Complete Vaccination Research Articles

Vaccination Shortens the Negative Nucleic Acid Conversion Time of the Older Population: A Retrospective Cohort Study of 73,456 Asymptomatic and Mild Patients with COVID-19 in Shanghai.

To explore the influencing factors to predict the negative nucleic acid conversion time and ORF1ab gene CT value changes in patients with asymptomatic and mild COVID-19. A total of 73,456 patients with asymptomatic and mild COVID-19 admitted to the Mobile Cabin Hospital in Shanghai from April 3 to April 23, 2022 were selected as the research objects. Epidemiological, clinical, and laboratory data were collected. Correlation analysis was performed. In patients <18 years old and ≥65 years old, COVID-19 vaccine can shorten the negative nucleic acid conversion time, which is reflected in the lower median or 75% quantile (P<0.001, P<0.05). In patients with underlying diseases, the negative nucleic acid conversion time of booster vaccination and complete vaccination was lower than that of non-vaccinated group (P<0.001, P<0.05). In patients ≤18 years of age or >65 years of age, patients with comorbidity and patients with symptoms, compared with patients 18-65 years of age, patients without comorbidity and patients without symptoms, there was a greater difference in the rate of rise of CT values between vaccinated and unvaccinated patients (P<0.05). The time of nucleic acid conversion to negative in patients with asymptomatic and mild COVID-19 is affected by age, comorbidity, and first nucleic acid CT value. Vaccination could shorten the negative nucleic acid conversion time of the older population, those with complications or symptoms. The vaccination of older patients does not increase the risk of symptoms.

Impact of Healthcare Location Concordance on Receipt of Preventive Care Among Children Whose Parents have a Substance Use and/or Mental Health Diagnosis.

Children of parents with substance use and/or other mental health (SU/MH) diagnoses are at increased risk for health problems. It is unknown whether these children benefit from receiving primary care at the same clinic as their parents. Thus, among children of parents with >1 SU/MH diagnosis, we examined the association of parent-child clinic concordance with rates of well-child checks (WCCs) and childhood vaccinations. Retrospective cohort study using electronic health record (EHR) data from the OCHIN network of community health organizations (CHOs), 2010-2018. Setting: 280 CHOs across 17 states. 41,413 parents with >1 SU/MH diagnosis, linked to 65,417 children aged 0 to 17 years, each with >1 visit to an OCHIN clinic during the study period. Dependent variables: rates of WCCs during (1) the first 15 months of life, and (2) ages 3 to 17 years; vaccine completeness (3) by the age of 2, and (4) before the age of 18. Estimates were attained using generalized estimating equations Poisson or logistic regression. Among children utilizing the same clinic as their parent versus children using a different clinic (reference group), we observed greater WCC rates in the first 15 months of life [adjusted rate ratio (aRR) = 1.06; 95% confidence interval (CI) = 1.02-1.10]; no difference in WCC rates in ages 3 to 17; higher odds for vaccine completion before age 2 [adjusted odds ratio (aOR) = 1.12; 95% CI = 1.03-1.21]; and lower odds for vaccine completion before age 18 (aOR = 0.88; 95% CI = 0.81-0.95). Among children whose parents have at least one SU/MH diagnosis, parent-child clinic concordance was associated with greater rates of WCCs and higher odds of completed vaccinations for children in the youngest age groups, but not the older children. This suggests the need for greater emphasis on family-oriented healthcare for young children of parents with SU/MH diagnoses; this may be less important for older children.

Assessing the long-term implications of age 9 initiation of HPV vaccination on series completion by age 13-15 in the US: projections from an age-structured vaccination model.

Routine human papillomavirus (HPV) vaccination in the US is recommended at ages 11 or 12 years and can be given at age 9. Vaccination completion rates among adolescents 13-15 years in the US remain below the 80% goal. This study evaluated the long-term effects of increasing proactive HPV vaccination initiation rates at age 9 years in completion rates of adolescents. An age-structured vaccination model was developed and parametrized based on the National Immunization Survey-Teen (NIS-Teen) survey data. The model projected vaccination coverage (by vaccination status and age group), for 20 years, for a routine initiation scenario (no increase in initiation rates of 9-year-olds) and different proactive initiation (increased age 9 initiation) scenarios. The time to reach a completion rate of 80% for 13-15-year-olds was estimated. The model also generated projections stratified for subgroups of interest. Results indicated that vaccine completion rates of 80% in 13-15-year-olds may not be achieved by 2040 under current trends of routine initiation at ages 11 or 12 years. However, increasing initiation rates in 9-year-olds by 1% and 3% annually could shorten the time to achieve 80% completion by 4 and 8 years, respectively. Stratification analyses showed that increasing initiation rates in 9-year-olds can also reduce disparities across subgroups in the time to achieve vaccination completion targets. Increasing HPV vaccination initiation rates in 9-year-olds by as little as 1%-3% annually may be an effective strategy to improve HPV vaccination completion rates in adolescents by age 15 and reach the Healthy People goal of 80% completion much earlier.

