Choice Of Vaccine Research Articles

Spatio-temporal games of voluntary vaccination in the absence of the infection: the interplay of local versus non-local information about vaccine adverse events.

Under voluntary vaccination, a critical role in shaping the level and trends of vaccine uptake is played by the type and structure of information that is received and used by parents of children eligible for vaccination. In this article we investigate the feedbacks of spatial mobility and the spatial structure of information on vaccination dynamics, by extending to a continuous spatially structured setting existing behavioral epidemiology models for the impact of vaccine adverse events (VAEs) on vaccination choices. We considered the simplest spatial setting, namely classical 'Fickian' diffusion, and focused on the noteworthy case where the infection is absent. This scenario mimics the important case of a population where a previously endemic vaccine preventable infection was successfully eliminated, but the re-emergence of the disease must be prevented. This is, for example, the case of poliomyelitis in most countries worldwide. In such a situation, the dynamics of VAEs and of the related information arguably become the key determinant of vaccination decision and of collective coverage. In relation to this 'information issue', we compared the effects of three main cases: (i) purely local information, where agents react only to locally occurred events; (ii) a mix of purely local and global, country-wide, information due e.g., to country-wide media and the internet; (iii) a mix of local and non-local information. By representing these different information options through a range of different spatial information kernels, we investigated: the presence and stability of space-homogeneous, nontrivial, behavior-induced equilibria; the existence of bifurcations; the existence of classical and generalized traveling waves; and the effects of awareness campaigns enacted by the Public Health System to sustain vaccine uptake. Finally, we analyzed some analogies and differences between our models and those of the Theory of Innovation Diffusion.

A systematic review of factors influencing pregnant women’s future vaccination choices

Abstract Background Over the last years, vaccine hesitancy has been increasing globally, leading to a decrease in vaccination coverage in several Countries, mostly in Europe. Several systematic reviews were conducted to assess the determinants of hesitancy and of vaccination choices, but none of them focused on pregnant women, which would represent an ideal population to promote correct information on vaccines. Methods We conducted a systematic review of studies assessing knowledge and attitudes on paediatric vaccinations, vaccination choices and their determinants among pregnant women. We searched Medline, Scopus and Web of Science, adapting search terms to the different databases, following PRISMA Statement criteria. No time limits were set. Results A total of 5,309 records were retrieved. After duplicates removal and title/abstract selection, 15 full texts were included in the narrative synthesis. Most studies (14/15) were quantitative surveys, 2 focused only on specific vaccines (rotavirus and HPV), 4 studies were conducted in European countries (Germany and Italy). The main factors associated with vaccine hesitancy or refusal were the fear of side effects, in particular for the most recent vaccines, the perception of a greater importance of natural immunity and a low perception of utility of vaccines, the lack of trust in health professionals, having obtained information on vaccines not from a doctor, primiparity and a low level of education (for these two last factors, with inconsistent results between studies). Conclusions Available evidence shows that the perceived risks and importance of vaccinations and the information received during pregnancy can influence vaccination choices of future mothers, and that the determinants of hesitancy may vary in different contexts. Pregnant women represent a key population for the implementation of interventions aimed at increasing knowledge and acceptance of vaccinations, which should be based on an analysis of the specific context. Key messages The perceived risks and importance of vaccinations and the information received during pregnancy can influence vaccination choices of future mothers. Interventions aimed at increasing knowledge and acceptance of vaccinations should be based on an analysis of the specific context.

Understanding influenza vaccine perspectives and hesitancy in university students to promote increased vaccine uptake

