santibanez TA . Am J Prev Med 2017 54 (1) 119-123 INTRODUCTION: Outbreaks of pertussis can occur in healthcare settings. Vaccinating healthcare personnel may be helpful in protecting healthcare personnel from pertussis and potentially limiting spread to others in healthcare settings. METHODS: Data from 21 states using the 2013 Behavioral Risk Factor Surveillance System industry/occupation module were analyzed in 2016. Tetanus, diphtheria, and acellular pertussis (Tdap) vaccination status was self-reported by healthcare personnel along with their occupation, healthcare setting/industry, demographics, and access to care factors. To compare groups, t-tests were used. The median state response rate was 44.0%. RESULTS: Among all healthcare personnel, 47.2% were vaccinated for Tdap. Physicians had higher Tdap coverage (66.8%) compared with all other healthcare personnel except nurse practitioners and registered nurses (59.5%), whose coverage did not statistically differ from that of physicians. Tdap vaccination coverage was higher among workers in hospitals (53.3%) than in long-term care facilities (33.3%) and other clinical settings, such as dentist, chiropractor, and optometrist offices (39.3%). Healthcare personnel who were younger, who had higher education, higher annual household income, a personal healthcare provider, and health insurance had higher Tdap vaccination coverage compared with reference groups. Tdap vaccination coverage among healthcare personnel in 21 states ranged from 30.6% in Mississippi to 65.9% in Washington. CONCLUSIONS: Improvement in Tdap vaccination among healthcare personnel is needed to potentially reduce opportunities for spread of pertussis in healthcare settings. On-site workplace vaccination, offering vaccines free of charge, and promoting vaccination may increase vaccination among healthcare personnel. |
National, regional, state, and selected local area vaccination coverage among adolescents aged 13-17 years - United States, 2016
Walker TY , Elam-Evans LD , Singleton JA , Yankey D , Markowitz LE , Fredua B , Williams CL , Meyer SA , Stokley S . MMWR Morb Mortal Wkly Rep 2017 66 (33) 874-882 The Advisory Committee on Immunization Practices (ACIP) recommends that adolescents routinely receive tetanus, diphtheria, and acellular pertussis vaccine (Tdap), meningococcal conjugate vaccine (MenACWY), and human papillomavirus (HPV) vaccine (1) at age 11-12 years. ACIP also recommends catch-up vaccination with hepatitis B vaccine, measles, mumps, and rubella (MMR) vaccine, and varicella vaccine for adolescents who are not up to date with childhood vaccinations. ACIP recommends a booster dose of MenACWY at age 16 years (1). In December 2016, ACIP updated HPV vaccine recommendations to include a 2-dose schedule for immunocompetent adolescents initiating the vaccination series before their 15th birthday (2). To estimate adolescent vaccination coverage in the United States, CDC analyzed data from the 2016 National Immunization Survey-Teen (NIS-Teen) for 20,475 adolescents aged 13-17 years. During 2015-2016, coverage increased for ≥1 dose of Tdap (from 86.4% to 88.0%) and for each HPV vaccine dose (from 56.1% to 60.4% for ≥1 dose). Among adolescents aged 17 years, coverage with ≥2 doses of MenACWY increased from 33.3% to 39.1%. In 2016, 43.4% of adolescents (49.5% of females; 37.5% of males) were up to date with the HPV vaccination series, applying the updated HPV vaccine recommendations retrospectively.dagger Coverage with ≥1 HPV vaccine dose varied by metropolitan statistical area (MSA) status and was lowest (50.4%) among adolescents living in non-MSA areas and highest (65.9%) among those living in MSA central cities. section sign Adolescent vaccination coverage continues to improve overall; however, substantial opportunities exist to further increase HPV-associated cancer prevention. |
Effect of a vaccine to prevent serogroup A N meningitidis epidemics in Africa
