Global Rollout Research Articles

Immune and Metabolic Alterations in Children with Perinatal HIV Exposure.

With the global rollout of mother-to-child prevention programs for women living with HIV, vertical transmission has been all but eliminated in many countries. However, the number of children who are exposed in utero to HIV and antiretroviral therapy (ART) is ever-increasing. These children who are HIV-exposed-but-uninfected (CHEU) are now well recognized as having persistent health disparities compared to children who are HIV-unexposed-and-uninfected (CHUU). Differences reported between these two groups include immune dysfunction and higher levels of inflammation, cognitive and metabolic abnormalities, as well as increased morbidity and mortality in CHEU. The reasons for these disparities remain largely unknown. The present review focuses on a proposed link between immunometabolic aberrations and clinical pathologies observed in the rapidly expanding CHEU population. By drawing attention, firstly, to the significance of the immune and metabolic alterations observed in these children, and secondly, the impact of their healthcare requirements, particularly in low- and middle-income countries, this review aims to sensitize healthcare workers and policymakers about the long-term risks of in utero exposure to HIV and ART.

Inequitable by Design: The Patent Culture, Law, and Politics Behind COVID-19 Vaccine Global Access

COVID-19 vaccine access has been highly inequitable worldwide, with coverage depending largely on a country’s wealth. By the end of 2021, 64.1% of people living in high-income countries had received at least one dose of the vaccine, compared to only 5.4% of those in low-income countries. Similarly, only high- and upper-middle-income countries had received the most effective vaccines. The uneven distribution of these lifesaving vaccines is made complex due to the convergence of several factors, but it suggests that the extraordinary expanding and ossifying market and political power of a few vaccine manufacturers founded on intellectual property and complementary policies is a decisive factor in shaping our healthcare systems and securing equitable access to vaccines. This Article analyzes the power dynamics of vaccine manufacturing and distribution of U.S. pharmaceutical companies in the context of global COVID-19 vaccination. Drawing on the health-justice and law-and-political-economy scholarship of the last decade, this Article demonstrates how a “patent culture” shaped by intellectual property law fundamentally neglects health-equity principles while politicizing healthcare access. These contemporary frameworks suggest that the global COVID-19 vaccine-access problem is the result of avoidable policy choices made by big manufacturers and affluent governments. Despite a long history of inequities in access to healthcare, policy choices—as predicted by Hart’s inverse equity theory—have favored a purposely inequitable-by-design vaccination program driven by the wealth and power of those allowed to control vaccine production and supply globally. Finally, this Article proposes ways to challenge the normalized and institutionalized patent culture that has commodified access to lifesaving medicines beyond national borders. As it examines national and international legal strategies to address the vaccine-access problem, the Article suggests equity-based principles of public value, transparency, and inclusivity to guide healthcare governance and future reformation of the vaccine-access landscape. An interdisciplinary analysis of the first year of the global vaccine rollout provides an account critical to future policies aiming to address the structural conditions needed to attain equitable health outcomes, even after the pandemic.

From the Beginning: Key Transitions in the First 15 Years of DNSSEC

When the global rollout of the DNS Security Extensions (DNSSEC) began in 2005, it started a first-of-its-kind trial: increasing complexity of a core Internet protocol in favor of better security for the overall Internet. The necessary cryptographic key management is made particularly challenging by DNS' loosely-federated delegation substrate and unprecedented cryptographic scale. Though fundamental for current and future operational success, our community lacks a clear notion of how to empirically evaluate the process of securely changing (or transitioning) keys. In this paper, we propose two building blocks to fundamentally understand and assess key transitions. First, the anatomy of key transitions: measurable and well-defined properties of key changes; and second a novel classification model based on this anatomy to describe key transitions practices in abstract terms. Our anatomy enables the evaluation of cryptographic keys' life cycles in general, and comparison of operational practices with prescribed key management processes, e.g., RFC key rollover guidelines. The fine-grained transition anatomy is then abstracted through our classification model to characterize transitions in abstract terms which rather describe a transition's behavior than its specific features. The applicability and utility of our proposed transition anatomy and transition classes are exemplified for the global DNSSEC deployment. Specifically, we use measurements from the first 15 years of the DNSSEC rollout to detect and measure which key rollover/transitions have been used, to what degree, and what their rates of errors and warnings have been. Our results show measurable gaps between prescribed key management processes and key transitions in the wild. We also find evidence that such noncompliant transitions are inevitable in the wild.