COVID-19 Vaccine Policy Implementation and Differential Vaccine Uptake Trajectories in Chicago Communities.

Since the onset of the COVID-19 pandemic, multiple public health interventions have been implemented to respond to the rapidly evolving pandemic and community needs. This article describes the scope, timing, and impact of coordinated strategies for COVID-19 vaccine uptake in Chicago for the first year of vaccine distribution. Using a series of interviews with public health officials and leaders of community-based organizations (CBOs) who participated in the implementation of the citywide COVID-19 vaccine outreach initiatives, we constructed a timeline of vaccine outreach initiatives. The timeline was matched to the vaccine uptake rates to explore the impact of the vaccine outreach initiatives by community area. Finally, we discussed the nature of policy initiatives and the level of vaccine uptake in relation to community characteristics. The Chicago Department of Public Health (CDPH) implemented myriad vaccine outreach strategies, including mass vaccination sites, improved access, and community-level vaccine campaigns. Protect Chicago+ was the primary vaccine outreach effort initiated by the CDPH, which identified 15 highly vulnerable community areas. More than 2.7 million (67%) Chicagoans completed the vaccine regimen by December 2021. Black (51.3%) Chicagoans were considerably less likely to be vaccinated than Asian (77.6%), White (69.8%), and Hispanic (63.6%) Chicago residents. In addition, there were significant spatial differences in the rate of COVID-19 vaccine completion: predominantly White and Hispanic communities, compared with Black communities, had higher rates of vaccine completion. The community outreach efforts to improve COVID-19 vaccine uptake in Chicago have shown the importance of community-engaged approaches in pandemic responses. Despite citywide efforts to build community infrastructure, Black communities had relatively lower levels of vaccine uptake than other communities. Broader social restructuring to mitigate disinvestment and residential segregation and to ameliorate medical mistrust will be needed to prepare for future pandemics and disasters.

The effect of previous SARS-CoV-2 infection on systemic immune responses in individuals with tuberculosis.

The impact of previous SARS-CoV-2 infection on the systemic immune response during tuberculosis (TB) disease has not been explored. An observational, cross-sectional cohort was established to evaluate the systemic immune response in persons with pulmonary tuberculosis with or without previous SARS-CoV-2 infection. Those participants were recruited in an outpatient referral clinic in Rio de Janeiro, Brazil. TB was defined as a positive Xpert-MTB/RIF Ultra and/or a positive culture of Mycobacterium tuberculosis from sputum. Stored plasma was used to perform specific serology to identify previous SARS-CoV-2 infection (TB/Prex-SCoV-2 group) and confirm the non- infection of the tuberculosis group (TB group). Plasmatic cytokine/chemokine/growth factor profiling was performed using Luminex technology. Tuberculosis severity was assessed by clinical and laboratory parameters. Participants from TB group (4.55%) and TB/Prex-SCoV-2 (0.00%) received the complete COVID-19 vaccination. Among 35 participants with pulmonary TB, 22 were classified as TB/Prex-SCoV-2. The parameters associated with TB severity, together with hematologic and biochemical data were similar between the TB and TB/Prex-SCoV-2 groups. Among the signs and symptoms, fever and dyspnea were significantly more frequent in the TB group than the TB/Prex-SCoV-2 group (p < 0,05). A signature based on lower amount of plasma EGF, G-CSF, GM-CSF, IFN-α2, IL-12(p70), IL-13, IL-15, IL-17, IL-1β, IL-5, IL-7, and TNF-β was observed in the TB/Prex-SCoV-2 group. In contrast, MIP-1β was significantly higher in the TB/Prex-SCoV-2 group than the TB group. TB patients previously infected with SARS-CoV-2 had an immunomodulation that was associated with lower plasma concentrations of soluble factors associated with systemic inflammation. This signature was associated with a lower frequency of symptoms such as fever and dyspnea but did not reflect significant differences in TB severity parameters observed at baseline.

