Basic Vaccination Research Articles

The impact of maternal health care utilisation on routine immunisation coverage of children in Nigeria: a cross-sectional study

ObjectiveTo examine the impact of maternal healthcare (MHC) utilisation on routine immunisation coverage of children in Nigeria.DesignIndividual level cross-sectional study using bivariate and multivariable logistic regression analyses to examine the...

Seroprotection rates of vaccine-preventable diseases among newly arrived Eritrean asylum seekers in Switzerland: a cross-sectional study.

According to 2016 World Health Organization and United Nations Children's Fund country estimates, Eritrea has overall high vaccination coverage with immunization rates for three doses of diphtheria/tetanus/pertussis and polio vaccine of 95%, for two doses measles vaccine of 85% and for three doses hepatitis B vaccine of 85%. If confirmed, this could imply that routine basic vaccination of newly arrived Eritreans could be safely omitted. We used stored serum samples from two cross-sectional studies that screened newly arrived Eritrean refugees for infectious diseases. Consenting refugees aged 16years and older who registered in one of three neighbouring cantons in northwestern Switzerland were enrolled between January 2016 and December 2017. Antibody titers against the following vaccine-preventable diseases were measured (applied thresholds for seroprotection in brackets): diphtheria (>0.1IU/ml), tetanus (>0.1IU/ml), measles (>150mIU/ml), rubella (only for women, >11IU/ml), varicella (>50mIU/ml), hepatitis B [hepatitis B surface antigen (HBsAg) Index >0.9, Hepatitis B core antibody (anti-HBc) Index >0.9 and antibodies to HBsAg (anti-HBs) >10IE/L]. Differences between sex and age groups (≤25 and >25 years) were measured by Fisher's exact test. We analysed samples of 133 study participants (20 women, 15%) with a median age of 25years (range 16-61). Rates of seropositivity were as follows for women/men, respectively: diphtheria 57.9%/74.8% (difference non-significant), tetanus 94.8%/41.1% (P < 0.001), measles 73.7%/76.6% (non-significant), rubella in women 78.9%, varicella 89.5%/95.3% (non-significant), anti-HBc 15.8%/26.2% (non-significant) and anti-HBs 15.8%/17.8% (non-significant). Seroprevalence for vaccine-preventable infections did not meet levels required to confer herd immunity in any of the human-to-human transmissible diseases that were studied. In general, the strategy proposed by the Federal Office of Public Health to offer basic immunization to all newly arrived refugees, including newly arriving Eritrean refugees, is justified.

Observation on safety of sequential vaccination schedule of different strain inactivated poliovirus vaccines

Objective: To evaluate the safety of population based sequential vaccination schedule of inactivated poliovirus vaccines prepared with different strains. Methods: This randomized, parallel-group controlled trial was conducted from March, 2017 to May, 2018, in Shanghai. Adverse reaction data of Sabin strain inactivated polio vaccine (sIPV), wild strains inactivated polio vaccines (wIPV) and bivalent types Ⅰ and Ⅲ oral poliomyelitis vaccine (bOPV) were systematically collected through active observation in 1 917 infants in Shanghai after the vaccination at 2, 3, 4 months old. The eligible infants aged 2 months were divided into 4 groups: ①sIPV+sIPV+bOPV group; ②sIPV+wIPV+bOPV group; ③wIPV+sIPV+bOPV group; ④wIPV+wIPV+bOPV group. Results: The incidence of adverse reaction 30 days later after 3 basic dose vaccinations was 16.79% (946/5 633). No serious adverse reaction was reported. Local and systemic reactions were mainly mild. Common local reactions were pain, erythema, cutaneous nodule, etc.; and common systemic reactions were abnormal crying, drowsiness, diarrhea and appetite lost, etc.. The incidence of local reactions 30 days later after 3 basic dose vaccinations was 1.65% (93/5 633), and the incidence rates of grade 1-3 reactions were1.26% (71/5 633), 0.21% (12/5 633) and 0.20% (11/5 633) respectively. The incidence rate of systemic reactions 30 days later after 3 basic vaccinations was 15.14% (853/5 633), and the incidence rates of grade 1-3 reactions were 11.33% (638/5 633), 3.18% (179/5 633) and 0.64% (36/5 633) respectively. There were no significant differences in the rate of grade 3 reaction among different groups (χ(2)=4.17, P=0.24). Conclusions: No severe adverse reactions related to sequential vaccination of different strain inactivated polio vaccines were observed, most of reactions were mild and all of them were cured. It is safe to use sIPV and wIPV simultaneously or alternately for childhood sequential vaccination.

