Domestic Vaccination Research Articles

Modeling the Health Impact and Cost-Effectiveness of a Combined Schoolgirl HPV Vaccination and Cervical Cancer Screening Program in Guangdong Province, China.

Low human papillomavirus (HPV) vaccine uptake is a key barrier to cervical cancer elimination. We aimed to evaluate the health impact and cost-effectiveness of introducing different HPV vaccines into immunization programs and scaling up the screening program in Guangdong. We used a dynamic compartmental model to estimate the impact of intervention strategies during 2023-2100. We implemented the incremental cost-effectiveness ratio (ICER) in costs per averted disability-adjusted life year (DALY) as an indicator to assess the effectiveness of the intervention. We used an age-standardized incidence of 4 cases per 100,000 women as the threshold for the elimination of cervical cancer. Compared with the status quo, scaling up cervical cancer screening coverage alone would prevent 215,000 (95% CI: 205,000 to 227,000) cervical cancer cases and 49,000 (95% CI: 48,000 to 52,000) deaths during 2023-2100. If the coverage of vaccination reached 90%, domestic two-dose 2vHPV vaccination would be more cost-effective than single-dose and two-dose 9vHPV vaccination. If Guangdong introduced domestic two-dose 2vHPV vaccination at 90% coverage for schoolgirls from 2023 and increased the screening coverage, cervical cancer would be eliminated by 2049 (95% CI 2047 to 2051). Introducing two doses of domestic 2vHPV vaccination for schoolgirls and expanding cervical cancer screening is estimated to be highly cost-effective to accelerate the elimination of cervical cancer in Guangdong.

Vaccination in patients with inflammatory bowel disease-Asian perspectives: results of a multinational web-based survey in the 8th Asian Organization for Crohn's and Colitis meeting.

Long-term immunosuppressive therapies used to treat inflammatory bowel disease (IBD) are associated with an increased risk of infections, many of which can be prevented by vaccination. We assessed physicians' current approaches and clinical practices regarding vaccinations for IBD patients in different Asian countries/regions. An internet-based survey was conducted among members of the Asian Organization for Crohn's and Colitis from September 2020 to November 2020. The questionnaire consisted of 2 parts covering general opinion on the relevance of vaccinations and clinical practice of vaccination. Overall, 384 Asian medical doctors responded to the survey. The majority of respondents considered it very (57.6%) or sufficiently (39.6%) important to perform vaccinations as recommended by the guidelines. About half of the Asian physicians (52.6%) were usually or always performing vaccinations. The influenza vaccine was the most frequently recommended vaccine for IBD patients. Half of the respondents (51.3%) did not recommend hepatitis A vaccine, especially in China (61.6%) and Japan (93.6%). The diphtheria, tetanus, and pertussis vaccine were never (35.2%) or rarely (29.4%) recommended. The findings of this survey indicated similarities among countries/regions in terms of the current approaches and practices regarding vaccination of IBD patients; however, there are some differences that might reflect each country's domestic vaccination guidelines and health insurance particularly with certain vaccines in some countries/regions. Although Asian physicians largely recommend vaccination, more awareness among doctors and Asian consensus regarding differences in IBD vaccination among countries/regions may be required.

Postpandemic international tourism restart: effect of border control and vaccination

