Implementation Of Vaccination Program Research Articles

The indirect costs of vaccine-preventable cancer mortality in the Middle East and North Africa (MENA).

Infections are responsible for ∼13% of cancer cases worldwide, with human papillomavirus (HPV) and hepatitis B (HBV) among the infections associated with cancer for which vaccines are available. The aim of this study was to estimate the indirect cost of premature mortality related to cancers caused by HPV and HBV in Middle East and North Africa (MENA) countries. The number of deaths and years of life lost (YLL) in 2019 from four HPV-related cancers: cervical cancer, oral cavity cancer, laryngeal cancer, and oropharynx cancer, as well as HBV-related liver cancer were sourced from the Institute for Health Metrics Evaluation (IHME) Global Burden of Disease database. HPV-attributable fractions were applied to deaths and YLL. The human capital approach was used to measure productivity loss, through value of YLL (VYLL), andestimated using gross domestic product per capita (World Bank; in USD). Seventeen countries in the MENA region were included. Four countries in the region were not included as due to data availability. In 2019, there were 11,645 potentially vaccine-preventable cancer-related deaths across the MENA region. This resulted in an indirect cost of $1,688,821,605, with 76.1% of this accrued in the Middle East ($1,284,923,633). The number of deaths in the Middle East (5,986) were similar to Northern Africa (5,659) but YLL were higher in Northern Africa (179,425) compared to the Middle East (169,207). The highest indirect cost per death occurred in Qatar ($1,378,991), compared to $14,962 in Sudan. Oral cavity cancer had the highest VYLL per death ($186,084). There is a high burden of premature mortality and indirect costs of potentially vaccine-preventable cancer-related deaths in the MENA region. Improved vaccination program implementation, increased vaccine coverage of HPV and HBV vaccinations, and continued prioritization of public health measures, such as screening, could effectively reduce premature mortality and associated costs.

Association between human papillomavirus and preterm delivery: A systematic review and meta-analysis.

The lifetime prevalence of human papillomavirus infection (HPV) is estimated to be around 80% and it is the most common sexually transmitted infection. Despite being well known for its oncologic relevance, it has been associated with adverse pregnancy outcomes, though available evidence is contradicting. Previous meta-analyses involved articles which based HPV infection on Pap smear results, leading to a significant source of bias. Therefore, we aimed to assess the burden of genetically proven HPV infection on adverse pregnancy outcomes. In our meta-analysis, pregnant women tested for HPV DNA were only considered eligible. We conducted a systematic search in three major databases (PubMed, Embase, and CENTRAL) on September 22, 2023. Cohort, cross-sectional, and case-control studies were eligible for the analysis. The exposed group consisted of HPV-infected patients. We assessed the odds ratios (OR) with a confidence interval (CI) of 95%. In order to reduce the heterogeneity, we performed subgroup analyses based on different strains (high risk HPV, HPV 16/18, study design). The study was prospectively registered on PROSPERO (CRD42022370228). Our study involved 14 articles with 7008 women. A significant association was found between preterm delivery and HPV infection (OR: 1.94, CI: 1.31-2.87). No significant association was found when separately examining high-risk HPV-infected women (OR: 1.94, CI: 0.82-4.59), and HPV 16 or 18-infected women (OR: 2.08, CI: 0.50-8.63) in terms of preterm delivery. No significant association was found between spontaneous abortion and HPV infection (OR: 1.02, CI: 0.16-6.31). Our analysis indicates an association between HPV infection and preterm delivery. It is imperative that future studies consider confounding variables more comprehensively. Additionally, the global implementation of HPV vaccination programs holds significance not only in oncology but also in obstetrics.

