Site Of Delivery Research Articles

Sub-district costs and efficiency of a combination HIV/AIDS prevention-intervention in the Northwest Province of South Africa.

BackgroundWe reviewed a combination prevention program to strengthen HIV prevention programming, community support mechanisms, community-based HIV testing, referral systems, and HIV prevention integration at the primary care level. The intervention included situational analysis to inform programming, community engagement and mobilization, and community-based biomedical and behavioral prevention. In support of PEPFAR’s country-ownership paradigm, we costed the combination HIV prevention program to determine data needed for local ownership. This research used costing and health system perspectives.ResultsCost per person reached with individual or small group prevention interventions ranged from $63.93 to $4,344.88. (cost per health facility strengthened). Personnel costs drove the intervention. This was true regardless of year or activity (i.e. wellness days or events, primary health care strengthening, community engagement, and wellness clubs).ConclusionsLabor-intensive rather than capital-intensive interventions for low-income settings, like this one, are important for treating and preventing HIV/AIDS and other health conditions sustainably. Over time, costs shifted from international cost centers to in-country headquarters offices, as required for sustainable PEPFAR initiatives. Such costing center evolution reflected changes in the intervention’s composition, including (1) the redesign and re-deployment of service delivery sites according to local needs, uptake, and implementation success and (2) the flexible and adaptable restructuring of intervention components in response to community needs.

Inhibition of neointimal hyperplasia in balloon-induced vascular injuries in a rat model by miR-22 loading Laponite hydrogels

Percutaneous coronary intervention (PCI) is the mainstream treatment to widen narrowed or obstructed coronary arteries due to pathological conditions. However, the post-operational neointimal hyperplasia occurs because of endothelium denudation during surgical procedures and the following inflammation. MicroRNAs (miRs) are new therapeutics of great potential for cardiovascular diseases. However, miRs easily degrade in vivo. A vehicle that can maintain their bioactivities and extend their retention at the site of delivery is prerequisite for miRs to play their roles as therapeutic reagents. Here, we reported the use of the Laponite hydrogels to deliver miR-22 that are modulators of phenotypes of smooth muscle cells (SMCs). The Laponite hydrogels allow a homogenous distribution of miR-22 within the gels, which had the capacity to transfect SMCs in vitro. Upon the injection of the miR-22 incorporated in the Laponite hydrogels in vivo, miR-22 could be well retained surrounding arteries for at least 7 days. Moreover, the miR-22 loading Laponite hydrogels inhibited the neointimal formation, reduced the infiltration of the macrophages, and reversed the adverse vascular ECM remodeling after the balloon-induced vascular injuries by upregulation of miR-22 and downregulation of its target genes methyl-CpG binding protein 2 (MECP2). The application of the Laponite hydrogels for miR local delivery may offer a novel strategy to treat cardiovascular diseases.

Induction of protein specific antibody by carbonated hydroxy apatite as a candidate for mucosal vaccine adjuvant.

Buccal mucosae are considered as a site for vaccine delivery since they are relatively abundant with antigen-presenting dendritic cells, mainly Langerhans cells. In this study, we formulated carbonated hydroxy apatite (CHA) with ovalbumin (OVA) (denoted as CHA-OVA), incorporated it into bilayer buccal membrane to form hydrogel films containing CHA-OVA complex for vaccination via buccal mucosae. Ethylcellulose blend with polyethylene glycol 400 were used as impermeable backing layer. Physical properties of all tested buccal membranes were found suitable for mucosal application. In vitro and ex vivo release study showed there was no burst release of OVA found from all tested formula. From the in vivo examination, rabbit buccal mucosae vaccinated by mucoadhesive membranes containing CHA-OVA complex demonstrated mucosal specific antibody induction, represented the potential of CHA as a candidate of needle-free vaccine adjuvant. Future research is awaiting to investigate proper CHA crystallinity in complex with protein against targeted diseases.

