Immunization Guidelines Research Articles

Glucocorticoid dosing and implications for vaccination: Evolution of global definitions.

Despite widespread adoption of "high-dose" glucocorticoid definitions across international immunisation guidelines (i.e., prednisone-equivalent dosing >20 mg/day, or >2 mg/kg/day in children), the rationale remains unclear. Literature searches were performed through academic databases for this narrative review to identify relevant evidence regarding glucocorticoid dosing on vaccine responses and safety. In people receiving prednisone <7 mg/day, vaccine responses are maintained. In people on 'high-dose' glucocorticoids (>20 mg/day), antibody titres and seropositivity are reduced, whereas the impact of low- to medium-dose glucocorticoids (7 to 20 mg/day) on vaccine efficacy remains inconclusive. Due to inconsistent paediatric dosing regimens, data is insufficient to support a unified "high-dose" glucocorticoid threshold. Non-live vaccines are well tolerated in patients receiving glucocorticoids with rheumatic/inflammatory disorders, but enhanced reactogenicity after live vaccination may occur in those with severe immunodeficiencies. Clinicians should consider individual risk-benefit profiles, rather than following strict dosing thresholds, when curating immunisation programs for patients prescribed glucocorticoids.

Evaluation of knowledge, attitude and practice (KAP) of pharmacy students’ acceptance of COVID-19 vaccines in South India

Purpose: To assess South Indian pharmacy students' knowledge, attitudes and practices (KAP) regarding adherence to COVID-19 immunization guidelines. Methods: A six-month prospective cross-sectional study was conducted among KMCH College of Pharmacy, Coimbatore pharmacy students. The 39 validated questions on knowledge, attitudes, practices, and concerns about the COVID-19 vaccine were used to grade replies using 3-point and 5- point Likert scales. IBM SPSS Statistics for Windows, Version 23.0, was used to analyze the data. Results: The survey was completed by a total of 271 pharmacy students. A majority (59 %) of students possessed adequate knowledge (p = 0.0003), and 92 % were willing to receive COVID-19 vaccinations. The majority of respondents have implemented COVID-19-appropriate practices. Majority of information sources (52 %) were from healthcare providers. Conclusion: Pharmacy students in South India have a fair knowledge of COVID-19 vaccination. More effort is required to improve awareness on this subject.

Assessment of Unwanted Side Effects of Vaccines in Cancer Patients: Where Do We Stand in Vaccination? Where Should Our Next Step Be?

For cancer patients, vaccination against diseases that can be prevented by vaccination is a crucial but often disregarded matter. Our aim was to find out how adult immunization guidelines were being used and to investigate undesirable effects after vaccination. Vaccination status against hepatitis A and hepatitis B virus, tetanus-diphtheria, pneumococcus, influenza and meningococcus of 535 patients with solid organ malignancies who were referred to the Adult Vaccination Polyclinic from oncology outpatient clinic between July 2020 and March 2024 were documented retrospectively. Data collection and statistical analyses were performed with SPSS statistical software version 22.0. The patients’ mean age±SD was 56.8±12.3. Of the patients, 329 (61.4%) are women. Breast cancer (n= 184, 34.3%), urogenital cancers (n= 89, 16.6%), and lung cancer (n= 69, 12.8%), are the most prevalent cancers among patients applying for vaccination. Pneumococcal vaccine was the most frequently administered vaccine in 515 patients (96.2%), while influenza vaccine was the least frequently administered vaccine in 12 patients (2.2%). Fifty-three (9.9%) patients had grade 1 side effects. Pain at the injection site was the most common side effect and occurred most frequently after tetanus-diphtheria vaccination. Undesirable side effects were more frequent in 7.9% (n= 42) of patients who were under treatment (p= 0.016). However, no significant relationship was found between age, sex, the disease stage and the types of treatment received and the incidence of side effects (p&gt; 0.05). None of the participants experienced any moderate or serious post-vaccination side effects serious enough to require medical attention. Although the pneumococcal vaccination rates in our study are greater than to the literature, the application rate of other vaccines, especially influenza vaccine, is low according to current guidelines. Increased awareness of this issue among oncology physicians is suggested by the fact that about 1/5 of patients were referred to vaccination outpatient clinics. This study is extremely valuable in demonstrating to oncology physicians the rarity of vaccine side effects. Keywords: Vaccination, Immunization, Cancer patient, Solid tumor, Post-vaccination unsiderable effect

The relationship between Zoster serology, vaccination uptake and infection rates: a single-centre cross-sectional study.