Prevalence of human papillomavirus genotypes in women of different ethnicity from rural northwestern Ecuador

BackgroundIn Ecuador, cervical cancer is the third most common cancer among women and the second most common cause of cancer-related death in women. Although HPV represents a serious public health problem worldwide, the information about its prevalence and genotypes in remote communities of Ecuador is limited. The aim of this study was to determine the distribution of HPV genotypes among ethnic minority women from two remote communities of the northwestern region of Ecuador: Afro-Ecuadorians and Chachis (Amerindian group).MethodsWe included 291 women who responded to a short survey and were screened for HPV by the amplification of the L1 gene and a nested multiplex PCR to detect 14 high risk (HR) genotypes. A survey collected information on ethnicity, age, community access, and sexual and gynecological history. We identified risk factors associated with HPV infection and co-infection using multivariate logistic regression to calculate odds ratio (OR) and Wald 95% confidence intervals (CI).ResultsOverall, HPV prevalence in the study cohort was 56%, and the five most common HR-HPV genotypes were HPV-58, -16, -68, -39, and -43; however, the distribution of HPV genotypes varied according to ethnicity. We identified lineage A (European variant) for HPV-16 and sublineage A2 for HPV-58 in both ethnic groups. Adjusting for ethnicity, age, community access, and number of sexual partners, we found that Afro-Ecuadorian women were less likely to have an HPV infection than Chachi women (OR: 0.49, 95% CI: 0.25, 0.96), and that participants in communities only accessible by river had 64% less chances of an HPV infection when compared to women in communities accessible by road (OR: 0.36, 95% CI: 0.19, 0.71), and women with 2 to 3 sexual partners had 2.47 times the odds of HPV infection than participants with 0–1 partners (OR: 2.47, 95% CI: 1.32, 4.6). Similar associations were observed with prevalence of co-infection.ConclusionsThis study provides baseline knowledge regarding the prevalence and distribution of HPV genotypes in ethnic groups of the northwestern coastal Ecuador and essential information for the implementation of appropriate HPV testing and vaccination program to prevent cervical cancer.

Prevalence of human papillomavirus genotypes in women of different ethnicity from rural northwestern Ecuador

BackgroundIn Ecuador, cervical cancer is the third most common cancer among women and the second most common cause of cancer-related death in women. Although HPV represents a serious public health problem worldwide, the information about its prevalence and genotypes in remote communities of Ecuador is limited. The aim of this study was to determine the distribution of HPV genotypes among ethnic minority women from two remote communities of the northwestern region of Ecuador: Afro-Ecuadorians and Chachis (Amerindian group).MethodsWe included 291 women who responded to a short survey and were screened for HPV by the amplification of the L1 gene and a nested multiplex PCR to detect 14 high risk (HR) genotypes. A survey collected information on ethnicity, age, community access, and sexual and gynecological history. We identified risk factors associated with HPV infection and co-infection using multivariate logistic regression to calculate odds ratio (OR) and Wald 95% confidence intervals (CI).ResultsOverall, HPV prevalence in the study cohort was 56%, and the five most common HR-HPV genotypes were HPV-58, -16, -68, -39, and -43; however, the distribution of HPV genotypes varied according to ethnicity. We identified lineage A (European variant) for HPV-16 and sublineage A2 for HPV-58 in both ethnic groups. Adjusting for ethnicity, age, community access, and number of sexual partners, we found that Afro-Ecuadorian women were less likely to have an HPV infection than Chachi women (OR: 0.49, 95% CI: 0.25, 0.96), and that participants in communities only accessible by river had 64% less chances of an HPV infection when compared to women in communities accessible by road (OR: 0.36, 95% CI: 0.19, 0.71), and women with 2 to 3 sexual partners had 2.47 times the odds of HPV infection than participants with 0–1 partners (OR: 2.47, 95% CI: 1.32, 4.6). Similar associations were observed with prevalence of co-infection.ConclusionsThis study provides baseline knowledge regarding the prevalence and distribution of HPV genotypes in ethnic groups of the northwestern coastal Ecuador and essential information for the implementation of appropriate HPV testing and vaccination program to prevent cervical cancer.

