Public Health Impact Research Articles

Modeling the potential public health and economic impact of different COVID-19 vaccination strategies with an adapted vaccine in the Kingdom of Saudi Arabia

ABSTRACT Background The dynamic evolution of the virus causing COVID-19 necessitates the development of adapted vaccines to protect against emerging variants. Research design and methods A combined Markov-decision tree model estimated the outcomes of alternative vaccination strategies. The Saudi Arabian population was stratified into standard-risk and high-risk subpopulations, defined as either the population comprising individuals aged ≥65 years and individuals with at least one comorbidity. The model estimated the health and economic outcomes of vaccination based on age-specific inputs taken from published sources and national surveillance data. Results The vaccination strategy targeting the elderly and high-risk subpopulation (was estimated to prevent 156,694 cases 12,800 hospitalizations, and 2,919 deaths and result in cost savings of SAR 1,239 million in direct costs and SAR 4,145 million in indirect costs. These gains increased with the vaccination strategies additionally targeting other subpopulations. Compared to the base case (aged ≥65 and those at high-risk), expanding vaccination coverage to 75% of the standard-risk population prevented more cases (323%), hospitalizations (154%), and deaths (60%) and increased the direct (232%) and indirect (270%) cost savings. Conclusions The adoption of broad vaccination strategies using a vaccine adapted to the dominant variant in circulation would yield substantial benefits in Saudi Arabia.

Commentary: The Need for Theories of Change in Training and Technical Assistance: Where the Rubber Meets the Road.

In this commentary, I revisit some of the core issues raised in both the first and second special issues on "Strengthening the Science and Practice of Implementation Support: Evaluating the Effectiveness of Training and Technical Assistance Centers." I first outline the concerns that I think are of paramount importance and then very briefly dissect each one from the perspective of a prevention scientist. I add commentary where I think the field can benefit and strengthen to advance the "science" of implementation support. At the same time, I also raise several points that I think will contribute to a better understanding of "how" TTA works, for "whom" and under what conditions. This portion of the commentary attends to the different training and learning modalities used for TTA, the argument that capacity building should be the objective, decluttering the constructs of motivation and readiness, and whether we can ever validly assess a public health impact from TTA. I offer suggestions to address each concern and hope that the field can benefit from this discussion as we usher in a new era.

Harnessing predictive analytics to enhance medication adherence: A strategic model for public health impact

This review paper explores the critical role of predictive analytics in enhancing medication adherence, a significant challenge impacting global public health and healthcare systems. Medication non-adherence is linked to increased healthcare costs, poor health outcomes, and reduced quality of life for patients. By leveraging predictive analytics, healthcare providers can identify patients at risk of non-compliance, enabling targeted interventions that address individual barriers to adherence. The paper outlines a strategic framework for integrating predictive analytics into healthcare systems, emphasizing the importance of data sources, algorithm selection, and patient engagement. Furthermore, it discusses the broader implications of improved medication adherence for public health, including potential reductions in healthcare costs and enhancements in system efficiency. The conclusion offers strategic recommendations for policymakers and healthcare providers, highlighting the need for further research and technological advancements in predictive analytics to fully realize its potential in improving medication adherence. This review underscores the importance of data-driven decision-making in healthcare and its role in fostering a culture of adherence that benefits patients and communities alike.

Modelled Public Health Impact of Introducing Adjuvanted Recombinant Zoster Vaccine into the UK National Immunisation Programme.