IntroductionInfluenza vaccine hesitancy is a global barrier to controlling seasonal influenza. Influenza vaccination rates in university students lag behind current goals and pose a significant threat to the health of students on campuses. A broader understanding of the knowledge, attitudes and beliefs of university students are needed to develop targeted interventions to increase vaccination. MethodsAn anonymous cross-sectional survey was developed and distributed via REDCap to graduate and undergraduate students via individual college listservs at a large public university. Survey questions included demographic information and questions about vaccination history, preference for vaccine type (inactivated vaccine (IIV) or live attenuated vaccine (LAIV), knowledge of influenza vaccines, reasons for accepting or refusing vaccine and preference for receiving vaccine information and education. ResultsStudents in 14 colleges received the survey and 1039 respondents were included in analysis. Sixty two percent reported having been vaccinated for influenza and of those vaccinated most were in health-related fields that require vaccination. Graduate and vaccinated students were more knowledgeable about influenza; undergraduates had lower vaccination rates. Students preferred IIV over LAIV and were more knowledgeable about IIV. Those with history of vaccination during childhood had higher rates of vaccination. Twenty six percent overall and 41.6% of the unvaccinated still believed you could get the flu from the flu vaccine. Fear of needles and inconvenience were cited as major reasons for not getting vaccinated. Incentives were cited as important motivators by only 20%. Students preferred to receive vaccine information from medical providers followed by online information and campus events. ConclusionsA multipronged approach to increasing influenza vaccination of university students will be needed. Myths about influenza vaccine persist even in a relatively educated population. Programs will need to target undergraduate and students in non health-related fields, offer vaccine choices - IIV and LAIV and promote vaccination through medical providers and online information.

Factors influencing intention to obtain the HPV vaccine and acceptability of 2-, 4- and 9-valent HPV vaccines: A study of undergraduate female health sciences students in Fujian, China

BackgroundLittle research has been conducted on the intention to obtain HPV vaccine now that the vaccine is approved for use in China. Acceptance of the three HPV vaccines, which differ in valency and price, has never been investigated. MethodsAn online cross-sectional survey assessing female undergraduate students’ intention to obtain the HPV vaccine and their acceptability of 2-, 4- and 9-valent HPV vaccines (2vHPV, 4vHPV, and 9vHPV, respectively). ResultsOf a total of 997 complete responses, 55.2% reported intent to obtain the HPV vaccine. Some of the significant factors exerting influence on intent to obtain HPV vaccination were high knowledge score (OR = 1.469, 95% CI:1.087–1.987), perceived high risk of HPV infection (OR = 1.466, 95%CI:1.017–2.114), perception of no serious side effects (OR = 1.562, 95%CI:1.150–2.121), and mass media exposure to HPV vaccination information (OR = 2.196, 95%CI: 1.625–2.966). Socioeconomic status indicators did not significantly influence intent to obtain the HPV vaccine. A higher proportion of respondents were willing to pay for 2vHPV (78.6%) and 4vHPV (68.0%) compared with 9vHPV (49.3%). Socioeconomic status indicators were the strongest correlates of acceptability for all the three vaccines. Exposure to mass media reporting about HPV vaccination is the factor which exerts the most influence on acceptance of 9vHPV after socioeconomic status indicators. ConclusionsIt is important to improve knowledge and health beliefs, and to establish a mass media marketing strategy to promote HPV vaccination in order to enhance HPV vaccine uptake. Undergraduate female students should be provided with detailed information about the different valency vaccine choices to help them make informed decisions about immunization.

Efficacy evaluation of two live virus vaccines against an emerging pseudorabies virus variant.

Since late 2011, porcine infections with highly virulent and antigenic variant of pseudorabies virus (PRV) cause great economic loss in the swine industry in China, and its emergence leads to variable protection efficacy of the commercially available PRV vaccine. In the present study, the potential cross-protective efficacy of two live virus vaccines, includ- ing a commercial vaccine, and an attenuated low pathogenic PRV variant (rPRVTJ-delTK/gE/gI) against a PRV variant Tianjing (TJ) was evaluated in piglets. Vaccination of piglets with the live vaccine Bartha-K61 could not reduce the clinical signs, and was partially efficacious in the reduc- tion of viral loads upon PRV variant TJ challenge, indicating that this live vaccine provided limited cross-protection efficacy against the PRV variant infection. Additionally, rPRVTJ-delTK/gE/gI appeared to exert some beneficial efficiency in shortening the period of clinical fever and improv- ing the growth performance of the challenged pigs. Our findings give a valuable guidance for the choice and use of PRV vaccines to control PRV variant infection in the field.

Vaccine-Hesitant and Vaccine-Refusing Parents' Reflections on the Way Parenthood Changed Their Attitudes to Vaccination.