Combating Malaria with Vaccines: Insights from the One Health Framework

Malaria remains a leading cause of morbidity and mortality worldwide, with significant efforts directed towards developing effective vaccines to curb its impact. The One Health concept, recognizing the interconnectedness of human, animal, and environmental health, offers a comprehensive approach to understanding and combating this disease. This review examines the development of malaria vaccine through the lens of the One Health framework, highlighting the integration of human, vector, and environmental factors in the fight against malaria. We discuss the current landscape of malaria vaccine development, including the deployment of the RTS,S/AS01 vaccine and the progress of other candidates such as the R21/Matrix-M and PfSPZ vaccine. The challenges posed by the complex lifecycle of the malaria parasite, its genetic diversity, and the environmental factors influencing transmission are explored. This review also discusses emerging technologies and innovations that could enhance vaccine efficacy and delivery. Additionally, we consider ethical, social, and economic factors critical to the successful implementation of vaccination programs. In concluding, this review underscores the importance of adopting a One Health approach to malaria vaccine development, advocating for integrated efforts to address the multifaceted challenges of malaria control and eradication.

Combating Malaria with Vaccines: Insights from the One Health Framework

Malaria remains a leading cause of morbidity and mortality worldwide, with significant efforts directed towards developing effective vaccines to curb its impact. The One Health concept, recognizing the interconnectedness of human, animal, and environmental health, offers a comprehensive approach to understanding and combating this disease. This review examines the development of malaria vaccine through the lens of the One Health framework, highlighting the integration of human, vector, and environmental factors in the fight against malaria. We discuss the current landscape of malaria vaccine development, including the deployment of the RTS,S/AS01 vaccine and the progress of other candidates such as the R21/Matrix-M and PfSPZ vaccine. The challenges posed by the complex lifecycle of the malaria parasite, its genetic diversity, and the environmental factors influencing transmission are explored. This review also discusses emerging technologies and innovations that could enhance vaccine efficacy and delivery. Additionally, we consider ethical, social, and economic factors critical to the successful implementation of vaccination programs. In concluding, this review underscores the importance of adopting a One Health approach to malaria vaccine development, advocating for integrated efforts to address the multifaceted challenges of malaria control and eradication.

Health Care Personnel Workdays Lost and Direct Health Care Salary Costs Incurred due to COVID-19 Infection in the Age of Widespread Vaccine Availability.

Vaccination against coronavirus disease 2019 (COVID-19) can mitigate the burden of health care worker (HCW) infection. We investigate the burden of HCW illness and its associated direct health care personnel costs in the setting of widespread vaccine availability and explore factors influencing these outcomes. This multicenter prospective study followed HCWs over an 8-month period from January to August 2023. Data recorded included incident COVID-19 infection, symptom burden, workdays missed, and vaccine history. Workdays lost due to illness were used to calculate direct health care personnel costs due to COVID-19 infection. Univariate analysis and multivariable regression investigated the factors associated with workdays lost and direct health care personnel. In total, 1218 participants were enrolled and followed for 8 months, with 266 incidents of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, 1191 workdays lost, and health care personnel costs of €397 974. Multivariable regression revealed that workdays lost were associated with incomplete primary COVID-19 vaccination course. Being unvaccinated, older age, and male were associated with increased health care personnel costs. Health care workdays lost remain a significant issue and are associated with health care system burden despite vaccine availability. These can be mitigated via targeted implementation of vaccine programs. Seasonal variation in health care workdays lost should inform workforce planning to accommodate surge periods.

