Influence of immune history when choosing a SARS-CoV-2 booster strategy

Candidate HIV/AIDS vaccines

Updated International Society of Geriatric Oncology COVID-19 working group recommendations on COVID-19 vaccination among older adults with cancer

Adenovirus 5 serotype vector-specific immunity and HIV-1 infection: a tale of T cells and antibodies

Background: Diphtheria remains a persistent public health issue, especially in low- and middle-income countries (LMICs), where vaccination coverage is often inadequate. Recent outbreaks, such as those in the 1990s, highlight the ongoing threat posed by this vaccine-preventable disease. The World Health Organization (WHO) provides data for monitoring the global trends in diphtheria cases, helping countries remain vigilant against its resurgence. Objective: This study aims to analyze the trend of diphtheria cases and incidence rates in 10 countries with the highest disease burden as a public health challenge in Low- and Middle-Income Countries (LMIC), with a focus on the impact of vaccination coverage. Methods: Longitudinal study was utilized in this research. G-power was performed to calculate the sample size. In accordance with the goal year that was being investigated, the research ranked the nations that were chosen into the top ten countries that had the largest number of cases of diphtheria. Our analysis was based on secondary data obtained from the WHO and included the years 2017 through 2021. In order to assess the distribution of healthcare access and vaccine coverage, we conducted a descriptive analysis of all of the data. This served the purpose of identifying significant public health concerns that contribute to diphtheria epidemics. We used the Stata 16 application to perform analysis on all of the data. Results: The majority of diphtheria cases occur in African and Asian countries, especially in areas with lower DTP-3 vaccination coverage. Yemen, Ethiopia, and Nigeria have high diphtheria rates due to disparities in access to health services and immunization programs. Countries with higher vaccination rates, such as India and Indonesia, report lower rates despite having high numbers of cases. This suggests that strong immunization programs are essential to control the disease. Conclusion: Diphtheria continues to be a significant public health challenge in LMICs, exacerbated by geographic and socioeconomic disparities in vaccination coverage. Global cooperation, including support from high-income countries, is essential to strengthen immunization programs and prevent future outbreaks. Diphtheria should be recognized as a global health threat, requiring comprehensive and coordinated efforts to achieve eradication. Keywords: Diphtheria; incidence rate; reported cases; vaccinated

Current conceptions of solidarity impose a morality and sacrifice that did not prevail in the case of COVID-19 vaccine distribution. Notably, the vaccine distribution disparity revealed that when push came to shove, in the case of global distribution, self-interested persons reached inward rather than reaching out, prioritized their needs, and acted to realize their self-interest. Self-interest and loyalty to one's own group are natural moral tendencies. For solidarity to be normatively relevant in difficult and emergency circumstances, solidarity scholars ought to leverage the knowledge of the human natural tendency to prioritize one's own group. This paper recommends a nonexclusive approach to solidarity that reflects an understanding of rational self-interest but highlights commonalities among all people. A recommended task for future studies is to articulate what the account of solidarity informed by loyalty to the group would look like.

ABSTRACTIntroduction: High variance is associated with influenza vaccine effectiveness (VE). Accumulating evidence suggests that preexisting influenza-specific immunity results in the variance in VE and skews overall immune response to vaccination. Nevertheless, the investigation of preexisting immunity is highly limited due to the lack of proper methodology to explore the complex individual immune history.Areas covered: Retrospective observational studies have shown that the preexisting influenza specific immunity influences on VE. To simplify a discussion, we summarized important findings from the observational studies based on the transition of the individual immune history: the first exposure to influenza virus, the first vaccination, and repetitive exposure throughout life. We also discussed the prospectus of pre-immunized animal models to investigate the interaction between preexisting immunity and vaccine efficacy.Expert opinion: A better understanding in the underlying mechanisms on preexisting immunity is critical to improve VE and to help develop novel vaccine strategies. Using animals pre-immunized with historical influenza strains is a promising approach to verify the underlying immunologic mechanism of interaction between preexisting immunity and vaccine antigen. Also, pre-immunized animal models will be better able to evaluate the efficacy of novel vaccine strategies than naïve animals.