Sapovirus Infections in an Australian Community-Based Healthy Birth Cohort During the First 2 Years of Life.

Sapovirus is an important cause of acute gastroenteritis (AGE) in young children. However, knowledge gaps remain in community settings. We investigated the epidemiology, disease characteristics, and healthcare use associated with sapovirus infections in Australian children during their first 2 years of life. Children in the Brisbane-based Observational Research in Childhood Infectious Diseases birth cohort provided daily gastrointestinal symptoms (vomiting/loose stools), weekly stool swabs, and healthcare data until age 2 years. Swabs were batch-tested for sapovirus using real-time polymerase chain reaction assays. Incidence rates and estimates of associations were calculated. Overall, 158 children returned 11 124 swabs. There were 192 sapovirus infection episodes. The incidence rate in the first 2 years of life was 0.89 infections per child-year (95% confidence interval [CI], .76-1.05), and the symptomatic incidence rate was 0.26 episodes per child-year (95% CI, .17-.37). Age ≥6 months, the fall season, and childcare attendance increased disease incidence significantly. Fifty-four of the 180 (30%) infections with linked symptom diaries were symptomatic, with 72% recording vomiting and 48% diarrhea. Prior infection reduced risk of further infections (adjusted hazard ratio, 0.70 [95% CI, .54-.81]) in the study period. Viral loads were higher and viral shedding duration was longer in symptomatic than asymptomatic children. Twenty-three (43%) symptomatic episodes required healthcare, including 6 emergency department presentations and 2 hospitalizations. Sapovirus infections are common in Australian children aged 6-23 months. Efforts to reduce childhood AGE after the global rollout of rotavirus vaccines should include sapovirus where estimates of its incidence in communities will be crucial.

8.M. Round table: Health literacy and vaccine literacy as determinants of vaccine acceptance: a critical discussion

Abstract In 2019, Sars-Cov-2 caused the greatest pandemic the modern world has ever faced. The pandemic was unprecedented regarding its effects on all aspects of society. Since the outbreak, debates on vaccines have been elevated in public health. The pandemic also emerged into a game changer regarding health communication and information delivery. With digital communication technologies, the Internet and Social Media being the most important tools to discuss health matters, exchange health knowledge and get advice from peers, every human has been part of a global communication network discussing the pandemic, related policies and vaccines. The digital realm allowed everybody to contribute to the state of Covid-19 related health information and absorb them. Altogether, this led to an overabundance of accurate and false information circulating the digital world, which culminated into the information epidemic (infodemic). Early on in the pandemic, it became obvious that people need competencies enabling them to navigate digital information environments, manage (digital) health information and to use digital health services that were accelerated through Covid-19. While health literacy and vaccine literacy were undervalued at the time, policy makers and practitioners soon highlighted their critical role in mitigating the spread of coronavirus, for protection against infection and increasing adherence to public health emergency measures. In context of the Covid-19 pandemic, health literacy enables people to find, understand and critically appraise relevant information and use it for prevention behaviour. Since it empowers individuals to mitigate the effects of the pandemic, health literacy is seen as a social vaccines. Vaccine literacy is a sub-dimension about health literacy, which especially became important when global roll-out of Covid-19 vaccines began in 2021. Vaccine literacy helps people to understand what a vaccine is, why it is relevant to get vaccinated and how it protects oneself and others. In addition, vaccine literacy empowers people to find vaccine-related information and judge about vaccine claims. The purpose of this roundtable is to discuss research findings on health literacy and vaccine literacy in relation to Covid-19, the determinants of vaccine acceptance, vaccine hesitancy and vaccine attitudes, generated in different European studies: (1) the international trend study HLS-Covid-19 conducted in Germany, Austria and Switzerland, (ii) HLCA-Kids-NRW on coronavirus-specific health literacy in primary schoolchildren (Germany) and (iii) the HLS19 European Health Literacy Survey. While the roundtable aims at introducing empirical findings, each panelist will provide a statement related to the roundtable theme based on the findings of their study. Together with the audiences, we will discuss about lessons learned from the pandemic and how to utilize health and vaccine literacy to increase vaccine acceptance. Key messages • Health literacy is a social vaccine and empowers people to manage health information and increase vaccine acceptance. • Vaccine literacy is a sub-dimension of health literacy and in particular is useful when addressed as part of public health emergency strategies. Speakers/Panellists Orkan Okan Technical University Munich, Munich, Germany Kristine Sørensen Global Health Literacy Academy, Risskov, Denmark Robert Griebler Austrian National Public Health Institute, Vienna, Austria Saskia De Gani Careum Center for Health Literacy, Zürich, Switzerland Torsten Michael Bollweg Technical University Munich, Munich, Germany