Purpose As the current Coronavirus 2019 pandemic eases, international tourism, which was greatly affected by the outbreak, is gradually recovering. The attraction of countries to overseas tourists is related to their overall performance in the pandemic. This research integrates the data of vaccination of different countries, border control policy and holidays to explore their differential impacts on the overseas tourists’ intention during the pandemic. This is crucial for destinations to built their tourism resilience. It will also help countries and industry organizations to promote their own destinations to foreign tourism enterprises. Design/methodology/approach This study proposes an analysis based on panel data for ten countries over 1,388 days. The coefficient of variation is used to measure monthly differences of Chinese tourists’ intention to visit overseas country destinations. Findings Results show that, for tourist intention of going abroad: border control of the destination country has a significant negative impact; daily new cases in the destination country have a significant negative impact; domestic daily new cases have a significant positive impact; holidays have significant negative impact; daily vaccination of the destination countries has significant positive impact; and domestic daily vaccination have negative significant impact. Research limitations/implications First, there is a large uncertainty in studying consumers’ willingness to travel abroad in this particular period because of unnecessary travel abroad caused by the control of the epidemic. Second, there are limitations in studying only Chinese tourists, and future research should be geared toward a broader range of research pairs. Practical implications First, from the government perspective, a humane response can earn the respect and trust of tourists. Second, for tourism industry, to encourage the public take vaccine would be beneficial for both the tourism destination and foreign tourism companies. The same effect can be achieved by helping tourists who are troubled by border control. Social implications First, this research provides suggestions for the government and the tourism industry to deal with such a crisis in the future. Second, this study found that vaccination has a direct impact on tourism. This provides a basis for improving people’s willingness to vaccinate. Thirdly, this study proves suggestion for the destinations to build tourism resilience. Originality/value This study analyzes the unique control measures and vaccination in different countries during the pandemic, then provides suggestions for the tourism industry to prepare for the upcoming postpandemic tourism recovery. This study is valuable for improving the economic resilience of tourism destinations. Additionally, it helps to analyze the advantages and disadvantages of different restrain policies around the world.

Predicting Measles Outbreaks in the United States: Evaluation of Machine Learning Approaches.

Measles, a highly contagious viral infection, is resurging in the United States, driven by international importation and declining domestic vaccination coverage. Despite this resurgence, measles outbreaks are still rare events that are difficult to predict. Improved methods to predict outbreaks at the county level would facilitate the optimal allocation of public health resources. We aimed to validate and compare extreme gradient boosting (XGBoost) and logistic regression, 2 supervised learning approaches, to predict the US counties most likely to experience measles cases. We also aimed to assess the performance of hybrid versions of these models that incorporated additional predictors generated by 2 clustering algorithms, hierarchical density-based spatial clustering of applications with noise (HDBSCAN) and unsupervised random forest (uRF). We constructed a supervised machine learning model based on XGBoost and unsupervised models based on HDBSCAN and uRF. The unsupervised models were used to investigate clustering patterns among counties with measles outbreaks; these clustering data were also incorporated into hybrid XGBoost models as additional input variables. The machine learning models were then compared to logistic regression models with and without input from the unsupervised models. Both HDBSCAN and uRF identified clusters that included a high percentage of counties with measles outbreaks. XGBoost and XGBoost hybrid models outperformed logistic regression and logistic regression hybrid models, with the area under the receiver operating curve values of 0.920-0.926 versus 0.900-0.908, the area under the precision-recall curve values of 0.522-0.532 versus 0.485-0.513, and F2 scores of 0.595-0.601 versus 0.385-0.426. Logistic regression or logistic regression hybrid models had higher sensitivity than XGBoost or XGBoost hybrid models (0.837-0.857 vs 0.704-0.735) but a lower positive predictive value (0.122-0.141 vs 0.340-0.367) and specificity (0.793-0.821 vs 0.952-0.958). The hybrid versions of the logistic regression and XGBoost models had slightly higher areas under the precision-recall curve, specificity, and positive predictive values than the respective models that did not include any unsupervised features. XGBoost provided more accurate predictions of measles cases at the county level compared with logistic regression. The threshold of prediction in this model can be adjusted to align with each county's resources, priorities, and risk for measles. While clustering pattern data from unsupervised machine learning approaches improved some aspects of model performance in this imbalanced data set, the optimal approach for the integration of such approaches with supervised machine learning models requires further investigation.

Societal volunteering and COVID-19 mortality in high-income countries: a cross-sectional study

ObjectivesThis study aims to quantify the relationship between societal volunteering and the impact of COVID-19 in that society.DesignCross-sectional study.Setting, participants and outcome measureData on societal volunteering were collected for 32...