Perception and Belief of Healthcare Workers regarding the COVID-19 Vaccine: A Cross-Sectional Study and Geographic Information System Mapping

The COVID-19 new deaths’ highest numbers in Southeast Asia were reported from Indonesia, with 8,784 new deaths. Healthcare workers (HCWs) have several roles in the COVID-19 vaccine implementation. This study aimed to assess COVID-19 vaccine perception and belief among HCWs and identify demographic mapping by using the geographical information system. This study used a quantitative method with cross-sectional design, wherein 112 registered HCWs in the Indonesian hospital and healthcare centre were shared a survey questionnaire using Google Forms® and then visualised it through geographic mapping. The perception of HCWs regarding the COVID-19 vaccine was considered good but in contrast to the belief. There was a significant relationship between age [ p value = .021; odds ratio (OR): 2.692; 95% confidence interval (CI): 1.229–5.896] and also HCWs’ workplace ( p value = .040; OR: 0.231; 95% CI: 0.0620–0.862) towards the belief of HCWs regarding the COVID-19 vaccine. Developing strategies to decrease HCWs and public hesitation and increase trust is vital for implementing vaccination programmes.

Learning from digital health investments during COVID-19 vaccine program implementation: a research collaboration and theory of change

Learning from digital health investments during COVID-19 vaccine program implementation: a research collaboration and theory of change

Strategies to strengthen COVID-19 vaccine uptake and improve vaccine equity in U.S. Territories and Freely Associated States during the first six months of vaccine rollout

The eight U.S. territories and freely associated states (TFAS) have historically faced unique social and structural barriers in the implementation of vaccination programs due to geographic remoteness, a high prevalence of socioeconomic disparities, increasing prevalence of natural disasters, limited vaccine providers and clinics, difficulties with procurement and shipping, and difficulty tracking highly mobile populations. In the months leading up to emergency authorizations for the use of COVID-19 vaccines, the TFAS developed tailored vaccination strategies to ensure that key at-risk populations received timely vaccination, and successfully implemented these strategies during the first six months of the vaccine rollout. Subject matter experts supporting the Centers for Disease Control and Prevention’s COVID-19 Response recognized the unique historical, geographic, social, and cultural dynamics for residents in the TFAS and worked with partners to prevent, detect, and respond to the pandemic in these jurisdictions. As a result of innovative partnerships and vaccine distribution strategies, vaccine equity was improved in the TFAS during the COVID-19 vaccine rollout.

Provincial Intra-Action Review of the COVID-19 Vaccination Programme: Opportunities to Improve Vaccine Response in North Kivu, Democratic Republic of Congo.

Low levels of COVID-19 vaccination coverage in many countries prompted the use of rapid assessments to characterize barriers to vaccination and identify corrective measures. The World Health Organization recommended the use of intra-action reviews (IARs) to identify best practices, gaps, and lessons learned to make real-time improvements to the COVID-19 vaccination response. The Democratic Republic of the Congo (DRC) implemented a national IAR in July 2021 that was poorly attended by the provincial health level, where vaccination activities are planned and implemented. To bridge this gap, we proposed sub-national IARs focused on COVID-19 vaccine program implementation at the provincial level. Using the WHO methodology, we organized a four-day provincial IAR workshop and invited national, provincial and health zone Ministry of Health (MoH) representatives and private and non-governmental organizations involved in the provincial COVID-19 vaccination response. Participants were divided into six groups based on their expertise, affiliation, and role within the health system to assess and identify lessons learned, challenges and the solutions within each of the six technical areas: (1) coordination, planning and monitoring; (2) service delivery; (3) risk communication and community engagement; (4) adverse effects following immunization (AEFI); (5) logistics; (6) and data management, monitoring and evaluation. The first provincial COVID-19 IAR was conducted in Goma, North Kivu, from January 19-22, 2022. A total of 56 participants came from provincial and health zone offices, and non-governmental organizations. Through work group discussions, they identified best practices, challenges, and lessons learned, and made recommendations to improve implementation of vaccination activities and reach coverage targets. Activities were proposed to operationalize recommendations and address challenges to improve the provincial response. This provincial IAR was a useful tool for reviewing progress and areas of improvement, while evaluating aspects of the COVID-19 vaccine rollout. It provided a means to share information with vaccination partners on areas of intervention, tailored to the local context.