In 2023, recombinant zoster vaccine (RZV) replaced zoster vaccine live (ZVL) vaccine in the UK National Immunisation Programme (NIP) for prevention of herpes zoster (HZ). The vaccination age was reduced from 70 to 65 years, with a subsequent planned reduction to 60 years. This modelling study aimed to evaluate the public health impact (PHI) of RZV vaccination in the 70 years of age (YOA) population and in younger individuals 65 and 60 YOA. PHI was evaluated from a National Health Service perspective, as cases of HZ, post-herpetic neuralgia (PHN), non-PHN complications and deaths, hospitalisations, and general practitioner (GP) visits avoided using a multicohort Markov model. Three scenarios (RZV vs. no vaccination, ZVL vs. no vaccination, and RZV vs. ZVL) were explored for each age group using population estimates from the UK Office for National Statistics, i.e. 70 YOA (n=649,822), 65 YOA (n=760,578) and 60 YOA (n=849,501). Modelled outcomes in 70 YOA individuals estimated that RZV vaccination would avoid 32,894 cases of HZ and 5915 cases of PHN compared with no vaccination and 26,954 HZ and 3218 PHN cases compared with ZVL. Compared with no vaccination, 2264 fewer hospitalisations and 158,549 fewer GP visits were predicted with RZV vaccination. Hospitalisations were predicted to be reduced by 1996 and GP visits by 130,821 for RZV versus ZVL vaccination. In individuals 65 YOA, it was estimated that RZV vaccination would avoid 50,128 HZ cases, 8623 PHN cases, 222,646 GP visits, and 2671 hospitalisations versus no vaccination. In the 60 YOA group, RZV vaccination was predicted to avoid 57,182 HZ cases, 9327 PHN cases, 234,330 GP visits, and 2547 hospitalisations versus no vaccination. The recent introduction of RZV into the NIP could substantially reduce HZ disease burden and healthcare resource use in the UK.A graphical abstract is available with this article.

Public Health Impact of Introducing a Pentavalent Vaccine Against Invasive Meningococcal Disease in the United States.

Invasive meningococcal disease (IMD) is primarily associated with five Neisseria meningitidis serogroups: A, B, C, W, or Y. In the United States (US), available vaccines protect against serogroups B (MenB), A, C, W, and Y (MenACWY), and A, B, C, W, and Y (MenABCWY). The Advisory Committee on Immunization Practices is re-evaluating the adolescent meningococcal vaccination schedule with varying recommendation formats. This analysis aimed to predict which schedule could avert the most IMD cases and have the most positive public health impact (PHI). An epidemiological model compared the 15-year PHI of vaccination schedules using MenB, MenACWY, and/or MenABCWY vaccines versus current US standard of care (SoC). Varying coverage rates reflected routine, shared clinical decision making, and risk-based recommendations. Sensitivity analyses assessed robustness of the results to different inputs/assumptions. The most positive PHI compared with SoC was observed with one dose of MenACWY at 11 years of age and two doses of MenABCWY (6 months apart) at 16 years of age, assuming routine recommendation and coverage reflecting real-world uptake of MenACWY. This strategy resulted in 123 IMD cases averted (MenB: 59, MenACWY: 64), 17 deaths prevented, 574 life-years saved, and 757 quality-adjusted life-years gained versus SoC. Eliminating MenACWY vaccination at 11 years was found to result in an additional IMD burden. A routinely recommended two-dose pentavalent vaccine, with doses administered 6 months apart at 16 years of age, alongside the routinely recommended MenACWY vaccine at 11 years of age, would improve the PHI and benefits of IMD vaccination to society.

Respiratory Syncytial Virus: A WAidid Consensus Document on New Preventive Options

Background/Objectives: Respiratory syncytial virus (RSV) is a leading cause of respiratory infections, particularly affecting young infants, older adults, and individuals with comorbidities. Methods: This document, developed as a consensus by an international group of experts affiliated with the World Association of Infectious Diseases and Immunological Disorders (WAidid), focuses on recent advancements in RSV prevention, highlighting the introduction of monoclonal antibodies (mAbs) and vaccines. Results: Historically, RSV treatment options were limited to supportive care and the monoclonal antibody palivizumab, which required multiple doses. Recent innovations have led to the development of long-acting mAbs, such as nirsevimab, which provide season-long protection with a single dose. Nirsevimab has shown high efficacy in preventing severe RSV-related lower respiratory tract infections (LRTIs) in infants, reducing hospitalizations and ICU admissions. Additionally, new vaccines, such as RSVpreF and RSVpreF3, target older adults and have demonstrated significant efficacy in preventing LRTIs in clinical trials. Maternal vaccination strategies also show promise in providing passive immunity to newborns, protecting them during the most vulnerable early months of life. This document further discusses the global burden of RSV, its economic impact, and the challenges of implementing these preventative strategies in different healthcare settings. Conclusions: The evidence supports the integration of both passive (mAbs) and active (vaccines) immunization approaches as effective tools to mitigate the public health impact of RSV. The combined use of these interventions could substantially reduce RSV-related morbidity and mortality across various age groups and populations, emphasizing the importance of widespread immunization efforts.

