Increase Immunization Rates Research Articles

Decline in Vaccination Coverage by Age 24 Months and Vaccination Inequities Among Children Born in 2020 and 2021 - National Immunization Survey-Child, United States, 2021-2023.

Data from the National Immunization Survey-Child (NIS-Child) were analyzed to estimate coverage with childhood vaccines recommended by the Advisory Committee on Immunization Practices among U.S. children by age 24 months. Coverage with nearly all vaccines was lower among children born in 2020 and 2021 than it was among those born in 2018 and 2019, with declines ranging from 1.3 to 7.8 percentage points. Analyses of NIS-Child data for earlier birth cohorts have not revealed such widespread declines in routine childhood vaccination coverage. Coverage among children born during 2020-2021 varied by race and ethnicity, health insurance status, poverty status, urbanicity, and jurisdiction. Compared with non-Hispanic White children, coverage with four of the 17 vaccine measures was lower among non-Hispanic Black or African American children as well as Hispanic or Latino (Hispanic) and non-Hispanic American Indian or Alaska Native children. Coverage was also generally lower among those covered by Medicaid or other nonprivate insurance, uninsured children, children living below the federal poverty level, and children living in rural areas. Coverage varied widely by jurisdiction, especially coverage with ≥2 doses of influenza vaccine. Children born during 2020-2021 were born during or after the period of major disruption of primary care from the COVID-19 pandemic. Providers should review children's histories and recommend needed vaccinations during every clinical encounter. Addressing financial barriers, access issues, vaccine hesitancy, and vaccine-related misinformation can also help to increase coverage, reduce disparities, and protect all children from vaccine-preventable diseases. Strategies that have been found effective include implementation of standing orders and reminder and recall systems, strong physician recommendations to vaccinate, and use of immunization information systems to identify areas of lower coverage that could benefit from targeted interventions to increase immunization rates.

Unraveling Herpes Zoster Vaccine Hesitancy, Acceptance, and Its Predictors: Insights From a Scoping Review.

Herpes zoster vaccination is critical in preventing herpes zoster virus infection and its associated consequences. Despite its relevance, global herpes zoster immunisation coverage remains alarmingly low. Understanding the factors that drive vaccine scepticism and acceptance is crucial for increasing immunisation rates and improving public health outcomes. This scoping review, following Joanna Briggs Institute guidelines, included 18 studies examining vaccine hesitancy, acceptance, and associated factors. Meticulous data analysis revealed hesitancy's intricate dynamics across countries and demographics. Studies displayed a wide range of acceptance rates (2.8%-89.02%), showcasing the complex interplay of attitudes and behaviors towards vaccination. Reasons for vaccine refusal were repeatedly identified in this setting, including worries about potential adverse effects, views of vaccine necessity, and vaccine supply constraints. Notably, individuals' patterns of vaccine acceptance and hesitancy differed among countries, vaccines, and vaccination-related factors. Addressing acceptance hurdles by improving accessibility, providing accurate information, and strengthening healthcare recommendations is crucial. Understanding the multifaceted factors influencing hesitancy allows for targeted interventions, elevating immunization rates and enhancing public health globally.

Completion of multidose vaccine series in early childhood: current challenges and opportunities.

Completion of all doses in multidose vaccine series provides optimal protection against preventable infectious diseases. In this review, we describe clinical and public health implications of multidose vaccine series noncompletion, including current challenges to ensuring children receive all recommended vaccinations. We then highlight actionable steps toward achieving early childhood immunization goals. Although coverage levels are high for most early childhood vaccinations, rates of completion are lower for vaccinations that require multiple doses. Recent research has shown that lower family socioeconomic status, a lack of health insurance coverage, having multiple children in the household, and moving across state lines are associated with children failing to complete multidose vaccine series. These findings provide contextual evidence to support that practical challenges to accessing immunization services are impediments to completion of multidose series. Strategies, including reminder/recall, use of centralized immunization information systems, and clinician prompts, have been shown to increase immunization rates. Re-investing in these effective interventions and modernizing the public health infrastructure can facilitate multidose vaccine series completion. Completion of multidose vaccine series is a challenge for immunization service delivery. Increased efforts are needed to address remaining barriers and improve vaccination coverage in the United States.