Meyer SA , Novak RT . Lancet Infect Dis 2017 17 (8) 789-790 Before the introduction of a meningococcal serogroup A conjugate vaccine (MenAfriVac), which began in December, 2010, countries in the so-called meningitis belt of sub-Saharan Africa experienced annual outbreaks and periodic large-scale epidemics of serogroup A Neisseria meningitidis.1 The devastating effects of these epidemics were seen not only on an individual level, with death or disabling sequelae occurring in 20–35% of cases,2 but also on the societal level. During the 2007 N meningitidis A epidemic in Burkina Faso, for instance, households spent a third of their gross annual income per meningitis case and the public health system spent 2% of the national health budget responding to the epidemic.3,4 Thus, the success of MenAfriVac hinges not only on prevention of individual N meningitidis A cases, but epidemics as well. | In the years since MenAfriVac introduction, remarkable short-term success of this vaccine in the prevention of N meningitidis A carriage and disease has consistently been shown, with surveillance data showing few N meningitidis A cases in vaccinated areas.5–8 However, the medium-term and long-term regional effects of the vaccine have not been previously described. In The Lancet Infectious Diseases, Caroline Trotter and colleagues9 show a 99% reduction in N meningitidis A incidence and a 57% reduction in overall incidence of suspected meningitis in vaccinated areas of nine countries in the meningitis belt. Additionally, district-level risk of reaching epidemic criteria (>ten cases of suspected meningitis per 100 000 population per week) decreased by 59%. This analysis shows that the first phase of vaccine introduction, consisting of mass campaigns of 1–29-year-olds with a single dose of MenAfriVac, was effective in the near-elimination of N meningitidis A disease in vaccinated areas for up to 5 years post-vaccine introduction. With the first countries now initiating the second phase of vaccine introduction, with catch-up campaigns of subsequent birth cohorts and introduction of the vaccine into the Expanded Programme on Immunization, efforts to ensure high routine vaccination coverage and continued assessments of the effect of this vaccination strategy will be crucial to ensure that these gains are maintained. |
Impact of provider recommendation on Tdap vaccination of adolescents aged 13-17 years
Lu PJ , Yankey D , Jeyarajah J , O'Halloran A , Meyer SA , Elam-Evans LD , Reagan-Steiner S . Am J Prev Med 2017 53 (3) 373-384 INTRODUCTION: Tetanus, diphtheria, and acellular pertussis (Tdap) vaccination has been recommended for adolescents in the U.S. since 2006. Information on Tdap vaccination by provider recommendation is limited. The purpose of this study is to assess recent Tdap vaccination by provider recommendation status among adolescents aged 13-17 years. METHODS: The 2013 National Immunization Survey-Teen data (N=18,948) were analyzed in 2016 to assess national and state-specific Tdap vaccination coverage disparities among adolescents by provider recommendation status, and other demographic and access to care variables. Multivariable logistic regression analysis and predictive marginal modeling evaluated associations between Tdap vaccination and provider recommendation status and other factors among adolescents aged 13-17 years. RESULTS: Overall, only 56.9% of adolescents aged 13-17 years received a provider recommendation for Tdap. Coverage was significantly higher among adolescents with a provider recommendation (88.6%) compared with those without a provider recommendation (80.5%) (p<0.05). Multivariable logistic regression showed that characteristics independently associated with a higher likelihood of Tdap vaccination included receiving a provider recommendation, Hispanic ethnicity, having two to three physician contacts in the past 12 months, having one or two vaccination providers, and receiving vaccinations from more than one type of facility (p<0.05). CONCLUSIONS: Provider recommendations were significantly associated with Tdap vaccination among adolescents aged 13-17 years. However, 43% of parents of adolescents did not receive a provider recommendation. Evidence-based strategies such as standing orders and provider reminders alone or health systems interventions in combination should be taken to improve provider recommendation and Tdap vaccination coverage. |
Increased Risk for Meningococcal Disease among Men who have Sex with Men in the United States, 2012-2015.