BackgroundUnderstanding the differences in timing and composition of physical distancing policies is important to evaluate the early global response to COVID-19. A physical distancing intensity monitoring framework comprising 16 domains was recently published to compare physical distancing approaches across 12 U.S. States. We applied this framework to a diverse set of low and middle-income countries (LMICs) (Botswana, India, Jamaica, Mozambique, Namibia, and Ukraine) to test the appropriateness of this framework in the global context and to compare the policy responses in these LMICs with a sample of U.S. States during the first 100-days of the pandemic.ResultsThe LMICs in our sample adopted wide ranging physical distancing policies. The highest peak daily physical distancing intensity during this period was: Botswana (4.60); India (4.40); Ukraine (4.40); Namibia (4.20); Mozambique (3.87), and Jamaica (3.80). The number of days each country stayed at peak policy intensity ranged from 12-days (Jamaica) to more than 67-days (Mozambique). We found some key similarities and differences, including substantial differences in whether and how countries expressly required certain groups to stay at home. Despite the much higher number of cases in the US, the physical distancing responses in our LMIC sample were generally more intense than in the U.S. States, but results vary depending on the U.S. State. The peak policy intensity for the U.S. 12-state average was 3.84, which would place it lower than every LMIC in this sample except Jamaica. The LMIC sample countries also reached peak physical distancing intensity earlier in outbreak progression compared to the U.S. states sample. The easing of physical distancing policies in the LMIC sample did not discernably correlate with change in COVID-19 incidence.ConclusionsThis physical distancing intensity framework was appropriate for the LMIC context with only minor adaptations. This framework may be useful for ongoing monitoring of physical distancing policy approaches and for use in effectiveness analyses. This analysis helps to highlight the differing paths taken by the countries in this sample and may provide lessons to other countries regarding options for structuring physical distancing policies in response to COVID-19 and future outbreaks.

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic has transitioned to a third phase and many variants have been originated. There has been millions of lives loss as well as billions in economic loss. The morbidity and mortality for COVID-19 varies by country. There were different preventive approaches and public restrictions policies have been applied to control the COVID-19 impacts and usually measured by Stringency Index. This study aimed to explore the COVID-19 trend, public restriction policies and vaccination status with economic ranking of countries.MethodsWe received open access data from Our World in Data. Data from 210 countries were available. Countries (n = 110) data related to testing, which is a key variable in the present study, were included for the analysis and remaining 100 countries were excluded due to incomplete data. The analysis period was set between January 22, 2020 (when COVID-19 was first officially reported) and December 28, 2021. All analyses were stratified by year and the World Bank income group. To analyze the associations among the major variables, we used a longitudinal fixed-effects model.ResultsOut of the 110 countries included in our analysis, there were 9 (8.18%), 25 (22.72%), 31 (28.18%), and 45 (40.90%) countries from low income countries (LIC), low and middle income countries (LMIC), upper middle income countries (UMIC) and high income countries (HIC) respectively. New case per million was similar in LMIC, UMIC and HIC but lower in LIC. The number of new COVID-19 test were reduced in HIC and LMIC but similar in UMIC and LIC. Stringency Index was negligible in LIC and similar in LMIC, UMIC and HIC. New positivity rate increased in LMIC and UMIC. The daily incidence rate was positively correlated with the daily mortality rate in both 2020 and 2021. In 2020, Stringency Index was positive in LIC and HIC but a negative association in LMIC and in 2021 there was a positive association between UMIC and HIC. Vaccination coverage did not appear to change with mortality in 2021.ConclusionNew COVID-19 cases, tests, vaccinations, positivity rates, and Stringency indices were low in LIC and highest in UMIC. Our findings suggest that the available resources of COVID-19 pandemic would be allocated by need of countries; LIC and UMIC.

SummaryBackgroundChildhood immunisation is one of the most cost-effective health interventions. However, despite its known value, global access to vaccines remains far from complete. Although supply-side constraints lead to inadequate vaccine coverage in many health systems, there is no comprehensive analysis of the funding for immunisation. We aimed to fill this gap by generating estimates of funding for immunisation disaggregated by the source of funding and the type of activities in order to highlight the funding landscape for immunisation and inform policy making.MethodsFor this financial modelling study, we estimated annual spending on immunisations for 135 low-income and middle-income countries (as determined by the World Bank) from 2000 to 2017, with a focus on government, donor, and out-of-pocket spending, and disaggregated spending for vaccines and delivery costs, and routine schedules and supplementary campaigns. To generate these estimates, we extracted data from National Health Accounts, the WHO–UNICEF Joint Reporting Forms, comprehensive multi-year plans, databases from Gavi, the Vaccine Alliance, and the Institute for Health Metrics and Evaluation's 2019 development assistance for health database. We estimated total spending on immunisation by aggregating the government, donor, prepaid private, and household spending estimates.FindingsBetween 2000 and 2017, funding for immunisation totalled US$112·4 billion (95% uncertainty interval 108·5–118·5). Aggregated across all low-income and middle-income countries, government spending consistently remained the largest source of funding, providing between 60·0% (57·7–61·9) and 79·3% (73·8–81·4) of total immunisation spending each year (corresponding to between $2·5 billion [2·3–2·8] and $6·4 billion [6·0–7·0] each year). Across income groups, immunisation spending per surviving infant was similar in low-income and lower-middle-income countries and territories, with average spending of $40 (38–42) in low-income countries and $42 (39–46) in lower-middle-income countries, in 2017. In low-income countries and territories, development assistance made up the largest share of total immunisation spending (69·4% [64·6–72·0]; $630·2 million) in 2017. Across the 135 countries, we observed higher vaccine coverage and increased government spending on immunisation over time, although in some countries, predominantly in Latin America and the Caribbean and in sub-Saharan Africa, vaccine coverage decreased over time, while spending increased.InterpretationThese estimates highlight the progress over the past two decades in increasing spending on immunisation. However, many challenges still remain and will require dedication and commitment to ensure that the progress made in the previous decade is sustained and advanced in the next decade for the Immunization Agenda 2030.FundingBill & Melinda Gates Foundation.

