Emergency Vaccination Program Research Articles

County-level barriers in the COVID-19 vaccine coverage index and their associations with willingness to receive the COVID-19 vaccine across racial/ethnic groups in the U.S.

County-level vaccination barriers (sociodemographic barriers, limited healthcare system resources, healthcare accessibility barriers, irregular healthcare seeking behaviors, history of low vaccination) may partially explain COVID-19 vaccination intentions among U.S. adults. This study examined whether county-level vaccination barriers varied across racial/ethnic groups in the U.S. and were associated with willingness to receive the COVID-19 vaccine. In addition, this study assessed whether these associations differed across racial/ethnic groups. This study used data from the REACH-US study, a large online survey of U.S. adults (N = 5,475) completed from January 2021-March 2021. County-level vaccination barriers were measured using the COVID-19 Vaccine Coverage Index. Ordinal logistic regression estimated associations between race/ethnicity and county-level vaccination barriers and between county-level vaccination barriers and willingness to receive the COVID-19 vaccine. Models adjusted for covariates (age, gender, income, education, political ideology, health insurance, high-risk chronic health condition). Multigroup analysis estimated whether associations between barriers and willingness to receive the COVID-19 vaccine differed across racial/ethnic groups. American Indian/Alaska Native, Black/African American, Hispanic/Latino ELP [English Language Preference (ELP); Spanish Language Preference (SLP)], and Multiracial adults were more likely than White adults to live in counties with higher overall county-level vaccination barriers [Adjusted Odd Ratios (AORs):1.63-3.81]. Higher county-level vaccination barriers were generally associated with less willingness to receive the COVID-19 vaccine, yet associations were attenuated after adjusting for covariates. Trends differed across barriers and racial/ethnic groups. Higher sociodemographic barriers were associated with less willingness to receive the COVID-19 vaccine (AOR:0.78, 95% CI:0.64-0.94), whereas higher irregular care-seeking behavior was associated with greater willingness to receive the vaccine (AOR:1.20, 95% CI:1.04-1.39). Greater history of low vaccination was associated with less willingness to receive the COVID-19 vaccine among Black/African American adults (AOR:0.55, 95% CI:0.37-0.84), but greater willingness to receive the vaccine among American Indian/Alaska Native and Hispanic/Latino ELP adults (AOR:1.90, 95% CI:1.10-3.28; AOR:1.85, 95% CI:1.14-3.01). Future public health emergency vaccination programs should include planning and coverage efforts that account for structural barriers to preventive healthcare and their intersection with sociodemographic factors. Addressing structural barriers to COVID-19 treatment and preventive services is essential for reducing morbidity and mortality in future infectious disease outbreaks.

B-094 Vaccination Anti-SARS-Cov2 Scheme Effect on Humoral Responses on Brazilian Cohort

Abstract Background Due to high spread of SARS-CoV-2, a global emergency vaccination program using diverse and new vaccines was implemented, providing protection mortality of COVID-19. In this way, populational investigation before and after vaccination is essential to understand and monitoring the effectiveness of these efforts. Methods Observational non-randomized study was performed using samples of 95 workers from healthcare institutions. They were vaccinated with two homologous doses of Sinovac, ChAdOx1 and Pfizer booster dose. Serum levels of anti-S1 IgA and IgG, anti-NCP IgG and neutralizing antibodies (Nabs) were measured immediately before (T0), two weeks after each dose (T1, T2), 21 days after T2 (T3) and two weeks after boost (T4). Tests were performed through commercial kits of EUROIMMUN. Results Results are summarized in Fig. 1. Anti-S1 IgG and IgA titles of CoronaVac samples showed a statistically significant increase after each vaccine dose (T1, T2 and T4). For ChAdOx1, statistically significant difference (SSD) was noticed between T1 and T4. Comparing anti- S1 IgG titles between both vaccines, SSD was observed between all collections, above 2500 BAU/mL on both.Anti-NCP titles increased after each CoronaVac dose, as expected since is an inactivated virus vaccine and SSD was observed from T1 to T4. NAbs at T3 and T4 showed SSD between collection times for each vaccine and between the vaccines. At T3 NAbs titles were higher for ChAdOx1 in comparison to Coronavac vaccinated. However, after the booster dose there was no difference of titles between vaccines and all participants were considered responsive. Conclusion The vaccine antibodies titles increased after each vaccine dose. Although there was difference of the diverse antibody titles between vaccines after 1st and 2nd doses, after booster dose all vaccinated were equally highly responsive. Such results reinforce the importance of the booster dose in the vaccination strategy against SARS-CoV-2.

