Ariel Higgins-Steele

Most countries use tally sheets across immunization programmes for health workers to mark vaccine doses administered to every person, alongside home-based records, yet their design and use is poorly understood at the global level. This paper presents a multi-country analysis on routine childhood immunization tally sheet content and design sourced from the annual electronic WHO/UNICEF Joint Reporting Form on Immunization (eJRF), which collected these forms for the first time in 2024 (for 2023). Of the total submissions (N = 71) of tally sheets by reporting entities, 51 submissions met the criteria for inclusion as a valid tally sheet allowing for data extraction. The 51 tally sheets were from countries and territories across all six regions of the World Health Organization (WHO) and all four World Bank income classifications. Analysis showed heterogeneity in immunization tally sheet design, core data fields, and the extent to which the available tally sheets aligned with globally recommendations found in recent vaccine-specific and programmatic guidance related to catch-up vaccination. As national immunization programmes and vaccination schedules protect against more diseases, and thereby become more complex, fit-for-purpose tally sheet design and instructions as well as support mechanisms for health workers on tally sheet use are essential, similar to what is recommended for home-based records.

Most countries use tally sheets across immunization programmes for health workers to mark vaccine doses administered to every person, alongside home-based records, yet their design and use is poorly understood at the global level. This paper presents a multi-country analysis on routine childhood immunization tally sheet content and design sourced from the annual electronic WHO/UNICEF Joint Reporting Form on Immunization (eJRF), which collected these forms for the first time in 2024 (for 2023). Of the total submissions (N=71) of tally sheets by reporting entities, 51 submissions met the criteria for inclusion as a valid tally sheet allowing for data extraction. The 51 tally sheets were from countries across all six regions of the World Health Organization (WHO) and all four World Bank income classifications. Analysis showed heterogeneity in immunization tally sheet design, core data fields, and the extent that the available tally sheets aligned with globally recommendations found in recent vaccine-specific and programmatic guidance related to catch-up vaccination. As national immunization programmes and vaccination schedules protect against more diseases, and thereby become more complex, fit-for-purpose tally sheet design and instructions as well as support mechanisms for health workers on tally sheet use are essential, similar to what is recommended for home-based records.

Background: During 2020 and immediately prior to the COVID-19 pandemic, Sudan was experiencing multiple emergencies including violence, seasonal flooding, and vector-borne disease outbreaks. After more than ten years since its last case of wild poliovirus, Sudan declared a circulating vaccine-derived poliovirus type 2 (cVDPV2) outbreak on 9 August 2020. Methods: cVDPV2 outbreak response data and programme documents of the Federal Ministry of Health and WHO were reviewed. Surveillance data was verified through WHO-recommended procedures for detecting and characterizing polioviruses from stool and sewage samples collected from acute flaccid paralysis (AFP) cases and the environment. Results: This outbreak in Sudan led to a total of 58 confirmed cases of cVDPV2 from 15 of the 18 states. Two nationwide vaccination campaigns were held to increase immunity of children under-five against poliovirus type 2. Funding challenges were overcome by intense additional resource mobilization from in-country sources. The funding gap was bridged from domestic resources (49%) sourced through GPEI partners, and in-country humanitarian funding mechanisms. Conclusions: During an outbreak response and challenge of funding shortfall, mobilizing in-country resources is possible through coordinated approaches, regular communication with partners, disaggregation of needs, and matching in-kind and financial support to fill gaps. A cVDPV2 outbreak requires a fast, resourced, and quality response to stop virus circulation.

Background: During 2020 and immediately prior to the COVID-19 pandemic, Sudan was experiencing multiple emergencies including violence, seasonal flooding, and vector-borne disease outbreaks. After more than ten years since its last case of wild poliovirus, Sudan declared a circulating vaccine-derived poliovirus type 2 (cVDPV2) outbreak on 9 August 2020. Methods: cVDPV2 outbreak response data and programme documents of the Federal Ministry of Health and WHO were reviewed. Surveillance data was verified through WHO-recommended procedures for detecting and characterizing polioviruses from stool and sewage samples collected from AFP cases and the environment. Results: This outbreak in Sudan led to a total of 58 confirmed cases of cVDPV2 from 15 of the 18 states. Two nationwide vaccination campaigns were held to increase immunity of children under-five against poliovirus type 2. Funding challenges were overcome by intense additional resource mobilization from domestic resources and partnerships. The funding gap was bridged from domestic resources (49%) sourced through GPEI partners, and in-country humanitarian funding mechanisms. Conclusions: During an outbreak response and challenge of funding shortfall, mobilizing domestic resources is possible through coordinated approaches and systematic communication with in-country partners, disaggregation of needs, and diverse interventions. A cVDPV2 outbreak requires a fast, resourced, and quality response to stop virus circulation.