Recombinant Proteins based ‘rELISA’ Field Validation for Differential Diagnosis of Johne’s Disease in Goats

Background: Johne’s disease (JD), caused by Mycobacterium avium subspecies paratuberculosis (MAP), is spreaded worldwide in domestic livestock. It is very clear that JD control program having tedious complications so, only ‘Test and cull’ and ‘vaccination’ strategies are key components in JD control program. ‘Test and cull’ policy is not feasible in Indian condition due to religious beliefs However, vaccination interferes with the immunological tests used for screening of infected and vaccinated (Healthy) animals. Thus, a test that can differentiate between infected and vaccinated animals (DIVA) is needed before implementation of vaccination program. Methods: Herein, we evaluated two in-house ELISA tests i.e., recombinant proteins-based ELISA (rELISA); developed by using six MAP specific recombinant culture filtrate proteins and indigenous ELISA (i_ELISA); developed using whole-cell protoplasmic MAP antigens for their potential. Sera collected from goats under ‘infected’, ‘healthy and vaccinated’ and ‘healthy and non-vaccinated’ groups were tested by both the tests. Result: On analyzing the anti-MAP antibodies level detected by both the ELISAs and anti-MAP antibodies against secretary proteins only detected in i_ELISA, it was concluded that rELISA can differentiate healthy, vaccinated and infected goats, if used in-combination with i_ELISA. Therefore, recombinant proteins based rELISA has potential to be considered as companion tool for future diagnostic for successful implementation of JD vaccination control program.

The Dynamics of COVID-19 in Hiroshima Prefecture Compared to Japan and Its Association With Meteorological Factors: A Comparative Analysis.

Introduction Despite the implementation of countermeasures and mass vaccination programs, the COVID-19 pandemic incidence was a vital public health concern. This study aimed to explore the dynamics of COVID-19 cases and assess the association of COVID-19 pandemic epidemiological data with meteorological factors in Hiroshima Prefecture compared to Japan. Methods We analyzed COVID-19 pandemic data in Japan's Hiroshima Prefecture from January 16, 2020, to May 9, 2023. Meteorological factors were examined at different time frames, and Spearman correlation coefficients were calculated for COVID-19 variables and variants based on GISAID whole genome analysis. Results Hiroshima Prefecture reported 816,788 COVID-19 cases and 1,371 fatalities, with a city-to-rural case ratio of 0.97:1. Infection rates were 17.42% for Japan and 15.83% for Hiroshima. Gender-wise, the ratio was 99:1, and the 30-39 age group in Hiroshima had the highest cases (15.5%). Among all meteorological factors, daily and 14-day average wind speed showed a weak correlation with incidence (-0.1954, P < 0.01; 0.3669 P < 0.01), fatalities (-0.1148, P < 0.01; -0.2232 P < 0.01), and incidence rate (-0.2042, P < 0.01; -0.3751, P < 0.01), respectively. Clade GRA was most frequent (39.7%), and among 61 variants, B.1.1.7, AY.29, and BA.1.1.2 were predominant. Precipitation was associated significantly with the Alpha variant (0.3373, P<0.01), while the Delta variant (0.2934, <0.05) weakly correlated with humidity. Conclusion COVID-19 pandemic trends in Hiroshima Prefecture paralleled Japan's, yet with lower incidence and fatalities compared to most prefectures. Significant associations were found between meteorological factors and COVID-19 metrics, including incidence, fatalities, incidence rate, and mutations in Hiroshima.

HPV-specific antibodies in female genital tract secretions captured via first-void urine retain their neutralizing capacity