The Analysis of Cold Chain Management of Basic Immunization Vaccine in Health Service Centers, 2018

Background: Vaccines are biological products that promote immunity activation in children. Vaccines content are susceptible and need more treatment in temperature (20C-80C), storage, and use during the delivery process to health service centers. Purpose: This study aims to determine the cold chain management of basic immunization vaccine in health service centers, South Solok Regency. Method: This research is a qualitative study. The sampling is done by using purposive sampling technique. This research was carried out at the health service center in South Solok Regency. This study uses primary and secondary data sources. The source of primary data is taken by in-depth interviews, while secondary data comes from document review and observations of data in 2018. Source and methodological triangulation were performed in this study. Results: The availability of human resources, funds, facilities and infrastructure and work procedures are sufficient, although there is still one untrained health service center staff, lack of vaccine flasks in two health service centers, and lack of voltage stabilizers in seven health service centers. Almost all health service centers have been applied vaccine boxes 20C-80C in vaccine transportation system. Based on the evaluation, only one health service center that need to improve especially in temperature evaluation procedure by thermometer. The vaccine storage procedure has been applied by the health service center. However, the observation noticed three health service centers have problems in time delay in the melting process. Conclusion: The management of the cold chain vaccine in the health service center, South Solok Regency is good.

Factors influencing basic vaccination coverage in Myanmar: secondary analysis of 2015 Myanmar demographic and health survey data

BackgroundImmunization is one of the most effective measures for preventing disease when vaccination coverage is sufficient. Although vaccination coverage is known to be influenced by social and cultural barriers, the determinants of childhood immunization in Myanmar remain poorly understood. This study analyzed factors that influenced complete vaccination status (one dose each for Bacillus Calmette-Guérin and measles and three doses each for diphtheria-pertussis and polio) using 2015 data from the Myanmar Demographic Health and Survey.MethodsData from 12 to 23-month-old children and their mothers were extracted from the nationally representative survey results. Bivariate and multivariate analyses with survey-weighted logistic regression were performed to examine the relationships between vaccination status and various sociodemographic and medical factors. The independent variables for the analyses included area of residence, economic status, maternal age, marital status, education, literacy, employment status, antenatal care attendance, tetanus vaccination, place of delivery, postnatal evaluations, child’s sex, number of children, previous child death, decision maker(s) regarding child’s health, frequency of healthcare visits, paternal education, and paternal occupation.ResultsA representative sample of 904 cases were extracted for the analysis. The overall complete vaccination rate was 55.4%. In the multivariate analysis with backward step-wise selection, complete vaccination was independently associated with middle or high economic status (adjusted odds ratio [AOR]: 2.64, 95% confidence interval [CI]: 1.85–3.78), older maternal age (AOR: 2.87, 95% CI: 1.62–5.10), ≥4 antenatal care visits (AOR: 1.87, 95% CI: 1.28–2.73), and maternal tetanus vaccination before delivery (AOR: 3.26, 95% CI: 1.82–5.85).ConclusionThe first Demographic and Health Survey in Myanmar revealed that only approximately one-half of 12–23-year-old children had received complete vaccination, which was lower than the estimated rate from routine administrative coverage. Our results indicate that incomplete immunization status was associated with low economic status, younger maternal age, fewer antenatal care visits, and no maternal tetanus vaccination. These findings may help improve the targeting and strategic implementation of the Expanded Programme on Immunization.