Digital health literacy for COVID-19 vaccination and intention to be immunized: A cross sectional multi-country study among the general adult population.

IntroductionIt is clear that medical science has advanced much in the past few decades with the development of vaccines and this is even true for the novel coronavirus outbreak. By late 2020, COVID-19 vaccines were starting to be approved by national and global regulators, and across 2021, there was a global rollout of several vaccines. Despite rolling out vaccination programs successfully, there has been a cause of concern regarding uptake of vaccine due to vaccine hesitancy. In tackling the vaccine hesitancy and improving the overall vaccination rates, digital health literacy (DHL) could play a major role. Therefore, the aim of this study is to assess the digital health literacy and its relevance to the COVID-19 vaccination.MethodsAn internet-based cross-sectional survey was conducted from April to August 2021 using convenience sampling among people from different countries. Participants were asked about their level of intention to the COVID-19 vaccine. Participants completed the Digital Health Literacy Instrument (DHLI), which was adapted in the context of the COVID Health Literacy Network. Cross-tabulation and logistic regression were used for analysis purpose.ResultsOverall, the mean DHL score was 35.1 (SD = 6.9, Range = 12–48). The mean DHL score for those who answered “Yes” for “support for national vaccination schedule” was 36.1 (SD 6.7) compared to 32.5 (SD 6.8) for those who either answered “No” or “Don't know”. Factors including country, place of residence, education, employment, and income were associated with the intention for vaccination. Odds of vaccine intention were higher in urban respondents (OR-1.46; C.I.-1.30–1.64) than in rural respondents. Further, higher competency in assessing the relevance of online information resulted in significantly higher intention for vaccine uptake.ConclusionPriority should be given to improving DHL and vaccination awareness programs targeting rural areas, lower education level, lower income, and unemployed groups.

Factors Influencing the Willingness to Download COVID-19 Contact Tracing Apps: The Moderating Effect of Persuasive Design and Smartphone Usage Experience

The COVID-19 pandemic culminated in the global roll-out of contact tracing apps, also known as exposure notification apps (ENAs), to contain the spread of the virus. ENAs notify users about a possible infection and advises them to take certain health measures such as self-isolation and COVID-19 test. While some work has been done on the factors that influence ENA adoption, little attention has been paid to the moderating effect of persuasive design and smartphone usage experience. This paper sets out to bridge this gap using the Government of Canada’s official app “COVID Alert” and Canadian non-adopter population (n = 133) as a case study. Of the seven factors we investigated, perceived trust (β = 0.29, p < 0.01) and perceived enjoyment (β = 0.21, p < 0.05) turned out to be the only significant predictors of non-adopters’ willingness to download the app in the overall model. Both persuasive design and smartphone usage experience moderated some of the relationships in the model. For example, while perceived enjoyment is significant in the persuasive design submodel (β = 0.34, p < 0.01) and low-experience submodel (β = 0.36, p < 0.001), it is not in the control design and high-experience submodels. Moreover, perceived enjoyment (β = 0.36, p < 0.001) and privacy concern (β = -0.46, p < 0.05) turned out to be the strongest predictors in the low-experience and high-experience submodels, respectively. These results indicate that, to improve the download of ENAs, sponsors should implement and highlight app features that foster trust in marketing campaigns and app-store descriptions. Particularly, they should highlight their privacy-protection feature and hedonic attribute among the high-experience and low-experience groups, respectively.