Sub-district costs and efficiency of a combination HIV/AIDS prevention-intervention in the Northwest Province of South Africa

Background: We reviewed a combination prevention program tostrengthen HIV prevention programming, community support mechanisms, community-based HIV testing, referral systems, and HIV prevention integration at the primary care level. The intervention included situational analysis to inform programming, community engagement and mobilization, and community-based biomedical and behavioral prevention. In support of PEPFAR’s country-ownership paradigm, we costed the combination HIV prevention program to determine data needed for local ownership. This research used costing and health system perspectives.Results: Cost per person reached with individual or small group prevention interventions ranged from $63.93 to $4,344.88. (cost per health facility strengthened). Personnel costs drove the intervention. This was true regardless of year or activity (i.e. wellness days or events, primary health care strengthening, community engagement, and wellness clubs).Conclusions: Labor-intensive rather than capital-intensive interventions for low-income settings, like this one, are important for treating and preventing HIV/AIDS and other health conditions sustainably. Over time, costs shifted from international cost centers to in-country headquarters offices, as required for sustainable PEPFAR initiatives. Such costing center evolution reflected changes in the intervention’s composition, including (1) the redesign and re-deployment of service delivery sites according to local needs, uptake, and implementation success and (2) the flexible and adaptable restructuring of intervention components in response to community needs.

Transplantation of human neural progenitor cells secreting GDNF into the spinal cord of patients with ALS: a phase 1/2a trial

Amyotrophic lateral sclerosis (ALS) involves progressive motor neuron loss, leading to paralysis and death typically within 3–5 years of diagnosis. Dysfunctional astrocytes may contribute to disease and glial cell line-derived neurotrophic factor (GDNF) can be protective. Here we show that human neural progenitor cells transduced with GDNF (CNS10-NPC-GDNF) differentiated to astrocytes protected spinal motor neurons and were safe in animal models. CNS10-NPC-GDNF were transplanted unilaterally into the lumbar spinal cord of 18 ALS participants in a phase 1/2a study (NCT02943850). The primary endpoint of safety at 1 year was met, with no negative effect of the transplant on motor function in the treated leg compared with the untreated leg. Tissue analysis of 13 participants who died of disease progression showed graft survival and GDNF production. Benign neuromas near delivery sites were common incidental findings at post-mortem. This study shows that one administration of engineered neural progenitors can provide new support cells and GDNF delivery to the ALS patient spinal cord for up to 42 months post-transplantation.

Evidence and methods required to evaluate the impact for patients who use social prescribing: a rapid systematic review and qualitative interviews