Vaccination Approaches of Primary Healthcare Personnel and Their Communication Levels with Parents Having Childhood Vaccine Hesitancy

Vaccines have saved more lives than any other health development in the 20th century. One of the most cost-effective programs for reducing infant/child morbidity and mortality is the vaccination of children against common vaccine-preventable diseases. Türkiye is one of the countries that has managed to achieve a significant reduction in the incidence of vaccine-preventable diseases by increasing immunization rates. Currently, 13 different antigens are included in the vaccination calendar of the Ministry of Health of the Republic of Türkiye, and all vaccines to be administered (vaccination calendar) are determined and continuously updated by the Immunization Advisory Board of the Ministry of Health of the Republic of Türkiye. Our study is a cross-sectional descriptive study. A total of 410 family physicians and family health workers were included in the study. An interactive training meeting on vaccines, vaccine hesitancy, communication, and counseling was organized in 18 groups (including the study participants) in May-June 2019. A questionnaire form consisting of 24 topics was applied to the participants before the training presentation. When comparisons between groups were analyzed according to the answers given by the participants to some questions, it was found that 57.1% of the group with a good average of knowledge, attitude and behavior score reflecting the level of communication with parents with vaccine hesitancy had received training on vaccines and their characteristics, while 43.6% of the group with a poor average had received this training, and the difference was statistically significant (p=0.008). Parents with vaccine refusal were most hesitant about Measles-Mumps-Rubella (MMR) vaccine (87.7%). Healthcare professionals play a very important role in the provision of healthcare services and in the decision-making of families about vaccination with the counseling they provide all over the world. To reduce vaccine hesitancy, continuous education activities on vaccination for health professionals, the creation of educational materials for public education, the use of mass media, and legal regulations can be made.

The acceptance and hesitancy of COVID-19 vaccination among chronic obstructive pulmonary disease (COPD) patients.

Severe acute respiratory syndrome coronavirus 2, which is responsible for the coronavirus disease 2019 (COVID-19), causes severe clinical outcomes in old individuals and patients with underlying diseases, including chronic obstructive pulmonary disease (COPD). Considering vaccination is still the most effective method to prevent COVID-19-associated death, it is imperative to evaluate COPD patients' attitudes toward the COVID-19 vaccine. This cross-sectional design study was conducted to assess vaccine acceptance and hesitancy among 212 COPD patients who attended the outpatient department from January 1, 2021, to July 31, 2022. All of the patients were not vaccinated and had undertaken lung function test at the time of our survey. Of 212 participants, 164 (77.4%) were willing to be vaccinated immediately while 48 (22.6%) were hesitant to be vaccinated. Compared with the acceptance group, patients who did not accept the vaccination instantly tended to have more comorbidities, like hypertension, coronary heart disease, recent cancers, and higher Modified British Medical Research Council score, or more frequent acute exacerbation. For the patients willing to be vaccinated, the main factors motivating them were an authorities-endorsed vaccine, free vaccination, and no obvious adverse reactions. For the hesitant group, no recommendation from the treating physician was the biggest obstacle for them to accept vaccination. Our results provide useful guidance for making intervention measures to enhance COPD patients' acceptance of a new COVID-19 vaccine. For those patients with comorbidities, treating physicians promoting messages framing the safety of vaccination is necessary to increase immunization rates.

Quality Improvement Project to increase pneumococcal vaccination rates in adults with inflammatory bowel diseases (IBD) being treated with immunosuppressants.

Patients with inflammatory bowel diseases (IBD) are at an increased risk of pneumonia, and using immunosuppressive medications further increases this risk. Hospitalized patients with IBD have a significantly higher mortality rate from infections with pneumonia being one of them. The American College of Gastroenterology recommends pneumococcal vaccination for all IBD patients as a part of preventative care for IBD patients. However, compliance rates of pneumococcal vaccination in IBD patients have been very low. Quality improvement projects in this regard have been successful at demonstrating increased immunization rates. Our quality improvement project was aimed at increasing pneumococcal vaccination rates in these adult IBD patients by establishing a process to identify eligible patients in primary care clinics.

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.