Effects of the vaccination campaign on hospitalization and mortality linked to measles in Brazil in the last decade

Measles is one of the main causes of morbidity and mortality in the pediatric population and it can be prevented with 100% effectiveness by vaccination. However, the disease remains active in throughout Brazil. The scope of this article is to evaluate the population's adherence to vaccination and the potential connection with hospitalizations and mortality in relation to measles in Brazil. This is an ecological study based on secondary data on mortality and hospitalizations due to measles and vaccination coverage against the disease in Brazil from 2013 to 2022. The peak of adherence to the measles vaccination schedule occurred in the 3 years that preceded the eradication of the disease in the country, which occurred in 2016. In this interval, there are the lowest hospitalization rates, with zero mortality from 2014 to 2017. On the other hand, there has been a marked drop in vaccination rates since 2019, when the disease resurfaced in Brazil. Concomitantly, hospitalization and mortality rates reach the highest recorded values. Population adherence to the complete measles vaccination schedule, which is essential to control the disease and related deaths, is insufficient, which is reflected in hospitalization and mortality rates.

Factors associated with adherence to the COVID-19 vaccine in pregnant women.

to identify factors associated with adherence to the COVID-19 vaccine during pregnancy. cross-sectional and analytical study with 348 postpartum women in shared accommodation at the Municipal Maternities of Recife-PE. Data was collected through interviews during the months of June to September 2022. Pearson's Chi-Square or Fisher's Exact tests and the Poisson regression model were applied for statistical analysis. 17.2% of pregnant women adhered to the complete vaccination schedule, and adherence was associated with access to the internet/TV/radio (p-value = 0.011), routine prenatal vaccination (p-value = 0.019), safety of the efficacy of the COVID-19 vaccine and partner support (p-value = 0.020). Postpartum women without access to the internet/TV/radio, and who feel confident about the effectiveness of the vaccine, had higher prevalence rates for adhering to COVID-19 vaccination, with PRs of 2.56 and 3.25, respectively. there was evidence of low adherence to the vaccination schedule against COVID-19 during the gestational period, considering the number of recommended doses and the interval between them. Therefore, professionals in their clinical practice must make pregnant women aware of the importance of immunization and compliance with the vaccination schedule. (1) Maternal vaccination plays a significant role in preventing and combating maternal morbidity. (2) Some factors may influence acceptance or hesitancy of the COVID-19 vaccine during pregnancy. (3) Safety regarding the effectiveness of vaccination against COVID-19 during pregnancy is a factor associated with adherence to COVID-19 vaccines. (4) Postpartum women without access to the internet/TV/radio have 2.56 times the risk of adhering to the COVID-19 vaccination schedule. (5) Health education helps to increase the level of knowledge and acceptance of the vaccine by pregnant women.

Knowledge of Hepatitis-B Management and its Prevention among the Senior Staff Nurses Working at Bangabandhu Sheikh Mujib Medical University (BSMMU)

Background: Hepatitis B, caused by the Hepatitis B virus (HBV), presents a significant global health challenge, especially in regions like Bangladesh where its prevalence is intermediate. The virus is transmitted through percutaneous or mucosal exposure to infectious blood or bodily fluids, posing a substantial risk to healthcare workers. Hepatitis B can lead to severe liver diseases if untreated. In Bangladesh, the burden of Hepatitis B is high, necessitating urgent intervention, particularly among healthcare professionals such as senior staff nurses who are on the frontline of managing and preventing the disease. Methods: This cross-sectional study assessed the knowledge levels of 210 senior staff nurses at Bangabandhu Sheikh Mujib Medical University (BSMMU) regarding Hepatitis B management and prevention. A structured questionnaire, translated into Bengali, was used for data collection through structured interviews. Convenience sampling was employed, and data were analyzed using SPSS (Version 24.0). Descriptive statistics and t-tests/ANOVA were used to explore the relationship between socio-demographic characteristics and nurses’ knowledge about Hepatitis B. Ethical clearance was obtained from the Institutional Review Board (IRB) of BSMMU. Results: The majority of respondents were female (70%), aged below 30 years (59.5%), and had basic nursing education (89.5%). Most had 1-10 years of work experience (89%) and earned less than 35,000 BDT monthly (78.1%). Regarding vaccination, 64.3% had completed it, 26.7% were partially vaccinated, and 9% were unvaccinated. Occupational exposure to blood or body fluids was reported by 73.3% of nurses. Knowledge about Hepatitis B infection, transmission, and prevention was generally high, with 85.44%, 89.14%, and 85.11% of nurses demonstrating good knowledge in these areas, respectively. Marital status and vaccination status were significantly associated with higher knowledge levels (p &lt; 0.05). Conclusion: Senior staff nurses at BSMMU exhibit substantial knowledge about Hepatitis B infection, transmission, and prevention. However, misconceptions persist regarding non-transmission routes and some preventive measures. Married nurses and those with complete vaccination status demonstrated higher knowledge levels. These findings highlight the need for targeted educational interventions to address knowledge gaps and reinforce preventive practices among nurses. This study underscores the importance of continuous education and vaccination programs to enhance the effectiveness of Hepatitis B management and prevention efforts in healthcare settings.