Understanding the incidence and timing of rabies cases in domestic animals and wildlife in south-east Tanzania in the presence of widespread domestic dog vaccination campaigns

The “Zero by 30” strategic plan aims to eliminate human deaths from dog-mediated rabies by 2030 and domestic dog vaccination is a vital component of this strategic plan. In areas where domestic dog vaccination has been implemented, it is important to assess the impact of this intervention. Additionally, understanding temporal and seasonal trends in the incidence of animal rabies cases may assist in optimizing such interventions. Data on the incidence of probable rabies cases in domestic and wild animals were collected between January 2011 and December 2018 in thirteen districts of south-east Tanzania where jackals comprise over 40% of reported rabies cases. Vaccination coverage was estimated over this period, as five domestic dog vaccination campaigns took place in all thirteen districts between 2011 and 2016. Negative binomial generalized linear models were used to explore the impact of domestic dog vaccination on the annual incidence of animal rabies cases, whilst generalized additive models were used to investigate the presence of temporal and/or seasonal trends. Increases in domestic dog vaccination coverage were significantly associated with a decreased incidence of rabies cases in both domestic dogs and jackals. A 35% increase in vaccination coverage was associated with a reduction in the incidence of probable dog rabies cases of between 78.0 and 85.5% (95% confidence intervals ranged from 61.2 to 92.2%) and a reduction in the incidence of probable jackal rabies cases of between 75.3 and 91.2% (95% confidence intervals ranged from 53.0 to 96.1%). A statistically significant common seasonality was identified in the monthly incidence of probable rabies cases in both domestic dogs and jackals with the highest incidence from February to August and lowest incidence from September to January. These results align with evidence supporting the use of domestic dog vaccination as part of control strategies aimed at reducing animal rabies cases in both domestic dogs and jackals in this region. The presence of a common seasonal trend requires further investigation but may have implications for the timing of future vaccination campaigns.

Socio-Economic and Demographic Factors Associated with the Spatial Distribution of COVID-19 in Africa.

Corona is a disease that affects the whole world. Countries with weak economies are specifically more vulnerable. A proper understanding of COVID-19 spreading, identifying the high-risk areas, and discovering factors influencing the spread of the disease are crucial to improving disease control. This study evaluates the geo-statistical distribution of COVID-19 to identify critical areas of Africa using spatial clustering pattern analysis. In addition, the spatial correlation between infected cases and variables such as the unemployment rate, gross domestic product (GDP), population, and vaccination rate is calculated using Geographically Weighted Regression (GWR) analysis. The hot-spot map showed a statistically significant cluster of high values in southern and northern Africa. Moreover, the outcome of the GWR analysis revealed the GDP and population had the most significant correlation with the spreading of COVID-19, with Local R2 values of (0.01-0.99) and (0-0.89), respectively.

Tackling barriers to collective action for effective vaccination campaigns: rabies in rural Africa as an example

Vaccine-based protection in populations that are vulnerable to infectious diseases represents a public good, whose successful attainment requires collective action. We investigated participation in mass domestic dog vaccination against dog-mediated human rabies endemic in Tanzania as a prototypical example of these issues. We employed advertising interventions, text messaging and/or engagement through community leaders, as well as operational adjustments to increase the saliency of rabies risks and reduce barriers to participation in vaccination campaigns. Neither advertising strategies were effective on their own, however, when taken together, the two advertising strategies substantially improved vaccination coverage. Operational interventions, such as increasing vaccination stations and extending time windows of delivery, greatly enhanced participation. Our experimental and theoretical findings highlight the importance of both salience and context: sparking successful collective action requires decision-making bodies to understand and respond to the challenges encountered by intended beneficiaries in their local contexts.