PARENTS‘ KNOWLEDGE AND PERCEPTION OF AND HESITANCY TOWARDS COVID-19 VACCINE AMONG PAEDIATRIC PATIENTS IN HOSPITAL SEBERANG JAYA, PULAU PINANG

The COVID-19 epidemic has had serious negative effects on children in terms of both their health and societal effects. However, owing to reports of a low vaccination rate, the objective of this study was to explore the factors associated with parents’ hesitation in getting their young children vaccinated. This is a cross-sectional study conducted in a tertiary hospital. All parents or legal guardians of paediatric patients with chronic illnesses aged 3 to 11 who visited the hospital during the study period filled out the online questionnaire. Two hundred and thirty-five outpatient clinic respondents and 77 ward respondents were asked to complete the questionnaire. Malays made up the majority (88.5%), followed by Chinese (6.7%) and Indians (4.8%). Ethnicity, information sources, children‘s age, knowledge score and vaccine perception were found to be significantly different across three degrees of acceptance – ‘Yes’, ‘No’ and ‘Not sure’. There was a significant correlation between ‘Yes’ and ‘No’ replies and parents‘ perceptions of immunisation hurdles. When compared to the Malays, the Chinese had substantially lower odds of responding with ‘Not sure’. Parents‘ acceptance of the vaccine was influenced by their awareness of COVID-19, the effectiveness of the vaccine, any side effects and doctors‘ recommendations. Parents were less concerned about vaccine side effects as their children aged. To infer, authorities should respond to public concerns and adverse events related to immunisation in a timely and transparent manner. To increase immunisation rates, it is important to inform the public that the advantages of receiving COVID-19 vaccination exceed its risks.

Covid-19 vaccination landscape in Malta through social media: Correspondence.

We would like to discuss om article entitled “A cross-sectional study exploring the Covid-19 vaccination landscape in Malta through social media: An insight into experiences, attitudes, and perspectives.”1 Even while vaccine hesitancy is still low, Cuschieri et al.1 came to the conclusion that vaccination resistance may operate as a barrier to controlling the pandemic. According to Cuschieri et al.,1 unified statement from governing authorities are essential for open public health communication that addresses issues and maximizes population safety. To increase immunization rates and convert doubters, public confidence in authorities, professionals, and scientists must grow. A lack of confidence in the community's healthcare system, for instance, has been linked to antivaccine beliefs.2 The degree of readiness is determined by one's confidence in their ability to carry out public health measures in the case of a catastrophe. Similar to immunization trends, epidemic conditions can much change over time. Furthermore, vaccination rates may change over time. As epidemic conditions change and new information about vaccinations becomes available, immunization usage patterns regularly change.3 The acceptance rate of COVID-19 vaccinations as of right now is the main cause for concern. Distribution of vaccines continues to be a very difficult problem for public health organizations all around the world. One study found that those who consistently reject immunizations have lower confidence in the local healthcare system.2 People may resort to public health solutions more or less frequently during a crisis, depending on how much faith they have in them. Depending on how much they trust their local public health administration, people may resort to public health remedies more or less frequently during a crisis. The public's trust in their local public health crisis response will have a significant impact on the effectiveness of public health initiatives during the COVID-19 pandemic.3 The authors declare no conflict of interest.

Community pharmacists as vaccinators in the Italian SARS-CoV-2 immunization campaign: implications beyond the pandemic

Italy was one of the last European countries to introduce vaccination in pharmacies. The urgent need to extend the vaccination campaign against SARS-CoV-2 led to the approval of Law no. 178/2020. The Law allowed the administration of COVID-19 vaccines in Italian pharmacies by community pharmacists on an experimental basis for the years 2021-2022. Stakeholders took contrasting positions on the idea of enabling pharmacist to vaccinate after proper training. Sometimes, controversy existed even within the same associations representing pharmacists. As observed in other countries, the medical profession in Italy also expressed its opposition to the idea of pharmacists as vaccinators, while the general public and pharmacy customers were generally in favour of the policy. Over two million doses of SARS-CoV-vaccines were administered in Italian pharmacies in less than one year after the introduction of the policy. Criticism and concerns raised during the debate about the introduction of vaccination in pharmacies has subsided. It is yet unclear whether vaccination in pharmacies will be prolonged after the pandemic and whether it will, in fact, be expanded to other vaccines. Potentially, this could contribute towards increasing immunisation rates, not only for COVID-19, but also for other vaccines.

Projected health and economic outcomes of extending public funding of pharmacy services to include administration of Pneu23 and Td/Tdap immunizations by pharmacy practitioners in New Brunswick.