Background Social prescribing encourages health-care and other professionals to refer patients to a link worker, who will develop a personalised plan to improve the patient’s health and well-being. We explore the feasibility of evaluating the service. Objective The objective was to answer the following research questions. (1) What are the most important evaluation questions that an impact study could investigate? (2) What data are already available at a local or national level and what else would be needed? (3) Are there sites delivering at a large enough scale and in a position to take part in an impact study? (4) How could the known challenges to evaluation (e.g. information governance and identifying a control group) be addressed? Data sources Data sources included MEDLINE ALL (via Ovid), searched from inception to 14 February 2019, and the first 100 hits of a Google (Google Inc., Mountain View, CA, USA) search. Review methods Rapid systematic review – electronic searches up to February 2019. Studies included any study design or outcomes. Screening was conducted by one reviewer; eligibility assessment and data extraction were undertaken by two reviewers. Data were synthesised narratively. Qualitative interviews – data from 25 participants in different regions of England were analysed using a pragmatic framework approach across 12 areas including prior data collection, delivery sites, scale and processes of current service delivery, and known challenges to evaluation. Views of key stakeholders (i.e. patients and academics) were captured. Results Rapid systematic review – 27 out of 124 studies were included. We identified outcomes and highlighted research challenges. Important evaluation questions included identification of the most appropriate (1) outcomes and (2) methods for dealing with heterogeneity. Qualitative interviews – social prescribing programmes are holistic in nature, covering domains such as social isolation and finance. Service provision is heterogeneous. The follow-on services that patients access are often underfunded or short term. Available data – there was significant heterogeneity in data availability, format and follow-up. Data were collected using a range of tools in ad hoc databases across sites. Non-attendance data were frequently not captured. Service users are more deprived and vulnerable than the overall practice population. Feasibility and potential limitations of an evaluation – current data collection is limited in determining the effectiveness of the link worker social prescribing model; therefore, uniform data collection across sites is needed. Standardised outcomes and process measures are required. Cost–utility analysis could provide comparative values for assessment alongside other NHS interventions. Limitations This was a rapid systematic review that did not include a systematic quality assessment of studies. COVID-19 had an impact on the shape of the service. We were not able to examine the potential causal mechanisms in any detail. Conclusions We describe possible future research approaches to determine effectiveness and cost-effectiveness evaluations; all are limited in their application. (1) Evaluation using currently available, routinely collected health-care, costing and outcomes data. (2) Evaluative mixed-methods research to capture the complexity of social prescribing through understanding heterogeneous service delivery across comparative settings. Cost-effectiveness evaluation using routinely available costing and outcomes data to supplement qualitative data. (3) Interventional evaluative research, such as a cluster randomised controlled trial focused on the link worker model. Cost-effectiveness data collected as part of the trial. Future work Mature data are currently not available. There needs to be an agreement across schemes on the key outcomes that need to be measured, harmonisation of data collection, and follow-up referrals (how and when). Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme and will be published in full in Health and Social Care Delivery Research; Vol. 10, No. 29. See the NIHR Journals Library website for further project information.

AMNIOTIC FLUID EMBOLISM: ABOUT A CASE

Amniotic fluid embolism is a rare and unpredictable complication of childbirth.with about fifteen cases per year in France, but very serious with maternal mortality that can vary from 20 to 60% , associating severe cardiovascular collapse, acute respiratory distress syndrome and hemorrhage with disseminated intravascular coagulation (DIC). As soon as the diagnosis is mentioned, management must be multidisciplinary and intensive. Amniotic embolism is responsible for such significant neonatal mortality. Over the past ten years, the maternal-fetal prognosis seems to have improved thanks to progress in standardized multidisciplinary care at the delivery site. We report a case of amniotic fluid embolism which occurred during fetal extraction during caesarean section.

Lubricant-entrenched slippery surface-based nanocarriers to avoid macrophage uptake and improve drug utilization

IntroductionReducing the protein adsorption of nanoparticles (NPs) as drug carriers to slow their rapid clearance by macrophages uptake is a critical challenge for NPs clinical translational applications. Despite extensive research efforts to inhibit cellular uptake, including covering biological agents or surface chemical coatings to impart “stealth” properties to NPs, their stability remains insufficient. ObjectivesDeveloped a novel surface modification technology based on a physical infusion engineering approach to achieve persistent inhibition of protein adhesion and cellular uptake by nanocarriers. MethodsThe nanoparticles were prepared based on conventional drug carrier mesoporous silica NPs through a two-step process. A functional nanoscale slippery surface was formed by grafting “liquid-like” brushes on the particles surface, and then a lubricant-entrenched slippery surfaces (LESS) was formed by infusing silicone oil lubricant into the entire surface. Co-incubation with macrophages (in vitro and in vivo) was used to examine the anti-uptake properties of modified NPs. The anti-adhesion properties of LESS coating surfaces to various liquids, proteins and cells were used to analyze the anti-uptake mechanism. Loaded with drugs, combined with tumor models, to evaluate the drug utilization of modified NPs. ResultsRelying on the stable and slippery LESS coating, the modified surface could prevent the adhesion of various liquids and effectively shield against the adhesion of proteins and cells, as well as remarkably reduce macrophage cellular uptake in vitro and in vivo. In addition, the LESS coating does not affect cell activity and allows NPs to be loaded with drugs, significantly improving the utilization of drugs in vitro and in vivo. This allows the NPs to reach to the target tumor site for drug delivery without active clearance by macrophages. ConclusionOur research introduces a new nanocarrier technology to improve anti-biofouling performance and stealth efficiency that will facilitate the development of nanomedicines for clinical transformation applications.