ABSTRACT Human papillomavirus (HPV) vaccines, primarily relying on neutralizing antibodies, have proven highly effective. Recently, HPV-specific antibodies have been detected in the female genital tract secretions captured by first-void urine (FVU), offering a minimally invasive diagnostic approach. In this study, we investigated whether HPV16-specific antibodies present in FVU samples retain their neutralizing capacity by using pseudovirion-based neutralization assays. Paired FVU and serum samples (vaccinated n = 25, unvaccinated n = 25, aged 18–25) were analyzed using two orthogonal pseudovirion-based neutralization assays, one using fluorescence microscopy and the other using luminescence-based spectrophotometry. Results were compared with HPV16-specific IgG concentrations and correlations between neutralizing antibodies in FVU and serum were explored. The study demonstrated the presence of neutralizing antibodies in FVU using both pseudovirion-based neutralization assays, with the luminescence-based assay showing higher sensitivity for FVU samples, while the fluorescence microscopy-based assay exhibited better specificity for serum and overall higher reproducibility. High Spearman correlation values were calculated between HPV16-IgG and HPV16-neutralizing antibodies for both protocols (rs: 0.54–0.94, p < .001). Significant Spearman correlations between FVU and serum concentrations were also established for all assays (rs: 0.44–0.91, p < .01). This study demonstrates the continued neutralizing ability of antibodies captured with FVU, supporting the hypothesis that HPV vaccination may reduce autoinoculation and transmission risk to the sexual partner. Although further protocol optimizations are warranted, these findings provide a foundation for future research and larger cohort studies that could have implications for the optimal design, evaluation, and implementation of HPV vaccination programs.

Prevalence and Risk Factors of Rubella and Cytomegalovirus Infections Among Pregnant Women in Makkah: Implications for Screening and Vaccination Programs.

Introduction Contracting rubella virus or cytomegalovirus (CMV) while pregnant can lead to severe health issues for both the mother and the unborn child. This study aims to determine the prevalence of these infections in pregnant women and identify associated risk factors. Methods A total of 146 pregnant women consented to participate in this research. Data were collected through a detailed questionnaire and blood samples were obtained from each participant. Blood was drawn into vacutainer tubes, and plasma was separated and stored at -20°C for analysis. We utilized specific enzyme-linked immunosorbent assays (ELISA) for immunoglobulin G (IgG) and Immunoglobulin M (IgM) to detect antibodies against rubella and CMV in the plasma samples. Results The study revealed that the prevalence rates of IgG antibodies for rubella and CMV were 68.5% and 97.3%, respectively. No samples tested positive for IgM antibodies for either disease. A significant relationship was found between chronic rubella infection and women aged 26 to 35 years (p < 0.05). A significant association was also observed between chronic CMV infection and women with lower income (p < 0.05). Conclusion This study confirms the widespread presence of chronic rubella and CMV infections among pregnant women in Makkah.The findings highlight the impact of socioeconomic factors on infection rates and underscore the importance of implementing vaccination programs to mitigate the severity of these infections in pregnant women and protect fetal health.

Effectiveness of Multifaceted Strategies to Increase Influenza Vaccination Uptake

Influenza vaccination rates remain low among primary school students and vary by school in Beijing, China. Theory-informed, multifaceted strategies are needed to improve influenza vaccination uptake. To evaluate the effectiveness of multifaceted strategies in improving influenza vaccination uptake among primary school students. This cluster randomized trial was conducted from September 2022 to May 2023 across primary schools in Beijing, China. Schools were allocated randomly in a 1:1 ratio to multifaceted strategies or usual practice. Schools were deemed eligible if the vaccination rates in the 2019 to 2020 season fell at or below the district-wide average for primary schools. Eligible participants included students in grades 2 and 3 with no medical contraindications for influenza vaccination. The multifaceted strategies intervention involved system-level planning and coordination (eg, developing an implementation blueprint, building social norms, and enhancing supervision), school-level training and educating school implementers (eg, conducting a 1-hour training and developing educational materials), and individual-level educating and reminding students and parents (eg, conducting educational activities and sending 4 reminders about vaccination). The primary outcomes were influenza vaccination uptake at school reported by school clinicians as well as overall vaccine uptake either at school or outside of school as reported by parents at 3 months. Generalized linear mixed models were used for analysis. A total of 20 schools were randomized. One intervention school and 2 control schools did not administer vaccination on school grounds due to COVID-19, resulting in a total of 17 schools (9 intervention and 8 control). There was a total of 1691 students aged 7 to 8 years (890 male [52.6%]; 801 female [47.4%]) including 915 in the intervention group and 776 in the control group. Of all participants, 848 (50.1%) were in grade 2, and 1209 (71.5%) were vaccinated in the 2021 to 2022 season. Participants in the intervention and control groups shared similar characteristics. At follow-up, of the 915 students in the intervention group, 679 (74.5%) received a vaccination at school, and of the 776 students in the control group, 556 (71.7%) received a vaccination at school. The overall vaccination rates were 76.0% (695 of 915 students) for the intervention group and 71.3% (553 of 776 students) for the control group. Compared with the control group, there was significant improvement of vaccination uptake at school (odds ratio, 1.40; 95% CI, 1.06-1.85; P = .02) and overall uptake (odds ratio, 1.49; 95% CI, 1.12-1.99; P = .01) for the intervention group. In this study, multifaceted strategies showed modest effectiveness in improving influenza vaccination uptake among primary school students, which provides a basis for the implementation of school-located vaccination programs of other vaccines in China, and in other countries with comparable programs. Chinese Clinical Trial Registry: ChiCTR2200062449.