This study aimed to assess the prevalence of Varicella-Zoster Virus (VZV) immunity, vaccination uptake and incidence of VZV-related events in inflammatory arthritis (IA) patients initiating biologic or targeted synthetic disease-modifying antirheumatic drugs. An observational study was conducted in a single hospital between March 2019 and December 2020. Ninety-three IA patients were included. Data were collected from electronic health records and analysed using the chi-squared test. The majority of patients (91.4%) were seropositive for VZV, reaffirming the necessity for vaccination. In total, 8.6% of the cohort received the Zostavax vaccine, despite a small yet significant number of patients (4.3%) experiencing Herpes Zoster after initiating treatment. Multiple factors contributed to low vaccine uptake, including limited vaccine availability, discrepancies between the British Society for Rheumatology and Joint Committee on Vaccination and Immunisation guidelines, vaccine hesitancy and concerns regarding vaccine efficacy and risks. Significant VZV immunity exists among patients prior to targeted therapy commencement. Risk factors for VZV-related events include Janus kinase inhibition, increasing age and long-term steroid use. VZV-related events occurred exclusively in patients with prior viral immunity. Despite most patients having serological evidence of prior VZV exposure, our study exposes critical gaps between current clinical guidelines and practice, particularly in VZV vaccine uptake. Barriers to vaccination include inconsistent guidelines, limited vaccine availability and patient-level hesitancy. This is concerning as our cohort demonstrated small but significant rates of zoster, mostly among patients on long-term steroids.

Time interval distribution of hepatitis B vaccine immunization among infants in China from 2017 to 2021

ABSTRACT Infant hepatitis B vaccine coverage in China is high, with over 95% of infants immunized; however, high vaccine coverage can often mask low timeliness. The vaccination interval between the second and third doses is not clearly defined by immunization guidelines in China. This retrospective cohort study assessed the time interval distribution of hepatitis B vaccination among a cohort of randomly selected live births from the Centers for Disease Control and Prevention across four provinces or municipalities in China between January 2017 and December 2021. Among the infants analyzed, 163,224 received the first dose of hepatitis B vaccine with 146,905 (90.0%) and 135,757 (83.2%) infants receiving the second and third doses, respectively. A total of 132,577 (90.2%) infants received the second dose between 28 and 61 days after the first dose. Of the 119,437 (88.0%) infants that completed the hepatitis B series between 61 and 214 days after the second dose 87,067 (64.1%) infants were vaccinated with the third dose between 151 and 180 days after the second dose. The time interval distribution varied across the four provinces or municipalities (p < .001). Of the 58,077 infants who completed the hepatitis B vaccine series, 36,377 (62.6%) infants used the same type of hepatitis B vaccine for all three doses. Overall, the timeliness of hepatitis B vaccination for infants was lower than expected, with regional disparities observed. This highlights the need for improved timeliness through the introduction of a defined timeframe for the last two doses of vaccine and training for obstetricians and related personnel.

236 Post-Splenectomy Patients: Reaudit of Current Practice at Living Well Partnership PCN

Abstract Aim Post-splenectomy patients are at increased risk of sepsis and overwhelming post-splenectomy infection (OPSI). This reaudit aimed to look at a primary care network’s (PCN) compliance with established immunisation guidelines and antibiotic prophylaxis post-splenectomy. Method A retrospective study of 29 splenectomy or asplenia patients between 2018-2022 was conducted within a primary care network. Hospital and GP records were reviewed for antibiotic prescriptions (prophylactic and emergency), vaccination records, electronic splenectomy alert and admission for infection. Interventions included a 15-minute patient intervention GP consultation and correction of EMIS coding. Results The 2018 audit showed that a proportion of splenectomy patients were not appropriately prescribed antibiotics. There was lack of patient insight into their condition (asplenia v splenectomy). An active, patient-centred intervention was employed to improve rates of antibiotic prescribing, perform counselling on regular recommended vaccinations and ensure correct clinical coding for follow up. Compliance to audit criteria increased across all measures between the 3 PDSA cycles. Antibiotic prophylaxis prescription increased from 53% (2018) to 71% in 2022. Emergency antibiotic prescription increased from 6% (2018) to 39% in 2022. Influenza vaccination rates increased from 71% (2018) to 82% in 2022. Following the intervention consultation, 85% of patients had appropriate antibiotic prophylaxis prescription and 64% had appropriate emergency antibiotics prescribed. Conclusions Prescription for emergency and prophylactic antibiotics, and correct coding for annual and 5-year vaccinations were improved for this cohort of splenectomy and asplenia patients. Patients valued a structured consultation leading to improved understanding and self-management.