Randomized Trial of 2 Schedules of Meningococcal B Vaccine in Adolescents and Young Adults, Canada1.

Emergency vaccination programs often are needed to control outbreaks of meningococcal disease caused by Neisseria meningitidis serogroup B (MenB) on college campuses. Such campaigns expend multiple campus and public health resources. We conducted a randomized, controlled, multicenter, observer-blinded trial comparing immunogenicity and tolerability of an accelerated vaccine schedule of 0 and 21 days to a longer interval of 0 and 60 days for 4-component MenB vaccine (MenB-4C) in students 17–25 years of age. At day 21 after the first MenB-4C dose, we observed protective human serum bactericidal titers >4 to MenB strains 5/99, H44/76, and NZ 98/254 in 98%–100% of participants. Geometric mean titers increased >22-fold over baseline. At day 180, >95% of participants sustained protective titers regardless of their vaccine schedule. The most common adverse event was injection site pain. An accelerated MenB-4C immunization schedule could be considered for rapid control of campus outbreaks.

The PanVax Tool to Improve Pandemic Influenza Emergency Vaccination Program Readiness and Partnership.

Objectives. To show how the Centers for Disease Control and Prevention's Pandemic Vaccine Campaign Planning Tool (PanVax Tool) can help state and local public health emergency planners demonstrate and quantify how partnerships with community vaccine providers can improve their overall pandemic vaccination program readiness.Methods. The PanVax Tool helps planners compare different strategies to vaccinate their jurisdiction's population in a severe pandemic by allowing users to customize the underlying model inputs in real time, including their jurisdiction's size, community vaccine provider types, and how they allocate vaccine to these providers. In this report, we used a case study with hypothetical data to illustrate how jurisdictions can utilize the PanVax Tool for preparedness planning.Results. By using the tool, planners are able to understand the impact of engaging with different vaccine providers in a vaccination campaign.Conclusions. The PanVax Tool is a useful tool to help demonstrate the impact of community vaccine provider partnerships on pandemic vaccination readiness and identify areas for improved partnerships for pandemic response.

A multi-site feasibility study to assess fever and wheezing in children after influenza vaccines using text messaging.

Using text messaging for vaccine safety monitoring, particularly for non-medically attended events, would be valuable for pandemic influenza and emergency vaccination program preparedness. We assessed the feasibility and acceptability of text messaging to evaluate fever and wheezing post-influenza vaccination in a prospective, observational, multi-site pediatric study. Children aged 2-11 years old, with an emphasis on children with asthma, were recruited during the 2014-2015 influenza season from three community-based clinics in New York City, and during the 2014-2015 and 2015-2016 seasons from a private practice in Fall River, Massachusetts. Parents of enrolled children receiving quadrivalent live attenuated (LAIV4) or inactivated influenza vaccine (IIV4) replied to text messages assessing respiratory symptoms (day 3 and 7, then weekly through day 42), and temperature on the night of vaccination and the next seven nights (day 0-7). Missing data were collected via diary (day 0-7 only) and phone. Phone confirmation was obtained for both presence and absence of respiratory symptoms. Reporting rates, fever (T≥100.4 °F) frequency, proportion of wheezing and/or chest tightness reports captured via text message versus all sources (text, phone, diary, electronic health record) and parental satisfaction were assessed. Across both seasons, 266 children were analyzed; 49.2% with asthma. Parental text message response rates were high (>70%) across sites. Overall, fever frequency was low (day 0-2: 4.1% [95% confidence interval (CI) 2.3-7.4%]; d3-7: 6.7% [95% CI 4.1-10.8%]). A third (39.2%) of parents reported a respiratory problem in their child, primarily cough. Most (88.2%) of the 52 wheezing and/or chest tightness reports were by text message. Most (88.1%) participants preferred text messaging over paper reporting. Text messaging can provide information about pediatric post-vaccination fever and wheezing and was viewed positively by parents. It could be a helpful tool for rapid vaccine safety monitoring during a pandemic or other emergency vaccination program. clinicaltrials.gov Identifier: NCT02295007.