Influence of Uric Acid on Vascular and Cognitive Functions: Evidence for an Ambivalent Relationship

The growing recognition of the public health impact of cognitive impairment and dementia has sparked a global initiative to identify risk factors and develop strategies to prevent or slow the progression of these cognitive disorders. Uric acid, the end product of the metabolism of purine nucleotides, has been reported as a key factor of many conditions potentially involved in cognitive dysfunction/dementia. In addition, some studies support the hypothesis that elevated uric acid levels could reduce the risk of Alzheimer’s disease, slow down the decline of cognition, and delay the progression of Alzheimer’s disease, while other evidence achieves opposite positions. These discrepancies might reflect a biological ambivalence for uric acid depending on a very complex interplay of factors that include its concentrations achieved in biological fluids, the nature, and concentration of free radicals, the presence and concentration of other antioxidant molecules, potentially responsible for bi-directional effects of uric acid on brain health/functioning. In this narrative review, we attempt to elucidate the influential role of uric acid metabolism in cognitive functioning by discussing pathophysiological mechanisms putatively involved, being well aware that none of them can be considered one-sided due to the complexity of the human organism.

PUBLIC HEALTH IMPACTS OF PRECISION MEDICINE: BALANCING INNOVATION WITH ACCESSIBILITY

PUBLIC HEALTH IMPACTS OF PRECISION MEDICINE: BALANCING INNOVATION WITH ACCESSIBILITY

Copper and zinc status in cord blood and breast milk and child's neurodevelopment at 18 months: Results of the Italian PHIME cohort

BackgroundTrace elements, including zinc (Zn) and copper (Cu), although toxic at higher concentrations are known to play important roles in the maintenance of human health and neurodevelopment. Few epidemiological studies have investigated the association between prenatal or early postnatal Cu and Zn levels and child neurodevelopment. The aim of this research is to assess the association between child neurodevelopment at 18 months of age and cord blood and breast milk concentrations of Cu and Zn in Italian mother-child pairs enrolled in the Italian Northern Adriatic Cohort II (NAC-II), a part of the “Public health impact of long-term, low-level, mixed element exposure in susceptible population strata” project PHIME. MethodsThe study population consisted of 632 children, and their mothers, born within the NAC-II, who were tested with the Bayley Scales of Infant and Toddler Development third edition (BSID-III) at age 18 months. Cu and Zn concentrations were measured in cord blood and breast milk samples. Only children born at term (≥37 gestational week), who completed the BSID-III test and had at least 1 measure of Cu and Zn concentrations were included in the analysis. Information about socio-demographics and lifestyles were collected through questionnaires at different phases of follow-up. Cu and Zn concentrations were log2 transformed because of their skewed distribution. Multiple linear regression models were performed to study the association between each BSID-III composite score (cognitive, motor and language) and each metal concentration. Separate models were applied for each biological sample. The β coefficient (β) and its 95% confidence interval (95% CI) were estimated. Stratified analyses by child's sex were also conducted. ResultsThe mean ± standard deviation (SD) of cognitive, motor and language composite scores were respectively: 106 ± 8, 101 ± 5 and 97 ± 8. The mean ± SD of Cu and Zn concentrations (ng/g) were respectively 699.2 ± 129.0 and 2538 ± 589 in cord blood and 607 ± 498 and 3226 ± 1428 in breast milk. No association between metal concentration and cognitive composite score was found. A higher motor composite score was associated with higher Cu concentrations in cord blood (β = 4.31 95% CI 2.03; 6.59). No associations were found between language composite score and metal concentrations. The effect of Cu cord blood concentration on motor composite score was confirmed when stratified by sex: males (β = 5.49 95% CI 2.15; 8.36) and females (β = 3.11; 95% CI 0.00; 6.22). A direct association, in females only, was found between language composite score and Cu concentration in cord blood (β = 5.60 95% CI 0.63; 10.57) and in breast milk (β = 3.04 95% CI 1.06; 5.03), respectively. ConclusionThe results from this cohort study showed a strong direct association between prenatal Cu levels and child motor neurodevelopment at 18 months. However, for generalizability, future research on the effects of Zn and Cu on neurodevelopment should include a larger range of early-life concentration of trace elements.

