Immunization Program Research Articles

Real-World Effectiveness of Nirsevimab Against Respiratory Syncytial Virus: A Test-Negative Case-Control Study.

Nirsevimab, a long-acting monoclonal antibody, has demonstrated efficacy against RSV-related lower respiratory tract infections (LRTIs) in clinical trials. Post-licensure monitoring is essential to confirm these benefits in real-world settings. To evaluate the real-world effectiveness of nirsevimab against medically attended RSV infections in infants and to assess how effectiveness varies by disease severity, dosage, and time since immunization. This test-negative case-control study used inpatient, outpatient, and emergency room data from the Yale New Haven Health System. Nirsevimab-eligible infants who were tested for RSV using polymerase chain reaction between October 1, 2023 and May 9, 2024 were included. Cases were infants with confirmed RSV infections; controls were those who tested negative. Nirsevimab immunization, verified through state immunization registries. Effectiveness was estimated using multivariable logistic regression, adjusting for age, calendar month, and individual risk factors. Separate models examined effectiveness by clinical setting, disease severity, dose, and time since immunization. Broader outcomes, including all-cause LRTI and LRTI-related hospitalization, were also analyzed, with stratification by early and late respiratory seasons. The analytic sample included 3,090 infants (median age 6.7 months, IQR 3.6-9.7), with 680 (22.0%) RSV-positive and 2,410 (78.0%) RSV-negative. 21 (3.1%) RSV-positive and 309 (12.8%) RSV-negative infants received nirsevimab. Effectiveness against RSV infection was 68.4% (95% CI, 50.3%-80.8%). Effectiveness was 61.6% (95% CI, 35.6%-78.6%) for outpatient visits and 80.5% (95% CI, 52.0%-93.5%) for hospitalizations. The highest effectiveness, 84.6% (95% CI, 58.7%-95.6%), was observed against severe RSV outcomes requiring ICU admission or high-flow oxygen. Although effectiveness against RSV infections declined over time, it remained significant at 55% (95% credible interval, 16%-75%) at 14 weeks post-immunization. Protective effectiveness was also observed against all-cause LRTI and LRTI-related hospitalizations during peak RSV season (49.4% [95% CI, 10.7%-72.9%] and 79.1% [95% CI, 27.6%-94.9%], respectively). However, from February to May, when RSV positivity was low, effectiveness against these broader outcomes was negligible. Nirsevimab provided substantial protection against RSV-related outcomes for at least three months. These findings support the continued use of nirsevimab and provide evidence that may help build public confidence in the immunization program. Question: What is the effectiveness of nirsevimab against medically attended respiratory syncytial virus (RSV) infections in infants?Findings: 680 RSV test-positive cases and 2,410 RSV test-negative controls were included in this test-negative case-control study. Nirsevimab's effectiveness was 69% against RSV infections, 81% against RSV-associated hospitalization, and 85% against severe RSV disease. Effectiveness against RSV infection declined from 79% at 2 weeks post-immunization to 55% at 14 weeks post-immunization.Meaning: Nirsevimab provides strong protection against a wide range of RSV outcomes, but its effectiveness diminishes over time. These data can be utilized to optimize nirsevimab's implementation and sustain its uptake.

Human papillomavirus type-specific distribution in cervical intraepithelial neoplasia and cancer in The Gambia prior to HPV immunization programme: a baseline for monitoring the quadrivalent vaccine

BackgroundCervical cancer is the leading cause of cancer deaths in Gambian women. Current estimates indicate that 286 women are annually diagnosed with cervical cancer with a fatality rate of 70%. In an attempt to address this, in 2019 the quadrivalent HPV vaccine was incorporated into the Gambia’s Expanded Programme on Immunisation. The study aims to retrospectively assess the prevalence and distribution of high-risk HPV genotype in archived, formalin fixed paraffin embedded cervical biopsy tissues diagnosed with cervical cancer in the Gambia from year 2013–2022.MethodA total of 223 samples with histologically diagnosis of cervical cancer with adequate tissues were sectioned and deparaffinised, followed by HPV DNA extraction and the detection of HR-HPV by real-time multiplex PCR. The human β-globin gene was amplified in 119 samples, which were subsequently tested for HPV DNA.ResultsHPV was prevalent in 87.4% (104 of 119) cervical cancer cases, 12.6% (15/119) samples tested negative. Amongst cervical cancer cases, HPV 16 genotype was the most frequent type accounting for 53.8% (56 /104), followed by other HR-HPV genotypes 17.3% (18/104), and HPV genotype 18 was 15.4% (16/104). Furthermore, multiple HPV infections involving HPV 16 and /or 18 was detected in 14 cases as follows: HPV genotypes 16 and 18 (3.8%, 4 /104), HPV 16 and other HR-HPV (6.7%, 8/104), and HPV 18 and other HR-HPV (1.9%, 2/104). A significant association between age and diagnosis with cervical cancer (p = 0.02), and HPV genotype 16 (p = 0.04) was observed.ConclusionThere was no difference in the distribution of HPV 16 and 18 genotypes in cervical cancer cases in The Gambia in comparison with the global distribution. However, the high prevalence of cervical cancer cases with other HR-HPV, and combined infections of HPV 16 with other HR-HPV genotypes seen in this study, clearly shows that the nonavalent HPV vaccine could be more beneficial for The Gambia. This study provides The Gambia with a baseline data to use in policy decisions regarding future evaluation of the quadrivalent HPV vaccine in the country.