Hepatitis B vaccine among healthcare workers: factors associated with the dimensions of the Health Belief Model.

To investigate the association between the dimensions of the Health Belief Model (HBM) and complete vaccination for hepatitis B among healthcare workers (HCW). Cross-sectional epidemiological study with HCW in Primary Health and Medium Complexity Care. Univariate and bivariate analyses were performed to test the association between the outcome variable (complete vaccination for hepatitis B based on self-report) and the variables of the HBM dimensions. Prevalence ratio (PR) and its respective 95% confidence intervals (95%CI) were calculated. 453 HCW participated. The prevalence of complete vaccination for hepatitis B was 56.9%. In the final analysis model, the following variables were associated with complete vaccination for hepatitis B: chances of having hepatitis B (PR=1.73) - related to the susceptibility dimension; disease severity (PR=0.74) - related to severity; reduced risk of absenteeism (PR=1.29) - related to benefits; not spending time to get vaccinated (PR=1.41) and not worrying about Events Supposedly Attributable to Vaccination or Immunization (PR=1.43) - related to barriers. The completeness of the hepatitis B vaccination schedule, reported by the investigated HCW, reveals the prevalence is below the target established by the Ministry of Health, which follows the national scenario of low coverage presented for other age groups. Understanding the risk perception and severity of hepatitis B can contribute to increasing the prevalence of vaccination for this infection.

Complete Dose of Hepatitis B Vaccination Among Children in Indonesia and Factors Associated: A Community-Based Study

Hepatitis B vaccination is widely recognized as the most effective way to prevent hepatitis B infection, yet the rate of complete vaccination among Indonesian children remains low. This study aimed to evaluate the extent of hepatitis B vaccination coverage among children and identify potential associated factors in Indonesia. A community-based cross-sectional study was conducted. The study involved 7,860 Indonesian mothers of children aged 12-59 months, providing data on their children's hepatitis B vaccination status and other relevant factors from the 2017 Indonesian Demographic Health Survey. Overall, the rate of complete hepatitis B vaccination among children was relatively high (89.8%). Several factors were found to be associated with complete hepatitis B vaccination among children: living in Java, the Lesser Sunda Islands, Kalimantan, and Sulawesi compared to Sumatra; having an older mother; having parents with secondary or higher education compared to no education; having an employed mother; belonging to middle or high economic status compared to low economic status; having mothers using media irregularly or regularly, as opposed to never using media; having health insurance; and having a larger family size. These findings highlight the need for further interventions to optimize childhood hepatic vaccination coverage, which health policymakers should support.

Vaccination coverage survey by social stratum in children up to 24 months of age in Londrina, Paraná, Brazil, between 2021 and 2022.

To analyze vaccination coverage according to social strata in children up to 24 months old, living in the municipality of Londrina (PR), Brazil. This was a population-based survey conducted between 2021 and 2022, in which vaccination coverage and sociodemographic aspects of mothers and families were evaluated using Pearson's chi-square test. In a sample of 456 children, complete vaccination coverage varied according to social strata, being 36.0% (95%CI 26.8;57.8); in stratum A; 59.5% (95%CI 26.1;86); in stratum B; 66.2% (95%CI 51.7;78.1); in stratum C; and 70.0% (95%CI 56.1;81.0) in stratum D. The analysis of vaccination coverage indicated that social stratum A is at highest risk for vaccine-preventable diseases. The results of the study showed low full vaccination coverage in children up to 24 months of age in Londrina, being higher in the less financially advantaged social stratum, compared to the most advantaged. The results found can support the qualification of the immunization program and enable, based on planning and ongoing health education, the definition of unique strategies to improve vaccination coverage. Future perspectives point to the importance of carrying out investigations into the challenges inherent to vaccination, as well as qualitative and quantitative research addressing health professionals to better understand the data.