HrHPV prevalence and type distribution in rural Zimbabwe: A community-based self-collection study using near-point-of-care GeneXpert HPV testing

ObjectivesHigh-risk human papilloma viruses (hrHPV) are the causative agents of cervical cancer, the leading cause of cancer deaths among Zimbabwean women. The objective of this study was to describe the hrHPV types found in Zimbabwe for consideration in cervical cancer screening and vaccination efforts. Design and methodsTo determine hrHPV prevalence and type distribution in Zimbabwe we implemented a community-based cross-sectional study of self-collected cervicovaginal samples with hrHPV screening using near-point-of-care Cepheid GeneXpert HPV. ResultsThe hrHPV prevalence was 17% (112/643); 33% (41/123) vs. 14% (71/520) among HIV-1-positive and -negative participants, respectively (p=2.3E-07). Typing via Xpert HPV showed very good overall agreement (77.2%, kappa=0.698) with the Seegene Anyplex II HPV HR Detection kit. The most common types were HPV16, HPV18, HPV35, HPV52, HPV58, HPV68, HPV18, and HPV51, each of which appeared in 14–20% of infections. 37% (28/76) of women with positive cytology results (ASCUS+) had a type not included in the basic vaccine and 25% (19/76) had a type not currently in the nine-valent vaccine. ConclusionshrHPV type distribution includes less common high-risk types in rural Zimbabwe. The distribution and carcinogenicity of hrHPV type distribution should be considered during screening assay design, program development, as well as vaccine distribution and design.

Clinical spectrum and outcomes of pediatric diphtheria

Background Although vaccination programs have succeeded in reducing the incidence of diphtheria, it remains a health problem in Asia, including Indonesia.&#x0D; Objective To investigate the clinical spectrum and outcomes of pediatric diphtheria in Wahidin Sudirohusodo Hospital.&#x0D; Methods This study was a retrospective review of childhood diphtheria medical records from January 2011 to December 2017 in Wahidin Sudirohusodo Hospital, Makassar, South Sulawesi. Recorded data consisted of age, gender, nutritional and immunization statuses, signs and symptoms, throat swab culture results, complications, and outcomes. &#x0D; Results Of 28 subjects aged 9 months to 17.10 years, the majority were &gt;5 years (57.1%) and male (60.7%). Subjects’ mean age was 6.15 years and 82.1% of cases were well nourished. Overall, 85.7% had received complete immunizations, while 14.3% were not immunized, having received neither basic nor booster vaccines. The presenting manifestations were fever, pseudomembranes, and sore throat in all subjects, enlarged tonsils (78.57%), dysphagia (67.86%), cough (57.14%), headache (57.14%), hoarseness (67.86%), bull neck (25%), and myocarditis (14.3%). Most subjects had hospital stays of &gt;10 days (67.9%). Mortality was 14.3%, usually in those admitted with a late, deteriorating condition and dying before getting optimal treatment. Poor outcome was significantly associated with the lack of basic or booster immunizations, poor nourishment, bull neck, myocarditis, and hospital stays &lt; 5 days (P&lt;0.05 for all). &#x0D; Conclusion The clinical spectrum and outcomes of pediatric diphtheria in this study are relatively similar to reports from other hospitals. Mortality was mostly in patients who lack basic or booster immunizations, are poorly nourished, or have bull neck, myocarditis, or hospital stays &lt; 5 days.

Quitting Smoking in Mainland China: A New Role for Hospital-Based Nurses.

China has more than 300 million cigarette smokers and 1 million deaths every year attributed to smoking. Despite its huge economic implications, the lack of smoking and associated lifestyle-related data on China's outpatients makes it difficult for health care professionals to provide individualized assessments and targeted interventions. This study aimed to identify factors to inform nurse-led smoking behavioral assessments and cessation interventions. Clinical data from new patients attending the family medicine outpatient department from a large tertiary hospital in a major Southern China city were collected between March and December 2015. Data including basic demographics, medical history, vaccination history, current medication, and information on lifestyle risk factors were collected by frontline nurses during nursing assessment on their initial visit. Chi-square and Student's t tests were used as univariate analysis and post hoc regression analysis to explore which factors contributed toward smoking cessation. Of 7913 eligible visits, smokers and ex-smokers accounted for 13.5% and 2.4% of new patients, respectively, with a majority of them being young and male (gender ratio of 8:1) smokers. Multiple behavioral risks and comorbidities such as hypertension and diabetes mellitus in smokers were common; for example, 17.9% of smokers were also current drinkers, making alcohol users 8.5 to 16.7 times more likely to have smoked. Ex-smokers were more likely to be divorced, to be ex-drinkers, or to have higher diastolic blood pressure and concurrent hypertension. Smoking and associated lifestyle risk assessments run by registered nurses should be incorporated into current outpatient health histories and in targeted smoking cessation intervention programs.