Monkeypox: Considerations as a New Pandemic Looms

Monkeypox: Considerations as a New Pandemic Looms

Clinical potential of human amniotic fluid stem cells.

To determine whether amniotic fluid derived stem cells maintain their stem cell characteristics (a)after processing by a licensed cell therapy center and (b)after the cells undergo simulated clinical application. Amniotic fluid was collected by laparotomy - a small uterine incision was made at proposed site for delivery and a sterile catheter inserted to collect fluid into a sterile bag. After flow stopped the catheter was withdrawn, the cesarean completed and the collected fluid delivered to the cell therapy center for processing and cryostorage. A clinical setting was simulated where amniotic fluid cells received from cell therapy center were thawed at room temperature for a maximum of 3h and passed through a clinical cell delivery device to monitor cell viability. The cells were examined for viability, stability, growth, differentiation, and markers of stemness. Amniotic fluid stem cells processed from a clinical cell therapy center behave similarly to amniotic fluid stem cells processed in a research laboratory with respects to viability, stability, growth, differentiation and maintain markers of stemness. There were differences due to heterogeneity of samples which were not methodological. Growth in cell culture and differentiation were satisfactory. Simulation of treating the cells in a clinical environment show a general stability in viability of amniotic fluid cells at room temperature for 3h minimum and when passed through a clinically approved delivery device. The data indicate human amniotic fluid processed in a clinical facility could be used therapeutically if proven to be safe.

Examining maternal morbidity across a spectrum of delivery locations: An analysis of the Global Network's Maternal and Neonatal Health Registry.

To better understand maternal morbidity, using quality data from low- and middle-income countries (LMICs), including out-of-hospital deliveries. Additionally, to compare to the WHO estimate that maternal morbidity occurs in 15% of pregnancies, which is based largely on hospital-level data. The Global Network for Women's and Children's Health Research Maternal Newborn Health Registry collected data on all pregnancies from seven sites in six LMICs between 2015 and 2020. Rates of maternal mortality and morbidity and the differences in morbidity across delivery location and birth attendant type were evaluated. Among the 280 584 deliveries included in the present analysis, the overall maternal mortality ratio was 138 per 100 000, while 11.7% of women experienced at least one morbidity. Rates of morbidity were generally higher for deliveries occurring within hospitals (19.8%) and by physicians (23.6%). The lowest rates of morbidity were noted among women delivering in non-hospital healthcare facilities (5.6%) or with non-physician clinicians (e.g. nurses, midwives [5.4%]). The present study shows important differences in reported maternal morbidity across delivery sites, with a trend towards lower morbidity in non-hospital healthcare facilities and among non-physician clinicians.

Root Hair Apex is the Key Site for Symplastic Delivery of Graphene into Plants.

Uptake kinetics and delivery mechanisms of nanoparticles (NPs) in crop plants need to be urgently understood for the application of nanotechnology in agriculture as delivery systems for eco-friendly nanoagrochemicals. Here, we investigated the uptake kinetics, translocation pathway, and key internalization process of graphene in wheat (Triticum aestivum L.) by applying three specific hydroponic cultivation methods (submerging, hanging, and split-root). Quantification results on the uptake of carbon-14 radiolabeled graphene in each tissue indicated that graphene could enter the root of wheat and further translocate to the shoot with a low delivery rate (<2%). Transmission electron microscopy (TEM) images showed that internalized graphene was transported to adjacent cells through the plasmodesmata, clearly indicating the symplastic pathway of graphene translocation. The key site for the introduction of graphene into root cells for translocation through the symplastic pathway is evidenced to be the apex of growing root hair, where the newly constructed primary cell wall is much thinner. The confirmation of uptake kinetics and delivery mechanisms is useful for the development of nanotechnology in sustainable agriculture, especially for graphene serving as the delivery vector for pesticides, genes, and sensors.