Post-marketing surveillance of 10,392 herpes zoster vaccines doses in Australia

BackgroundImmunisation against herpes zoster is recommended for adults aged ≥ 50 years. Two vaccines, a live attenuated (ZVL, Zostavax®) and an adjuvant recombinant subunit (HZ/su, Shingrix®), are available in Australia. Immunisation guidelines are shifting their recommendations towards HZ/su because of higher efficacy in preventing herpes zoster and associated complications. However, there are limited post-marketing data comparing the safety profiles of these vaccines. MethodsData from SmartVax, an active surveillance system for monitoring adverse events following immunisation (AEFIs) utilised by > 450 clinics throughout Australia, were analysed. Data from patients aged ≥ 50 years, who received ZVL or HZ/su, from 1 June 2021 to 31 May 2022, at clinics that utilised SmartVax were included. The proportion of records where patients who reported any, local, and systemic AEFIs after receiving ZVL or HZ/su were compared using multivariable logistic regression models. ResultsData from 10,392 immunisation records (n = 8341 ZVL; n = 2051 HZ/su) were included. The proportion of AEFIs reported was higher with HZ/su (41.9 % [any], 33.8 % [local], 25.2 % [systemic]) than with ZVL (8.7 % [any], 6.2 % [local], 3.5 % [systemic]). After controlling for demographic variables, HZ/su presented a 6-fold increase in the odds (OR 6.44; 95 %CI: 5.57–7.46) of a reported AEFI compared to ZVL. Only 59 (0.6 %) of vaccinations lead to medical attention being sought due to an AEFI. ConclusionsWhile rates of AEFIs was higher with HZ/su than ZVL, most AEFIs were mild and did not require medical attention. Our findings support the change in vaccine recommendations and the use of HZ/su in immunisation programs.

Live vaccinations in dermatology for immunosuppressed patients: a narrative review.

Given the higher susceptibility to infectious disease in patients receiving immunosuppressive therapies for inflammatory dermatologic conditions, immunization is important in this population. While live vaccines protect against life-threatening diseases, they can be harmful in immunosuppressed patients given the risk of replication of the attenuated pathogen and adverse reactions. The utilization of live vaccines in immunosuppressed patients depends on multiple factors such as the vaccine and therapy regimen. To provide an overview of evidence-based recommendations for the use of live vaccines in patients receiving immunosuppressive therapies for dermatological conditions. A literature search of the PubMed database was performed using keywords live vaccine, live-attenuated vaccine, dermatology, immunosuppressed, and immunocompromised, and specific immunosuppressive therapies: corticosteroids, glucocorticoids, methotrexate, azathioprine, cyclosporine, mycophenolate mofetil, biologics. Relevant articles written in English were included. Using these keywords, 125 articles were reviewed, of which 28 were ultimately selected. Recommendations for live vaccines can be determined on a case-by-case basis. Measles, mumps, rubella, varicella (MMRV) vaccines may be safely administered to patients on low-dose immunosuppressive agents while the yellow fever vaccine is typically contraindicated. It may be safe to administer live MMRV boosters to children on immunosuppressive therapies and the live herpes zoster vaccine to patients on biologics. Given poor adherence to immunization guidelines in immunosuppressed patients, dermatologists have a critical role in educating patients and general practitioners regarding live vaccines. By reviewing a patient's vaccination history and following immunization guidelines prior to initiating immunosuppressive therapies, physicians can mitigate morbidity and mortality from vaccine-preventable diseases.

Recommendations for Adult Immunization by the Korean Society of Infectious Diseases, 2023: Minor Revisions to the 3rd Edition.