Folaranmi TA , Kretz CB , Kamiya H , MacNeil JR , Whaley MJ , Blain A , Antwi M , Dorsinville M , Pacilli M , Smith S , Civen R , Ngo V , Winter K , Harriman K , Wang X , Bowen VB , Patel M , Martin S , Misegades L , Meyer SA . Clin Infect Dis 2017 65 (5) 756-763 Background: Several clusters of serogroup C meningococcal disease among men who have sex with men (MSM) have been reported in the United States in recent years. The epidemiology and risk of meningococcal disease among MSM is not well-described. Methods: All meningococcal disease cases among men aged 18-64 years reported to the National Notifiable Disease Surveillance System between January 2012 and June 2015 were reviewed. Characteristics of meningococcal disease cases among MSM and men not known to be MSM (non-MSM) were described. Annualized incidence rates among MSM and non-MSM were compared through calculation of the relative risk and 95% confidence intervals. Isolates from meningococcal disease cases among MSM were characterized using standard microbiological methods and whole genome sequencing. Results: Seventy-four cases of meningococcal disease were reported among MSM and 453 among non-MSM. Annualized incidence of meningococcal disease among MSM was 0.56 cases per 100,000 population, compared to 0.14 among non-MSM, for a relative risk of 4.0 (95% CI: 3.1-5.1). Among the 64 MSM with known status, 38 (59%) were HIV-infected. HIV-infected MSM had 10.1 times (95% CI: 6.1-16.6) the risk of HIV-uninfected MSM. All isolates from cluster-associated cases were serogroup C sequence type 11. Conclusions: MSM are at increased risk for meningococcal disease, although the incidence of disease remains low. HIV infection may be an important factor for this increased risk. Routine vaccination of HIV-infected persons with a quadrivalent meningococcal conjugate vaccine in accordance with Advisory Committee on Immunization Practices recommendations should be encouraged. |
Household transmission of Neisseria meningitidis in the meningitis belt
Meyer SA , Kristiansen PA . Lancet Glob Health 2016 4 (12) e885-e886 The epidemiology of Neisseria meningitidis is dynamic, with risk of meningococcal disease varying widely by region and depending on a confluence of host, organism, and environmental factors. Because transmission of N meningitidis results mainly in asymptomatic carriage, evaluation of oropharyngeal carriage can be helpful to understand the epidemiology and transmission of N meningitidis and, in turn, develop strategies for the prevention and control of meningococcal disease. The bacterium is transmitted through respiratory droplets and close contact, with transmission increasing in crowded settings such as military camps, universities, and schools.1 Household contacts of patients with meningococcal disease have been shown to be at increased risk of meningococcal carriage and disease in developed countries, where incidence of meningococcal disease is low and outbreaks infrequent. However, less is known about household transmission dynamics of N meningitidis in the unique epidemiological context of the meningitis belt of sub-Saharan Africa, which is characterised by high rates of endemic disease, annual outbreaks, and periodic large-scale epidemics, historically due to serogroup A meningococci.2 | In The Lancet Global Health, Caroline Trotter and colleagues3 describe the importance of household transmission of N meningitidis in the meningitis belt using data from a series of cross-sectional meningococcal carriage surveys held across seven countries to describe meningococcal carriage and impact of a novel meningococcal serogroup A conjugate vaccine (MenAfriVac; Serum Institute of India PVT, Pune, India). Within the study the investigators recruited a subset of 184 households containing putative N meningitidis carriers due to any serogroup for longitudinal household carriage surveys carried out over 6 months. 133 households with confirmed index carriers were compared with 51 control households in which N meningitidis in the putative index carrier was ruled out by reference testing. 21% (152 of 739) of individuals within index carrier households subsequently acquired N meninigitidis compared with 9% (35 of 371) of individuals in control households. Due to a paucity of serogroup A carriers, the impact of MenAfriVac vaccination on carriage acquisition or loss within households could not be determined. Although the overall carriage acquisition rate was 2·4% per month (95% CI 1·6–4·0), rates among all age groups were four-to-five-times higher in households with an index carrier. Overall, the mean duration of carriage was 3·4 months (2·7–4·4). Index carriers were most likely to be adolescents, with a median age of 12 years, and children younger than 5 years were most likely to acquire carriage. In index carrier households, most individuals that subsequently developed carriage acquired the same or a similar strain as the index carrier, providing evidence for within-household transmission, although external acquisition was also noted. Further analysis of the strains with next-generation sequencing will be useful to further differentiate transmission within households versus external acquisition. |
Whole-Genome Characterization of Epidemic Neisseria meningitidis Serogroup C and Resurgence of Serogroup W, Niger, 2015.