What Constitutes a Competitive Environment? A Case Study of the FQHCs Industry In California

Objective: This study aims to identify competitive forces in the FQHCs environment using Porter’s Five Force model. Data Sources: The study utilized various secondary data sources. The Health Resources and Services Administration (HRSA) requires FQHCs to submit a performance report using the measures defined in the Uniform Data System (UDS). The UDS provides data such as the scope and volume of services provided by FQHCs, staffing, number of delivery sites, and finances. The UDS consider being a census of aggregate level health center data for FQHCs. Secondly, the American Hospital Association Annual Survey (AHA), which provides organizational details regarding hospitals. The third dataset is the Area Health Resources File (AHRF). It includes county-level data about health services volume, demographics, and health professional supply. The fourth dataset is the Internal Revenue Service (IRS) Form 990, which was used was used to calculate FQHCs’ total margin. The fifth dataset is the California Health and Human Services Open Data Portal (CHHS), which includes county-level data such as the number of Medicaid eligible populations and the number of primary care clinics. Finally, the study used the U.S. Department of Housing and Urban Development (HUD) United States Postal Service Zip Code Crosswalk Files. The Crosswalk Files was used to allocate both FQHC’s and FQHC’s sites Zip-Codes to counties. Method: this was a descriptive study. Descriptive statistics included frequencies and percentages to describe categorical variables. In addition, means (standard deviations, SD) will describe continuous variables. The study utilized bivariate analysis, including the chi-square test and ANOVA test, to find differences regarding the competitive forces variables among counties that had a new established FQHCs and counties that did not have newly established FQHCs in California for the years 2014 and 2015. Result: the study found that the number of FQHCs sites and primary care clinics in a county is statistically different between counties that had a newly established FQHC compared to counties that did not have a newly established FQHC. Counties that had newly established FQHCs had on an average a lower number of FQHCs sites and primary care clinics. Competition for FQHCs might arise when more FQHCs exist in a market. More research can be conducted to understand how FQHCs behave in a competitive environment.

In-Vitro Dissolution Study protocol for various Vaginal Dosage Forms

The vaginal mucosa is well recognized as a route for delivering variety of drugs. Considerable number of anti-fertility drugs have been successfully delivered through vaginal and uterine canals. The goal of this review is to summarize the present clinical state of intravaginal medicines and IUDs, with a prime focus on the available in-vitro dissolution study methods and their importance. At present different vaginal drug delivery systems are available in the market and a few are under clinical trial. The accurate estimation drug release profile of any of such dosage form is primarily depends on the standard dissolution study protocol. The vaginal delivery system is an effective site for local and systemic drug delivery, and a range of innovative formulation strategies are being researched for its development. The concept behind the study is mainly lies on the fact that the standard dissolution protocol may vary based on formulation type, its design and its therapeutic goals.

TRANSITIONAL STATES PARTICIPATION IN PHOTODEGRADATION OF METHYL ORANGE FROM GREEN TITANIUM NANOPARTICLES SYNTHESIS USING Deinbollia pinnta LEAVES