Governance matters: Exploring the impact of governance on routine immunization performance in 54 African countries: A 10-year (2012−2021) analysis using linear mixed models

BackgroundImmunization coverage across numerous African nations has, unfortunately, shown little improvement and, in some cases, has even decreased over the past decade, leaving millions of children vulnerable to vaccine-preventable diseases. While efforts to improve immunization performance have primarily focused on the health system, effective delivery of immunization services is intricately linked to a country's governance, which, in this context, reflects a government's ability to provide comprehensive services to its citizens. This study investigated the relationship between governance, measured using the Mo Ibrahim Index for African Governance, and the trajectory of immunization coverage for three vaccines in 54 African countries from 2012 to 2021. MethodsWe conducted an ecological study utilizing publicly available datasets, the WHO/UNICEF estimates of National Immunization Coverage and the Ibrahim Index of African Governance score (IIAG). We described the trends in routine immunization performance, evaluated and assessed the impact of governance on immunization coverage across 54 African countries for the period 2012 to 2021, using linear mixed models and focusing on three vaccines provided through the Expanded Program on Immunization (DTPCV1, DTPCV3, and MCV1). ResultsAmong the 54 African countries studied, 32 (59.3 %) witnessed an overall decrease (slope of change in immunization coverage over time < 0) in immunization coverage, with 16 (29.6 %) experiencing a significant decline (slope of change significantly different from zero (P < 0.05)) in coverage. For DTPCV3, 31 countries (57.4 %) demonstrated a decline in coverage, with 12 (22.2 %) being significant declines. Thirty-two countries (59.2 %) reported a decrease in MCV1 coverage over the analysis period, with 17 (31.5 %) significant. Across all three antigens, the IIAG overall score was positively associated with immunization coverage over time. One unit increase in the IIAG score correlated with an average annual increase of 0.64 (95 % CI: 0.35–0.93) percentage points in DTPCV1 coverage, 0.74 percentage points (95 % CI: 0.42–1.07) in DTPCV3 coverage, and 0.60 (95 % CI: 0.30–0.91) percentage points in MCV1 coverage. These findings suggest that an African country with an average IIAG score just one unit higher than their observed average value over the study period, would have achieved a 6.4 %, 7.4 %, and 6.0 % coverage for DTPCV1, DTPCV3, and MCV1, respectively, above its 2021 coverage levels. ConclusionThe Expanded Program on Immunization aspires to reach all eligible populations with life-saving vaccines, regardless of the context. We found that country governance may be an important determinant of immunization performance, potentially explaining the observed stagnation or decline in immunization performance and the heightened vulnerability of immunization programs to external shocks. Understanding the nexus between governance and service delivery suggests that immunization actors, funders, and other stakeholders may need to adjust their expectations of countries' immunization performance accordingly.

Evaluating the effectiveness of the HPV vaccination programme in England, using regression discontinuity design

Objective and ApproachIn England, the National human papillomavirus (HPV) HPV Immunisation Programme was introduced for young girls in 2008. Whilst clinical trials have shown high vaccine effectiveness, real-world evidence is still accruing. Estimating vaccine effectiveness based on real-world data without randomised control trials is challenging, but critical for policy makers. Using Census 2011 data and a population level linked dataset, we exploit a regression discontinuity design (RDD) to assess the impact of the catch-up vaccination programme on cervical dysplasia and cancer diagnoses as recorded in hospital and mortality data in girls born between 1987 and 1992. ResultsWe estimate that vaccination reduces the incidence of cervical dysplasia diagnoses by 27% and cervical cancer diagnoses by 75% respectively. Girls were followed for a 7-year period between ages 23 and 30 years in girls who were offered vaccination at ages 17 to 18 years as part of the catch-up cohort compared to those who were not eligible for HPV vaccination. Conclusions and ImplicationsOur work demonstrates how pivotal the HPV vaccination programme has been for reducing adverse cervical outcomes in young women. Additionally, it shows that the estimates of the effectiveness of HPV vaccination obtained using a RDD are comparable to those based on more classic observational studies. This work shows real world vaccination effectiveness and demonstrates how pivotal the national HPV campaign has been in young girls.