Advances in Vaccines.

Graphical

Assessment of stability of Live Plague vaccine Manufacturing and Basic Preparation Quality Indicators

Objective of the study was to analyze the basic quality parameters of the produced live plague vaccine and stability of the preparation during the storage process. Materials and methods . Specifications for batch series of the live plague vaccine on the basis of Yersinia pestis EV NIIEG, manufactured between 2012 and 2017, in compliance with the regulations of the normative documentation were assessed. The parameters under investigation were: viability, thermal resistance, absence of extraneous substances and fungi, weight loss in the process of drying, immunogenicity. Results and conclusions . Comparative analysis of the vaccine viability (quantity of live microbe cells) in the batches manufactured over the past 6 years was carried out. All the studied vaccine series have the appropriate indicators stated in the Specification to the Pharmacopeia Monograph and master formula which testifies to the stability of manufacturing line and basic live plague vaccine quality parameters throughout the whole term of storage. It is outlined that the production of the vaccine, corresponding to the requirements of the normative regulations, depends upon the strict adherence to the rules by the personnel, usage of high-grade stock and materials, validation of equipment and technological processes of manufacturing.

Licensure, Approval, and Uptake of Vaccines in the United States.

Immunization is one of the most effective public and private preventive health interventions, resulting in significant reductions in vaccine-preventable diseases and in substantial cost savings to the US healthcare system. Vaccine licensure, development of recommendations for use, and implementation of those recommendations leading to uptake, community protection, and effect on disease burden represent a complex system that requires collaboration in the areas of basic science, public health, vaccine delivery, outcome monitoring, and public perception. The Advisory Committee on Immunization Practices (ACIP) sets standards for immunization delivery for both public and private vaccine providers, and state immunization programs can use these ACIP recommendations to develop school immunization requirements.

Effects of Maternal Decisional Authority and Media Use on Vaccination for Children in Asian Countries.

Background and objectives: It is now accepted that vaccination is a critical public health strategy in preventing child morbidity and mortality. Understanding factors that promote vaccination is a critical first step. The objective of this study was to investigated associations of maternal decisional authority and media use on vaccination for children in six South and Southeast Asian countries. Materials and Methods: Data come from demographic and health surveys conducted in Bangladesh, Cambodia, Indonesia, Nepal, Pakistan, and the Philippines between 2011 and 2014 (N = 45,168 women). Main outcome variables were four types of basic vaccination for children. Independent variables were maternal decisional authority and media use. Hierarchical multivariable regression analyses were performed to examine associations. Results: Children of mothers who had more decisional authority were more likely to be vaccinated compared to those participants who did not have such authority. The likelihood to have their children vaccinated was higher among women who frequently used media than those who did not use media. Conclusions: Maternal decisional authority and media use are related to improved vaccination for children. To increase vaccination rates in developing countries in South and Southeast Asia, programs and policies that promote maternal decisional authority and the use of media for health need to be implemented to help families and local communities.

Zindagi Mehfooz (Safe Life) Digital Immunization Registry: Leveraging Low-Cost Technology to Improve Immunization Coverage and Timeliness in Pakistan