Although legislation permits New Brunswick pharmacy professionals to administer a wide range of immunizations, public funding for these services is currently limited to immunizations against influenza and COVID-19 and was recently extended to include pneumococcal immunization (Pneu23) in individuals aged 65 years or older. We used administrative data to project health and economic outcomes associated with the current Pneu23 program and with extension of public funding to include: 1) younger adults aged 19 years or older in the Pneu23 program, and 2) tetanus boosters (Td/Tdap). Two model scenarios were compared: a Physician-Only model in which physicians remain the only practitioners to administer publicly funded Pneu23 and Td/Tdap, and a Blended model in which this service is also provided by pharmacy professionals. Immunization rates by practitioner type were projected based on physician billing data accessed via the New Brunswick Institute for Research, Data and Training in conjunction with trends observed with influenza immunization by pharmacists. These projections were used along with published data to estimate health and economic outcomes under each model. Public funding of Pneu23 (65+), Pneu23 (19+) and Td/Tdap (19+) administration by pharmacy professionals is projected to yield increased immunization rates and physician time savings compared with the Physician-Only model. Public funding of Pneu23 and Td/Tdap administration by pharmacy professionals in those aged ≥19 years would result in cost savings, owing primarily to productivity losses avoided in the working age population. Increased immunization rates, physician time savings and cost savings may be realized if public funding were extended to include administration of Pneu23 in younger adults and Td/Tdap, by pharmacy practitioners.

Parents' Attitudes toward Childhood Vaccines and COVID-19 Vaccines in a Turkish Pediatric Outpatient Population.

Our participants were the parents of children admitted to hospitals in three different cities in Turkey between September 2021 and December 2021. The parents were asked to complete sociodemographic data and their attitudes toward COVID-19 diseases, the Parental Attitudes Toward Childhood Vaccines (PACV) scale, and the Attitudes Toward COVID-19 Vaccine (ATV-COVID-19) scale. Participants were categorized as "non-hesitant", with a score of &lt;50, and "hesitant", with a score of ≥50. A total of 1087 parents with a mean age of 33.66 (SD 9.1) years old participated in the study. VH was noted in 102 (9.38%) parents. Age, gender, education, and income levels did not significantly differ from one another, according to the PACV; however, parents who delayed vaccinating their children and indicated that social media had an impact on vaccination decisions were more hesitant. Parents who were male and had a family member diagnosed with COVID-19 showed more positive attitudes in the ATV-COVID-19. Parents who were hesitant about childhood vaccinations had lower positive attitudes toward the COVID-19 vaccine (2.84 ± 0.97) than parents who were not hesitant (3.77 ± 0.9). A total of 761 (70.14%) parents need more information about childhood immunizations. Parents who are hesitant about childhood immunization programs in Turkey have a less positive attitude toward COVID-19 vaccines and are affected by social media. Parents need information about vaccines, and because the controversy surrounding COVID-19 vaccines can diminish parents' confidence in routine childhood immunizations, understanding the complex causes behind vaccination hesitancy can help public health policy break through barriers and increase immunization rates.

Significant Features and Applications of Drones for Healthcare: An Overview

The revolutionary digital technology of drones, also known as unmanned aerial vehicles (UAVs), has altered healthcare. This technology proved highly effective for healthcare, research, start-ups, and large corporations. Various drones are used across the industries such as infrastructure, transportation, insurance, telecommunications, agriculture, media and entertainment, security, and mining. Drones have been utilized to help the medical industry for several years, with numerous start-up firms with considerable investment-testing innovative methods. This new drone delivery network will give healthcare practitioners and the communities they serve better access to critically needed therapeutic goods. Compared to traditional approaches, drones to map disaster zones give better cost savings and faster reaction times. Drones can immediately deploy, provide high-resolution and three-dimensional (3D) mapping, identify hotspot locations with the most damage, and upload data in real-time to coordinate rescue operations. This study is mainly about drones and their primary functions. Devoted features and various aspects associated with drone technology for healthcare are briefly discussed and, finally, significant applications of drones for healthcare are identified and discussed. The COVID-19 pandemic has brought to light several long-hidden health disparities worldwide. Drones have resulted in innovation, such as the unprecedented success of developing new vaccinations at record speed. Drones can distribute vaccinations in low-income countries, lowering transportation costs and increasing immunization rates. People are now receiving good care, and the medical infrastructure is also improving, which is made possible by drone technology.