The Korean Society of Infectious Diseases has been regularly developing guidelines for adult immunization since 2007. In 2023, the guidelines for the following seven vaccines were revised: influenza, herpes zoster, pneumococcal, tetanus-diphtheria-pertussis (Tdap), human papillomavirus (HPV), meningococcal, and rabies vaccines. For the influenza vaccine, a recommendation for enhanced vaccines for the elderly was added. For the herpes zoster vaccine, a recommendation for the recombinant zoster vaccine was added. For the pneumococcal vaccine, the current status of the 15-valent pneumococcal conjugate vaccine and 20-valent PCV was described. For the Tdap vaccine, the possibility of using Tdap instead of tetanus-diphtheria vaccine was described. For the HPV vaccine, the expansion of the eligible age for vaccination was described. For the meningococcal vaccine, a recommendation for the meningococcal B vaccine was added. For the rabies vaccine, the number of pre-exposure prophylaxis doses was changed. This manuscript documents the summary and rationale of the revisions for the seven vaccines. For the vaccines not mentioned in this manuscript, the recommendations in the 3rd edition of the Vaccinations for Adults textbook shall remain in effect.

The vaccination of the aged in post COVID-19 era

As human grow older, immune-senescence, inflammaging, decline in physical and cognitive functions, frailty, various comorbidities and related polypharmacy make us vulnerable to infectious diseases, which in turn accelerates aging vice versa. Immunization for the aged against vaccine-preventable diseases is being emphasized more and more. However, in reality, the effective immune response is hindered for the similar reasons, so strategies to overcome this are being taken. The goal of elderly vaccination is to reduce the severity, mortality, and burden of disease. This review introduces 2023 adult immunization guidelines of the Korean Society of Infectious Diseases including influenza, pneumococcus, varicella zoster and coronavirus disease 2019 (COVID-19), and recently licensed respiratory syncytial virus vaccination. Clinicians are required to play a role in helping client’s decisions by providing and discussing scientific information about the benefits and risks of vaccination based on an understanding of the their medico-social condition in this post-COVID-19 era.

699 Audit of Post-Splenectomy Patients in Primary Care

Abstract Aim To describe the demographics of a large general practices post-splenectomy patient population (including sex, age, and indication for splenectomy), and audit of cohort's care against national immunisation and antibiotic prophylaxis guidelines. Method All adult patients registered with the practice who had undergone surgical splenectomy were included. Included patients’ medical records were reviewed and data including sex; age; date and indication of splenectomy; immunisation history; and drug history were collected. Results Fifteen of approximately 13,000 registered patients were coded for having previously undergone surgical splenectomy. The main indications included trauma; haematological disease; major intra-abdominal resection. Patient cohort were of an older patient population (mean age 69) having undergone splenectomy several years previously (mean 39 years ago). Three patients had outstanding pneumococcal vaccine in the past five years, however there was 100% compliance with annual influenza vaccine. All patients had received a minimum of two COVID vaccinations. Variation in prescribed phenoxymethylpenicillin dose, with two patients on incorrect antibiotic prophylaxis, and four patients without antibiotic prophylaxis. Conclusions Despite our small patient cohort, this audit highlighted variation and deficiencies in patient care, and has led to a recall of patients with outstanding pneumococcal vaccination and review of antibiotic prophylaxis offered to patients. Additionally, there is no national recommendation that post-splenectomy patients should be offered an annual COVID booster. We recommend that this is reviewed urgently by public health officials due to an increased risk of secondary pneumococcal infection with COVID infection, which may be life-threatening.

A prospective cohort study protocol: monitoring and surveillance of adverse events following heterologous booster doses of Oxford AstraZeneca COVID-19 vaccine in previous recipients of two doses of Sinopharm or Sputnik V vaccines in Iran

BackgroundRegarding the paucity of evidence on the side effects of the booster dose of Oxford AstraZeneca vaccine in vaccinated people with Sinopharm or Sputnik V, we aimed to set up a cohort event monitoring (CEM) study to capture adverse events occurring in individuals who will receive the booster doses of AstraZeneca (either the first or second booster dose) following being vaccinated with Sinopharm or sputnik V vaccines in Iran.MethodsThe present study is an active COVID-19 vaccine safety surveillance through an observational prospective cohort study that will be conducted in vaccination centers in Iran. The study will be conducted in twelve provinces of Iran. Study sites are vaccination centers where the AstraZeneca vaccine is administered to the cohort population. The study population includes all individuals who have received two doses of Sinopharm or Sputnik V vaccines and either the first or second booster dose of AstraZeneca according to the national guidelines for immunization in Iran in 2023. We are planning to include 30,000 eligible people in this study. Each individual will be followed up for 13 weeks after either the first or second booster dose of the AstraZeneca vaccine. Furthermore, convenience sampling is used to include participants in the present study. Participation in the study will be strictly voluntary.DiscussionWith the planned study we will provide a valid epidemiological evidence to improve the understanding of the safety of the booster dose of the AstraZeneca and to better evaluate the effectiveness of public health interventions. This could help policy makers in managing the COVID-19 pandemic according to scientific evidence.