Public Health and Economic Impact of Periodic COVID-19 Vaccination with BNT162b2 for Old Adults and High-Risk Patients in an Illustrative Prefecture of Japan: A Budget Impact Analysis.

Japan will be transitioning from the free-of-charge COVID-19 vaccination program to annual periodic vaccination under a national immunization program for old adults and high-risk patients from 2024 fall/winter season. The policy transition including out-of-pocket payment requirement may discourage vaccination, leading to a lower vaccination rate. This study aimed to estimate the impact of varying vaccination rates with BNT162b2 COVID-19 mRNA vaccine on economics and public health in an illustrative prefecture which administers and promotes the periodic vaccination program, using budget impact analysis. A combined cohort Markov decision tree model estimated the public health outcomes of COVID-19-related symptomatic cases, hospitalizations and deaths; and the economic outcomes including vaccine-related cost, non-vaccine-related medical cost, and productivity loss from the societal perspective. The base case examined the impact on the outcomes when vaccination coverage changed from the reference value of 50% to upper and lower values, respectively. Scenario analyses were performed based on multiple scenarios. Increase in the vaccination rate demonstrated improvement in all public health outcomes. At 50% vaccination, the vaccine-related cost for 3years in a prefecture was estimated at JPY 7.58 billion (USD 57.67 million), the non-vaccine-related medical cost at JPY 79.22 billion (USD 602.48 million), the productivity loss at JPY 253.11 billion (USD 1.92 billion), and the total cost at JPY 339.92 billion (USD 2.59 billion). When the vaccination rate increased to 90%, the total cost decreased by JPY 4.88 billion (USD 37.11 million) (1.4%). When the vaccination rate decreased to 10%, the total cost increased by JPY 5.73 billion (USD 43.58 million) (1.7%). Results were consistent across almost all scenario analyses. Maintaining a high vaccination rate with BNT162b2 is important from both public health and economic perspectives in Japan. The findings highlight to local governments the importance of continued effort to promote vaccination.

Economic evaluation on meningococcal vaccination strategies among children under nine years of age in Zhejiang province, China.

Meningococcal vaccination in Chinese national immunization program (NIP) includes polysaccharide vaccine against Neisseria meningitidis serogroup A (MPV-A) and polysaccharide vaccine against Neisseria meningitidis serogroup A and C(MPV-AC). This study aimed to assess the cost-effectiveness of an alternative strategy using polysaccharide conjugate vaccine against Neisseria meningitidis serogroup A,C,W,Y(MCV-ACWY) and polysaccharide vaccine against Neisseria meningitidis serogroup A,C,W,Y(MPV-ACWY). From a societal perspective, we constructed a decision tree-Markov model to simulate the economic and health consequences of meningococcal disease in a 2023 birth cohort with the current meningococcal vaccination strategy and the alternative. Parameters of epidemiology, vaccine efficacy, cost, and utility were extracted from database and previous literatures. The sensitivity analysis was implemented to evaluate the robustness of the model. Compared to the current practice, the alternative strategy could avoid 513 meningococcal disease cases, 53 sequelae and 47 deaths. The ICER was estimated at $16899.81 /QALY, under the threshold of one time of the GDP per capita of Zhejiang province in 2023. The incidence of meningococcemia, the incidence of meningococcal meningitis, the case fatality of meningococcemia, the vaccine efficacy of MCV-ACWY and the price of MCV-ACWY would influence the cost-effectiveness of the meningococcal vaccination strategies. At the threshold, the probability of cost-effectiveness was 14.76% for the current strategy and 55.98% for the alternative strategy, respectively. The current meningococcal vaccination strategy had effectively prevented meningococcal disease at a low cost, but with limited serogroup coverage. Strategy using MCV-ACWY and MPV-ACWY could increase health benefits at a substantial cost at a cost-effective manner.

The Impact of Public Health on Disease Prevention

Public health plays an important role in preventing diseases by supporting measures that prioritise the well-being of entire populations over individuals. This study investigates the history of public health, the approaches used in illness prevention, and the difficulties encountered in executing these tactics. Public health strategies, such as immunisation programs and lifestyle modifications, are critical in combating communicable and non-communicable diseases. Case studies like the Diabetes Prevention Program and REACH U.S. demonstrate the effectiveness of public health efforts. The paper also discusses current difficulties, such as limited resources, misinformation, and increasing dangers, as well as possible future strategies for improving public health systems through innovation, research, and community participation. Keywords: Public Health, Disease Prevention, Vaccination, Health Promotion, Preventive Healthcare.