Pathomorphological diagnostics of panleukopenia in cats (case description)

The article highlights the results of autopsy and histopathological studies of cats diagnosed with panleukopenia (FPV), confirmed by immunochromatographic rapid test. The spread of FPV among cats is declining sharply worldwide due to domestic vaccination of cats. However, the number of deaths among homeless animals is still high. The disease course usually varies from subclinical infection to acute syndrome with sudden death. Typical clinical manifestations are characterized by fever, lethargy, and anorexia. Sick cats suffer from vomiting and subsequent watery or hemorrhagic diarrhea. Homeless animals often die from complications associated with secondary bacterial infection, sepsis, and dehydration. Cats aged four months to one year are the most severely affected. Mortality varies depending on the disease course, the animal’s general condition, and timely veterinary care. The autopsy of the dead animals showed signs of catarrhal gastritis, catarrhal and hemorrhagic enterocolitis, splenomegaly, serous lymphadenitis, liver and kidneys’ acute congestive hyperemia, and pulmonary edema. Duodenum histological examination revealed villi necrosis, edema of the mucous membrane’s stroma, and desquamation of enterocytes into the intestinal lumen. Necrosis of Lieberkühn crypts and viral intracytoplasmic inclusions in enterocytes were very pronounced. Microscopic changes in the stomach and large intestine were characterized by dystrophic and necrobiotic changes of mainly the epithelial plate of the mucous membrane. Extracapillary glomerulonephritis developed in the kidneys, while focal emphysema and edema occured in the lungs. Stroma edema, delimphatization and lymphocytic necrosis were observed in the spleen and lymph nodes.

Consideration on implementation of co-administration of Seasonal Influenza and COVID-19 vaccines during pandemic in China

Influenza is an infectious respiratory disease caused by the influenza viruses. Older people, infants and people with underlying medical conditions could have a higher risk of severe influenza symptoms and complications. The co-infection of Coronavirus Diseases 2019 (COVID-19) with influenza viruses could lead to the complication of prevention, diagnosis, control, treatment, and recovery of COVID-19. Influenza vaccine and COVID-19 vaccine overlapped in target populations, vaccination time, and inoculation units. Although there was insufficient evidence on the immunogenicity and safety of co-administration of influenza vaccine and COVID-19 vaccine, World Health Organization and some countries recommended co-administration of inactivated influenza vaccine and COVID-19 vaccine. This review summarized domestic and international vaccination policies and research progress, and put forward corresponding suggestions in order to provide scientific support for the formulation of vaccination strategy on seasonal influenza vaccine and COVID-19 vaccine.

Changes of the Public Attitudes of China to Domestic COVID-19 Vaccination After the Vaccines Were Approved: A Semantic Network and Sentiment Analysis Based on Sina Weibo Texts.

Introduction: On December 31, 2020, the Chinese government announced that the domestic coronavirus disease-2019 (COVID-19) vaccines have obtained approval for conditional marketing and are free for vaccination. This release drove the attention of the public and intense debates on social media, which reflected public attitudes to the domestic vaccine. This study examines whether the public concerns and public attitudes to domestic COVID-19 vaccines changed after the official announcement.Methods: This article used big data analytics in the research, including semantic network and sentiment analysis. The purpose of the semantic network is to obtain the public concerns about domestic vaccines. Sentiment analysis reflects the sentiments of the public to the domestic vaccines and the emotional changes by comparing the specific sentiments shown on the posts before and after the official announcement.Results: There exists a correlation between the public concerns about domestic vaccines before and after the official announcement. According to the semantic network analysis, the public concerns about vaccines have changed after the official announcement. The public focused on the performance issues of the vaccines before the official approval, but they cared more about the practical issues of vaccination after that. The sentiment analysis showed that both positive and negative emotions increased among the public after the official announcement. “Good” was the most increased positive emotion and indicated great public appreciation for the production capacity and free vaccination. “Fear” was the significantly increased negative emotion and reflected the public concern about the safety of the vaccines.Conclusion: The official announcement of the approval for marketing improved the Chinese public acceptance of the domestic COVID-19 vaccines. In addition, safety and effectiveness are vital factors influencing public vaccine hesitancy.