Comprehensive evaluation of Toxoplasma gondii in sheep intended for human consumption in Brazil: seroprevalence, isolation, and genotyping.

Ovine toxoplasmosis caused by Toxoplasma gondii is a zoonotic disease responsible for triggering reproductive problems in sheep with great public health impact. The zoonotic risk for humans occurs through the ingestion of meat contaminated with bradyzoites, water and vegetables contaminated with oocysts, or by ingesting unprocessed sheep milk contaminated with tachyzoites. The study aimed to determine the seroprevalence, isolate, and genetically characterize T. gondii from sheep in northeastern Brazil. Blood and tissue samples, including the liver, heart, brain, lung, and diaphragm, were collected from 256 sheep in slaughterhouses. The presence of anti-T. gondii IgG antibodies was assessed by the indirect fluorescent antibody test (IFAT), and sera with titers ≥ 1: 64 were considered positive. Tissue samples from seropositive sheep were digested in acidic pepsin solution and inoculated into two Swiss mice for T. gondii isolation and further characterized by molecular methods. The prevalence of anti-T. gondii antibodies in sheep was 31.64% and the isolation rate was 40.7%. Sixteen out of 33 isolates were submitted to mnRFLP-PCR using ten genetic markers. Four isolates were fully genotyped, and four isolates were amplified at least in one marker. All isolates were characterized as atypical genotypes, and ToxoDB #57 (n = 3) and #143 (n = 1) were identified. The detection of viable T. gondii in sheep from slaughterhouses in Brazil highlights the risk of human exposure. There is the need for proactive control and prevention measures to mitigate the risk of human exposure, considering the importance of sheep meat as a source of protein to humans.

Public health and economic impact of COVID-19 vaccination with the Pfizer-BioNTech COVID-19 Vaccine, KP.2, among adults in 2024/2025 in the United States

ABSTRACT Objectives To assess the public health and economic impact of vaccination with the Pfizer-BioNTech COVID-19 vaccine, KP.2, in 2024/2025 in the United States. Methods A combined cohort Markov-decision tree model was used to estimate the cost-effectiveness and budget impact of vaccination versus no vaccination in adults aged ≥18 years. The adult population was further stratified into 18-64 years and ≥65 years age groups. Public health surveillance data informed the annual proportion of individuals infected with and vaccinated against SARS-CoV-2 and the proportion of those infected who were hospitalized, stratified by age. Other age-stratified clinical, cost, and vaccine effectiveness parameters were informed by literature. The budget impact analysis was based on a hypothetical 1-million-member plan and used a payer perspective. Parameter uncertainty was tested in sensitivity analyses. Results Without vaccination, the model projected 21.4 million new symptomatic cases, 15,793 deaths, 629,098 hospitalizations, $115.5 billion in total costs, and 1 million QALYs lost among adults aged ≥18 years, with the greatest health burden observed among older adults aged ≥65 years (72% of hospitalizations and 86% of deaths) and the greatest economic burden in adults aged 18 to 64 years (62% of total costs). Vaccination was projected to prevent 915,501 cases, 1,057 deaths, and 37,489 hospitalizations, resulting in cost savings of $513 million, 9,173 LYs gained, 56,482 QALYs gained, and a dominant ICER. In the budget impact analysis, vaccination was estimated to result in total incremental cost savings for the population aged ≥ 65 years and a modest budget increase for the population aged 18 to 64 years. Conclusions Vaccination with the Pfizer BioNTech COVID-19 vaccine, KP.2, is a cost-effective measure from the societal perspective at a willingness-to-pay threshold of $50,000 that could reduce the health and economic burden of COVID-19.

Why an Integrated Approach to Tick-Borne Pathogens (Bacterial, Viral, and Parasitic) Is Important in the Diagnosis of Clinical Cases.

