Infant Immunization Research Articles

The role of management elements in achieving complete basic immunization in infants

Effective efforts to prevent sickness and death of children with Immunization. Immunization protects children from several diseases. The achievement of UCI Puskesmas is still below the national target of 100%. The availability of human resources, costs, facilities infrastructure, and functions management implementation immunization base influences the success of the immunization program base complete in babies. This study aimed to determine the role of management elements in achieving complete basic Immunization in infants. Quantitative research type with cross-sectional design. The population of the study was 32 immunization program holders. The sampling technique used was Total Sampling. Data collection method by interview. Data analysis with Chi-Square Test. The results showed that the elements of poor management were 15 (46.9%), good management elements were 17 (53.1%), immunization coverage was not achieved by 13 (40.6%), and immunization coverage was achieved by 19 (59.4%). There is a relationship between management elements and immunization coverage with a p-value of 0.001. It is expected that there will be the development of immunization health workers in terms of number and competence and rewards for good health workers in the immunization program to achieve immunization coverage rates in each health center area.

Pengaruh Sikap dan Dukungan Keluarga terhadap Kelengkapan Imunisasi Dasar Bayi di Papua: Tantangan dan Strategi Peningkatan

This study examines the impact of family attitudes and support on the completeness of basic immunization for infants in Papua. The findings reveal that Papua’s immunization coverage of only 55.3% is far below the national average of 84.2%, indicating significant challenges. Geographic, cultural, and socioeconomic barriers hinder access to immunization services. Positive family attitudes and strong emotional support significantly increase immunization completeness, while distrust in vaccines and limited access remain obstacles. Community-based interventions, the involvement of cultural leaders, and the use of innovative technologies like drones are crucial strategies. This research underscores the importance of a holistic approach involving government, healthcare workers, and local communities to achieve equitable and effective immunization programs in Papua.

P-1863. Maternal Mycobacterial-Specific T-cell Signatures and Infant Risk of Mycobacterium tuberculosis Infection

Abstract Background Tuberculosis disease (TB) caused 214,000 pediatric deaths in 2022. A growing body of evidence suggests that HIV exposed uninfected infants (iHEU) are at increased risk for Mycobacterium tuberculosis (Mtb) infection. Harnessing the power of the maternal immune system to protect infants has shown promise in other infections. Yet no well powered study has evaluated the association between maternal mycobacterial-specific T cell memory and infant protection from Mtb infection. To address this knowledge gap, we examined the hypothesis that previously undescribed maternal factors modulate infant immunity to bacillus Calmette-Guèrin (BCG) and Mtb.Fig 1.Mothers of infants negative for Mtb infection had higher proportions of CD8 T cells expressing IL2 in response to mycobacterial antigens.ESAT-6/CFP-10 negative median 0.004710 (95% CI 0.00096000-0.01103), positive median 0.0 (95% CI 0-0.009410). TBWCL negative median 0.01172 (95% CI 0.005340-0.01860), positive median 0.003710 (95% CI 0-0.008467). Methods This study was nested within a randomized controlled trial of isoniazid to prevent Mtb infection in 300 iHEU (iTIPS) who were vaccinated with BCG at birth, randomized to isoniazid or placebo at 6-10 weeks, and had Quantiferon-Plus (with IFNγ, IL2, IP10, TNF measured in supernatant) (QFT-4) at 14 months, and/or tuberculin skin testing (TST) at 14 and 24 months. Paired maternal peripheral blood mononuclear cells were collected at the 6-10 week visit. The majority (73%) of mothers started antiretroviral therapy before pregnancy, 26.3% during pregnancy, and 0.7% after pregnancy. Frequency of self-reported history of TB disease was 10.7%. We assessed the response of maternal T cells to Mtb whole cell lysate (TBWCL), a proxy for BCG, and ESAT-6/CFP-10 (E6C10), an Mtb specific peptide pool, by flow cytometry with a T cell panel including surface, memory, and activation markers and IL2, IL17A, IFNγ, and TNF. Results Our preliminary analysis of 166 of 235 maternal samples with flow cytometry revealed that mothers of infants with positive TST or QFT-4 had significantly fewer CD8+IL2+ cells in response to TBWCL (median 0.0037% vs 0.0117%, p=0.032) (Fig 1). Conversely mothers of these infants had significantly higher CD4+TNFa+ responses to E6C10 (median 0.0458% vs 0%, p=0.0014) and CD4+IFNγ+ responses to TBWCL (median 0.0533% vs 0.0302%, p=0.0395). Conclusion These results establish that maternal mycobacterial-specific immune signatures are associated with infant outcomes, which we plan to further investigate by comparing these maternal signatures with infant T cell response to TBWCL and determining the role of maternal microchimeric cells. Disclosures Sylvia M. LaCourse, MD, MPH, Merck: Grant/Research Support|UpToDate: Royalties