Analysis of the status and related factors of vaccination against respiratory diseases among elderly people aged ≥60 in Zhejiang Province

The objective of this study is to assess the current status of vaccination against respiratory disease among the elderly aged ≥60 and analyze the factors influencing vaccination rates at both service provider and recipient levels in Zhejiang Province. Using a stratified random sampling method, a questionnaire survey was conducted from September 2022 to January 2023 among elderly people aged ≥60 in 30 townships/streets in Zhejiang Province, as well as immunization planning staff at the provincial, municipal, county/district, and township/street levels. Logistic regression models were used to analyze the factors related to vaccination among elderly people in Zhejiang Province. Based on the Zhejiang Provincial Comprehensive Management Information System for Vaccine and Vaccination, the systematic coverage rates of influenza vaccine and pneumonia vaccine for the elderly were 21.76% and 4.57%, respectively. Multivariate logistic regression analysis indicated that advanced age (OR=1.74, 95%CI: 1.51-1.99), knowing that influenza is more severe than the common cold (OR=1.67, 95%CI: 1.37-2.04) and having heard of the influenza vaccine (OR=9.78, 95%CI: 7.03-13.59) were motivating factors for elderly to receive influenza vaccines. Advanced age (OR=1.71, 95%CI: 1.43-2.06), knowing the serious consequences of pneumonia in the elderly (OR=1.93, 95%CI: 1.47-2.55) and knowing that pneumonia vaccines can prevent pneumonia (OR=6.36, 95%CI: 4.84-8.36) were motivating factors for elderly to receive pneumonia vaccines. Zhejiang Immunization Program staff believed that the main reasons why the elderly aged ≥60 would not be vaccinated against influenza or pneumonia were that they felt they would not get sick (55.52% and 56.35% respectively), it would not be serious if get sick (47.73% and 37.46% respectively), lacking trust in vaccine efficacy and safety (38.31% and 43.69% respectively). Vaccination rates for influenza and pneumonia vaccines among the elderly aged ≥60 in Zhejiang Province are suboptimal. Advanced age, awareness of the severity of respiratory diseases and awareness of vaccines against such diseases are related factors for elderly individuals to receive influenza and pneumonia vaccines.

The Shigella flexneri effector IpaH1.4 facilitates RNF213 degradation and protects cytosolic bacteria against interferon-induced ubiquitylation.

A central signal that marshals host defense against many infections is the lymphocyte-derived cytokine interferon-gamma (IFNγ). The IFNγ receptor is expressed on most human cells and its activation leads to the expression of antimicrobial proteins that execute diverse cell-autonomous immune programs. One such immune program consists of the sequential detection, ubiquitylation, and destruction of intracellular pathogens. Recently, the IFNγ-inducible ubiquitin E3 ligase RNF213 was identified as a pivotal mediator of such a defense axis. RNF213 provides host protection against viral, bacterial, and protozoan pathogens. To establish infections, potentially susceptible intracellular pathogens must have evolved mechanisms that subdue RNF213-controlled cell-autonomous immunity. In support of this hypothesis, we demonstrate here that a causative agent of bacillary dysentery, Shigella flexneri, uses the type III secretion system (T3SS) effector IpaH1.4 to induce the degradation of RNF213. S. flexneri mutants lacking IpaH1.4 expression are bound and ubiquitylated by RNF213 in the cytosol of IFNγ-primed host cells. Linear (M1-) and lysine-linked ubiquitin is conjugated to bacteria by RNF213 independent of the linear ubiquitin chain assembly complex (LUBAC). We find that ubiquitylation of S. flexneri is insufficient to kill intracellular bacteria, suggesting that S. flexneri employs additional virulence factors to escape from host defenses that operate downstream from RNF213-driven ubiquitylation. In brief, this study identified the bacterial IpaH1.4 protein as a direct inhibitor of mammalian RNF213 and highlights evasion of RNF213-driven immunity as a characteristic of the human-tropic pathogen Shigella.