Complete vaccination coverage of children born in 2017-2018, living in urban areas of state capitals and in 12 inland cities in Brazil: a population-based survey from a retrospective cohort study

RESUMO Objetivo Estimar a cobertura vacinal em crianças nascidas entre 2017-2018, residentes nas áreas urbanas das capitais, do Distrito Federal e em 12 municípios do interior do Brasil, e identificar fatores associados. Métodos Inquérito domiciliar realizado entre 2020-2022, em crianças até 24 meses. Estimou-se a cobertura vacinal segundo características da família, da mãe e da criança. Resultados Nas 37.801 crianças da amostra, a cobertura completa (doses aplicadas) foi de 60,1% (IC95% 58,6;61,6), e 6,1% (IC95% 5,4;7,0) não receberam qualquer vacina. A cobertura foi menor em crianças de mães com menor instrução (OR = 0,70; IC95% 0,54;0,90) e nas que tinham atraso em qualquer vacina até os 6 meses de vida (OR = 0,28; IC95% 0,24;0,32). Conclusão As coberturas vacinais estão aquém do esperado. É necessário adotar estratégias de comunicação efetivas para reforçar a importância da vacinação de rotina, prevenindo atrasos e abandono do esquema vacinal, para retomar os altos níveis alcançados em décadas passadas.

The prevalence of long COVID-19 syndrome in hospitalized patients with COVID-19 pneumonia.

Long COVID affects millions of individuals worldwide with a wide range of persistent symptoms. Pathogenesis, prevalence and clinical approach of this syndrome remain not well characterized.The aim of the study is the estimation of prevalence of long-COVID and identification of possible risk factors. This is an observational prospective study including COVID-19 patients hospitalized at the Department of Infectious Diseases of the University General Hospital of Alexandroupolis (Greece). Eligible COVID-19 patients were interviewed and examined 6, 12 and 18 months after COVID-19 symptoms onset and hospital discharge in order to evaluate the prevalence and consequences of long-COVID symptoms. A total number of 995 patients were included. The median age at discharge was 55 years and 53% of patients were retired. The majority was males (57%). Vaccination against SARS-CoV-2 was completed in 52% (n=517) COVID-19 patients. More than 40% of COVID-19 patients had at least one symptom at 18 months after hospitalization. Intravenous antiviral 0treatment with remdesivir and complete vaccination status were found to lead to lower rates of Long-COVID. More studies in larger patient cohorts are needed in order to identify the underlying biological mechanisms of long-COVID and create effective interventions for prevention and treatment.

Improving Vaccine Equity: How Community Engagement and Informatics Facilitate Health System Outreach to Underrepresented Groups.

Given the inequities in access to health care resources like COVID-19 vaccination, health systems should carefully consider how to reach underrepresented groups. Reflecting on vaccine rollout efforts holds insight on the role of community engagement and informatics support in promoting health equity. This study aimed to assess the effectiveness of four outreach strategies deployed by University of Washington (UW) Medicine in improving vaccine equity over traditional vaccine scheduling online or by phone, we report on appointment scheduling and completion of appointments (i.e., vaccine administration) through (1) automated outreach to individuals from underrepresented groups, (2) temporary "pop-up" clinics in neighborhoods highly impacted by COVID-19, (3) vulnerable population clinics, and (4) mobile vaccine vans. We conducted a 6-month retrospective analysis of electronic health records (EHR) to describe the sociodemographic characteristics of individuals who scheduled appointments using the outreach strategies and characteristics associated with a greater likelihood of vaccine administration based on appointment completion. To help explain trends in the EHR data, we engaged 10 health system leaders and staff who spearheaded the outreach strategies in follow-up conversations to identify qualitative insights into what worked and why. Compared with traditional scheduling, all outreach strategies except vulnerable population clinics had higher vaccine appointment completion rates, including automated outreach (N = 3,734 [94.7%], p < 0.001), pop-up clinics (N = 4,391 [96.0%], p < 0.001), and mobile vans (N = 4,198 [99.1%], p < 0.001); and lower cancellation rates, including automated outreach (N = 166 [1.1%], p < 0.001), pop-up clinics (N = 155 [0.6%], p < 0.001), and mobile vans (N = 0 [0%], p < 0.001). Qualitative insights emphasized ongoing community partnerships and information resources in successful outreach. Vaccine equity outreach strategies improved the proportion of patients who scheduled and completed vaccination appointments among populations disproportionately impacted by COVID-19. Engaging community partners and equity-focused informatics tools can facilitate outreach. Lessons from these outreach strategies carry practical implications for health systems to amplify their health equity efforts.