Protection of White Leghorn chickens by U.S. emergency H5 vaccination against clade 2.3.4.4 H5N2 high pathogenicity avian influenza virus.

During December 2014-June 2015, the U.S. experienced a high pathogenicity avian influenza (HPAI) outbreak caused by clade 2.3.4.4 H5Nx Goose/Guangdong lineage viruses with devastating consequences for the poultry industry. Three vaccines, developed based on updating existing registered vaccines or currently licensed technologies, were evaluated for possible use: an inactivated reverse genetics H5N1 vaccine (rgH5N1) and an RNA particle vaccine (RP-H5), both containing the hemagglutinin gene of clade 2.3.4.4 strain, and a recombinant herpesvirus turkey vectored vaccine (rHVT-H5) containing the hemagglutinin gene of clade 2.2 strain. The efficacy of the three vaccines, alone or in combination, was assessed in White Leghorn chickens against clade 2.3.4.4 H5N2 HPAI virus challenge. In Study 1, single (rHVT-H5) and prime-boost (rHVT-H5+rgH5N1 or rHVT-H5+RP-H5) vaccination strategies protected chickens with high levels of protective immunity and significantly reduced virus shedding. In Study 2, single vaccination with either rgH5N1 or RP-H5 vaccines provided clinical protection in adult chickens and significantly reduced virus shedding. In Study 3, double rgH5N1 vaccination protected adult chickens from clinical signs and mortality when challenged 20weeks post-boost, with high levels of long-lasting protective immunity and significantly reduced virus shedding. These studies support the use of genetically related vaccines, possibly in combination with a broad protective priming vaccine, for emergency vaccination programs against clade 2.3.4.4 H5Nx HPAI virus in young and adult layer chickens.

Vaccine hesitancy as self-determination: an Israeli perspective

Vaccine hesitancy can be portrayed as a broad spectrum of phenomena, ranging from a genuine call for help to complete defiance of authorities. The emphasis here is made on mid-spectrum hesitancy; hesitancy as an act of personal exploration and deliberation whether to get vaccinated or not. This form of vaccine hesitancy can be identified in the attitude of the Israeli public towards routine childhood vaccination programs, seasonal flu vaccination, newly introduced vaccines, such as human papilloma virus vaccine, as well as towards the emergency vaccination programs against poliovirus and H1N1 pandemic influenza. Vaccine hesitancy in Israel appears to be a process where individuals exercise self-determination and self-empowerment and make their own decisions based on assessment, reflection, choosing between various options and dealing with considerable complexities.Addressing this form of vaccine hesitancy could be challenging, but ultimately fruitful. This would require change of attitudes on the part of policymakers. The first steps should involve the realization that deliberative hesitancy is here to stay, and that hesitant individuals should be respected. This could pave the way for designing appropriate intervention strategies for convincing the hesitant public about the advantages of vaccination.

ECONOMIC IMPACT OF ALTERNATIVE FMD EMERGENCY VACCINATION STRATEGIES IN THE MIDWESTERN UNITED STATES

AbstractAn outbreak of foot-and-mouth disease (FMD) in the United States would likely result in major costs to producers, consumers, and government. How animal health officials manage such an outbreak has substantial impact on probable losses. Without an emergency FMD vaccination strategy, producer and consumer losses of an FMD outbreak in the midwestern United States would likely approach $188 billion, and government costs would likely exceed $11 billion. In contrast, a high-capacity emergency vaccination program together with a large vaccination zone would reduce median consumer and producer losses to approximately $56 billion and government costs to a little more than $1 billion.