Kretz CB , Retchless AC , Sidikou F , Issaka B , Ousmane S , Schwartz S , Tate AH , Pana A , Njanpop-Lafourcade BM , Nzeyimana I , Nse RO , Deghmane AE , Hong E , Brynildsrud OB , Novak RT , Meyer SA , Oukem-Boyer OO , Ronveaux O , Caugant DA , Taha MK , Wang X . Emerg Infect Dis 2016 22 (10) 1762-8 In 2015, Niger reported the largest epidemic of Neisseria meningitidis serogroup C (NmC) meningitis in sub-Saharan Africa. The NmC epidemic coincided with serogroup W (NmW) cases during the epidemic season, resulting in a total of 9,367 meningococcal cases through June 2015. To clarify the phylogenetic association, genetic evolution, and antibiotic determinants of the meningococcal strains in Niger, we sequenced the genomes of 102 isolates from this epidemic, comprising 81 NmC and 21 NmW isolates. The genomes of 82 isolates were completed, and all 102 were included in the analysis. All NmC isolates had sequence type 10217, which caused the outbreaks in Nigeria during 2013-2014 and for which a clonal complex has not yet been defined. The NmC isolates from Niger were substantially different from other NmC isolates collected globally. All NmW isolates belonged to clonal complex 11 and were closely related to the isolates causing recent outbreaks in Africa. |
Tetanus, diphtheria, and acellular pertussis vaccination among women of childbearing age - United States, 2013
O'Halloran AC , Lu PJ , Williams WW , Ding H , Meyer SA . Am J Infect Control 2016 44 (7) 786-93 The incidence of pertussis in the United States has increased since the 1990s. Tetanus, diphtheria, and acellular pertussis (Tdap) vaccination of pregnant women provides passive protection to infants. Tdap vaccination is currently recommended for pregnant women during each pregnancy, but coverage among pregnant women and women of childbearing age has been suboptimal. Data from the 2013 Behavioral Risk Factor Surveillance System (BRFSS) and 2013 National Health Interview Survey (NHIS) were used to determine national and state-specific Tdap vaccination coverage among women of childbearing age by self-reported pregnancy status at the time of the survey. Although this study could not assess coverage of Tdap vaccination received during pregnancy because questions on whether Tdap vaccination was received during pregnancy were not asked in BRFSS and NHIS, demographic and access-to-care factors associated with Tdap vaccination coverage in this population were assessed. Tdap vaccination coverage among all women 18-44 years old was 38.4% based on the BRFSS and 23.3% based on the NHIS. Overall, coverage did not differ by pregnancy status at the time of the survey. Coverage among all women 18-44 years old varied widely by state. Age, race and ethnicity, education, number of children in the household, and access-to-care characteristics were independently associated with Tdap vaccination in both surveys. We identified associations of demographic and access-to-care characteristics with Tdap vaccination that can guide strategies to improve vaccination rates in women during pregnancy. |
Serogroup A meningococcal conjugate (PsA-TT) vaccine coverage and measles vaccine coverage in Burkina Faso - implications for introduction of PsA-TT into the Expanded Programme on Immunization