Exploring public perceptions of the COVID-19 vaccine online from a cultural perspective: Semantic network analysis of two social media platforms in the United States and China

The development and uptake of the COVID-19 (coronavirus disease 2019) vaccine is a top priority in stifling the COVID-19 pandemic. How the public perceives the COVID-19 vaccine is directly associated with vaccine compliance and vaccination coverage. This study takes a cultural sensitivity perspective and adopts two well-known social media platforms in the United States (Twitter) and China (Weibo) to conduct a public perception comparison around the COVID-19 vaccine. By implementing semantic network analysis, results demonstrate that the two countries' social media users overlapped in themes concerning domestic vaccination policies, priority groups, challenges from COVID-19 variants, and the global pandemic situation. However, Twitter users were prone to disclose individual vaccination experiences, express anti-vaccine attitudes. In comparison, Weibo users manifested evident deference to authorities and exhibited more positive feelings toward the COVID-19 vaccine. Those disparities were explained by the cultural characteristics' differences between the two countries. The findings provide insights into comprehending public health issues in cross-cultural contexts and illustrate the potential of utilizing social media to conduct health informatics studies and investigate public perceptions during public health crisis time.

Reservoir dynamics of rabies in south-east Tanzania and the roles of cross-species transmission and domestic dog vaccination.

Understanding the role of different species in the transmission of multi-host pathogens, such as rabies virus, is vital for effective control strategies. Across most of sub-Saharan Africa domestic dogs Canis familiaris are considered the reservoir for rabies, but the role of wildlife has been long debated. Here we explore the multi-host transmission dynamics of rabies across south-east Tanzania.Between January 2011 and July 2019, data on probable rabies cases were collected in the regions of Lindi and Mtwara. Hospital records of animal-bite patients presenting to healthcare facilities were used as sentinels for animal contact tracing. The timing, location and species of probable rabid animals were used to reconstruct transmission trees to infer who infected whom and the relative frequencies of within- and between-species transmission.During the study, 688 probable human rabies exposures were identified, resulting in 47 deaths. Of these exposures, 389 were from domestic dogs (56.5%) and 262 from jackals (38.1%). Over the same period, 549 probable animal rabies cases were traced: 303 in domestic dogs (55.2%) and 221 in jackals (40.3%), with the remainder in domestic cats and other wildlife species.Although dog-to-dog transmission was most commonly inferred (40.5% of transmission events), a third of inferred events involved wildlife-to-wildlife transmission (32.6%), and evidence suggested some sustained transmission chains within jackal populations.A steady decline in probable rabies cases in both humans and animals coincided with the implementation of widespread domestic dog vaccination during the first 6 years of the study. Following the lapse of this program, dog rabies cases began to increase in one of the northernmost districts. Synthesis and applications. In south-east Tanzania, despite a relatively high incidence of rabies in wildlife and evidence of wildlife-to-wildlife transmission, domestic dogs remain essential to the reservoir of infection. Continued dog vaccination alongside improved surveillance would allow a fuller understanding of the role of wildlife in maintaining transmission in this area. Nonetheless, dog vaccination clearly suppressed rabies in both domestic dog and wildlife populations, reducing both public health and conservation risks and, if sustained, has potential to eliminate rabies from this region.

Inactivated rabies vaccines: Standardization of an in vitroassay for residual viable virus detection.

Human rabies, a neglected viral zoonosis, is preventable through domestic animals vaccination and post-exposure prophylaxis using inactivated rabies vaccines. During vaccine production, several mandatory in vivo quality control trials, such as potency, live virus, and safety, are responsible for the use of large numbers of laboratory animals. Over the years, global organizations encouraged the development of alternative methods to reduce, replace and refine the use of animals in the pharmaceutical industry. In this study we standardized an in vitro assay for determination of residual live virus combining viral isolation techniques with direct immunofluorescence detection and viral quantification by a molecular method. Standardization of viral recovery steps and quantification by RT-qPCR were performed and the combined method was shown to be 3 fold more sensitive than the in vivo assay. It was possible to identify viral suspensions cultures, which still had residual viable rabies virus particles, evidencing the importance to implement this method in quality control schemes of rabies vaccine production. In addition, this developed assay is more practical, inexpensive and less time consuming, producing results in just 4 days, which may allow greater agility in the internal quality control of the vaccine. The in vitro method may reduce 2/3rd of laboratory animals numbers used for this purpose, since it can be applied in the intermediate quality control of inactivated rabies vaccine production.