Evaluation of avian paramyxovirus serotypes 2 to 10 as vaccine vectors in chickens previously immunized against Newcastle disease virus

Newcastle disease virus (NDV), also known as avian paramyxovirus (APMV) serotype 1, is used as a vaccine vector to express the hemagglutinin protein of avian influenza (AI) virus. However, use of live NDV recombinant vaccines expressing AI virus hemagglutinin is not desirable in emergency vaccination programs to control severe AI outbreaks in chickens, because commercial chickens often possess pre-existing NDV immunity induced by routine vaccination. Therefore, a novel vaccine vector is required for emergency vaccination of chickens to control AI during outbreaks. We investigated whether candidate APMV strains could be used as vaccine vectors that could evade the pre-existing immunity acquired by chickens through NDV vaccination and that would replicate in the mucosal tissues where AI virus primarily replicates. To this end, we examined strains of APMV serotypes 2 to 10 for their immunogenicity and replication in chickens with pre-existing immunity to NDV. APMV serotypes 2, 6, and 10 were the least cross-reactive to antibodies to NDV in hemagglutination inhibition and/or virus neutralization tests. Virus replication in mucosal tissues, as well as antibody response after oculonasal inoculation, was observed when 7-week-old chickens were challenged with APMV of serotype 2, 6, or 10. The APMV also replicated in mucosal tissues and induced antibody responses in chickens that had been vaccinated twice with NDV before challenge. These results warrant further study to develop vaccine vectors based on APMV serotype 2, 6, or 10 for emergency vaccination of chickens against AI.

Impact of Vaccines and Vaccination on Global Control of Avian Influenza

There are 30 recorded epizootics of H5 or H7 high pathogenicity avian influenza (HPAI) from 1959 to early 2012. The largest of these epizootics, affecting more birds and countries than the other 29 epizootics combined, has been the H5N1 HPAI, which began in Guangdong China in 1996, and has killed or resulted in culling of over 250 million poultry and/or wild birds in 63 countries. Most countries have used stamping-out programs in poultry to eradicate H5N1 HPAI. However, 15 affected countries have utilized vaccination as a part of the control strategy. Greater than 113 billion doses were used from 2002 to 2010. Five countries have utilized nationwide routine vaccination programs, which account for 99% of vaccine used: 1) China (90.9%), 2) Egypt (4.6%), 3) Indonesia (2.3%), 4) Vietnam (1.4%), and 5) Hong Kong Special Administrative Region (< 0.01%). Mongolia, Kazakhstan, France, The Netherlands, Cote d'Ivoire, Sudan, North Korea, Israel, Russia, and Pakistan used < 1% of the avian influenza (AI) vaccine, and the AI vaccine was targeted to either preventive or emergency vaccination programs. Inactivated AI vaccines have accounted for 95.5% of vaccine used, and live recombinant virus vaccines have accounted for 4.5% of vaccine used. The latter are primarily recombinant Newcastle disease vectored vaccine with H5 influenza gene insert. China, Indonesia, Egypt, and Vietnam implemented vaccination after H5N1 HPAI became enzootic in domestic poultry. Bangladesh and eastern India have enzootic H5N1 HPAI and have not used vaccination in their control programs. Clinical disease and mortality have been prevented in chickens, human cases have been reduced, and rural livelihoods and food security have been maintained by using vaccines during HPAI outbreaks. However, field outbreaks have occurred in vaccinating countries, primarily because of inadequate coverage in the target species, but vaccine failures have occurred following antigenic drift in field viruses within China, Egypt, Indonesia, Hong Kong, and Vietnam. The primary strategy for HPAI and H5/H7 low pathogenicity notifiable avian influenza control will continue to be immediate eradication using a four-component strategy: 1) education, 2) biosecurity, 3) rapid diagnostics and surveillance, and 4) elimination of infected poultry. Under some circumstances, vaccination can be added as an additional tool within a wider control strategy when immediate eradication is not feasible, which will maintain livelihoods and food security, and control clinical disease until a primary strategy can be developed and implemented to achieve eradication.