Pediatric Subacute Sclerosing Panencephalitis: A Narrative Review on Measles and the Future of Vaccination.

Subacute sclerosing panencephalitis is a rare complication due to persistent measles infection, characterized by cognitive and motor deterioration. Because subacute sclerosing panencephalitis is considered a potentially fatal complication of measles and usually presents in young populations, particularly those with measles infection under the age of 2 years, new approaches to implement vaccination programs must be devised to help avoid the worsening of patient outcome. Until the disease is eradicated globally, children in all regions of the world remain at risk of measles infection and its respective complications, and therefore, the vaccine is considered the optimal preventative measure. The legacy of measles virus goes beyond the immediate complications. Our study, therefore, aims to provide a comprehensive review on the updated insights into subacute sclerosing panencephalitis as a complication, as well as the extent and future considerations pertaining to vaccination programs in the pediatric population.

THE IMPORTANCE OF VACCINATION AGAINST MEASLES, RUBELLA AND MUMPS IN PREVENTING NEUROLOGICAL COMPLICATIONS IN CHILDREN

Childhood vaccination against measles, rubella and mumps has been a crucial measure in preventing neurological complications. These potentially debilitating and, in extreme cases, fatal diseases have significant impacts on public health. Among the most serious complications, the neurological consequences that can affect the cognitive and motor development of children stand out. With the introduction of large-scale immunization programs, there has been a substantial reduction in the incidence of these diseases, providing not only individual protection, but also contributing to the eradication of outbreaks in communities. Objective: To analyze scientific literature from the last 10 years to comprehensively understand how vaccination against measles, rubella and mumps impacts the prevention of neurological complications in children. Methodology: The review was conducted following the PRISMA checklist guidelines. We used the PubMed, Scielo and Web of Science databases to search for relevant articles. The descriptors were "vaccination", "measles", "rubella", "mumps" and "neurological complications". Inclusion criteria covered studies published in the last 10 years, focused on children and addressing post-vaccination neurological effects. Exclusion criteria included studies with unrepresentative samples and lack of detailed information on neurological outcomes. Results: The analysis revealed a significant reduction in neurological complications associated with measles, rubella and mumps after the implementation of vaccination programs. Studies have highlighted the effectiveness of vaccines in preventing encephalitis and other neurological sequelae. Additionally, a decline in hospitalizations related to these complications was observed. Conclusion: This systematic review reinforces the importance of vaccination in preventing neurological complications in children resulting from measles, rubella and mumps. Analysis of the last 10 years reinforces the effectiveness of vaccines, highlighting not only the individual benefits, but also the public health gains in preventing outbreaks and reducing the serious consequences associated with these diseases.

Global perspectives of determinants influencing HPV vaccine introduction and scale-up in low- and middle-income countries.