국내 산란계의 주요 전염성 질병에 대한 혈청학적 모니터링

Serological monitoring has been conducted worldwide for early diagnosis of disease and monitoring of immune status in poultry. This study was conducted to evaluate the immune status of layers with sera submitted to the Avian Disease Laboratory, Chungbuk National University from 2015 to 2017. The test results were analyzed by the time submitted and by the age of the chicks. Low pathogenic avian influenza (LPAI) showed a low positive rate of antibody compared with those of Newcastle disease, indicating that domestic vaccination against LPAI was not sufficient. The antibody profile of infectious bronchitis (IB) depicted high level of titer and a low tendency of CV as compared to the uninfected control flocks, which indicated that most layer farms have been exposed to the field IB virus. In case of avian metapneumovirus infection (aMPV) and <italic>Mycoplasma synoviae</italic> (MS), since the introduction of the vaccine in 2011 and 2017, respectively, the positive rate and the titer level were higher than those in pevious times. No significant difference in the changes of seasonal result was observed, indicating proper vaccination and improvement in biosecurity and management.

Animal Bites: Epidemiological Considerations in the East of Ahvaz County, Southwestern Iran (2011 - 2013)

Background: Animal bite is an emerging public health problem. Annually, in different parts of the world, more than 15 million people are treated for animal bites. Each year,140 cases of animal bites per100,000 population are estimated to occur in Iran, more than 85 of which are dog bites. Objectives: The aim of this study was to investigate the epidemiology of animal bites during years 2011 and 2013 in the East of Ahvaz county. Methods: This was a descriptive cross-sectional study performed on whole cases of animal bite registered at the health center of Eastern Ahvaz, Southwestern Iran. According to the current study, a person is bitten by an animal, and refers to the rabies prevention centers due to animal bites and fear of rabies. During a three-year period, through a questionnaire-based study, 2493 bitten individuals were enrolled in the research. In this respect, for all cases, demographic and epidemiological data, such as treatment, biting animals, age, gender, occupation, place of residence, month of the year, season and biting site on the body were recorded. Descriptive statistics, including frequency distribution and percentage were used to analyze the data. The analysis was performed using the SPSS version 18 software. Results: The highest number of bitten individuals were recorded during year 2012. Out of 2493 bitten individuals, 76.6 were male and 23.4 were female. Bites were most frequent among the age group of 21 to 30 years old. Most cases (24.7) were self-employed. in total, 65 of animal-bite incidents were in the city and 35 were in rural areas. The cases were mostly related to dog bites (78.4) and cat bites (17.3), respectively. Moreover, 100 of cases were vaccinated within the first 24 hours, 61.4 had incomplete while 38.6 had complete vaccination. Lower extremities were the most frequent bite site (46.9) followed by upper extremities (41.6), head and neck (5.7), and trunk (5.8). Animal bites were more common during spring (26.7) and autumn (25.2). Maximum number of incidents were reported during the month of April (9.2) and July (9). Conclusions: Dogs were the most common animals causing this problem. Control of stray dog population by animal birth control and domestic animal vaccination is needed. Meanwhile, training people at risk can playan important role in reducing the incidence of animal bites and rabies.

A Perspective on Rabies in the Middle East-Beyond Neglect.