Having children compels parents to examine their vaccine beliefs, particularly if they are vaccine-hesitant or refuse all vaccines. Presently, little is known about the specific ways in which having children influences the vaccine beliefs of parents. This research examined how having children changed the attitudes of Australian vaccine-hesitant and vaccine-refusing parents towards childhood vaccination. We asked 904 Australian parents who believed that having children changed their attitudes to vaccination to describe these changes. Parents' responses were inductively, iteratively coded and thematically analysed. Themes were compared between parents who believed all vaccines should be refused, parents with varying degrees of vaccine hesitancy, and parents who were fully vaccine-accepting. Low numbers of responses from fully vaccine-accepting parents meant that this paper focused on mostly vaccine-hesitant and vaccine-refusing vaccine parents. Five themes were identified. Having children prompted all parents to learn about vaccine choices. Hesitant and refusing parents' interpreted vaccine choices through a lens of distrust of pharmaceutical companies and regulatory bodies overseeing vaccine safety. The distrust fuelled parents' fears about vaccination risks, such as side effects. Parents became concerned about the scheduled timing of vaccinations, particularly of the Hepatitis B vaccine. Parents among the three groups that believed some or all vaccines should be refused reported that a vaccine permanently injured their child. This research contributes to understanding how having children affects the vaccine attitudes among vaccine-hesitant and vaccine-refusing parents. Greater support for parents with negative vaccination experiences may prevent hesitant attitudes. The vaccination schedule needs to be communicated to parents better.

Are Healthcare Choices Predictable? The Impact of Discrete Choice Experiment Designs and Models

BackgroundLack of evidence about the external validity of discrete choice experiments (DCEs) is one of the barriers that inhibit greater use of DCEs in healthcare decision making. ObjectivesTo determine whether the number of alternatives in a DCE choice task should reflect the actual decision context, and how complex the choice model needs to be to be able to predict real-world healthcare choices. MethodsSix DCEs were used, which varied in (1) medical condition (involving choices for influenza vaccination or colorectal cancer screening) and (2) the number of alternatives per choice task. For each medical condition, 1200 respondents were randomized to one of the DCE formats. The data were analyzed in a systematic way using random-utility-maximization choice processes. ResultsIrrespective of the number of alternatives per choice task, the choice for influenza vaccination and colorectal cancer screening was correctly predicted by DCE at an aggregate level, if scale and preference heterogeneity were taken into account. At an individual level, 3 alternatives per choice task and the use of a heteroskedastic error component model plus observed preference heterogeneity seemed to be most promising (correctly predicting >93% of choices). ConclusionsOur study shows that DCEs are able to predict choices—mimicking real-world decisions—if at least scale and preference heterogeneity are taken into account. Patient characteristics (eg, numeracy, decision-making style, and general attitude for and experience with the health intervention) seem to play a crucial role. Further research is needed to determine whether this result remains in other contexts.

Do traditional economic theories of free riding behavior explain spatial clustering of HPV vaccine uptake?

RationaleGeographic clusters of low vaccination uptake reduce the population-level efficacy of vaccination programs. However, little is known about the mechanisms that drive geographic patterns in vaccination rates. Traditional economic theory considers vaccination as a classic public good and suggests that free riding—individuals taking advantage of public goods by relying on others’ immunization behavior without contributing toward them—is a primary cause of low vaccination rates. However, behavioral economics suggests that free riding does not fully explain observed individual behavior, and the presence of both high and low clusters of vaccination rates suggest that this theory alone does not fully explain geographic patterns of vaccination.ObjectiveWe assessed geographic clustering of HPV vaccination uptake and examined the evidence for or against free riding in HPV vaccination decisions.MethodsWe analyzed HPV vaccination decisions of low-income adolescent females (N = 601) residing in urban neighborhoods in Dallas, Texas, USA during 2011–2012. Spatial econometric models were estimated to assess the relationship between neighborhood vaccination rates and individual vaccination decisions.ResultsWe found a positive and significant relationship between individual HPV vaccination choices and the average neighborhood vaccination rate at the time parents were making vaccine decisions for their adolescent daughters while controlling for neighborhood sorting and other confounders.ConclusionIndividuals were more likely to complete the HPV vaccination series when others in their neighborhood had already completed the series. We do not find evidence for free riding in HPV vaccination decisions.