Young children still to treat, unfortunately

Young children still to treat, unfortunately

Once-daily dolutegravir-based antiretroviral therapy in infants and children living with HIV from age 4 weeks: results from the below 14 kg cohort in the randomised ODYSSEY trial

Young children living with HIV have few treatment options. We aimed to assess the efficacy and safety of dolutegravir-based antiretroviral therapy (ART) in children weighing between 3 kg and less than 14 kg. ODYSSEY is an open-label, randomised, non-inferiority trial (10% margin) comparing dolutegravir-based ART with standard of care and comprises two cohorts (children weighing ≥14 kg and <14 kg). Children weighing less than 14 kg starting first-line or second-line ART were enrolled in seven HIV treatment centres in South Africa, Uganda, and Zimbabwe. Randomisation, which was computer generated by the trial statistician, was stratified by first-line or second-line ART and three weight bands. Dispersible 5 mg dolutegravir was dosed according to WHO weight bands. The primary outcome was the Kaplan-Meier estimated proportion of children with virological or clinical failure by 96 weeks, defined as: confirmed viral load of at least 400 copies per mL after week 36; absence of virological suppression by 24 weeks followed by a switch to second-line or third-line ART; all-cause death; or a new or recurrent WHO stage 4 or severe WHO stage 3 event. The primary outcome was assessed by intention to treat in all randomly assigned participants. A primary Bayesian analysis of the difference in the proportion of children meeting the primary outcome between treatment groups incorporated evidence from the higher weight cohort (≥14 kg) in a prior distribution. A frequentist analysis was also done of the lower weight cohort (<14 kg) alone. Safety analyses are presented for all randomly assigned children in this study (<14 kg cohort). ODYSSEY is registered with ClinicalTrials.gov, NCT02259127. Between July 5, 2018, and Aug 26, 2019, 85 children weighing less than 14 kg were randomly assigned to receive dolutegravir (n=42) or standard of care (n=43; 32 [74%] receiving protease inhibitor-based ART). Median age was 1·4 years (IQR 0·6-2·0) and median weight 8·1 kg (5·4-10·0). 72 (85%) children started first-line ART and 13 (15%) started second-line ART. Median follow-up was 124 weeks (112-137). By 96 weeks, treatment failure occurred in 12 children in the dolutegravir group (Kaplan-Meier estimated proportion 31%) versus 21 (48%) in the standard-of-care group. The Bayesian estimated difference in treatment failure (dolutegravir minus standard of care) was -10% (95% CI -19% to -2%; p=0·020), demonstrating superiority of dolutegravir. The frequentist estimated difference was -18% (-36% to 2%; p=0·057). 15 serious adverse events were reported in 11 (26%) children in the dolutegravir group, including two deaths, and 19 were reported in 11 (26%) children in the standard-of-care group, including four deaths (hazard ratio [HR] 1·08 [95% CI 0·47-2·49]; p=0·86). 36 adverse events of grade 3 or higher were reported in 19 (45%) children in the dolutegravir group, versus 34 events in 21 (49%) children in the standard-of-care group (HR 0·93 [0·50-1·74]; p=0·83). No events were considered related to dolutegravir. Dolutegravir-based ART was superior to standard of care (mainly protease inhibitor-based) with a lower risk of treatment failure in infants and young children, providing support for global dispersible dolutegravir roll-out for younger children and allowing alignment of adult and paediatric treatment. Paediatric European Network for Treatment of AIDS Foundation, ViiV Healthcare, UK Medical Research Council.