Acceptance and uptake of vaccines against tetanus, influenza, pertussis, and COVID-19 among pregnant and postpartum women in low- and middle-income countries: a systematic review and meta-analysis protocol

BackgroundPregnant women, fetuses, and neonates are particularly vulnerable to vaccine-preventable diseases (VPDs). These VPDs are associated with high morbidity and mortality among expectant mothers and their fetuses and neonates. Vaccination during pregnancy can protect the expectant mother from VPDs to which she may be especially vulnerable while pregnant. In addition, the passive transfer of maternal neutralizing immunoglobulin G (IgG) and secretory immunoglobulin A (IgA) also protects the fetus against congenital infections and may further protect the neonate from infection during the first few months of life. Despite this, coverage of recommended maternal vaccines remains suboptimal globally, especially in resource-constrained settings. Determinants of vaccine acceptance and uptake are frequently understudied in low- and middle-income countries (LMICs) and among specific groups such as pregnant and postpartum women. This proposed systematic review will assess the acceptance and uptake of vaccines against tetanus, influenza, pertussis, and COVID-19 among pregnant and postpartum women in LMICs.MethodsA Boolean search strategy employing common and medical subject heading (MeSH) terms for tetanus, influenza, pertussis, and COVID-19 vaccines, as well as vaccine acceptance, hesitancy, together with uptake, pregnancy, and postpartum, will be used to search electronic databases for relevant literature published between 2009 and 2024. Only studies conducted in LMICs that investigated determinants of acceptance, hesitancy, and uptake of tetanus, influenza, pertussis, and COVID-19 vaccines among pregnant and postpartum women will be eligible for inclusion in the review. The quality and the risk of bias of all eligible full-text articles will be assessed using the Joanna Briggs Institute’s (JBI) critical appraisal tools.DiscussionThis protocol proposes a systematic review and meta-analysis that aims to assess the uptake of maternal vaccines and to systematically appraise and quantify determinants of the acceptance and uptake of recommended vaccines during pregnancy and postpartum in LMICs. A better understanding of these factors and how they influence maternal vaccine decision-making will enable public health practitioners as well as global and national policymakers to design more effective interventions as we look towards expanding the scope and reach of maternal immunization programs.

The impact of Germany’s human papillomavirus immunization program on HPV-related anogenital diseases: a retrospective analysis of claims data from statutory health insurances

PurposeHuman papillomavirus (HPV) is the most common sexually transmitted infection, responsible for multiple HPV-related diseases, including almost all cervical cancers. The highly effective HPV vaccination has been recommended under the German HPV national immunization program (NIP) since 2007 and is reimbursed by health insurances. Vaccination uptake rates, however, remain suboptimal and data on the real-world impact of HPV vaccination in Germany are lacking. This study aims to demonstrate the population-level impact of Germany’s NIP on HPV-related anogenital diseases among young women.MethodsRetrospective claims data analysis using a classic impact study design comparing disease prevalence among 28- to 33-year-old women before and after introduction of the HPV-immunization program in Germany. Claims data representing approximately two thirds of German health insurances were used. HPV-related disease outcomes included cervical cancer and high grade precancers (cervical intraepithelial neoplasia (CIN) 2+), anogenital warts, as well as vulvar, vaginal, and anal precancer/cancer.ResultsSignificant declines were seen for CIN2+, anogenital warts, and vaginal precancer/cancer. Prevalence of CIN2+ declined 51.1% from 0.92% (95% CI = 0.78%, 1.08%) to 0.45% (95% CI = 0.38%, 0.53%). There was a 38.6% decline in anogenital warts prevalence from 0.44% (95% CI = 0.36%, 0.54%) to 0.27% (95% CI = 0.22%, 0.32%) and 75.0% decline in vaginal precancer/cancer prevalence from 0.04% (95% CI = 0.02%, 0.07%) to 0.01% (95% CI = 0.00%, 0.02%).ConclusionThe German HPV-immunization program has led to significant declines in female anogenital disease among young women in Germany, highlighting the importance of the vaccination. Moreover, the data suggest that increasing vaccination coverage in Germany could further strengthen the public-health impact of its HPV-immunization program.

Pediatric Varicella-related Hospitalization in Turkey Between 2008 and 2018: Impact of Universal Single Dose Varicella Vaccine (VARICOMP Study).