Adverse Events of Interest Vary by Influenza Vaccine Type and Brand: Sentinel Network Study of Eight Seasons (2010-2018)

Background: There are a range of types of influenza vaccines: Inactivated vaccines vary by number of component virus strains, they are trivalent (TIV) or quadrivalent (QIV) and are given by injection. Live attenuated influenza vaccine (LAIV) is given intranasal. Monitoring of adverse events of interests (AEIs) following influenza vaccination is recommended by the European Medicines Agency (EMA) to monitor common and detect infrequent but important adverse events of interest (AEI). Methods: A retrospective cohort study of the computerised medical record data from the Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) sentinel network database 2010-2018 (N=848,375). We extracted data about vaccine exposure (n=3,121,334) and AEIs specified by the EMA (1,488,870 consultations by 430,029 unique individuals). We report relative incidence (RI) of AEIs. An RI <1 signified lower AEI rate compared to TIV. Findings: QIV was associated with a RI of AEIs of 1.14 (95%CI, 1.10-1.18, p<0.01), though the number of years exposure was limited. By way of contrast, LAIV had a lower rate 0.60 (95%CI 0.63-0.68, p<0.001). Cellular manufacture was also associated with a lower rate 0.78 (95%CI 0.61-0.99, p=0.04). AEIs varied by season rash and musculoskeletal conditions are particularly pronounced in the 2014/15 season and respiratory conditions in 2016/17. Interpretation: Routine sentinel network data can be used to contrast AEIs between vaccine types and may provide a consistent method of observation of vaccine benefit-risk over time. The contracting RIs may help guide policy and vaccine choice. Funding: JWC Health Education England academic placement. Declaration of Interest: SdeL received funding from GSK to conduct EMA specification enhanced surveillance of AEIs, through the University of Surrey. He has attended Sanofi, and Seqirus advisory boards. Ethical Approval: The study was approved by RCGP, and the Health Research Authority/ Medical Research Council tool suggested this was a service evaluation of usual practice study not requiring further ethical review.

Vaccine-derived varicella zoster infection in a kidney transplant recipient after zoster vaccine live administration

A 49-year-old kidney transplant recipient, presented with a skin rash, and interstitial infiltrates three weeks after receiving a live attenuated varicella-zoster vaccine. Varicella-zoster Oka-vaccine strain was detected in plasma by polymerase chain reaction and sequencing analysis targeting open reading frame 62 (ORF 62). She was treated successfully with intravenous acyclovir. Our case report supports the current contraindication of live attenuated varicella-zoster vaccine in the solid-organ transplant recipients. Recombinant subunit varicella-zoster vaccine may be the vaccine of choice in these patients; nevertheless, further information is required to establish its safety, efficacy, and optimal timing.

The duopoly of ten-valent and 13-valent pneumococcal conjugate vaccines: do they differ?

The duopoly of ten-valent and 13-valent pneumococcal conjugate vaccines: do they differ?

Immunogenicity and reactogenicity of ten-valent versus 13-valent pneumococcal conjugate vaccines among infants in Ho Chi Minh City, Vietnam: a randomised controlled trial