A low-profile wideband compressed single-arm spiral antenna array for mid-band 5G beam steering applications

A low profile wideband spiral antenna array is presented for global mid-band 5G beam steering applications. In the global rollout of mid-band 5G, different frequencies have been licensed within each region (e.g. 3.4–3.8 GHz in the EU and 3.7–5 GHz in the USA). Therefore, antenna arrays must be able to cover a bandwidth of 3.3 GHz to 5 GHz to provide true global coverage. Initially, this work presents the design of a wideband compressed spiral antenna that provides an axial beam throughout its operational bandwidth of 3.3 GHz to 5 GHz, enabling beam steering functionality. Then, this antenna has been placed in a 4 × 4 array with a triangular lattice. The proposed spiral antenna array can provide a scanning range of − 40° ≤ θ ≤ + 40° in all azimuth directions with an average back lobe level of less than − 9.5 dB. This development will allow for low-cost integration of 5G systems for global use, such as passenger aircraft, UAVs, drones, and marine and ground vehicles.

Global burden of SARS-CoV-2 infection, hospitalization and case fatality rate among COVID-19 vaccinated individuals and its associated factors: A systematic review and meta-analysis protocol.

BackgroundCOVID-19 has been the most important public health concern worldwide since 2020. Several vaccines are now available to help in controlling COVID-19 associated morbidity and mortality. This study will aim to provide the global and regional prevalence of SARS-CoV-2 infection as well as an estimate of disease severity among COVID-19 vaccinated individuals.Materials and methodsIn order to determine the global burden of SARS-CoV-2 infection among vaccinated individuals, we will systematically extract and review papers from PubMed/MEDLINE, Excerpta Medica database (EMBASE), Cochrane Central Register of Controlled Trials (CENTRAL), Science direct and Cumulative Index to Nursing and Allied Health Literature (CINAHL). All the studies describing the prevalence and/or disease severity (hospitalization and case fatality rate) data of COVID-19 among individuals who received a partial or complete dose of WHO-approved COVID-19 vaccines will be eligible. A random effect model will be used to calculate the pooled prevalence and to estimate the disease severity. Subgroup analysis will be performed to explore the association between the number of vaccine doses received and the COVID-19 burdens.DiscussionThis systematic review and meta-analysis will provide the global estimate data on pooled prevalence, hospitalization and case fatality rates of COVID-19 among vaccinated individuals. Moreover, the factors associated with reinfection and disease severity will be equally investigated in the meta-analysis. The results of this study will contribute in the understanding and estimation of the global burden of COVID-19 among vaccinated individuals. Findings will provide meaningful information for the success of the current global rollout of COVID-19 vaccination strategies and pave the way for future interventions.Systematic review registrationCRD42021273074.

The Social, Behavioral, and Ethical Modalities of COVID-19 on HIV Care in South Africa: A Systematic Review.

The profound public health impact of the novel outbreak of the SARS-CoV-2 virus in 2019 has been unparalleled in the last century. Rapid spread of the disease and a high death toll fueled the development and global rollout of effective vaccines regardless of the massive inequitable access. However, some public health measures intended to control COVID-19 have had collateral effects on the control of other infectious diseases. In this systematic review, we analyze the impact of the COVID-19 pandemic on efforts to control HIV in South Africa, emphasizing the social, ethical, and behavioral ramifications. The SCOPUS, PubMed, Ovid, PsychINFO, and Cochrane Library databases were searched for publications between March 2020 and January 2022. Of the 854 articles identified, 245 were found duplicated, and 609 were screened, 241 of which were potentially eligible, and 15 of which were ultimately included. Although no studies on the ethical implications were eligible for our study criteria due to insufficient primary data to perform an analysis on, we explored this topic in the Discussion section of this paper. We confirm declines in ART, PrEP, and HIV testing during the initial lockdown period, with slight variations across the South African provinces. Protecting routine services and reducing the disease burden on high-risk nations such as South Africa is imperative moving forward with the pandemic.

Guillain-Barré syndrome in an era of global infections and 21st century vaccination.