Cross sectional survey of Varicella-Zoster virus and measles seropositivity in people living with HIV in a Parisian suburb and a review of current immunization guidelines.

According to evidence-based guidelines, vaccines against measles and varicella are generally recommended to susceptible HIV-positive patients, as long as they are not severely immunocompromised. However, routine screening to determine serologic status is not recommended. We conducted a seroprevalence study of anti-measles and anti-Varicella-Zoster virus (VZV) antibodies in adults living with HIV (PLWHA) consulting at Avicenne University Hospital in a Parisian suburb. Sera were collected in years 2018-2020 and tested by commercial immunoassays in 268 patients. Most of the patients were born in Sub-Saharan Africa (55%) and only 23% in Europe. Measles and varicella seropositivity were present respectively in 91.4% and 96.2% of patients. One patient in ten was seronegative to at least one of tested diseases. In the univariate analysis, only younger age (p=0.027) was associated with a higher risk of measles seronegativity, while shorter time since arrival in France (p<0.001) and shorter time since HIV discovery (p=0.007) were associated with a higher risk of VZV seronegativity. In multivariate analysis no association was found. This study highlights the absence of specific risk factors for VZV and measles seronegativity in PLWHA and supports the importance of routine screening, in order to increase immunization rates and reduce risk of complications.

Revaccination of children with acute lymphoblastic leukemia following completion of chemotherapy

Intensive chemotherapy for acute lymphoblastic leukemia (ALL) may affect the immune system and potentially the immune memory causing antibodies provided by vaccination to disappear. There are disagreements regarding the guidelines for posttreatment immunization strategy. Ninety-six children (aged 1-18 years at diagnosis) who completed chemotherapy for ALL were recruited. Antibody levels in the patient's serum against measles, varicella, polio, pertussis, hepatitis A, and hepatitis B were tested after completion of chemotherapy in patients who were fully vaccinated against these agents. Children who did not have positive serology to specific agents were revaccinated with a single dose accordingly. Antibody concentrations were measured again at least 4weeks after revaccination. Positive antibody levels varied between the different agents. The highest percentage of positive serology was against polio (87%) and the lowest against pertussis (4%) (p<.001). There were significant differences between patients with high risk (HR) and non-HR ALL regarding serology status for some vaccines. After revaccination, the levels of response to each booster dose were significantly different: 100% after booster dose for varicella and polio, and only 34% after pertussis booster. Loss of humoral protection for vaccine preventable diseases is a common finding among patients with ALL. Revaccination with one dose of vaccine after completion of chemotherapy achieved seroconversion in 34-100% of the patients depending on the type of vaccine. We recommend this revaccination schedule to all children who completed ALL therapy and were previously fully vaccinated.

Patient Perspective: Vaccines for Older People.

Pharmacists, as one of the most accessible health care professionals in the community, can educate, promote, and administer vaccinations. Immunizations are an important way to protect communities from potentially severe diseases, including COVID-19, influenza, pneumonia, shingles, hepatitis, and monkeypox. Though adults 65 years of age and older tend to have higher vaccination rates than other age groups, there are health care disparities that exist in relation to socioeconomic status, race, ethnicity, gender, and sexuality. Vaccine hesitancy and misconceptions cause concerns in older people that can challenge both vaccine administration and rates. Other concerns for older people are the cost, safety, and side effects of vaccines. In addition, updated vaccine guidelines were released by the Centers for Disease Control and Prevention (CDC) in early 2023 that affect recommendations for influenza, COVID-19, and pneumonia vaccines. Older people are at higher risk for severe illness, making immunizations especially important in this patient population. Pharmacists can play a pivotal role in health promotion by staying up to date on immunization guidelines and addressing barriers to vaccination.

When should a longer needle be used for intramuscular injection in obese patients? A combined analysis of New Zealand data.