The surface chemistry of nanostructures concerning their smaller sizes, unique optical and electronic properties continue to benefit organic medicinal chemistry and biosynthesis of active titania nanoparticles with metabolites present in plant extracts. Deinbollia pinnata ethyl acetate leave extracts with sol-gel method afforded titania nanoparticles (TiO2 NPs-anatase) with photodegradation performance at 98.7% of methyl orange (MO) conversion within 150 mins. Together with observed participation of π-π* transition state more than that of η-π* state. The GC-MS spectrum revealed classes of compounds which include long-chain fatty acids, galloyl ester, long-chain esters, tetraterpenoids, triterpenoids, sesquiterpenoid terpenoid (isoprenoids) with a correlation maximum of stigmasterol (94%)as phytochemical contents of the crude extracts. The physiochemical analysis using X-ray diffraction (XRD) showed average crystallite size in the range of 19 – 21 nm, field emission scanning electron microscopy (FESEM) displayed uniform semi-spherical shape in the size range of 33 – 48 nm, energy dispersive X-ray (EDX) spectra depicted main elements of Ti (61 Wt.%) and O (35 Wt.%), UV-Vis spectroscopy exhibited band-gap energy of 3.2 eV, nitrogen sorption analysis specified type IV isotherm and BET surface area of 31.77 m2/g. The super-striking green TiO2 NPs photodegradation in this work with wide-ranged transitional states involvement, can, in turn, be used as bio-mediated TiO2 NPs in medicinal chemistry to enhance pharmacokinetics, pharmacological properties and replace chemical agents thereby reducing side effects at drug delivery site actions. Thus, natural products continue to integrate research advances and innovation.

A Descriptive Study of Maternal Choices for Labor Pain Relief.

In a setting with a wider than usual variety of available labor pain relief methods, a prospective, descriptive study was conducted of labor pain relief methods desired by low-risk women prenatally, during labor, and at delivery. Of all women registering for care between 2017 and 2020, a total of 2562 women were screened for low-risk status and then offered study participation, if eligible. Of 1185 eligible women, 512 remained at low risk until admission in labor and completed the study. Pain relief methods chosen were compared with the type of labor, type of delivery, and between delivery sites. Hydrotherapy and a "none/unmedicated" labor were favored by a majority of subjects, regardless of ultimate method used. Multiple labor pain relief methods were used by 54.5% of subjects. Epidural analgesia most often occurred with augmented labor. Hydrotherapy was used more by those with spontaneous labors, water birth deliveries, and birth center births. Effectiveness of all pain relief measures was rated above average. Differences between planned hospital and planned birth center births were clear on most variables. Results can be used by childbirth educators, health professionals, and administrators to respect and improve the individualization of care and satisfaction of laboring women.

EPH117 Factors Associated with Receipt of Second Dose of mRNA-1273 Vaccine at Walgreens Pharmacies during the COVID-19 Pandemic

EPH117 Factors Associated with Receipt of Second Dose of mRNA-1273 Vaccine at Walgreens Pharmacies during the COVID-19 Pandemic

Equine Platelet Lysate Gel: A Matrix for Mesenchymal Stem Cell Delivery.

A variety of bioscaffolds have been developed as carriers for the delivery of mesenchymal stem cells (MSCs), however, many of them are unable to provide direct cell nourishment, a critical factor for survival and retention of MSCs at the site of delivery. Platelet lysate is a plasma-derived product rich in growth factors that can be turned into a gel matrix following the addition of calcium chloride. Our objective was to characterize growth factor and cytokine release of equine platelet lysate gel (ePL gel) encapsulated with MSCs over time and to measure the viability and proliferation of ePL gel-encapsulated MSCs for up to 14 days. The release of interleukin-1β (IL-1β), interleukin-10 (IL-10), transforming growth factor beta (TGF-β), vascular endothelial growth factor (VEGF), and platelet-derived growth factor BB (PDGF-BB), as well as fibrinogen degradation, were measured from ePL gel with and without equine bone marrow-derived MSCs and compared with MSCs in monolayer. MSC proliferation and viability within the gel were assessed up to 14 days. Compared with monolayer MSC cultures, significantly higher concentrations of IL-1β, IL-10, and TGF-β were measured from supernatants collected from ePL gel containing MSCs at various time points. Significantly lower concentrations of PDGF-BB were measured in the supernatant when MSCs were incorporated in ePL gel while VEGF tended to be increased compared with MSCs in monolayer. Incorporation in ePL gel for up to 14 days did not appear to affect viability and proliferation rates of MSCs as these were found to be similar to those measured in monolayer cell culture. ePL gel may have the potential to serve as bioscaffold for MSC delivery since it appears to support the proliferation and viability of MSCs for up to 14 days.