Racial inequalities in child vaccination and barriers to vaccination in Brazil among live births in 2017 and 2018: an analysis of a retrospective cohort of the first two years of life.

To describe timely vaccination completion and obstacles in the first 24 months of life in Brazil, examining associations with maternal race/skin color. Study participants were 37,801 children born in 2017 and 2018 included in the National Immunization Coverage Survey. We calculated prevalence and 95% confidence intervals for timely vaccine completeness and obstacles at 5, 12 and 24 months of life, according to maternal race/skin color. Associations were analyzed using logistic regression. 7.2% (95%CI 6.3;8.2) of mothers faced difficulties in taking their children to be vaccinated, and 23.4% (95%CI 21.7;25.1) were not vaccinated when taken. These proportions were 75% (95%CI 1.25;2.45) and 97% (95%CI 1.57;2.48) higher, respectively, among Black mothers. At least one vaccination was delayed among 49.9% (95%CI 47.8;51.9) and 61.1% (95%CI 59.2;63.0) of children by 5 and 12 months, respectively. These rates were higher among Black/mixed race mothers. There are racial inequalities in both the obstacles faced and in vaccination rates in Brazil. Marked racial inequalities were found in the obstacles to vaccination of children under 24 months in Brazil and to timely vaccination at 5 months and in the first year of life. Racial inequalities in the occurrence of vaccination shortcomings in health services, in the objective restrictions faced by families in taking their children to vaccination centers and in incomplete vaccination in a timely manner need to be addressed by the Brazilian National Health System. Equal public policies to address barriers to vaccination and qualification of health services need to be implemented. Studies need to deepen understanding of the structural determinants that lead to racial disparities.

Can non-individual factors be associated with mothers’ intention to complete childhood immunization? Findings from a cross-sectional study in Nigeria

Objective: Child immunization completion remains worrisome in Sub-Saharan Africa. Immunization completion is affected by individual and non-individual factors, although, the non-individual factors have not been well studied and documented in Nigeria. The study examined the non-individual factors influencing mothers’ intention to complete immunization of children 0-2 years in Nigeria. Methods: A cross-sectional study was conducted among mothers of children 0-2 years registered in three selected Primary Health Centres in a district of Lagos State who completed a self/interviewer-administered Socio-ecological model-based questionnaire. Descriptive and inferential statistics at a 5% level of significance were performed. Results: Mean age of respondents was 32.68 ± 7.19 years. The mean level of interpersonal factors was (1.18 ± 0.39) and therefore low. Environmental and policy factors were also low with mean scores of (1.09±0.28) and (1.06±0.24) respectively. All mothers (100%) had the intention to complete immunization. There was no significant relationship between interpersonal factors (r(421) = 0.089, p = 0.067) and environmental factors (r(421) = 0.057, p=0.242) and the mother’s intention to complete child immunization, but, there was a significant relationship between policy factor (r(421) = 0.100, p=0.039) and mother’s intention to complete child immunization. Conclusion: Continuous encouragement of mothers through policy-level mechanisms should continue, to aid the completion of childhood vaccination for the maintenance of health and welfare of both the mother and the child (ren).

Comparative Analysis of Primary and Monovalent Booster SARS-CoV-2 Vaccination Coverage in Adults with and without HIV in Catalonia, Spain.