P-628. Real-world impact of pneumococcal conjugate vaccines on vaccine serotypes and cross-reacting non-vaccine serotypes

Abstract Background Cross-reactivity of vaccine-induced antibodies with some non-vaccine serotypes has been demonstrated in clinical trials and serological studies, but there is limited longitudinal data on the impact of pneumococcal conjugate vaccines (PCVs) on cross-reactive serotypes after implementation in infant immunization programs. This study describes the impact of PCVs on pneumococcal disease cases due to potential cross-reactive serotypes.Table 1.Countries included in analysis Methods We identified 13 countries with serotyped invasive pneumococcal disease (IPD) surveillance data that had introduced PCV10 or PCV13 (Table 1). Analyses were restricted to IPD cases due to serotypes included in PCV10/13 (VTs: 6B, 9V, 18C, 19F, 23F, 7F; PCV13 only VTs: 6A, 19A) and to non-vaccine serotypes (NVTs: 6C, 7A, 7B, 7C, 9N, 18A, 18B, 18F, 23A, 23B) that could be immunologically related to VTs in children < 5 years. For each country, we compared case counts 1 year before and the latest year of data available (2018/19) after PCV introduction and calculated relative percent change. Results Decreases in VT IPD cases were observed across all countries after PCV introduction, while some NVT IPD cases had no change or increased. VT cases declined by 59-100%. Serotype 19A cases declined by 34-100% (0-26 cases in 2018/19) in PCV13 countries but increased by 63-1460% (13-78 cases in 2018/19) in PCV10 countries. NVT 6C cases had little to no change (0-6 cases in 2018/19) in PCV13 countries but increased by 100-1200% (1-12 cases in 2018/19) in PCV10 countries. In PCV13 countries, 7B, 7C, and 9N cases did not change (0-6 cases in 2018/19), while 23A and 23B increased moderately by 200-900% (2-16 cases in 2018/19). NVT 7B, 7C, 9N, 23A, and 23B had no data available for PCV10 countries, while NVT 7A, 18A, 18B, and 18F did not have sufficient cases in any PCV setting to include in the analysis. Conclusion The inclusion of VT 19A in PCV13 and not in PCV10 may explain the significant increase of NVT 19A cases in PCV10 countries. Conversely, the minimal change of NVT 6C cases in PCV13 countries but large increases in PCV10 countries suggest cross-protection of serotype 6C by PCV13, likely due to inclusion of serotype 6A. For other NVTs, cross-protection was not identified based on observing no change or increasing cases or could not be evaluated due to low case counts. Disclosures Kevin Apodaca, MPH, Pfizer, Inc: Employee of company|Pfizer, Inc: Stocks/Bonds (Private Company) Lindsay Grant, PhD, MPH, Pfizer, Inc: Employee of company|Pfizer, Inc: Stocks/Bonds (Private Company) Johnna Perdrizet, MPH, Pfizer, Inc: Employee of company|Pfizer, Inc: Stocks/Bonds (Private Company) Derek Daigle, PhD, Pfizer, Inc: Employee of company|Pfizer, Inc: Stocks/Bonds (Private Company) Gabriel Mircus, PhD, Pfizer, Inc: Employee of company|Pfizer, Inc: Stocks/Bonds (Private Company)

October 2024 ACIP Meeting Update: Influenza, COVID-19, RSV and Other Vaccines.