To estimate thresholds for Body Mass Index (BMI) and arm circumference above which a longer needle is needed to ensure intramuscular (IM) delivery of a vaccine in the deltoid muscle at the site recommended by New Zealand (NZ) immunization guidelines. A combined analysis of two studies, including 442 adults, with measurements of arm circumference, BMI and skin to deltoid muscle distance (SDMD) at the NZ immunization guideline-recommended IM injection site. Receiver Operator Characteristic curves identified arm circumference and BMI cut-points that gave 100% sensitivity for SDMD thresholds. These thresholds were: SDMD of 20mm, accounting for a minimal penetration of 5mm into muscle with the standard needle; and 25mm, which is the length of a standard needle for IM injection, representing the depth this can reach. Cut-point values for arm circumference, at which a longer needle would be required, were higher for males than females: 35cm versus 30cm for the 20mm cut-point, and 40cm versus 36.7cm for the 25mm cut-point respectively. The BMI cut-points were also higher for male than females: 24.6kg/m2 versus 23.7kg/m2 for the 20mm cut-point, and 38.2kg/m2 vs 31.6kg/m2 for the 25mm cut-point respectively. Arm circumference and BMI cut-points provide practical measures from which to choose a needle length that increases the chance of successful IM vaccination. Based on our data, an arm circumference of 35cm for men and 30cm for women should prompt selection of a longer needle to ensure intramuscular injection at the deltoid site. Thresholds for the different skin to deltoid sites proposed internationally should be determined to enable successful IM vaccination in clinical practice beyond NZ.

Recommended Adult Immunization Schedule, United States, 2023.

Recommended Adult Immunization Schedule, United States, 2023.

342 A case series of live attenuated vaccine administration in dupilumab-treated children with atopic dermatitis

Abstract In patients with atopic dermatitis (AD), it is unknown whether suppression of dysregulated type 2 immune cytokines, interleukin-4 and interleukin-13, with dupilumab impacts the risk of viral infections following live attenuated vaccination. Current medical consensus and regulatory labelling recommend completing age-appropriate non-live vaccinations according to immunization guidelines at least 4 weeks prior to starting dupilumab and to avoid the use of live vaccines in patients treated with dupilumab. Phase 3 dupilumab AD clinical trial protocols prohibited the administration of live attenuated vaccines within 4 weeks before the baseline visit and during treatment. For patients in the LIBERTY AD PED open-label extension (OLE; NCT02612454) who required a live attenuated vaccine, the protocol specified that the study drug be discontinued for 12 weeks prior to planned administration and could be re-initiated 4 weeks after vaccine administration. However, one patient in the 16-week LIBERTY AD PRESCHOOL (NCT03346434, part B) study received a live attenuated vaccine with a ≤ 12 weeks gap between dupilumab administration and vaccination and eight patients in the LIBERTY AD PED-OLE received a live attenuated vaccine, four patients were vaccinated with a ≤ 12 weeks gap and four patients &amp;gt; 12 weeks after discontinuing dupilumab. To describe the clinical course of children with moderate-to-severe AD administered a live attenuated vaccine during the LIBERTY AD PRESCHOOL or LIBERTY AD PED-OLE study. Paediatric patients with moderate-to-severe AD who had previously participated in the phase 2 open-label, multicentre, sequential study LIBERTY AD PRESCHOOL (part A; 3 or 6 mg/kg dupilumab single dose) or the randomized, double-blind placebo-controlled phase 3 study LIBERTY AD PRESCHOOL (part B; 200 mg dupilumab every 4 weeks [q4w] if baseline weight 5 to &amp;lt;15 kg, or 300 mg q4w if 15 to &amp;lt;30 kg) were subsequently enrolled into the LIBERTY AD PED-OLE study (200 mg dupilumab q4w if baseline weight 5 to &amp;lt;15 kg, 300 mg q4w if 15 to &amp;lt;30 kg, or 200 mg q2w if 30 to &amp;lt;60 kg). This case series includes nine patients with severe AD at the parent study baseline (Investigator’s Global Assessment score = 4) and Peak Pruritus Numerical Rating Scale (range: 0–10) scores of 5.2 (n = 1), 8 (n = 2), 9 (n = 4) or 10 (n = 2), who were administered a live attenuated vaccine, with or without pause, during dupilumab treatment in the LIBERTY AD PRESCHOOL (part B; n = 1) or LIBERTY AD PED-OLE study (n = 8). Of the nine patients in this case series, eight were male. All were first diagnosed with AD between 0 and 6 months of age and age at enrolment varied from 8 to 56 months old. Dupilumab treatment duration up to the date of vaccination with live attenuated measles, mumps, rubella (MMR) and varicella vaccines (n = 5) or MMR vaccine only (n = 4) ranged from 85 to 840 days. No adverse events (AEs), including serious AEs, treatment-emergent infections and infestations, or serious infections were observed in the 4-week window post-vaccination. In this limited prospective case series of children with moderate-to-severe AD who also received the live attenuated MMR vaccine, with or without live attenuated varicella vaccine, no serious adverse events were observed within 4 weeks or after 4 weeks post-vaccination. Additional research is needed to assess the safety of live attenuated vaccines in patients on dupilumab treatment and to investigate whether dupilumab treatment impacts vaccine efficacy.