Tick-borne diseases have emerged as a major global public health problem in recent decades. The increasing incidence and geographical dissemination of these diseases requires the implementation of robust surveillance systems to monitor their prevalence, distribution, and public health impact. It is therefore not unexpected that tick-borne pathogens coexist in the same vectors, but the interactions of these agents between vectors and vertebrate hosts, including humans, remain poorly understood. The impact of infection in humans extends to the diagnostic challenges that arise when the same symptomatology can be associated with any tick-borne pathogen, and therapeutic recommendations only focus on the major or best-known tick-borne diseases, ignoring other lesser-known or less prevalent infections. Both surveillance systems and the holistic diagnosis of tick-borne pathogens are necessary tools to address the emergence of vector-borne diseases. In this study, we will focus on the main tick-borne viral, bacterial, and parasitic diseases in Spain to reflect the need to establish syndromic diagnostics in samples from patients with a history of tick bites and symptomatology compatible with them. On the other hand, and highlighting this need, innovations in molecular techniques, syndromic surveillance, and surveillance programs for ticks and tick-borne pathogens with public health implications are expected to be developed.

Effectiveness of BNT162b2 XBB vaccine in the US Veterans Affairs Healthcare System

Data evaluating effectiveness of XBB.1.5-adapted vaccines against JN.1-related endpoints are scarce. This nationwide test-negative case-control study within the US Veterans Affairs Healthcare System aims to estimate vaccine effectiveness (VE) of BNT162b2 XBB.1.5-adapted vaccine compared to not receiving an XBB vaccine of any kind against COVID-19 hospitalization, emergency department or urgent care visits (ED/UC), and outpatient visits. Between September 25, 2023 and January 31, 2024, effectiveness was 24–35% during a period of JN.1 predominance and 50–61% during XBB predominance across all outcomes. VE within 60 days of vaccination during the likely JN.1 period was 32% (95% confidence interval 3–52%) against hospitalization, 41% (23–54%) against ED/UC visits, and 31% (1–52%) against outpatient visits. Corresponding VE during the likely XBB period was 62% (44–74%), 52% (37–63%), and 50% (25–66%) by setting, respectively. Here, we show the importance of strain match to maximize the public health impact of COVID-19 vaccination.

Challenges and opportunities for risk- and systems-based control of Listeria monocytogenes transmission through food.

Listeria monocytogenes contamination of ready-to-eat (RTE) food products and food-associated built environments (e.g., processing facilities) represents a food safety issue with major public health and business risk implications. A number of factors make L. monocytogenes control a particular challenge, including (i) its frequent presence in different environments, (ii) its propensity for establishing persistence in food-associated environments, (iii) its ability to grow under a variety of stressful conditions, and (iv) its ability to cause severe illness, particularly in immunocompromised individuals and pregnant people. Key sources of L. monocytogenes contamination of RTE foods are food-associated built environments. However, raw materials can also be an important source, particularly for products without a "kill step" (e.g., fresh produce, raw dairy products, cold-smoked seafood). While certain RTE foods (e.g., deli meats, soft cheeses, produce) have commonly been linked to listeriosis outbreaks, cases, and recalls, a number of factors will influence the specific public health risk a given RTE food represents, including the likelihood of contamination, ability to support L. monocytogenes growth, and consumer-related factors (including consumption by pregnant or immunocompromised individuals). Consequently, a risk-based approach presents the most appropriate strategy to minimize the public health and business impact of L. monocytogenes. Key challenges to control L. monocytogenes include (i) development and implementation of food safety systems that prevent L. monocytogenes persistence in food-associated built environments, (ii) minimizing L. monocytogenes contamination of raw material sources, (iii) implementation of effective root cause analysis procedures, (iv) minimizing L. monocytogenes growth in finished product, and (v) consumer education.

Real-World Assessment of Economic and Clinical Outcomes in Thai Patients With Respiratory Syncytial Virus Infection Across Age Groups: A Retrospective Cohort Analysis.