Adverse events following pandemic influenza vaccine Pandemrix ® reported in the French military forces—2009–2010

Background In the face of the A(H1N1) 2009 influenza pandemic, in October 2009 the French military health service (SSA) initiated a large vaccination campaign with Pandemrix ® vaccine in the military forces. The aim of this study was to describe vaccine adverse events (VAE) reported during this campaign. Methods VAE and the number of people vaccinated were surveyed by the SSA Epidemiological network across all military forces during the campaign, from October 2009 to April 2010. For each case, a notification form was completed, providing patient and clinical information. Three types of VAE were considered: non-serious, serious and unexpected. Results There were 315.4 reported VAE per 100,000 vaccinations. Vaccination and VAE incidence rate peaks coincided with influenza epidemic peak in early December. The number of injected doses was 49,138, corresponding to a 14.5% vaccination coverage among military personnel, and 155 VAE were reported, including 5 serious VAE (1 Guillain-Barre syndrome, 2 malaises and 1 convulsive episode). Most VAE were non-serious (97.1%). Among these, 6 cases of local, rapidly regressive paresthesia were observed. Discussion The military VAE surveillance system constitutes the only observatory on benign VAE in France. The reporting rate was much higher after the pandemic vaccine than after the seasonal vaccine, which may be a reflection of stimulated reporting. This report provides a useful description of VAE among military personnel during a mass emergency vaccination program, showing that the tolerance of the pandemic vaccine appeared acceptable.

First serological investigation of peste-des-petits-ruminants and Rift Valley fever in Tunisia

This study, carried out between September 2006 and January 2007, is the first cross-sectional serological investigation of peste-des-petits-ruminants (PPR) and Rift Valley fever (RVF) in Tunisia. The objective was to assess the potential need to develop a dual, recombinant PPR-RVF vaccine and how such a vaccine might be utilised in Tunisia. An overall PPR seroprevalence of 7.45% was determined, a finding supported by the high specificity (99.4%) and sensitivity (94.5%) of the ELISA used. On assessment of the diversity and density of mosquitoes in the sampling area, four species of RVF-vectors of the genus Aedes and Culex were identified. However, no serological evidence of RVF was found despite the use of a highly sensitive ELISA (99-100%). Larger scale investigations are underway to confirm these findings and the continuation of the emergency vaccination program against these two diseases remains valid.

Evaluation of the Efficacy of Intervention Measures and Vaccination for the Control of LPAI Epidemics in Verona Province (Veneto, Italy)

Meat-type turkey farms in Verona province (Veneto, Italy) have been affected by three low-pathogenicity avian influenza (LPAI) epidemics between 2000 and 2004. Control measures implemented ranged from stamping out to controlled marketing in conjunction with restocking bans and movement restriction on live poultry, vehicles, and personnel. These measures were complemented with two emergency vaccination programs (2000-01, 2002-03) started after the beginning of the epidemics, while 2004 outbreaks occurred in vaccinated farms. The three epidemics differed in the number of outbreaks, duration, and economic impact. The aim of the investigation was to estimate the risk of infection and the effect of vaccination on the LPAI epidemics affecting turkey farms in Verona province. Farm probability to avoid infection (Ps) was calculated by Kaplan-Meier for each epidemic. The vaccination effect was evaluated for the 2000-01 and 2002-03 epidemics considering different risk before or after the emergency vaccination. The epidemics and vaccination entered as predictors in a Cox regression model and hazard ratios (HR) were calculated. Ps values at the end of the epidemics were as follows: 2000-01 = 0.66, 2002-03 = 0.51, and 2004 = 0.91. Vaccination reduced dramatically the risk of infection. The measures implemented had different effects on the three epidemics. The lower probability of being infected during the 2004 epidemic was most likely related to the protection level of the vaccinated farms acquired before the beginning of the epidemic, which was also responsible for the reduced spread of infection.