The Advisory Committee on Immunization Practices (ACIP), a group of medical and public health experts that provides advice to the Centers for Disease Control and Prevention, normally meets 3 times per year to develop US vaccine recommendations. The ACIP met October 23-24, 2024, to discuss influenza vaccines, chikungunya vaccines, coronavirus disease (COVID-19) vaccines, RSV immunizations, meningococcal vaccines, human papillomavirus (HPV) vaccines, pneumococcal vaccines, and adult and child/adolescent immunization schedule revisions. This update summarizes the proceedings of these meetings, with an emphasis on topics that are most relevant to the pediatric population. Major updates for pediatric clinicians include information regarding COVID-19 and influenza vaccine recommendations, meningococcal vaccination considerations, and updates regarding implementation and effectiveness of RSV immunization in pregnant people and infants.

An Acceptability and Feasibility Study of a Nurse-Led Model of Contraception and Abortion Care in Rural General Practice.

To assess the acceptability and perceived feasibility of integrating a co-designed nurse-led model of contraception and medication abortion care within rural and regional general practices. Qualitative exploratory design utilising Sidani and Braden's indicators of acceptability and feasibility. We conducted semi-structured interviews with 12 practice nurses, 8 general practitioners and 3 practice managers who currently or previously worked in rural, regional or remote general practice. Participants were recruited purposively through social media, partner organisation newsletters and snowballing. During the interview, participants were presented with an overview of the co-designed model of care and asked specific questions to gain feedback on its acceptability and perceived feasibility. Data were analysed in NVivo using template analysis and iterative categorisation. Findings were mapped according to Sidani and Braden's indicators of acceptability and feasibility. Three overarching themes were identified: nurses are acceptable providers, factors influencing the feasibility of the model and factors supporting greater feasibility of the model. Participants found the nurse-led model acceptable, describing nurses as suitable and sometimes preferred providers of long-acting reversible contraception and abortion care in rural and regional settings. They also perceived the model as feasible, citing similarities to existing care processes such as infant immunisations and chronic disease management, contributing to its feasibility. However, contextual factors such as the need to adapt the model to each clinic and patient's unique needs, foster strong general practitioner-practice nurse professional relationships and ensure that staff have shared values and adequate training for contraception and abortion provision were described as critical for feasibility. Overall, participants found the nurse-led model of care to be acceptable and feasible for implementation in rural and regional general practices. This perception carries important implications for policy and practice, highlighting the need for supportive policies to enhance the effectiveness of such models across Australian general practice. Our findings emphasise the need for initiatives aimed at addressing inadequate funding for nurse-led care, improving documentation of this care, enhancing understanding among general practitioners and nurses regarding the scope of practice for practice nurses, and overcoming training barriers specific to rural areas. These measures are essential for enabling nurse-led models of contraception and medication abortion to function effectively in practice. This paper is reported according to the consolidated criteria for reporting qualitative research (COREQ) guidelines. Two consumer representatives contributed to the development of the co-design methodology as members of the ORIENT Intervention Advisory Group Governance Committee.

Pregnant women's choices for preventing respiratory syncytial virus (RSV).