Achieving WHO cervical cancer elimination goals will necessitate efforts to increase HPV vaccine access and coverage in low-and-middle-income countries (LMICs). Although LMICs account for the majority of cervical cancer cases globally, scale-up of HPV vaccine programs and progress toward coverage targets in LMICs has been largely insufficient. Understanding the barriers and facilitators that stakeholders face in the introduction and scale-up of HPV vaccination programs will be pivotal in ensuring that LMICs are equipped to optimize the implementation of HPV vaccination programs. This qualitative study interviewed 13 global stakeholders categorized as either academic partners or global immunization partners to ascertain perspectives regarding factors affecting the introduction and scale-up of HPV vaccination programs in LMICs. Global stakeholders were selected as their perspectives have not been as readily highlighted within the literature despite their key role in HPV vaccination programming. The results of this investigation identified upstream (e.g., financial considerations, vaccine prioritization, global supply, capacity and delivery, and vaccine accessibility, equity, and ethics) and downstream (e.g., vaccine acceptability and hesitancy, communications, advocacy, and social mobilization) determinants that impact program introduction and scale-up and confirmed that strong political commitment and governance are significant in garnering support for HPV vaccines. As LMICs introduce HPV vaccines into their national immunization programs and develop plans for scaling up vaccination efforts, strategic approaches to communications and advocacy will also be needed to successfully meet coverage targets.

Costs and cost-effectiveness of influenza illness and vaccination in low- and middle-income countries: A systematic review from 2012 to 2022.

Historically, lack of data on cost-effectiveness of influenza vaccination has been identified as a barrier to vaccine use in low- and middle-income countries. We conducted a systematic review of economic evaluations describing (1) costs of influenza illness; (2) costs of influenza vaccination programs; and (3) vaccination cost-effectiveness from low- and middle-income countries to assess if gaps persist that could hinder global implementation of influenza vaccination programs. We performed a systematic search in Medline, Embase, Cochrane Library, CINAHL, and Scopus in January 2022 and October 2023 using a combination of the following key words: "influenza" AND "cost" OR "economic." The search included studies with publication years 2012 through 2022. Studies were eligible if they (1) presented original, peer-reviewed findings on cost of illness, cost of vaccination program, or cost-effectiveness of vaccination for seasonal influenza; and (2) included data for at least 1 low- or middle-income country. We abstracted general study characteristics and data specific to each of the 3 study types. Of 54 included studies, 26 presented data on cost-effectiveness, 24 on cost-of-illness, and 5 on program costs. Represented countries were classified as upper-middle income (UMIC; n = 12), lower-middle income (LMIC; n = 7), and low-income (LIC; n = 3). The most evaluated target groups were children (n = 26 studies), older adults (n = 17), and persons with chronic medical conditions (n = 12); fewer studies evaluated pregnant persons (n = 9), healthcare workers (n = 5), and persons in congregate living settings (n = 1). Costs-of-illness were generally higher in UMICs than in LMICs/LICs; however, the highest national economic burden, as a percent of gross domestic product and national health expenditure, was reported from an LIC. Among studies that evaluated the cost-effectiveness of influenza vaccine introduction, most (88%) interpreted at least 1 scenario per target group as either cost-effective or cost-saving, based on thresholds designated in the study. Key limitations of this work included (1) heterogeneity across included studies; (2) restrictiveness of the inclusion criteria used; and (3) potential for missed influenza burden from use of sentinel surveillance systems. The 54 studies identified in this review suggest an increased momentum to generate economic evidence about influenza illness and vaccination from low- and middle-income countries during 2012 to 2022. However, given that we observed substantial heterogeneity, continued evaluation of the economic burden of influenza illness and costs/cost-effectiveness of influenza vaccination, particularly in LICs and among underrepresented target groups (e.g., healthcare workers and pregnant persons), is needed. Use of standardized methodology could facilitate pooling across settings and knowledge sharing to strengthen global influenza vaccination programs.