People with HIV (PWH) may be more susceptible to SARS-CoV-2 infection and worse clinical outcomes. We investigated the disparity in SARS-CoV-2 vaccination coverage between PWH and those without HIV (PWoH) in Catalonia, Spain, assessing primary and monovalent booster vaccination coverage from December 2021 to July 2022. The vaccines administered were BNT162, ChAdOx1-S, mRNA-127, and Ad26.COV2.S. Using a 1:10 ratio of PWH to PWoH based on sex, age, and socioeconomic deprivation, the analysis included 201,630 individuals (183,300 PWoH and 18,330 PWH). Despite a higher prevalence of comorbidities, PWH exhibited lower rates of complete primary vaccination (78.2% vs. 81.8%, p < 0.001) but surpassed PWoH in booster coverage (68.5% vs. 63.1%, p < 0.001). Notably, complete vaccination rates were lower among PWH with CD4 <200 cells/μL, detectable HIV viremia, and migrants compared to PWoH (p < 0.001, all). However, PWH with CD4 < 200 cells/μL received more boosters (p < 0.001). In multivariable logistic regression analysis of the overall population, a prior SARS-CoV-2 diagnosis, HIV status, migrants, and mild-to-severe socioeconomic deprivation were associated with lower primary vaccination coverage, reflecting barriers to healthcare and vaccine access. However, booster vaccination was higher among PWH. Targeted interventions are needed to improve vaccine coverage and address hesitancy in vulnerable populations.

Social determinants of low uptake of childhood vaccination in high-risk squatter settlements in Karachi, Pakistan – A step towards addressing vaccine inequity in urban slums

BackgroundRoutine vaccination has remained historically low in major urban pockets of Pakistan, and now lags behind rural vaccination rates. Grossly insufficient publicly funded primary healthcare infrastructure, heterogeneous mix of providers and multi-ethnicity of populations pose challenges in the delivery of essential health services. This paper ascertains factors associated with uptake of routine childhood vaccination, using Pentavalent-3 vaccine, as a proxy indicator for completion of age-appropriate vaccines in urban slums of Karachi, at high risk of Polio and vaccine preventable disease outbreaks. MethodsData was drawn from baseline assessment of an urban immunization delivery pilot project in urban slums of Karachi, Pakistan. The study sample comprised of 2,097 households with children aged 4–12 months, sampled through a cross-sectional cluster survey, applying a structured questionnaire. Multivariable logistic regression was used to determine the association between Penta-3 vaccination, as the outcome variable, and predictor variables including socio-demographic characteristics and healthcare access factors. ResultsThe findings showed that the likelihood of being immunized with Penta-3 was higher for non-Pashtun ethnicity [adjusted odds ratio (aOR) 1.69; 95% CI 1.33–2.14], children of educated mothers, secondary or higher [aOR 2.95, 95% CI 2.34–3.71], and those whose fathers were formally employed (aOR 1.53; 95% CI 1.19–1.97). No association was seen by gender of child [aOR 0.89; 95% CI 0.73–1.08], and place of new born delivery [aOR 1.01; 95% CI 0.83–1.24]. ConclusionPockets of critically low under-vaccinations within the urban slums of Karachi are associated with Pashtun ethnicity, distance to the vaccination centre, lack of mothers’ education and lack of stable family income as in the case of unemployed and daily wage-earning fathers. Recognition of these factors is required in designing contextually appropriate strategies to address vaccine inequity in urban settings.

The COVID-19 Vaccination Problem and Its Solutions in the United States

With COVID-19 coming to an end, the challenges faced in its epidemic prevention process will undoubtedly play an exemplary role in the large-scale public health crisis that may be faced in the future. Among them, the promotion of vaccination is the first to bear the brunt. As one of the most effective means to curb the spread of the COVID-19 epidemic, the complete vaccination rate is not satisfactory in some countries, such as the United States. This is because, as a complex issue, the reasons for its emergence involve conflicts and trust between government credibility, race, culture, and religion. This article provides a detailed analysis of the reasons for the low complete vaccination rate in the United States and corresponding solutions. At the same time, it is expected that when other countries encounter similar government credibility crises or large-scale public health crises in the future, the example of the United States can be used as an effective reference.

The Delayed-Steroid-Strategy (DSS) for Idiopathic Granulomatous Mastitis during the COVID-19 Pandemic: A Case Series

Idiopathic granulomatous mastitis (IGM) is an inflammatory disease. It is often treated with steroids which could result in the recipient having an impaired immune defence and increases risk of getting infections. This could also hinder an adequate immune response post vaccination and render vaccines to be less effective. This was a study to assess the role and outcome of non steroidal anti-inflammatory drugs (NSAIDs) to delay corticosteroid treatment. This strategy aims to allow the patients to achieve complete vaccination with adequate post vaccination response for better COVID-19 protection prior to commencement of steroids. All three newly diagnosed patients with IGM completed their NSAIDs bridging therapy. None of them reported any worsening of disease during that time.