Rabies is a neglected but preventable viral zoonosis that poses a substantial threat to public health. In this regard, a global program has been initiated for the elimination of human rabies caused by rabid dogs through the mass vaccination of canine populations. Geographic areas vary greatly towards attainment of this objective. For example, while dog-mediated and wildlife rabies have been largely controlled in major parts of the Americas and Western Europe, the Middle East still grapples with human rabies transmitted by unvaccinated dogs and cats. Rabies prevention and control in the Middle East is quite difficult because the region is transcontinental, encompassing portions of Africa, Asia, and Europe, while consisting of politically, culturally, and economically diverse countries that are often subject to war and unrest. Consequently, one over-riding dilemma is the misinformation or complete lack of rabies surveillance data from this area. This communication is an attempt to provide an overview of rabies in the Middle East, as a cohesive approach for the honing of disease management in each area, based on data compiled from multiple sources. In addition, the related regional transboundary movement of rabies was investigated through phylogenetic studies of available viral gene sequences. Thereafter, the epidemiological status of rabies was assessed for the region. Finally, localities were classified first by the Stepwise Approach towards Rabies Elimination framework and then categorized into four different groups based on management theme: “rabies free”; owned dog and domestic animal vaccination; community dog vaccination; and wildlife vaccination. The classification system proposed herein may serve as a baseline for future efforts. This is especially important due to the severe lack of rabies information available for the Middle East as a whole and a need for a comprehensive program focusing on the entirety of the region in light of renewed international commitment towards canine rabies elimination.

The Local Chicken Breeders Levels Knowledge of the Implementation of Newcastle Disease Vaccination in Ulu Mowewe, Indonesia

This research aims to determine the level of knowledge in domestic poultry vaccination Newcastle Disease (ND) in the village of Ulu Mowewe, Mowewe District of Kolaka Regency, Indonesia. There are two variables includes namely theprimary variable and the supporting variable. The identity of respondents consisted of the respondents’ age, education level, some innocent families, land area, and experience in breeding are the supporting variables. The primary variable is the knowledge level in implementing ND vaccination. Doing tabulation data Qualitativelyand percentage. Based on the results, known that the breeder chicken in the village of Ulu Mowewe included in the categoryas experienced breeding regarding experience working farm free-range chicken. In another hand, the breeders chicken in thetownisskilled yet in vaccinating Newcastle Disease. From 20 respondents, there is only one skilled person who has ability to vaccinate the ND. Therefore, it is essential to train the breeders at the village.

Lessons Learned From Domestic and International Human Papillomavirus Vaccination Programs: A Review

(Abstracted from Am J Obstet Gynecol 2017; http://dx.doi.org/10.1016/j.ajog.2017.08.109) Persistent infection with oncogenic human papillomavirus (HPV) leads to the development of many cervical cancers, as well as cancers of other anatomic locations. Among the more than 150 types of HPV, 13 have been identified as carcinogenic; types 16 and 18 are responsible for 70% of invasive cervical cancer.

Vaccine delivery to newly arrived refugees and estimated costs in selected U.S. clinics, 2015

BackgroundNewly arrived refugees are offered vaccinations during domestic medical examinations. Vaccination practices and costs for refugees have not been described with recent implementation of the overseas Vaccination Program for U.S.-bound Refugees (VPR). We describe refugee vaccination during the domestic medical examination and the estimated vaccination costs from the US government perspective in selected U.S. clinics. MethodsSite-specific vaccination processes and costs were collected from 16 clinics by refugee health partners in three states and one private academic institution. Vaccination costs were estimated from the U.S. Vaccines for Children Program and Medicaid reimbursement rates during fiscal year 2015. ResultsAll clinics reviewed overseas vaccination records before vaccinating, but all records were not transferred into state immunization systems. Average vaccination costs per refugee varied from $120 to $211 by site. The total average cost of domestic vaccination was 15% less among refugees arriving from VPR- vs. nonVPR-participating countries during a single domestic visit. ConclusionOur findings indicate that immunization practices and costs vary between clinics, and that clinics adapted their vaccination practices to accommodate VPR doses, yielding potential cost savings.