SummaryBackgroundFew data are available to support the choice between the two currently available pneumococcal conjugate vaccines (PCVs), ten-valent PCV (PCV10) and 13-valent PCV (PCV13). Here we report a head-to-head comparison of the immunogenicity and reactogenicity of PCV10 and PCV13.MethodsIn this parallel, open-label, randomised controlled trial, healthy infants from two districts in Ho Chi Minh City, Vietnam, were randomly allocated (in a 3:3:5:4:5:4 ratio), with use of a computer-generated list, to one of six infant PCV schedules: PCV10 in a 3 + 1 (group A), 3 + 0 (group B), 2 + 1 (group C), or two-dose schedule (group D); PCV13 in a 2 + 1 schedule (group E); or no infant PCV (control; group F). Blood samples were collected from infants between 2 months and 18 months of age at various timepoints before and after PCV doses and analysed (in a blinded manner) by ELISA and opsonophagocytic assay. The trial had two independent aims: to compare vaccination responses between PCV10 and PCV13, and to evaluate different schedules of PCV10. In this Article, we present results pertaining to the first aim. The primary outcome was the proportion of infants with an IgG concentration of at least 0·35 μg/mL for the ten serotypes common to the two vaccines at age 5 months, 4 weeks after the two-dose primary vaccination series (group C vs group E, per protocol population). An overall difference among the schedules was defined as at least seven of ten serotypes differing in the same direction at the 10% level. We also assessed whether the two-dose primary series of PCV13 (group E) was non-inferior at the 10% level to a three-dose primary series of PCV10 (groups A and B). This trial is registered with ClinicalTrials.gov, number NCT01953510.FindingsOf 1424 infants screened between Sept 30, 2013, and Jan 9, 2015, 1201 were allocated to the six groups: 152 (13%) to group A, 149 (12%) to group B, 250 (21%) to group C, 202 (17%) to group D, 251 (21%) to group E, and 197 (16%) to group F. 237 (95%) participants in group C (PCV10) and 232 (92%) in group E (PCV13) completed the primary vaccination series and had blood draws within the specified window at age 5 months, at which time the proportion of infants with IgG concentrations of at least 0·35 μg/mL did not differ between groups at the 10% level for any serotype (PCV10–PCV13 risk difference −2·1% [95% CI −4·8 to −0·1] for serotype 1; −1·3% [–3·7 to 0·6] for serotype 4; −3·4% [–6·8 to −0·4] for serotype 5; 15·6 [7·2 to 23·7] for serotype 6B; −1·3% [–3·7 to 0·6] for serotype 7F; −1·6% [–5·1 to 1·7] for serotype 9V; 0·0% [–2·7 to 2·9] for serotype 14; −2·1% [–5·3 to 0·9] for serotype 18C; 0·0% [–2·2 to 2·3] for serotype 19F; and −11·6% [–18·2 to −4·9] for serotype 23F). At the same timepoint, two doses of PCV13 were non-inferior to three doses of PCV10 for nine of the ten shared serotypes (excluding 6B). Reactogenicity and serious adverse events were monitored according to good clinical practice guidelines, and the profiles were similar in the two groups.InterpretationPCV10 and PCV13 are similarly highly immunogenic when used in 2 + 1 schedule. The choice of vaccine might be influenced by factors such as the comparative magnitude of the antibody responses, price, and the relative importance of different serotypes in different settings.FundingNational Health and Medical Research Council of Australia, and Bill & Melinda Gates Foundation.

A bread-based lyophilized C-strain CSF virus vaccine as an oral vaccine in pigs.

A live attenuated cereal-based classical swine fever (CSF) vaccine for oral application, a form of vaccine that farmers can use themselves, demonstrated the improvement of CSF control in backyard production systems in endemic areas. Due to the dependency on very low storage temperature (-20°C) of the cereal-based oral CSF vaccine, a lyophilized cereal-based oral vaccine has been developed and tested. Although some studies showed total protection against a virulent virus strain, the production procedure is still considered complex. In this study, the lyophilized oral CSF virus, which is easy to produce and could be kept in the form of a bread-based vaccine at 4°C for an extended time, was tested for the ability to induce a humoral immune response in pigs. Among the materials tested as a base for the CSF virus vaccine, plain sliced bread was considered the most appropriate base because of its absorbing ability and virus titre maintenance. Titres of bread-based lyophilized CSF virus vaccine were stable at around 3.67 log10 TCID50 per ml for 7months at 4°C. Pigs aged 5 and 8weeks that orally received five bread-based lyophilized CSF virus vaccine showed seroconversion of over 90% at 14 dpv. At 28 dpv, both age groups showed 100% seroconversion. In conclusion, the bread-based lyophilized CSF virus vaccine can be an alternative choice for oral vaccination of pigs. Due to the simple process of production and the need for less virus titre, vaccine prices could be lowered. However, vaccine thermostability has to be improved to allow the vaccine delivery to be less dependent on functioning cool chains.

Adjuvanted influenza vaccine for the Italian elderly in the 2018/19 season: an updated health technology assessment.