Respiratory syncytial virus (RSV) is the leading cause of bronchiolitis and pneumonia in infants and can lead to severe respiratory distress, especially in very young infants. No specific treatments exist for RSV. However, new preventative strategies have become available including RSV vaccine for pregnant women and monoclonal antibody for infants. This study aimed to identify and understand barriers and facilitators to the uptake of a new RSV vaccine in pregnant women and determine their underlying choices for a maternal RSV immunisation program. Additionally, the study investigated choice for maternal vaccination or administration of a long-lasting monoclonal antibody to infants. Eligible participants were pregnant women residing in Australia and aged 18years or older. Focus group discussions and individual online interviews were conducted and data were analysed using a thematic analysis approach. A total of 34 pregnant women participated in online focus group discussions or interviews, with an average age of 34years. The identified themes were categorised into four overarching domains: 1) motivators for vaccinating during pregnancy to safeguard their babies and prevent severe diseases, 2) barriers to vaccination including vaccine safety concerns, uncertainties regarding vaccine effectiveness, and vaccine hesitancy arising from COVID-19 vaccination experiences, 3) preferred vaccination promotion strategies, including constant reminders/prompts, personalised messages, campaign focusing on serious outcomes and using diverse/lay languages, recommendations from local obstetricians and health authorities, 4) clear vaccine recommendation policies and a preference for maternal immunisation over infant immunisation. The maternal RSV vaccination was generally welcomed and preferred by pregnant women in our study comparing to other strategies. Preferences for RSV program promotion included diversity in languages, "nudge" reminders, and recommendations from healthcare providers.

Maternal Lifestyle Factors Affecting Breast Milk Composition and Infant Health: A Systematic Review.

Breast milk is a dynamic, personalized nutrition source, influenced by maternal diet, lifestyle, and environmental factors, which shape its composition and impact infant health. This review synthesizes evidence on the associations between maternal lifestyles (e.g., diet, physical activity, smoking), breast milk composition, and child health, offering insights for interventions to optimize breastfeeding benefits. We searched Web of Science, Medline, Embase, and PubMed for studies published up to March 2024 using predefined terms. Out of 5244 articles, 20 studies met the inclusion criteria. Maternal Body Mass Index and macronutrient intake significantly affected breast milk fatty acid composition, influencing infant growth, cognitive development, and metabolic health. Micronutrient intake, particularly iodine, omega-3 fatty acids, and vitamins, was linked to better neurodevelopment and reduced atopic risks. Maternal diet and supplementation improved breast milk nutrient profiles and infant outcomes, though exposure to toxins like ochratoxin A raised concerns. Smoking was associated with altered milk composition, including lower osteopontin levels, potentially affecting infant immunity and growth. This review emphasizes that adequate intake of key nutrients is essential for infant development, highlighting the need for policies that address nutritional deficiencies, promote healthy lifestyles, and reduce socio-economic barriers. These efforts can improve outcomes for both mothers and children, enhancing public health and reducing disparities.

Breastfeeding Practices and Immunity Outcomes among Infants: A Bibliometric Analysis 2012-2022

This study aimed to understand the significant relationships between human milk and a newborn's developing immune system over the decade as well as their history, research hotspots, frequency of publications, contextual associations between multiple publications related to the topic, and current trends. The electronic database TM Dimension AI was searched using the keywords “breastfeeding”, “immunity” and “infants” to include manuscripts published between 2012 and 2022. Bibliometric analysis was performed using VOSviewer 1.6.14. Network maps were created to analyze collaborations among distinct authors and countries, and recognize top institutions. The study covered 334 papers that meet the inclusion criteria. According to the network visualization, the United States has made a substantial contribution to the study of breastfeeding's effects on newborn immunity, as evidenced by the country's highest number of publications 74 (22.1%). The analysis of journals revealed the research in this area is heavily focused on Nutrient Journal, with maximum publications 104 (31.1%). On analyzing the contribution of institutes, the University of Western Australia showed a maximum publication 16 (4.7%). This bibliometric analysis highlights the United States as a leading contributor to research on breastfeeding's impact on infant immunity, with a significant focus on Nutrients journal and key institutional input from the University of Western Australia.