Knowledge about Obstetric Danger Signs and Related Factors in Reproductive-Age Women in the Southeast Zone of Tigray, 2021: A Cross-Sectional Study.

Background Pregnancy complications are the major health problems among women in developing countries. Globally, around 295,000 women die from pregnancy-related causes annually and 86% of these maternal deaths happen in developing countries. Objective To assess knowledge of obstetric danger signs among reproductive-age women living in southeastern zone of Tigray Region, Ethiopia, 2021. Methods A community-based quantitative cross-sectional survey was undertaken in southeastern zone of Tigray. A multistage random sampling technique was implemented to select total participants of 410 reproductive-age women. Two districts were randomly selected, and from those districts, 12 kebeles were selected randomly, and the calculated sample size (410) was proportionally allocated to each selected kebel. The data were collected by using face-to-face interview with a structured questionnaire from January 20 to February 20/2021 after ensuring that all requirements of ethical considerations were fulfilled. The collected data were entered into EpiData version 4.2 and then exported to SPSS version 20 for analysis. Descriptive statistics with frequency, percentage, table and graph, and cross-tabulation were used for presentation of result. Bivariable and multivariable analyses were used to examine the association. Odds ratios with 95% confidence interval and P value < 0.05 were used to determine the statistical association. Result Four hundred ten reproductive-age women participated in the study making a response rate of 100%. Leakage of fluid per vagina was the most commonly mentioned obstetric danger signs (61%). Overall, one hundred seventy-two (42%) had good knowledge on obstetric danger sign. Educational status of the mother (AOR (95%CI = 2.7 (1.189-6.24))), site of delivery (AOR (95%CI = 2.2 (1.6-3.432))), and having history of an ANC follow-up (AOR (95%CI = 2.4 (1.13-5.6))) were found to be independent predictors of knowledge of women about the obstetric danger sign. Conclusion and Recommendation. Educational status of the mother site of delivery and having history of an ANC follow-up were independently associated with knowledge of women about obstetric danger signs. Thus, provision of the Information, Education and Communication targeting women, family, and the general community on obstetric danger signs and associated factors was recommended.

Mucosal immunization with a delta-inulin adjuvanted recombinant spike vaccine elicits lung-resident immune memory and protects mice against SARS-CoV-2

Multiple SARS-CoV-2 vaccine candidates have been approved for use and have had a major impact on the COVID-19 pandemic. There remains, however, a significant need for vaccines that are safe, easily transportable and protective against infection, as well as disease. Mucosal vaccination is favored for its ability to induce immune memory at the site of infection, making it appealing for SARS-CoV-2 vaccine strategies. In this study we performed in-depth analysis of the immune responses in mice to a subunit recombinant spike protein vaccine formulated with the delta-inulin adjuvant Advax when administered intratracheally (IT), versus intramuscular delivery (IM). Both routes produced robust neutralizing antibody titers (NAb) and generated sterilizing immunity against SARS-CoV-2. IT delivery, however, produced significantly higher systemic and lung-local NAb that resisted waning up to six months post vaccination, and only IT delivery generated inducible bronchus-associated lymphoid tissue (iBALT), a site of lymphocyte antigen presentation and proliferation. This was coupled with robust and long-lasting lung tissue-resident memory CD4+ and CD8+ T cells that were not observed in IM-vaccinated mice. This study provides a detailed view of the lung-resident cellular response to IT vaccination against SARS-CoV-2 and demonstrates the importance of delivery site selection in the development of vaccine candidates.