BackgroundThe elderly, defined here as subjects aged ≥ 65 years, are among at-risk subjects for whom annual influenza vaccination is recommended. For the 2018/19 season, three vaccine types are available for the elderly in Italy: trivalent inactivated vaccine (TIV), adjuvanted TIV (aTIV) and quadrivalent inactivated vaccines (QIV). No health technology assessment (HTA) of seasonal influenza vaccination in the elderly has previously been conducted in Italy.MethodsAn HTA was conducted in 2017 to analyze the burden of influenza illness, the characteristics, efficacy, safety and cost-effectiveness of available vaccines and the related organizational and ethical implications. This was then contextualized to the 2018/19 influenza season. Comprehensive literature reviews/analyses were performed and a static mathematical model developed in order to address the above issues.ResultsIn Italy, influenza is usually less common in the elderly than in other age-classes, but the burden of disease is the highest; >10% of infected elderly subjects develop complications, and about 90% of all influenza-related deaths occur in this age-class. All available vaccines are effective, safe and acceptable from an ethical standpoint. However, aTIV has proved more immunogenic and effective in the elderly. Furthermore, from the third payer’s perspective, aTIV is highly cost-effective and cost-saving in comparison with TIV and QIV, respectively. Nevertheless, vaccination coverage needs to be improved.ConclusionsAccording to this HTA, aTIV appeared the vaccine of choice in the elderly. HTA should be reapplied whenever new relevant data become available.

Civility, credibility, and health information: The impact of uncivil comments and source credibility on attitudes about vaccines.

As individuals turn to social media sites for health information, it is important to understand the factors that influence their perceptions of this information. This study employed an experiment to investigate the impact of social media discussion on perceptions of vaccines. Analysis, using structural equation modeling, revealed that source credibility and the civility of a discussion indirectly influence policy support requiring vaccinations, intention to vaccinate future children, and willingness to engage in discussion about vaccines. This impact is mediated by message elaboration and attitudes of the value of vaccinations. As individuals think about a pro-vaccine message and understand the importance of receiving vaccinations, they are more likely to engage in pro-social vaccination choices.

Cost-Effectiveness Comparison of Pneumococcal Conjugate Vaccines in Turkish Children

BackgroundThe 13-valent pneumococcal conjugate vaccine (PCV13) is used for universal infant vaccination in Turkey. ObjectivesTo assess the cost effectiveness of replacing PCV13 with pneumococcal nontypeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV). MethodsA Markov cohort model with monthly cycles following 1 cohort of infants over a 10-year time horizon was used. Local input parameters were obtained from published sources and expert consultation whenever possible. The model was adapted to estimate the health benefits and economic impact of each vaccine on invasive pneumococcal disease, pneumonia, and acute otitis media (AOM). An annual discount rate of 3% was used for benefits and costs (2016 euros). ResultsUnder base-case assumptions, vaccinating 1 birth cohort of 1 325 783 infants with PHiD-CV instead of PCV13 was predicted to have the same impact on meningitis and pneumonia, a similar impact on bacteremia (+30 cases), but greater reductions in AOM-related general practitioner visits (−34 955) and hospitalizations (−624). Assuming equal vaccine prices, PHiD-CV was predicted to be dominant over PCV13 (176 additional quality-adjusted life-years while saving €635 330 [discounted]). One-way sensitivity analysis indicated that varying the vaccine price differential had the largest effect on the incremental cost-effectiveness ratio, and then AOM parameters. Probabilistic sensitivity analysis predicted PHiD-CV to be dominant over PCV13 in 92.4% of simulations. ConclusionsAny difference in price between PHiD-CV and PCV13 is expected to be the key driver of vaccine choice for preventing childhood pneumococcal disease in Turkey. At price parity, PHiD-CV use is likely to be a dominant strategy over the use of PCV13.

Vaccine Education, Reasons for Refusal, and Vaccination Behavior

Little is known about associations between the reasons parents refuse or delay vaccines for their children, their responsiveness to vaccine counseling, and their children's vaccination status at various ages. Since 2015, Michigan has required parents to attend education sessions at local health departments to receive nonmedical exemptions. This requirement provides an opportunity to study otherwise opaque aspects of vaccine refusal. In 2017 and 2018, researchers analyzed a combined data set that included electronic medical records (n=4,098) generated by one Michigan health department during 2015 immunization education sessions, and immunization records from an August 2016 report of the Michigan Care Improvement Registry immunization registry. Analyses employed difference of proportions and ANOVAs to explore group differences in vaccination behaviors after education sessions and on-time vaccination status at various ages. Children whose parents stated a commitment to an alternative schedule at the education session subsequently received a vaccine their parents had refused at a much higher rate (39.2%) than did children whose parents refused for reasons of religion (4.4%), concerns about the risks of vaccines (8.1%), or beliefs that vaccines provide little benefit (10.5%). Different reasons for refusal are associated with different patterns of vaccination behavior. Furthermore, results suggest that education sessions may overcome vaccine refusal in some cases, and that distinct refusal reasons mark real differences in parental motivations regarding vaccination choices. These differences in parental motivations may indicate the existence of different sites for potential pro-vaccination interventions.