Management of Quadruplet Infants at the General Hospital of West Nusa Tenggara Province, Indonesia: A Case Report

Multiple pregnancies with more than two fetuses significantly increase maternal and infant complications. Almost all multiple pregnancies with more than two fetuses result in preterm birth. Prematurity is the main consequence of multiple pregnancies with more than two fetuses. Early provision of optimal nutrition is crucial for the growth and immunity of premature infants. We report our first-hand experience as the primary referral hospital in West Nusa Tenggara Province, Indonesia, in providing multidisciplinary care for the birth of quadruplet premature infants. A 39-year-old woman, gravida 3, para 2, living 2, nulliparous, was referred to the General Hospital of West Nusa Tenggara Province from Bima District Hospital due to a quadruplet pregnancy at 28-29 weeks gestation. A multidisciplinary team consisting of obstetricians, pediatricians, and nurses was assembled. All four infants were diagnosed with hyaline membrane disease (HMD) and immediately transferred to the Neonatal Intensive Care Unit (NICU). Premature infants received parenteral and enteral nutrition support. Family-centered care approach was implemented for the care of the premature infants and their families. All infants were discharged at 35 weeks postmenstrual age (PMA). Spontaneous quadruplet pregnancies are rare cases, and this particular case represents the first experience of our hospital in managing quadruplet infants. A well-coordinated multidisciplinary approach, coupled with good preparedness for delivery, is essential and has proven to yield favorable outcomes for both the mother and the infants.

VACCIDOC: An Infant Immunization Tracker for Private Hospitals by Integrating OTP- based Verification

VACCIDOC: An Infant Immunization Tracker for Private Hospitals by Integrating OTP- based Verification

Effect of HIV and Malaria in Pregnancy on Pertussis-specific Antibodies and Transplacental Antibody Transfer: A Secondary Analysis of a Prospective Cohort Study in Mozambican Pregnant Women and Their Infants.

Infection during pregnancy may affect maternal and infant immunity against childhood diseases. We aimed to evaluate the effects of maternal HIV and malaria on maternal and infant pertussis immunity and placental antibody transfer. A prospective study was conducted in mother-infant pairs in Mozambique. Peripheral and cord blood samples were collected for pertussis-specific immune assays. Maternal HIV serostatus and Plasmodium falciparum infection were assessed. The placental transfer was assessed using cord-to-mother ratios of IgG against pertussis toxin (PT), pertactin (PRN) and fimbriae 2/3 (FIM). A total of 270 mother-infant pairs were included: 99 mothers with HIV and 40 mothers with malaria. Pregnant women with HIV showed a reduction in placental transfer [PT: 12.7%, 95% confidence interval (CI): 2.6-21.7, P = 0.015; PRN: 14.6%, 95% CI: 6.3-22.1, P = 0.001; and FIM: 7.5%, 95% CI: -6.6 to 19.7, P = 0.282] compared with women without HIV. A trend toward reduction in IgG transfer was observed among women with malaria (PT: 9.5%, 95% CI: -4.2 to 21.4, P = 0.165; PRN: 5.0%, 95% CI: -7.0 to 15.7, P = 0.394; and FIM: 15.9%, 95% CI: -0.9 to 30.0, P = 0.062) compared with those without. Maternal HIV infection (odds ratio: 4.43, 95% CI: 2.14-9.1; P < 0.001) and high viral load (odds ratio: 4.37, 95% CI: 1.4-12.2; P = 0.033) were associated with impaired placental transfer. Maternal HIV infection is associated with lower mother-to-infant transfer of pertussis antibodies. While efforts continue in the health care of pregnant women with HIV, interventions such as maternal immunization can be a valuable strategy to prevent pertussis in infants.

Gestational Diabetes Mellitus-Induced Milk Fat Globule Membrane Protein Changes of Human Mature Milk Based on TMT Proteomic Analysis

Breastfeeding by mothers with gestational diabetes mellitus (GDM) has been shown to reduce maternal insulin demands and diminish the risks of diabetes in infants, leading to improved long-term health outcomes. Milk fat globule membrane (MFGM) proteins play a crucial role in influencing the immunity and cognitive development of infants. Understanding the alterations in MFGM proteins in breastmilk from mothers with GDM is essential for enhancing their self-efficacy and increase breastfeeding rates. The objective of this study is to investigate and compare MFGM proteins in milk from mothers with GDM and without based on tandem mass tag (TMT) labeling and liquid chromatography tandem mass spectrometry (LC-MS) techniques. A total of 5402 proteins were identified, including 4 upregulated proteins and 24 downregulated proteins. These significantly altered proteins were found to be associated with human diseases, cellular processes, and metabolism pathways. Additionally, the oxidative phosphorylation pathway emerged as the predominant pathway through Gene Set Enrichment Analysis (GSEA) involving all genes.