Guillain-Barre syndrome is sometimes a severe and disabling postinfectious neuromuscular paralysis that is causally associated with a number of well defined infections, and occasionally with immunization. The severe acute respiratory syndrome coronavirus 2 (Sars-CoV-2) pandemic and the worldwide immunization programme provoked fears of an epidemic of coronavirus disease 2019 (COVID-19) related disease. As we emerge from the pandemic this review summarises some of the huge volume of publications about Guillain-Barre syndrome (GBS), COVID-19 and immunisation against it. In the early months of COVID-19, there were concerns of significant numbers of cases of GBS resulting from SARS-CoV-2 infection. Large epidemiological studies have provided reassurance that the association of GBS with COVID-19 is small or absent. Despite considerable efforts, plausible pathogenic mechanisms aligned with our understanding of GBS causation have not been identified. Reliable data from national surveillance of COVID-19 vaccinations have shown GBS to occur at about 5.8 cases per million first doses of adenovirus vectored COVID-19 vaccines, otherwise not distinguishable from incident naturally occurring cases. However, this risk is far outweighed by the protective benefits of vaccination in the at-risk older deciles of age. With no obvious link of GBS to COVID-19 epitopes, in particular the spike (S-)protein, but a clearly demonstrable causation in some susceptible individuals from the global rollout of novel adenovirus vectored vaccine technologies, adenoviruses are of significant interest in the pathogenesis of GBS as well as vectors in their many expanding pharmaceutical applications.

Keeping up with the COVID's-Could siRNA-based antivirals be a part of the answer?

Coronavirus disease 2019 (COVID‐19) is a highly contagious viral disease caused by severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). This deadly infection has resulted in more than 5.2 million deaths worldwide. The global rollout of COVID‐19 vaccines has without doubt saved countless lives by reducing the severity of symptoms for patients. However, as the virus continues to evolve, there is a risk that the vaccines and antiviral designed to target the infection will no longer be therapeutically viable. Furthermore, there remain fears over both the short and long‐term side effects of repeat exposure to currently available vaccines. In this review, we discuss the pros and cons of the vaccine rollout and promote the idea of a COVID medicinal toolbox made up of different antiviral treatment modalities, and present some of the latest therapeutic strategies that are being explored in this respect to try to combat the COVID‐19 virus and other COVID viruses that are predicted to follow. Lastly, we review current literature on the use of siRNA therapeutics as a way to remain adaptable and in tune with the ever‐evolving mutation rate of the COVID‐19 virus.

Blockchain Based Privacy Preserving Framework for Emerging 6G Wireless Communications

With the global rollout of fifth-generation communication networks, the development on sixth-generation (6G) communication network has begun. The 6G technology is an emerging technology that will meet the ever-increasing demands of evolving industrial services and applications. This technology consists of varied number of heterogeneous resources and communication protocols to guarantee the seamless access to the services. Because of its heterogeneous nature and authorization delegation, security is a major concern in 6G communication environment. The emerging blockchain technology can able to solve the aforementioned privacy and security challenges. The blockchain technique also offers enhanced services like openness, decentralization, immutability, trust free, and so on. Motivated by the aforementioned facts, this article proposes a novel idea of integration of privacy preserving blockchain framework with 6G communication network. We also propose an integrated system for blockchain radio access network as a reliable and stable model for 6G networking based on blockchain technology with improved efficiency and protection. Furthermore, the critical components of blockchain such as smart contract, consensus protocol, mathematical model, secure data sharing, and auditing are clearly defined and experimental results are analyzed.

Phage-like particle vaccines are highly immunogenic and protect against pathogenic coronavirus infection and disease

The response by vaccine developers to the COVID-19 pandemic has been extraordinary with effective vaccines authorized for emergency use in the United States within 1 year of the appearance of the first COVID-19 cases. However, the emergence of SARS-CoV-2 variants and obstacles with the global rollout of new vaccines highlight the need for platforms that are amenable to rapid tuning and stable formulation to facilitate the logistics of vaccine delivery worldwide. We developed a “designer nanoparticle” platform using phage-like particles (PLPs) derived from bacteriophage lambda for a multivalent display of antigens in rigorously defined ratios. Here, we engineered PLPs that display the receptor-binding domain (RBD) protein from SARS-CoV-2 and MERS-CoV, alone (RBDSARS-PLPs and RBDMERS-PLPs) and in combination (hCoV-RBD PLPs). Functionalized particles possess physiochemical properties compatible with pharmaceutical standards and retain antigenicity. Following primary immunization, BALB/c mice immunized with RBDSARS- or RBDMERS-PLPs display serum RBD-specific IgG endpoint and live virus neutralization titers that, in the case of SARS-CoV-2, were comparable to those detected in convalescent plasma from infected patients. Further, these antibody levels remain elevated up to 6 months post-prime. In dose-response studies, immunization with as little as one microgram of RBDSARS-PLPs elicited robust neutralizing antibody responses. Finally, animals immunized with RBDSARS-PLPs, RBDMERS-PLPs, and hCoV-RBD PLPs were protected against SARS-CoV-2 and/or MERS-CoV lung infection and disease. Collectively, these data suggest that the designer PLP system provides a platform for facile and rapid generation of single and multi-target vaccines.