Meyer SA , Kambou JL , Cohn A , Goodson JL , Flannery B , Medah I , Messonnier N , Novak R , Diomande F , Djingarey MH , Clark TA , Yameogo I , Fall A , Wannemuehler K . Vaccine 2015 33 (12) 1492-8 BACKGROUND: A new serogroup A meningococcal conjugate vaccine (PsA-TT, MenAfriVac) has been developed to combat devastating serogroup A Neisseria meningitis (MenA) epidemics in Africa. A mass immunization campaign targeting 1-29 year olds was conducted in Burkina Faso in December 2010. Protection of subsequent infant cohorts will be necessary through either introduction of PsA-TT into the routine Expanded Programme on Immunization (EPI) or periodic repeat mass vaccination campaigns. OBJECTIVES: To inform future immunization policy for PsA-TT vaccination of infants through a comparison of PsA-TT campaign vaccination coverage and routine measles-containing vaccine (MCV) coverage in Burkina Faso. METHODS: A national survey was conducted in Burkina Faso during December 17-27, 2011 using stratified cluster sampling to assess PsA-TT vaccine coverage achieved by the 2010 nationwide immunization campaign among 2-30 year olds and routine MCV coverage among 12-23 month olds. Coverage estimates and 95% Confidence Intervals (CI) were calculated, reasons for non-vaccination and methods of campaign communication were described, and a multivariable analysis for factors associated with vaccination was conducted. RESULTS: National overall PsA-TT campaign coverage was 95.9% (95% CI: 95.0-96.7) with coverage greater than 90% all 13 regions of Burkina Faso. National overall routine MCV coverage was 92.5% (95% CI: 90.5-94.1), but ranged from 75.3% to 95.3% by region. The primary predictor for PsA-TT vaccination among all age groups was a head of household informed of the campaign. PsA-TT vaccination was more likely in residents of rural settings, whereas MCV vaccination was more likely in residents of urban settings. CONCLUSION: Overall national vaccination rates in Burkina Faso were similar for PsA-TT and MCV vaccine. The regions with MCV coverage below targets may be at risk for sub-optimal vaccination coverage if PsA-TT is introduced in EPI. These results highlight the need for assessments of routine vaccination coverage to guide PsA-TT immunization policy in meningitis belt countries. |
Improved acute flaccid paralysis surveillance performance in the Democratic Republic of the Congo, 2010-2012
Alleman MM , Meyer SA , Mulumba A , Nyembwe M , Riziki Y , Mbule A , Mayenga M , Coulibaly T . J Infect Dis 2014 210 Suppl 1 S50-61 BACKGROUND: The Democratic Republic of the Congo (DRC) began polio eradication activities in 1996. By 2001, DRC was no longer polio endemic. However, wild poliovirus (WPV) transmission was reestablished in 2006 continuing through 2011 (last WPV case onset 20 December 2011), and vaccine-derived poliovirus type 2 (VDPV2) outbreaks occurred during 2004-2012 (last VDPV2 case onset 4 April 2012). Gaps in acute flaccid paralysis (AFP) surveillance have been consistently documented. METHODS: AFP surveillance indicators were assessed at the national, provincial, and zone de sante (ZS) levels for 2010-2012. A spatiotemporal analysis of compatible, WPV type 1 (WPV1), and VDPV2 cases was performed. RESULTS: During 2010-2012, AFP cases were reported from all provinces but not every ZS, particularly in Equateur province and Province Orientale. A spatiotemporal relationship between compatible, WPV1, and VDPV2 cases was noted. Nonpolio AFP rates met objectives at national and provincial levels but were sub-optimal in certain ZS. National and provincial trends in timely stool collection, stool condition, adequate stool, and 60-day follow-up exams improved. CONCLUSIONS: DRC's AFP surveillance system is functional and improved during 2010-2012. Maintaining improvements and strengthening AFP case detection at the ZS level will provide further support for the apparent interruption of WPV and VDPV2 transmission. |
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