Respiratory syncytial virus (RSV) is an important cause of acute lower respiratory infections worldwide, including Thailand. This study aimed to assess clinical and economic burdens of RSV infections across different age groups in Thailand. A retrospective cohort study was conducted using data from a tertiary care hospital from 2014 to 2021. Patients who tested at least one positive RSV were included and stratified into five age groups (< 2, 2-5, 5-18, 18-65, and > 65 years). Healthcare resource utilization, direct medical costs, and clinical outcomes were analyzed with descriptive statistics. Generalized linear models with gamma distributions and log link were used to model cost outcomes. Costs were reported in 2021 US dollars (USD), with 1 USD = 31.98 Thai Baht. A total of 2122 RSV-positive patients were identified, half of which (1097) were hospitalized. The median (interquartile range [IQR]) total hospitalization costs ranged from USD780 (IQR: USD488-USD1185) in those < 2 years to USD2231 (IQR: USD1250-USD4989) in those aged 65+ years. Case fatality rates among hospitalized patients also varied from 2.5% to 28.4% depending on age. Increased age, presence of comorbidities, and need for critical care were associated with higher hospitalization costs. Among RSV-positive patients, younger children experienced the greatest burden, but poorer outcomes were observed in older adults. Higher costs were associated with older age, comorbidities and critical care needs. Understanding RSV economic burdens is crucial for assessing the cost-effectiveness and public health value of vaccination programs that prioritize at-risk groups to mitigate the public health impact.

Assessing Barriers and Facilitators to Participation in a Nurse-Driven, Opt-Out HIV Screening Program in the Emergency Department

Emergency department (ED) HIV screening is a key component of the strategy to end the HIV epidemic, reaching populations with limited access to care for screening and early diagnosis. Many screening programs rely primarily on participation from ED nurses; however, little is known about the factors affecting nurse participation in screening. Guided by the Consolidated Framework for Implementation Research, 20 semi-structured interviews were conducted with ED nurses to explore perceptions of HIV screening, barriers and facilitators to participation, and implementation insights. Nurses were categorized as either high adopters or low adopters based on the number of HIV tests ordered 3 months prior to interviews. The Stanford Lightning Report Method, a rapid qualitative analysis approach, was used to analyze field notes. All participants generally agreed that the ED was an appropriate location for screening and that frequent, multimodal education about screening was needed. Integration of screening into standard workflows, education about the public health impact of screening, and the use of peer champions and mentors were identified as important strategies to increase participation. By incorporating these findings into implementation strategies, EDs may be able to increase nurse participation in screening, addressing important health equity issues in HIV diagnosis.

Cell-Free Screening, Production and Animal Testing of a STI-Related Chlamydial Major Outer Membrane Protein Supported in Nanolipoproteins.

Vaccine development against Chlamydia, a prevalent sexually transmitted infection (STI), is imperative due to its global public health impact. However, significant challenges arise in the production of effective subunit vaccines based on recombinant protein antigens, particularly with membrane proteins like the Major Outer Membrane Protein (MOMP). Cell-free protein synthesis (CFPS) technology is an attractive approach to address these challenges as a method of high-throughput membrane protein and protein complex production coupled with nanolipoprotein particles (NLPs). NLPs provide a supporting scaffold while allowing easy adjuvant addition during formulation. Over the last decade, we have been working toward the production and characterization of MOMP-NLP complexes for vaccine testing. The work presented here highlights the expression and biophysical analyses, including transmission electron microscopy (TEM) and dynamic light scattering (DLS), which confirm the formation and functionality of MOMP-NLP complexes for use in animal studies. Moreover, immunization studies in preclinical models compare the past and present protective efficacy of MOMP-NLP formulations, particularly when co-adjuvanted with CpG and FSL1. Ex vivo assessments further highlight the immunomodulatory effects of MOMP-NLP vaccinations, emphasizing their potential to elicit robust immune responses. However, further research is warranted to optimize vaccine formulations further, validate efficacy against Chlamydia trachomatis, and better understand the underlying mechanisms of immune response.

Cost-effectiveness and public health impact of 24-valent pneumococcal conjugate vaccine compared to recommended pneumococcal vaccines in older adults