Social networks and COVID-19 vaccination hesitancy in Mexican older adults

Introduction: The importance of social networks is growing, impacting everyday life. At this stage of global COVID-19 vaccination roll-out, hesitancy to get immunized is slowing this process; it is thought that this decision could be impacted by information shared on social networks. Objective: Determine whether the use of social networks is associated with the willingness to get the COVID-19 vaccine. Methods: This is a secondary analysis of the ENSANUT COVID-19 study, that measures the impact of the pandemic on the Mexican population. Only older adults, aged 65 years or older, were included in this work. Face to face interviews were performed to determine social network utilization, willingness to get vaccinated, and socio-demographic information on health and COVID-19. Bivariate analysis and logistic regression were performed. Results: From a total of 1,490 older adults, 59.3 % were women whose mean age was 73.5 (SD 6.8), and 53.3% (n = 795) were willing to get a COVID-19 vaccine when available. In an adjusted multivariate logistic regression model, WhatsApp was found to be a significant variable related to lower risk of vaccine hesitancy (OR 0.43, 95% CI, 0.2–0.85; p = 0.016). Other variables related to vaccine hesitancy were being a woman (OR 1.58, 95% CI, 2–1.23; p &lt; 0.001) and COVID-19 literacy (OR 1.32, 95% CI, 1.01–1.74; p = 0.047). Conclusion: The use of social networks such as WhatsApp is a factor that can influence older adult vaccination against COVID-19. Social networks, among other variables, should be taken into account when analyzing factors that lead to vaccination hesitancy in older adults.

Achieving safe surgery after COVID-19 vaccination.

Achieving safe surgery after COVID-19 vaccination.

Emicizumab state-of-the-art update.

IntroductionEmicizumab is a bispecific monoclonal antibody developed to address the unmet needs of clotting factor replacement therapy and has become the benchmark for optimal prophylaxis in managing patients with haemophilia A with inhibitors. We describe the emicizumab rollout and pharmacokinetic strategies and their use in paediatric patients.MethodsThe evolving real‐world experience in using emicizumab has confirmed its safety, efficacy and pharmacokinetic profile in paediatric, adolescent and adult patients receiving emicizumab at various prophylactic dosing regimens. The emicizumab current global rollout includes over 100 countries with 29 low to middle‐income countries accessing emicizumab through the World Federation of Haemophilia (WFH) Humanitarian Aid Program. The diversity of emicizumab dosing and pharmacokinetic tools such as the Calibra® and the WAPPS‐Hemo platforms make it possible to achieve prophylaxis goals in line with the WFH Haemophilia treatment guidelines recommendations, with minimal drug wastage. The emerging experience from long term clinical trials and long‐term real‐world follow‐up confirm the safety, efficacy, and pharmacokinetic profile of emicizumab in paediatric haemophilia A patients. A few questions, including inhibitor recurrence, concurrent use of emicizumab with various replacement therapies and inhibitor eradication, are being addressed through multiple ongoing clinical studies.ConclusionThe current global rollout of emicizumab is remarkable, and versatile dosing regimens and evolving pharmacokinetic tools such as the Calibra® and WAPPS‐Hemo platforms make it a treatment choice available also for pharmacokinetic guided personalised treatment. Data from paediatric studies are consistent with those seen in adolescent and adult Haemophilia A.

Closing the global vaccine equity gap: equitably distributed manufacturing

Closing the global vaccine equity gap: equitably distributed manufacturing