An ethical appraisal of the choice of vaccines against Poliomyelitis.

Medical ethics is invoked for immunisation of children as it involves an interaction between a healthcare professional and the child. Immunisation under the national immunisation programme is a public health intervention and the common belief is that ethics is not relevant. Two vaccines with contrasting safety and efficacy profiles were available against polio before the national immunisation programme was launched: the inactivated poliovirus vaccine (IPV) and the live attenuated oral poliovirus vaccine (OPV). India chose OPV and excluded IPV. We carried out an ethical appraisal of that choice. Principles of medical ethics comprising four elements-non-maleficence, beneficence, autonomy and justice-was already in vogue at the time. Applying each of them, a head-to-head comparison between IPV and OPV is made. The results clearly show that the choice of vaccine was made without using ethical principles, resulting in serious adverse effects in hundreds of thousands of children. We recommend that medical ethics must be applied to all choices of public health interventions.

Projected impact, cost-effectiveness, and budget implications of rotavirus vaccination in Mongolia

IntroductionRotavirus disease in Mongolia is estimated to cause more than 50 deaths yearly and many more cases and hospitalizations. Mongolia must self-finance new vaccines and does not automatically access Gavi prices for vaccines. Given the country’s limited resources for health, it is critical to assess potential new vaccine programs. This evaluation estimates the impact, cost-effectiveness, and budget implications associated with a nationwide rotavirus vaccine introduction targeting infants as part of the national immunization program in Mongolia, in order to inform decision-making around introduction. MethodsThe analysis examines the use of the two-dose vaccine ROTARIX®, and three-dose vaccines ROTAVAC® and RotaTeq® compared to no vaccination from the government and the societal perspective. We use a modelling approach informed by local data and published literature to analyze the impact and cost-effectiveness of rotavirus vaccination over a ten-year time period starting in 2019, using a 3% discount rate. Our main outcome measure is the incremental cost-effectiveness ratio (ICER) expressed as US dollar per DALY averted. We assessed uncertainty around a series of parameters through univariate sensitivity analysis. ResultsRotavirus vaccination in Mongolia could avert more than 95,000 rotavirus cases and 271 deaths, over 10 years. Averted visits and hospitalizations represent US$2.4 million in health care costs saved by the government. The vaccination program cost ranges from $6 to $11 million depending on vaccine choice. From the governmental perspective, ICER ranged from $412 to $1050 and from $77 to $715 when considering the societal perspective. Sensitivity analysis highlights vaccine price as the main driver of uncertainty. ConclusionIntroduction of rotavirus vaccination is likely to be highly cost-effective in Mongolia, with ICERs estimated at only a fraction of Mongolia’s per capita GDP. From an economic standpoint, ROTAVAC® is the least costly and most cost-effective product choice.

Evaluation of Humoral Immune Response Against Lumpy Skin Disease Virus in Cattle Vaccinated with Sheep Pox Virus Vaccine

The present study aimed to determine the humeral immune response against lumpy skin disease (LSD) of animals vaccinated with live attenuated sheep pox virus vaccine in Egypt, and to predict the efficacy of this vaccine in protecting indigenous cattle against LSD, The study was carried on 15 apparently healthy calves 5 of them were kept for control. And 10 were vaccinated with live attenuated sheep-pox vaccine. The humeral immune response was assessed using serum neutralization test and results revealed that Abs titers were significantly increased from week to week till the tenth week after vaccination and become protective against lumpy skin disease infection from after the third week post vaccination. The same test also made on animals having natural infection with LSD to compare the level of antibodies formed against LSD natural infection with that formed post vaccination with live attenuated sheep-pox vaccine. Results revealed that level of Abs formed against LSD natural infection with was higher than those formed post vaccination with live attenuated sheep-pox vaccine. In conclusion, live attenuated sheep pox vaccine has the ability to induce a high level of antibody titer with prolongation of the duration of immunity, so it considered the best choice of vaccine to control the LSD disease in the field.