IntroductionRoutine immunisation is a cost-effective way to save lives and protect people from disease. Some low-income countries (LIC) achieved remarkable success in childhood immunisation. Yet, previous studies comparing the relationship...

Estimation of distribution of childhood diarrhoea, measles, and pneumonia morbidity and mortality by socio-economic group in low-income and middle-income countries

Many low- and middle-income countries (LMICs) continue to experience substantial inequities in vaccination coverage despite recent efforts to reach missed communities and reduce zero-dose prevalence. Geographic inequities in vaccination coverage are often characterized by a multiplicity of risk factors which should be operationalized through data integration to inform more effective and equitable vaccination policies and programmes. Here, we explore approaches for integrating information from multiple risk factors to create a zero-dose vulnerability index to improve the identification and prioritization of vulnerable communities and understanding of inequities in vaccination coverage. We assembled geolocated data on vaccination coverage and associated risk factors in six LMICs, focusing on the coverage of DTP1, DTP3 and MCV1 vaccines as indicators of zero dose and under-vaccination. Using geospatial modelling techniques built on a suite of geospatial covariate information, we produced 1 × 1 km and district level maps of the previously unmapped risk factors and vaccination coverage. We then integrated data from the maps of the risk factors using different approaches to construct a zero-dose vulnerability index to classify districts within the countries into different vulnerability groups, ranging from the least vulnerable (1) to the most vulnerable (5) areas. Through integration with population data, we estimated numbers of children aged under 1 living within the different vulnerability classes. Our results show substantial variation in the spatial distribution of the index, revealing the most vulnerable areas despite little variation in coverage in some cases. We found that the most distinguishing characteristics of the most vulnerable areas cut across the different subdomains (health, socioeconomic, demographic and geographic) of the risk factors included in our study. We also demonstrated that the index can be robustly estimated with fewer risk factors and without linkage to information on vaccination coverage. The index constitutes a practical and effective tool to guide targeted vaccination strategies in LMICs.

ACT-A: “The international architecture did not work for us”

Lower- and middle-income countries (LMICs) are disproportionately impacted by human papillomavirus (HPV) and would benefit from implementing the HPV vaccine. In the context of competing health priorities, utilizing scarce domestic infrastructure and human resources for HPV vaccination remains challenging for many LMICs. Given the high benefits of the HPV vaccine, the World Health Organization (WHO) is now encouraging for all countries, particularly LMICs, to introduce HPV vaccines into their routine immunization programs. Understanding the barriers and facilitators to HPV adolescent vaccine programs in LMICs may help strengthen how LMICs implement HPV vaccine programs, in turn, increasing HPV vaccine acceptance, uptake, and coverage. To identify and assess barriers and facilitators to implementing adolescent HPV vaccination programs in LMICs. This study comprised a review of literature assessing adolescent HPV vaccination in LMICs published after 2020 from a sociocultural perspective. Overall, the findings showed that LMICs should prioritize increasing HPV vaccine availability and HPV vaccine knowledge, particularly focusing on cancer prevention, as knowledge reduces misinformation and increases vaccine acceptance. Evidence suggests that factors promoting HPV vaccine uptake include fostering low vaccine hesitancy, integrating HPV vaccination as a primary school routine vaccination, and vaccinating both genders. A one-dose HPV vaccine may enable many LMICs to increase vaccine acceptance, uptake, and coverage while controlling financial, infrastructure, and human resource costs. As HPV is one of the leading causes of death in many LMICs, implementing the HPV vaccine may be highly beneficial. Cohesive national HPV vaccine buy-in and understanding the success and challenges of prior LMIC HPV vaccine implementation is crucial to developing effective, efficient, and sustainable HPV vaccination programs.

An appeal for practical social justice in the COVID-19 global response in low-income and middle-income countries