IntroductionThe potential impact of an in-development 24-valent pneumococcal conjugate vaccine (PCV24) compared to currently recommended vaccines in older adults is unclear. Similar to most currently available PCVs, PCV24’s formulation is based on childhood pneumococcal disease epidemiology. Decision analysis techniques were used to estimate PCV24 cost-effectiveness and public health effects in US older adults. MethodsA Markov model compared PCV24 to currently recommended US pneumococcal vaccination strategies in older adults (aged ≥65 years) and to no vaccination. Age-, race-, and chronic medical condition-specific pneumococcal illness risks and serotype-specific disease risks were obtained from CDC data. Vaccine effectiveness was estimated using Delphi panel and clinical trial data. Vaccination and pneumococcal illness costs were from US databases. Scenario analyses examined indirect effects of childhood pneumococcal vaccination on adult disease. Data were collected and analyses performed in 2024. ResultsPCV24 prevented fewer pneumococcal disease cases and deaths than the recently recommended 21-valent pneumococcal conjugate vaccine (PCV21), which is formulated based on adult pneumococcal disease serotypes. In cost-effectiveness analyses, PCV21 was economically favorable compared to PCV24 and all other vaccination strategies, both without and with consideration of potential childhood vaccination indirect effects. These findings were robust and consistent in deterministic and probabilistic sensitivity analyses. ConclusionIn older adults, PCV24 was clinically and economically unfavorable compared to PCV21, which covers more adult disease-causing pneumococcal serotypes and is less susceptible to childhood vaccination indirect effects.

How do local public health teams in North Wales consider their role in influencing the obesogenic environment through planning processes? A qualitative study

BackgroundOverweight and obesity affect 2·6 billion people worldwide, causing significant morbidity and 4 million deaths annually. In Wales, over 60% of people are affected. Betsi Cadwaladr University Health Board Public Health team recently began systematically to provide public health advice and evidence in response to planning applications to try to influence the obesogenic environment. This study aims to explore team members’ experiences of responding to fast-food outlet applications. MethodsQualitative, semi-structured online interviews were conducted with 12 practitioners, registrars and consultants in the team. The interviews addressed the planning process, application prioritisation, power over the obesogenic environment and stakeholder relationships. Interview transcripts were in vivo coded and subjected to thematic analysis. Ethical approval granted on June 6, 2023 by the Institute of Population Health Research Ethics Committee at the University of Liverpool (ref: 12503). FindingsParticipants’ interpretations of the nature, scope and determinism of the obesogenic environment varied considerably. Regardless, the concept was considered to have significant real-world applicability for problematising fast-food outlets. Complexity, the evidence base and defining unhealthy outlets were thought problematic. Participants considered their skills in evidence provision, impact assessment and networking essential. However, no relationship-building strategy was defined, and contradictory approaches were adopted, due to capacity, inadequate legal standing and fear of backlash. Most felt public health lacked power to effect lasting change through planning. Hopes were placed in a favourable future policy environment despite recognition that current supportive policy is routinely ignored. Intervention success was unclearly defined. InterpretationThis is the first study to consider public health professionals’ beliefs about using planning to modify the fast-food environment in Wales’ specific policy environment. It highlights the need for logic-based strategies which maximise effectiveness, rather than achieve adherence with established processes. Public health contributions tailored to other stakeholders’ priorities and language, especially in the absence of supportive policy and law, may be essential. Procedural, policy and research recommendations to strengthen public health impact on the obesogenic environment are made. FundingNone.

Metagenomic Nanopore Sequencing of Tickborne Pathogens, Mongolia.

We performed nanopore-based metagenomic screening on 885 ticks collected from 6 locations in Mongolia and divided the results into 68 samples: 23 individual samples and 45 pools of 2-12 tick samples each. We detected bacterial and parasitic pathogens Anaplasma ovis, Babesia microti, Coxiella burnetii, Borrelia miyamotoi, Francisella tularensis subsp. holarctica and novicida, Spiroplasma ixodetis, Theileria equi, and Rickettsia spp., including R. raoultii, R. slovaca, and R. canadensis. We identified the viral pathogens Crimean-Congo hemorrhagic fever virus (2.9%), recently described Alongshan virus (ALSV) (2.9%), and Beiji nairovirus (5.8%). We assembled ALSV genomes, and maximum-likelihood analyses revealed clustering with viruses reported in humans and ticks from China. For ALSV, we identified surface glycoprotein markers associated with isolates from Asia viruses hosted by Ixodes persulcatus ticks. We also detected 20 virus species of unknown public health impact, including a near-complete Yanggou tick virus genome. Our findings demonstrate that nanopore sequencing can aid in detecting endemic and emerging tickborne pathogens.