Background: Despite free access to vaccines through the Expanded Program on Immunization (EPI) in Pakistan, only 54% of children receive all basic vaccinations. The global success of mobile health (mHealth) technologies, particularly, Digital immunization registries (DIRs), offers immense potential for comprehensive improvement in immunization programs. In 2012, we developed and piloted Zindagi Mehfooz (Safe Life; ZM) Digital Immunization Registry, an Android phone-based platform that enables vaccinators to digitally enroll and track the immunization status of their catchment population while allowing real-time access to data and easy generation of monitoring reports. Leveraging cutting edge mHealth technology, ZM includes features such as identification through quick response barcodes, interactive SMS reminders, decision support systems for routine/catch-up immunizations, real-time workforce tracking, predictive analytics for identifying high-risk children and customized report generation for monitoring. In 2017, ZM was scaled up, in collaboration with EPI, across the entire Sindh province and is currently being used by 1589 government vaccinators in 1296 basic health facilities. Objective: We evaluated the ZM Registry in terms of improvement in immunization coverage and timeliness. The primary outcome of interest was fully immunized child (FIC) coverage in children under 2 years of age, ie, a child who has received one dose of Bacillus-Calmette-Guerin (BCG), three doses each of OPV and Pentavalent immunizations, and one dose of Measles vaccine. The secondary outcomes of interest included the Pentavalent-3 coverage rate and dropout rate between BCG and Measles-1 vaccine. Methods: The provincial scale-up commenced in October 2017, and as of July 2018, over 700,000 children between 0-2 years have been enrolled in the Registry. At enrollment, the caretaker’s information, child’s bio-data, and immunization history are recorded and a unique Quick Response (QR)-code sticker is provided for identification. For the follow-up immunization visits, 3 SMS reminders are sent to parents for each vaccination. At the follow-up immunization, the child’s history is retrieved on the phone by scanning the QR-code, and the vaccination record is updated accordingly. Data exported from the ZM DIR records was used to calculate the coverage rate for children enrolled in the Registry and the outcomes were compared with the coverage estimates from the most recent demographic survey (MICS 2014) to determine the impact of the Registry. Results: Full immunization coverage of children (12-23 months) increased significantly from 35% as reported in MICS 2014 to 45% for children enrolled in ZM. Pentavalent-3 coverage of children enrolled in the Registry showed a 7% increase (from 53% reported in MICS 2014 data to 60% for children enrolled in the Registry). The dropout rate from BCG to Measles 1 vaccine was 24% as per the MICS 2014 figures and only 4% for children enrolled in the Registry. Conclusions: ZM demonstrates the potential of DIRs to improve immunization outcomes within low-resource settings by enabling better child tracking, efficient data monitoring and most importantly a higher retention rate for completing all the recommended immunizations. The evidence base generated through the evolution of ZM over the years has also facilitated global replication and can be leveraged to achieve universal immunization coverage in underserved regions.

The Natural Large Genomic Deletion Is Unrelated to the Increased Virulence of the Novel Genotype Fowl Adenovirus 4 Recently Emerged in China.

Since 2015, severe hydropericardium-hepatitis syndrome (HHS), caused by a highly pathogenic fowl adenovirus 4 (FAdV-4), emerged in China. In our previous study, the FAdV-4 has been identified as a novel genotype with a unique 1966-bp nucleotide deletion (1966Del) between open reading frame 42 and 43. In this study, the natural 1966Del was frequently identified among 17 clinical isolates and other reported Chinese clinical strains. To investigate the relationship between 1966Del and the increased virulence of the novel FAdV-4, a CRISPR/Cas9 operating platform for FAdV-4 was developed for the first time in this study. Based on this platform, a Re1966 strain was rescued, inserted the relative 1966Del sequence of a nonpathogenic strain KR5. In the pathogenicity study, the Re1966 strain retained high virulence for specific-pathogen-free chickens, similar to the parental wild-type HLJFAd15, although the survival time of chickens infected with Re1966 was much longer. Therefore, the natural 1966Del was identified as a non-essential site for the increased virulence of the emerged novel FAdV-4. Although further research on the virulence-determining region or point within the genome of the novel FAdV-4 is needed, the CRISPR/Cas9 operating platform for the novel FAdV-4 was developed and successfully applied to edit the genomic DNA for the first time, and it provides a novel powerful tool for both basic virology studies and vaccine vector development of FAdVs.

Vaccination Innovation: New Technologies Are Leading the Way to Vaccines That Work Better, Hurt Less.