Maternal and new-born health policy indicators for low-resourced countries: The example of Liberia

Aim: Over the past two decades, two catastrophic events caused a steep decline in health services in Liberia: the long-lasting civil war (1989-2003) and the weak response of the health system to the Ebola Viral Disease (EVD) outbreak (2013-2015). In early 2015 The Liberian Government reacted and developed a strategic health policy framework. This paper reviews that framework with a focus on maternal and newborn health. Methods: The study is designed as a narrative review executed during the second half of 2017 in Monrovia. It takes advantage of triangulation, derived from recent international and national documents, relevant literature, and available information from primary and secondary sources and databases. Results: In 2015 the severely compromised health system infrastructure included lack of functional refrigerators, low availability of vaccines and child immunization guidelines, high stock-out rates, and an absence of the cold chain minimum requirements in 46% of health facilities. The public health workforce on payroll during 2014/15 included only 117 physicians. Skilled birth attendance as an indicator of maternal health services performance was 61%. Presently, approximately 4.5 women die each day in Liberia due to complications of pregnancy, delivery, and during the post-partum period, equalling about 1,100 women per 100,000 live births. Of particular note is the adolescent birth rate of 147 per 1000 women aged 15-19 years, three times higher than the world average of 44. Additionally, with a neonatal mortality rate of 19.2 neonatal deaths per 1,000 live births, Liberia stands higher than the world average as well. The high mortality rates are caused by multiple factors, including a delay in recognition of complications and the need for medical care, the time it takes to reach a health facility due to a lack of suitable roads and transportation, and a delay in receiving competent care in the health facilities. Conclusions: The fact that performance is above average for some indicators and far below for other points to unexplained discrepancies and a mismatch of international and national definitions or validity of data. Therefore, it is recommended to concentrate on the core of tracer indicators adopted at the global level for Universal Health Coverage and the Sustainable Development Goals to enable a permanent update of relevant information for policymaking and adjustment. At present all health policy documents miss a thorough application of the SMART objectives (Specific, Measurable, Attainable, Relevant and Timely), notably missing in most documents are realistic and detailed budgeting and obligatory timelines for set targets.

System and facility readiness assessment for conducting active surveillance of adverse events following immunization in Addis Ababa, Ethiopia.

To help distinguish vaccine-related adverse events following immunization (AEFI) from coincidental occurrences, active vaccine pharmacovigilance (VP) prospective surveillance programs are needed. From February to May 2021, we assessed the system and facility readiness for implementing active AEFI VP surveillance in Addis Ababa, Ethiopia. Selected hospitals were assessed using a readiness assessment tool with scoring measures. The site assessment was conducted via in-person interviews within the specific departments in each hospital. We evaluated the system readiness with a desk review of AEFI guidelines, Expanded Program for Immunization Guidelines and Ethiopian Food and Drug Administration and Ethiopian Public Health Institute websites. Of the hospitals in Addis Ababa, 23.1% met the criteria for our site assessment. During the system readiness assessment, we found that essential components were in place. However, rules, regulations and proclamations pertaining to AEFI surveillance were absent. Based on the tool, the three hospitals (A, B and C) scored 60.6% (94/155), 48.3% (75/155) and 40% (62/155), respectively. Only one of three hospitals assessed in our evaluation scored >50% for readiness to implement active AEFI surveillance. We also identified the following areas for improvement to ensure successful implementation: training, making guidelines and reporting forms available and ensuring a system that accommodates paper-based and electronic-based recording systems.