An integrated disease management strategy for the control of rabies in Ethiopian wolves

Infectious diseases pose an important extinction risk for a number of endangered carnivore populations. Wild canids are particularly susceptible to generalist pathogens transmitted from domestic dogs – particularly rabies virus and canine distemper virus (CDV). Here we present a review of rabies as a threat to Ethiopian wolves, an endangered canid restricted to a few isolated Afro-alpine ranges in the Ethiopian highlands, and the impact of rabies on the largest population in the Bale Mountains. In the Bale Mountains, two confirmed rabies outbreaks among Ethiopian wolves in 1991–1992 and 2003–2004 were each responsible for over 70% mortality among focal packs and a third rabies outbreak was suspected in 1990. This review also presents an integrated disease management strategy for Ethiopian wolves combining long-term population monitoring, disease surveillance, conventional and emergency vaccination programs, and advanced modelling techniques.

Emergency vaccination of rabies under limited resources – combating or containing?

BackgroundRabies is the most important viral zoonosis from a global perspective. Worldwide efforts to combat the disease by oral vaccination of reservoirs have managed to eradicate wildlife rabies in large areas of central Europe and North-America. Thus, repeated vaccination has been discontinued recently on a geographical scale. However, as rabies has not yet been eradicated globally, a serious risk of re-introduction remains. What is the best spatial design for an emergency vaccination program – particularly if resources are limited? Either, we treat a circular area around the detected case and run the risk of infected hosts leaving the limited control area, because a sufficient immunisation level has not yet been built up. Or, initially concentrate the SAME resources in order to establish a protective ring which is more distant from the infected local area, and which then holds out against the challenge of the approaching epidemic.MethodsWe developed a simulation model to contrast the two strategies for emergency vaccination. The spatial-explicit model is based on fox group home-ranges, which facilitates the simulation of rabies spread to larger areas relevant to management. We used individual-based fox groups to follow up the effects of vaccination in a detailed manner. Thus, regionally – bait distribution orientates itself to standard schemes of oral immunisation programs and locally – baits are assigned to individual foxes.ResultsSurprisingly, putting the controlled area ring-like around the outbreak does not outperform the circular area of the same size centred on the outbreak. Only during the very first baitings, does the ring area result in fewer breakouts. But then as rabies is eliminated within the circle area, the respective ring area fails, due to the non-controlled inner part.We attempt to take advantage of the initially fewer breakouts beyond the ring when applying a mixed strategy. Therefore, after a certain number of baitings, the area under control was increased for both strategies towards the same larger circular area. The circle-circle strategy still outperforms the ring-circle strategy and analysis of the spatial-temporal disease spread reveals why: improving control efficacy by means of a mixed strategy is impossible in the field, due to the build-up time of population immunity.ConclusionFor practical emergency management of a new outbreak of rabies, the ring-like application of oral vaccination is not a favourable strategy at all. Even if initial resources are substantially low and there is a serious risk of rabies cases outside the limited control area, our results suggest circular application instead of ring vaccination.

Low-pathogenicity avian influenza (LPAI) in Italy (2000-01): epidemiology and control.

In 1999-2000, Italy was affected by the most severe avian influenza (AI) epidemic that has ever occurred in Europe. The epidemic was caused by a type A influenza virus of the H7N1 subtype, which originated from the mutation of a low-pathogenicity (LP) AI virus of the same subtype. From August to November 2000, 4 months after the eradication of the highly pathogenic (HP) AI virus, the LPAI strain re-emerged and infected 55 poultry farms mainly located in the southern area of Verona province (Veneto region). To supplement disease control measures already in force, an emergency vaccination program against the disease was implemented in the area. Vaccination was carried out using an inactivated heterologous vaccine (A/chicken/Pakistan/1995-H7N3). In order to establish whether LPAI infection was circulating in the area, regular serological testing of sentinel birds in vaccinated flocks and a discriminatory test able to distinguish the different types of antineuraminidase antibodies (anti-N1 and anti-N3) were performed. Shortly after the beginning of the vaccination campaign (December 2000 to March 2001), the H7N1 LPAI virus emerged again, infecting 23 farms. Among these, only one vaccinated flock was affected, and infection did not spread further to other vaccinated farms. The data reported in the present paper indicate that the combination of biosecurity measures, official control, and vaccination can be considered successful for the control of LPAI infections in densely populated poultry areas.