EE820 Cost-Utility Analysis of an All-Preterm Infant Immunization With Nirsevimab Against Respiratory Syncytial Virus (RSV): Associated Disease at the Brazilian Private Healthcare System

EE820 Cost-Utility Analysis of an All-Preterm Infant Immunization With Nirsevimab Against Respiratory Syncytial Virus (RSV): Associated Disease at the Brazilian Private Healthcare System

Respiratory syncytial virus (RSV) prevention: Perception and willingness of expectant parents in the Netherlands

BackgroundRespiratory syncytial virus (RSV) is a leading cause of infant respiratory disease. Recent approval of preventive measures like a long-acting monoclonal antibody and a maternal vaccine signals a potential shift in early-life RSV infection control. However, success hinges on acceptance. MethodsWe conducted a cross-sectional survey among pregnant women and partners in the Netherlands, recruited via healthcare professionals, social media platforms, and the 9-Months Fair. The survey assessed willingness and motivation for maternal RSV vaccination and neonatal RSV immunization, including strategy preferences and informational needs. ResultsIn total 1001 pregnant women (mean age: 31.1 years) and their partners (mean age: 33.2 years) completed the survey. On average, they were 24 weeks pregnant at the time, and 54.6 % had no other children yet. The majority was Dutch-born (95.2 % of women); with 68.3 % of women having completed higher education and with overall strong pro-vaccination attitudes (93.9 % of partners intended to vaccinate their expected newborn). The overall acceptability to vaccination and immunization was high, with 87 % of respondents indicating they would (likely) accept both strategies. A positive attitude towards both methods was associated with previous experience with severity of RSV, intention to vaccinate the newborn and parental vaccination status during childhood and current pregnancy. When the choice was given, the majority of participants, in particular those with children and the intention to breastfeed, favoured maternal vaccination over passive immunization of infants (75.3 % of the pregnant and 71.6 % of the partners). A majority of the respondents cited optimal protection for the child and knowledge of RSV as important factors for accepting RSV prophylaxis. ConclusionsWhile most participants would accept both strategies for RSV protection of their infant, a majority, especially those with other children, favoured maternal vaccination, due to concerns about infant safety and awareness of RSV severity.

Local Lidocaine-Prilocaine for Immunisation in Infants.

Introduction: Lidocaine-prilocaine cream effectively reduces vaccination pain, improving vaccination adherence and advocating for its routine use in healthcare settings. Methods: This review used PRISMA guidelines and the PICOT format to structure the analysis. The focus was on paediatric patients aged 0-12 months requiring intramuscular vaccinations, comparing the application of lidocaine-prilocaine cream to other interventions or no treatment. Data sources included MEDLINE, PUBMED, EMBASE, BMC, Research GATE, and Cochrane Library. Studies were selected based on predefined inclusion and exclusion criteria, with data extracted regarding participant demographics, pain assessment scales, and study conclusions. The Cochrane Risk of Bias Tool assessed study quality, while statistical analyses evaluated the effectiveness of the intervention. Results: Fifty studies were identified, with nine ultimately included in the analysis, involving 704 participants. The primary outcome was the effectiveness of lidocaine-prilocaine cream in reducing pain after vaccinations. Results showed a significant mean difference of -1.719 in pain scores for infants treated with lidocaine-prilocaine compared to those receiving other interventions. Behavioural indicators, such as crying duration and latency to the first cry, favoured the lidocaine-prilocaine group. Conclusions: Lidocaine-prilocaine cream effectively reduces vaccination pain, supporting its routine use in healthcare settings. Engaging parents can enhance vaccination adherence. Training healthcare professionals on lidocaine-prilocaine cream application and pain scales is vital for improving patient satisfaction. Further research is needed to evaluate the long-term effects of lidocaine-prilocaine cream on vaccination experiences and infant behavioural health.