A single-dose varicella vaccine at 12 months of age was introduced to the National Immunization Program in February 2013 in Turkey. This study aimed to evaluate varicella-related hospitalization in children and the impact of a single-dose live attenuated varicella vaccine over the first 5.5 years of introducing a universal varicella vaccination. We analyzed data collected from the medical records of children <18 years old who required hospitalization due to varicella in 17 cities representing 50% of the childhood population in Turkey between 2008 and 2018. We calculated the rate of hospitalization for varicella per 100,000 children during the study period. The main objective of this study was to determine the yearly rate of hospitalization due to varicella and to compare these rates in the pre-vaccine and post-vaccine periods. The secondary objective was to compare demographic features, varicella-related complications, and outcomes between the pre-vaccine and post-vaccine periods. A total of 4373 children (2458 boys and 1915 girls; 72.3% previously healthy) were hospitalized for varicella over a 10-year period, including 2139 children during the pre-vaccine period and 2234 children during the post-vaccine period. Overall, varicella hospitalization rates decreased significantly after the introduction of varicella vaccination [pre-vaccine vs. post-vaccine period; 3.79 vs. 2.87 per 100,000 per year; P < 0.001; odds ratio 0.75; 95% confidence interval 0.64-0.88]. The incidence of varicella-related hospitalization among children between 1 and 5 years of age was significantly lower in the post-vaccine era than in the pre-vaccine era, with a 60.2% decrease in hospitalizations (2.43 vs. 6.12 per 100,000 children; P < 0.001, odds ratio 0.39; 95% confidence interval 0.34-0.46). In both the <1-year and 6- to 10-year age groups, the incidence of varicella-related hospitalizations was similar in the pre-vaccine and post-vaccine periods. The incidence of varicella-related hospitalization was higher in the post-vaccine era among 11-15 years and >15-year-old groups (P < 0.01 and P < 0.05). The mean age was higher during the post-vaccine period than during the pre-vaccine period (P < 0.001). The absolute number of secondary bacterial infections (P < 0.01), respiratory complications (P < 0.01), and neurological complications (P < 0.001) was significantly lower during the post-vaccine period. The incidence of severe varicella was lower during the post-vaccine period than during the pre-vaccine period (P < 0.001). After 5.5 years of routine single-dose varicella vaccine use, we observed the impact of varicella vaccination on the incidence of varicella-related hospitalizations, especially in the target age group. However, we did not observe herd protection in the other age groups. The implementation of a second dose of the varicella vaccine in the National Immunization Program would help control disease activity.

Parents' views on pediatric COVID-19 vaccine in Saudi Arabia.

To end the COVID-19 pandemic, we need to reach herd immunity. A successful pediatric COVID-19 immunization program is the only way to achieve this goal. The objective of this study was to determine the views of parents in Saudi Arabia on the COVID-19 vaccine in children. This cross-sectional study took place within the Family Medicine Pediatric clinics at the King Faisal Specialist Hospital and Research Center (KFSH and RC). All parents of patients of Family Medicine Pediatric Clinics at KFSH and RC, Riyadh, were invited to participate in this study between January 2022 and June 2022. A culturally sensitive and specially designed questionnaire was administered using an interview-based model. Safety concerns were the primary reason for vaccine hesitancy among parents, with 29.7% of parents expressing concerns about side effects and 25.1% not knowing where to get reliable information about vaccines. Negative information and lack of perceived need were also important factors, with 17.1% and 18.3% of parents citing these reasons, respectively. Poor knowledge about vaccines was a significant predictor of parental vaccine hesitancy. Mothers had more concerns about the efficacy and safety of vaccines than fathers. Our study demonstrated a negative attitude toward the pediatric COVID-19 vaccine among parents in Saudi Arabia. A higher level of awareness about the vaccine was significantly associated with planning on having the vaccine. There is a need for effective awareness programs for better pediatric COVID-19 vaccine-related education to increase the acceptance of the vaccine among parents in Saudi Arabia.

A perspective on the novel pentavalent Men5CV (NmCV-5) meningitis vaccine and Nigeria's pioneering rollout campaign.

The burden of meningitis poses great challenges for neurology and global health, manifesting with a range of symptoms from mild fever and headaches, to severe long term complications such as paralysis and cognitive impairment.. Unfortunately, those living in endemic regions, especially survivors, are often confronted with the harsh reality of reduced quality of life as measured by disability-adjusted life years. Meningitis is one of the leading causes of mortality and morbidity, especially in the meningitis belt of sub-Saharan Africa, with a recorded disease burden of over 2.5 million cases globally and children under five disproportionately impacted. This paper examines the global burden of meningitis, exploring its prevalence and impact across different regions. It further analyzes the evolution of vaccination strategies for meningitis prevention, emphasizing the recent development and introduction of the novel Men5CV meningococcal conjugate vaccine. Recurrent meningitis outbreaks across the meningitis belt have resulted in significant mortality over decades. A major turning point in the fight against the serogroup A epidemic was the development of the MenAfriVac vaccine, which resulted in declining cases. However, serogroups C, W, and X continue to pose problems. The novel pentavalent (Men5CV) vaccine has emerged as a remarkable advancement in the fight against meningitis, with its safety and effectiveness against a variety of serogroups, including the elusive serogroup X, demonstrated in clinical trials. Its pre-qualification by the World Health Organization (WHO), and subsequent recommendation for incorporation into routine immunization programs issued a new era with the potential for meningitis eradication. Nigeria now sets a benchmark for other nations in the meningitis zone, becoming the first country in the world to roll out the new Men5CV vaccines. Funding from organizations like Gavi, the Vaccine Alliance, highlights the importance of coordinated international efforts aligned with the WHO's roadmap for meningitis elimination by 2030. Stakeholder involvement, extensive immunization campaigns, and a strong healthcare infrastructure are all practical recommendations for public health integration.