Children in developing countries often don't receive their full set of basic vaccines, which leaves them at risk for diseases that can cause serious illness and even death. According to the World Health Organization (WHO), data from 2016 show that approximately 19.5 million infants globally were not fully vaccinated against diphtheria, tetanus, and pertussis, and some 1.5 million children die from vaccine-preventable illnesses each year [1]. And when it comes to seasonal influenza vaccines, they can be difficult to prepare in advance. In addition, people often skip flu shots because they don't like needles or they don't have time to get them. As a result, many go on to get the flu, along with complications that are sometimes fatal.

Persistence of Vaccine-Induced Immunity in Preschool Children: Effect of Gestational Age

BackgroundA program of immunization that ensures optimal development of acquired immunity should be carried out in all healthy newborns. The aim of the present study was to verify, at 2.5–3 years after the last dose of basic vaccination, if preschool children who have been delivered preterm and at term differ in their levels of post-vaccination protective antibodies.Material/MethodsHumoral response was assessed in 352 children (mean age: 5.22±0.34 years) who received a series of obligatory vaccinations in the period from birth to 2.5–3 years of age. Antibodies (in IgG class) against vaccine antigens – diphtheria (D), tetanus (T), pertussis (P), Haemophilus influenzae type b (Hib), poliomyelitis (IPV), measles, mumps, and rubella (MMR) – were measured using ELISA. The level of antibodies against hepatitis B (HBV) was assessed by chemiluminescence.ResultsAll children had been immunized according to the Polish National Vaccination Program. The group of 352 children eligible for the study included 46 (13.1%) preschoolers delivered preterm (32–36 weeks of gestation), and 306 (86.9%) born at term (37–42 weeks of gestation). All children maintained seroprotective antibody levels against polioviruses type 1, 2, and 3 (>12 mIU/mL), and against measles antigens (>300 U/mL). No statistically significant differences were found in the proportions of preschoolers born preterm and at term who were seroprotected against other vaccine antigens.ConclusionsAmong preschool children who were immunized according to chronological age, those we were born late preterm do not seem to differ in vaccine-induced immunity from those who were born full-term.

VALIDATE: Exploiting the synergy between complex intracellular pathogens to expedite vaccine research and development for tuberculosis, leishmaniasis, melioidosis and leprosy

For several complex intracellular pathogens, we have an urgent need for effective vaccines and yet there are common barriers to vaccine development. These diseases, including tuberculosis, leishmaniasis, leprosy and melioidosis, cause a huge burden of disease and disproportionately affect low and middle income countries. They are therefore often neglected due to the marginalisation of affected populations and the poor predicted commercial return on investment. Barriers to vaccine development include an incomplete understanding of protective immunity and translation from the bench into clinical vaccine trials. The current linear approach to vaccine research and development for these pathogens, which involves basic research, vaccine design, and vaccine evaluation in preclinical challenge models and clinical trials, is inefficient for these complex intracellular pathogens. We have established a Global Challenges Research Fund Network for VAccine deveLopment for complex Intracellular neglecteD pAThogEns, “VALIDATE”, where we aim to adopt a more flexible, integrated cross-pathogen approach to accelerate vaccine research and clinical development for these four pathogens, by cross-pathogen analyses, cross-discipline collaborations, and repeated integration of data from human and animal studies. This network provides a unique opportunity to bring together individuals working on four exemplar complex intracellular neglected pathogens ( M.tb, Leishmania spp., B. pseudomallei and M.leprae), which share a common lifestyle as pathogens of macrophages, induce similar end-stage pathologies and alter host immune and metabolic responses. The horizontal collaborations established throughout this network, together with the provision of a protected environment for early data sharing, will exploit these biological synergies. By interrogating mechanisms that lead from infection to disease, we will be able to develop common vaccine development strategies for these and other complex intracellular pathogens.

Beyond the Magic Bullet: Current Progress of Therapeutic Vaccination in Multiple Sclerosis.