Parental vaccine hesitancy toward routine childhood immunizations and COVID-19 vaccines in Japan: A cross-sectional study

BackgroundThis study aimed to elucidate the prevalence and characteristics of parental vaccine hesitancy towards routine infant immunizations and COVID-19 vaccines in Japan.MethodsA web-based survey was conducted among 3,227 parents of children aged 0–11 years to assess vaccine-related hesitancy for routine infant immunizations and COVID-19 vaccines for children using the Parent Attitudes about Childhood Vaccines (PACV) questionnaire. Data were collected from January 18 to 25, 2023. Covariates included demographic characteristics, economic status, COVID-19 infection status, decisional conflict scale, and the fear of COVID-19 Scale.ResultsVaccine hesitancy was found to be 52.4% for routine infant immunizations and 73% for COVID-19 vaccines. Significant differences in parental attitudes were observed between general childhood vaccines and COVID-19 vaccines for 12 out of 13 PACV survey items. The COVID-19 vaccines showed higher hesitancy rates in 10 items; largest discrepancies were noticed in schedule adherence (22.5% vs 61%), overall hesitancy (40% vs 55.1%), and trust in pediatric doctors (37.2% vs 53.6%). Safety concerns were high for both vaccine types, exceeding 50%. Multivariable analysis identified decisional conflict (RR: 1.01 95% CI: 1.00–1.02) and COVID-19-related fear (RR: 1.04, 95% CI: 1.02–1.05) as hesitancy predictors for routine immunizations.ConclusionVaccine-related hesitancy for COVID-19 was significantly higher than that for routine immunizations, with decisional conflict emerging as a primary predictor for both. Fear of COVID-19 was associated with routine immunization-related hesitancy. These findings provide critical insights for future pandemic preparedness and vaccine acceptance strategies, highlighting the importance of strengthening trust between healthcare providers and parents, providing clear and reliable information, and implementing decision support tools.

In utero exposure to per - and polyfluoroalkyl substances (PFAS) associates with altered human infant T helper cell development.

Environmental exposures to chemical toxicants during gestation and infancy can dysregulate multiple developmental processes, causing lifelong effects. There is compelling evidence of PFAS-associated immunotoxicity in adults and children. However, the effect of developmental PFAS exposure on infant T-cell immunity is unreported, and, if present, could be implicated in immune-related health outcomes. We seek to model longitudinal changes in CD4+ T-cell subpopulations from birth through 12 months and their association with in-utero PFAS exposure and postnatal CD4+ T-cell frequencies and functions. Maternal-infant dyads were recruited as part of the UPSIDE-ECHO cohort during the first trimester between 2015 and 2019 in Rochester, New York; dyads were followed through the infant's first birthday. Maternal PFAS concentrations (PFOS, PFOA, PFNA, and PFHXS) were quantified in serum during the second trimester using high-performance liquid chromatography and tandem mass spectrometry. Infant lymphocyte frequencies were assessed at birth, 6- and 12-months using mass cytometry and high-dimensional clustering methods. Linear mixed-effects models were employed to analyze the relationship between maternal PFAS concentrations and CD4+ T-cell subpopulations (n=200). All models included a PFAS and age interaction and were adjusted for parity, infant sex, and pre-pregnancy body mass index. In-utero PFAS exposure correlated with multiple CD4+ T-cell subpopulations in infants. The greatest effect sizes were seen in T-follicular helper (Tfh) and T-helper 2 (Th2) cells at 12 months. A log 2 -unit increase in PFOS was associated with lower Tfh [0.17% (95%CI: -0.30, -0.40)] and greater Th2 [0.27% (95%CI: 0.18, 0.35)] cell percentages at 12 months. Similar trends were observed for PFOA, PFNA, and PFHXS. Maternal PFAS exposures correlate with cell-specific changes in the infant T-cell compartment, including key CD4+ T-cell subpopulations that play central roles in coordinating well-regulated, protective immunity. Future studies into the role of PFAS-associated T-cell distribution and risk of adverse immune-related health outcomes in children are warranted.