Pediatric Pneumococcal Conjugate Vaccine and Dosing Schedule Perceptions Among Health Care Providers and Caregivers in Germany, France, Spain, and Greece.

Most European infant national immunization programs (NIPs) recommend pneumococcal conjugate vaccines (PCVs), which currently cover 10-15 serotypes administered in a three-dose schedule (two primary plus one booster). Recently, a PCV covering 20 serotypes that is administered in a four-dose schedule (three primary plus one booster) was licensed. An online survey was administered to collect data from health care providers (HCPs) and caregivers of children aged 0-5 (including expectant mothers) in four European countries (Germany, France, Spain, and Greece). All caregiver respondents had a shared or full responsibility to make health decisions for their child. Data on opinions, perceptions, and openness to a change in childhood vaccination dosing schedules were collected, along with demographic information for HCPs as well as caregivers. A total of 601 HCPs and 1954 caregivers were recruited across the four countries. Nearly all HCPs (93%) agreed that broader serotype coverage against pneumococcal disease for children is a significant unmet need, and 92% had a "sense of urgency" to vaccinate children. Both HCPs and caregivers were supportive of an additional PCV dose and doctor visit, assuming it provided at least 20% more serotype coverage than what is currently available. Caregivers strongly agreed on the importance of full vaccination for pneumococcal disease, even if an extra dose and visit to the doctor was required. HCPs and caregivers were virtually unanimous in their support for a PCV with broader serotype coverage and showed a subsequent willingness to include an extra infant dose/visit. These results can help guide broader discussions regarding public health policy and vaccine administration in the context of important efforts to reduce the global disease burden associated with pneumococcal disease.

The Pandemic's Shadow: Measles Vaccination Challenges and Trends

Measles is a highly contagious, serious disease caused by a virus. Before the introduction of measles vaccine in 1963, major epidemics occurred approximately every 2-3 years and caused an estimated 2.6 million deaths each year (1). Government of India launched Universal Immunization Program in 1985, which provides vaccination against 8 life threatening disease including measles and 65% vaccine coverage was achieved. In order to increase the vaccination coverage, Mission Indradhanush was launched in phased manner which aimed to fully immunize more than 90% of newborn by 2020. India has adopted the National strategic Plan for achieving and sustaining measles and Rubella elimination in India and has vaccinated over 324 million children between 2017 and 2020 through MR vaccination campaign (2). Due to the lag, India had shifted its self-imposed deadline to eliminate measles to 2023 and launched another vaccination campaign in 2021 called the Intensified Mission Indradhanush 3.0, targeting unvaccinated children.

Factors Affecting The Completeness Of Completeness Of Basic Immunization Of Infants Aged 12 To 24 Months In The Working Area Of Puskesmas X Pekanbaru City

Background: Complete Basic Immunization (IDL) is an indicator in the immunization program. IDL aims to actively gain early immunity. IDL data at Puskesmas X in 2021 was 83.5% and there was a decrease in the percentage rate in 2022 to 82.87%. Based on an initial survey, on May 9-19, 2023, it was found that out of 73 mothers who brought their children to the posyandu for immunization, around 22 children (30%) were not fully immunized. Objective: Knowing the factors that influence the completeness of immunization in the working area of Puskesmas X Pekanbaru City. Methods: Using analytic observational study design, with cross sectional research design. This research was conducted at Puskesmas X Pekanbaru city. The sampling technique was done by accidental sampling. Variables of knowledge level, and education were analyzed using Kendall Tau test, while variables of employment, family support, mother's attitude and number of children used contingency coefficient test. Results: The results of the Kendall Tau test analysis of the variable level of knowledge, and education obtained a p value of 0.001 and 0.392 respectively. While in the contingency coefficient test the variables of employment, family support, maternal attitudes and number of children obtained a p value of 0.889; 0.000; 0.000 and 0.455 respectively. Conclusion: There is a significant relationship between the level of knowledge, mother's attitude and family support with the completeness of basic immunization of infants aged 12-24 months in the working area of Puskesmas X Pekanbaru City.