Multiple sclerosis (MS) is a chronic immune-mediated disease of the central nervous system (CNS) characterized by neuroinflammation, neurodegeneration and impaired repair mechanisms that lead to neurological disability. The crux of MS is the patient’s own immune cells attacking self-antigens in the CNS, namely the myelin sheath that protects nerve cells of the brain and spinal cord. Restoring antigen-specific tolerance via therapeutic vaccination is an innovative and exciting approach in MS therapy. Indeed, leveraging the body’s attempt to prevent autoimmunity, i.e., tolerization, focuses on the underlying cause of the disease and could be the key to solving neuroinflammation. In this perspective, antigen-specific vaccination targets only the detrimental and aberrant immune response against the specific disease-associated antigen(s) involved while retaining the capacity of the immune system to respond to unrelated antigens. We review the experimental approaches of tolerance-inducing vaccination in relapsing and progressive forms of MS that have reached the clinical development phase, including vaccination with autologous T cells, autologous tolerogenic dendritic cells, T cell receptor peptide vaccination, altered peptide ligand, ATX-MS-1467, cluster of differentiation (CD)-206-targeted liposomal myelin basic protein peptides and DNA vaccination. Failures, successes and future directions are discussed.

VALIDATE: Exploiting the synergy between complex intracellular pathogens to expedite vaccine research and development for tuberculosis, leishmaniasis, melioidosis and leprosy.

For several complex intracellular pathogens, we have an urgent need for effective vaccines and yet there are common barriers to vaccine development. These diseases, including tuberculosis, leishmaniasis, leprosy and melioidosis, cause a huge burden of disease and disproportionately affect low and middle income countries. They are therefore often neglected due to the marginalisation of affected populations and the poor predicted commercial return on investment. Barriers to vaccine development include an incomplete understanding of protective immunity and translation from the bench into clinical vaccine trials. The current linear approach to vaccine research and development for these pathogens, which involves basic research, vaccine design, and vaccine evaluation in preclinical challenge models and clinical trials, is inefficient for these complex intracellular pathogens. We have established a Global Challenges Research Fund Network for VAccine deveLopment for complex Intracellular neglecteD pAThogEns, "VALIDATE", where we aim to adopt a more flexible, integrated cross-pathogen approach to accelerate vaccine research and clinical development for these four pathogens, by cross-pathogen analyses, cross-discipline collaborations, and repeated integration of data from human and animal studies. This network provides a unique opportunity to bring together individuals working on four exemplar complex intracellular neglected pathogens ( M.tb, Leishmania spp., B. pseudomallei and M.leprae), which share a common lifestyle as pathogens of macrophages, induce similar end-stage pathologies and alter host immune and metabolic responses. The horizontal collaborations established throughout this network, together with the provision of a protected environment for early data sharing, will exploit these biological synergies. By interrogating mechanisms that lead from infection to disease, we will be able to develop common vaccine development strategies for these and other complex intracellular pathogens.

An educational intervention to improve human papilloma virus (HPV) and cervical cancer knowledge among African American college students

ObjectivesMisinformation and lack of formal education about cervical cancer may contribute to disparities. The objective of this study was to assess the role of an educational intervention in improving knowledge about Human papilloma virus (HPV) and cervical cancer among African American female college students. MethodsWe completed a total of 5 lectures at 4 different historically Black Colleges in North Carolina, Virginia, and West Virginia. Each 60min lecture reviewed basic female anatomy, HPV pathogenesis, cervical dysplasia, cervical cancer, HPV vaccination and cervical cancer screening. Participants completed pre- and post-lecture surveys assessing knowledge, attitudes and beliefs related to cervical cancer screening, HPV, and the HPV vaccine. ResultsA total of 72 students attended the lectures and 57 students completed the surveys. 96% of students reported knowledge of the HPV vaccine, however only 52% reported receiving the vaccine, and 42% completed the 3-shot series. About 77% of students over 21years of age reported having a Pap smear. Of the 16 knowledge-based questions, correct response rates significantly increased (74% v. 91%, p=0.005) with the intervention. At the completion of the intervention, 94% affirmed plans to get regular Pap smears and 87% affirmed plans to get the HPV vaccine. ConclusionsPrimary prevention and early detection are key interventions for reducing disparities in cervical cancer incidence and treatment. Community outreach efforts play an important role in reducing inequities in cancer among high-risk groups. The educational intervention utilized in this study was successful in improving knowledge about HPV and cervical cancer.