“They say it may cause cancer:” A Qualitative Exploration of Filipinos' Contraceptive Misconceptions and Primary Healthcare Interventions

Background and Objective. Contraceptives are widely acknowledged for preventing unwanted pregnancies. However, there is a prevalent lack of awareness regarding contraceptives, leading to unaddressed misconceptions. This study aimed to identify common contraceptive misconceptions among men and women of reproductive age and explore how primary health workers address them. Methods. A qualitative study was conducted in two phases within District 5, Manila City. Phase 1 comprised focused group discussions with men and women of reproductive age (n=60), while Phase 2 involved conducting in-depth interviews with primary healthcare providers (n=16). MAXQDA, a qualitative software, to organize and code the data, was utilized. Results. Women of reproductive age reported several misconceptions about contraceptives, including concerns about adverse health effects, emotional and behavioral changes, perceived ineffectiveness, and cosmetic or bodily changes. For instance, they believed that contraceptives could lead to serious health complications, such as cancer, genital injury, and even death. Primary healthcare providers addressed these misconceptions through open dialogue during service delivery, particularly during prenatal and postpartum check-ups and infant immunizations. They utilized patient education strategies, including the teach-back method, and conducted community outreach and workshops on contraceptives and family planning, especially during Women’s Month. Conclusion. Several misconceptions were identified among women of reproductive age regarding the proper use and safety of contraceptive methods, as well as misguided beliefs. In contrast, men did not exhibit any misconceptions about contraceptives, which warrants further investigation. Primary healthcare providers have taken a proactive approach to address this issue by offering comprehensive explanations and ensuring clear understanding between healthcare providers and women. Promoting contraceptive health literacy could help bridge the knowledge gap between men and women of reproductive age.

A whole-cell pertussis vaccine engineered to elicit reduced reactogenicity protects baboons against pertussis challenge.

Whole-cell pertussis (wP) vaccines introduced in the 1940s led to a dramatic reduction of pertussis incidence and are still widely used in low- and middle-income countries (LMICs) worldwide. The reactogenicity of wP vaccines resulted in reduced public acceptance, which drove the development and introduction of acellular pertussis (aP) vaccines in high-income countries in the 1990s. Increased incidence of pertussis disease has been observed in high-income countries following the introduction of aP vaccines despite near universal rates of pediatric vaccination. These increases are attributed to the reduced protection against colonization, carriage, and transmission as well as reduced duration of immunity conferred by aP vaccines relative to the wP vaccines they replaced. A reduced reactogenicity whole-cell pertussis (RRwP) vaccine was recently developed with the goal of achieving the same protection as conferred by wP vaccination but with an improved safety profile, which may benefit countries in which wP vaccines are still in routine use. In this study, we tested the RRwP vaccine in a baboon model of pertussis infection. We found that the RRwP vaccine induced comparable cellular and humoral immune responses and comparable protection following challenge relative to the wP vaccine, while significantly reducing injection-site reactogenicity.IMPORTANCEThe World Health Organization (WHO) recommended in 2015 that countries administering wP vaccines in their national vaccine programs should continue to do so, and that switching to aP vaccines for primary infant immunization should only be considered if periodic booster vaccinations and/or maternal immunization could be assured and sustained in their national immunization schedules (WHO, Vaccine 34:1423-1425, 2016, https://doi.org/10.1016/j.vaccine.2015.10.136). Due to the considerably higher cost of aP vaccines and the larger number of doses required, most LMICs continue to use wP vaccines. The development and introduction of a wP vaccine that induces fewer adverse events without sacrificing protection would significantly benefit countries in which wP vaccines are still in routine use. The results of this study indicate this desirable goal may be achievable.