Predictors of the willingness to accept a free COVID-19 vaccine among households in Nigeria

BackgroundTo inform vaccination policy and programmatic strategies to increase COVID-19 vaccine uptake, an understanding of the factors associated with the willingness to vaccinate is needed. MethodsWe analyzed data collected from the sixth and tenth round of the Nigerian COVID-19 National Longitudinal Phone Survey conducted by the National Bureau of Statistics and the World Bank in 2020 and 2021, respectively. Exploratory data analysis and feature selection techniques were used to identify important variables. Multivariable logistic regression models were fitted to assess the association between socio-demographic and economic factors and the willingness to receive a free COVID-19 vaccine among Nigerian households at two different time points before vaccines became widely available. ResultsData from 1,733 and 1,651 Nigerian households who completed the sixth and tenth round of the survey, respectively, were included. Most respondents (>85% of households) were willing to receive a free COVID-19 vaccine from both survey rounds. The median household size was 6 (IQR: [4, 8]) with females heading about 18% of the households. Approximately 22% of the household heads had not received any formal education. Compared to households whose head had no education, households whose heads had completed tertiary education or higher had significantly lower odds of willingness to be vaccinated (ORround 6: 0.46, 95% CI: [0.31, 0.68], ORround 10: 0.49, 95% CI: [0.34, 0.71]). An increasing proportion of male household members was associated with greater willingness to receive a free COVID-19 vaccine (ORround 6: 1.84, 95% CI: [1.01, 3.33], ORround 10: 5.25, 95% CI: [2.86, 9.65]). Significant associations with vaccine willingness were also observed across geopolitical zones of residence with households in South-East Nigeria (ORround 6: 0.16, 95% CI: [0.10, 0.24]; ORround 10: 0.29, 95% CI: [0.19, 0.43]) and South-South Nigeria (ORround 6: 0.57, 95% CI: [0.36, 0.90], ORround 10: 0.32, 95% CI: [0.22, 0.48]) less likely to be willing to receive a free vaccine compared to households in North-Central Nigeria. ConclusionThese findings from two different time points before vaccine roll-out suggest that the educational level of household head, proportion of male household members, and the geopolitical zone of residence are important baseline predictors of the willingness to receive a free COVID-19 vaccine in Nigeria. These factors should be carefully considered and specifically targeted when designing public health programs to inform early-stage strategies that address underlying vaccine hesitancy, improve vaccine uptake, promote ongoing COVID-19 vaccination efforts, and potentially enhance other immunization programs in Nigeria.

Vaccine Confidence and Coverage among Medical Students at a Federal University in Brazil.

Declining vaccination coverage (VC) and vaccine hesitancy among medical students are global challenges. These challenges reflect individual and logistical barriers to a sufficient adherence toward essential vaccines for healthcare professionals, as well as presenting a need for educational strategies during undergraduate training. This is a prospective study for evaluating VC rates, sociodemographic associations, and the vaccine confidence among medical students at a federal university in Brazil. The data collection included questionnaires and individual analyses of the participants' vaccination records. A total of 237 medical students from all six years of an undergraduate program participated, of whom 124 (52.3%) had a vaccination record. Although the majority considered the vaccines to be "Completely Safe" (86.9%), the VC rates for complete vaccination schedules were relatively low, ranging from 87.9% (hepatitis B vaccine) to 3.2% (meningococcal B vaccine), including the vaccines from the National Immunization Program (NIP) and the private sector. Higher VC rates were found to occur among students in the final years of their undergraduate studies, in those from families with higher monthly incomes, and those from private secondary schools. Given the low VC rates among medical students, other factors in addition to vaccine confidence may be determinants, thus highlighting the importance of reviewing policies for the inclusion of priority groups in the NIP and in implementing educational interventions during undergraduate training.

Health beliefs and associated factors related to HPV and HPV vaccination in a sample of Turkish women: A cross-sectional study.

This study was conducted to determine women's health beliefs about HPV and HPV vaccination and factors associated with health beliefs. This cross-sectional study was conducted with 300 women aged 21-64 in Turkey. Data were collected using the human papillomavirus (HPV) knowledge scale (HPV-KS) and the health belief model scale for human papillomavirus and its vaccination (HBMS-HPVV). The mean age of the women who participated in the study was 35.16±9.52 years. Of them, 72.3% heard of the HPV test, 30.3% had an HPV test, 62% heard of HPV vaccination, and 9.7% had HPV vaccination. Educational level, hearing about the HPV vaccine, and HPV knowledge level were significant predictors of perceived benefit (p<.001). HPV knowledge level significantly predicted perceived susceptibility (p<.001). HPV knowledge level and hearing about HPV tests and vaccines were significant predictors of perceived severity (p<.001). A high level of education, a high level of HPV knowledge, and hearing about HPV tests and the HPV vaccine positively affect women's health beliefs. Health belief model-based education programs should be used to improve women's HPV knowledge and health beliefs about HPV and the HPV vaccine. In addition to women's health beliefs, cervical cancers can only be prevented by including the HPV vaccine in national immunization programs and increasing the coverage of HPV screening tests.