Sustained Management of COVID-19: Doing More of What Works to Control Future Surges.

Sustained Management of COVID-19: Doing More of What Works to Control Future Surges.

Training student pharmacists to administer pediatric immunizations

Background and purposeTo describe the implementation of a pediatric vaccination training for student pharmacists and to assess student confidence in providing pediatric vaccinations after taking part in a mixed media, traditional lecture, and active learning, formatted training course. Educational activity and settingStudent pharmacists were trained with a two-hour pediatric immunization training module which consisted of materials to detail administration techniques. Students were assessed using a live skills assessment and a multiple-choice knowledge examination. To assess student confidence in these skills, the students were given a pre- and post-instruction survey which was analyzed using the Mann-Whitney U test. FindingsAll 170 students enrolled successfully completed the knowledge assessment with an average score of 87% (SD 10%). The skills assessment items most commonly needing remediation were verifying that caregivers received the Vaccine Information Sheet (24%) and reviewing comfort measures and after care instructions with the caregiver (24%). The pre-course survey was completed by 169 out of 170 student pharmacists (99.4%) while the post-course survey was completed by 164 student pharmacists (96.4%) with each item showing a statistically significant increase in perceived confidence in vaccine administration. SummaryPediatric vaccination training was integrated into a doctor of pharmacy curriculum with the goals of increasing student knowledge and confidence in giving pediatric immunizations. Upon course completion, there was a statistically significant increase in student-perceived knowledge and confidence when administering pediatric immunizations. By expanding access to pediatric immunizers, pharmacists can aid in increasing immunization rates improving public health in their communities.

A Smartphone App to Increase Immunizations in the Pediatric Solid Organ Transplant Population: Development and Initial Usability Study

BackgroundVaccine-preventable infections result in significant morbidity, mortality, and costs in pediatric transplant recipients. However, at the time of transplant, less than 20% of children are up-to-date for age-appropriate immunizations that could prevent these diseases. Smartphone apps have the potential to increase immunization rates through their ability to provide vaccine education, send vaccine reminders, and facilitate communication between parents and a multidisciplinary medical group.ObjectiveThe aim of this study was to describe the development of a smartphone app, Immunize PediatricTransplant, to promote pretransplant immunization and to report on app functionality and usability when applied to the target population.MethodsWe used a mixed methods study design guided by the Mobile Health Agile Development and Evaluation Lifecycle. We first completed a formative research including semistructured interviews with transplant stakeholders (12 primary care physicians, 40 parents or guardians of transplant recipients, 11 transplant nurse coordinators, and 19 transplant subspecialists) to explore the acceptability of an immunization app to be used in the pretransplant period. Based on these findings, CANImmunize Inc developed the Immunize PediatricTransplant app. We next held 2 focus group discussions with 5-6 transplant stakeholders/group (n=11; 5 parents of transplant recipients, 2 primary care physicians, 2 transplant nurse coordinators, and 2 transplant subspecialists) to receive feedback on the app. After the app modifications were made, alpha testing was conducted on the functional prototype. We then implemented beta testing with 12 stakeholders (6 parents of transplant recipients, 2 primary care doctors, 2 transplant nurse coordinators, and 2 transplant subspecialists) to refine the app through an iterative process. Finally, the stakeholders completed the user version of the Mobile Application Rating Scale (uMARS) to assess the functionality and quality of the app.ResultsA new Android- and Apple-compatible app, Immunize PediatricTransplant, was developed to improve immunization delivery in the pretransplant period. The app contains information about vaccine use in the pretransplant period, houses a complete immunization record for each child, includes a communication tool for parents and care providers, and sends automated reminders to parents and care providers when immunizations are due. During usability testing, the stakeholders were able to enter a mock vaccine record containing 16 vaccines in an average of 8.1 minutes (SD 1.8) with 87% accuracy. The stakeholders rated engagement, functionality, aesthetics, and information quality of the app as 4.2/5, 4.5/5, 4.6/5, and 4.8/5, respectively. All participants reported that they would recommend this app to families and care teams with a child awaiting solid organ transplant.ConclusionsThrough a systematic, user-centered, agile, iterative approach, the Immunize PediatricTransplant app was developed to improve immunization delivery in the pretransplant period. The app tested well with end users. Further testing and agile development among patients awaiting transplant are needed to understand real-world acceptability and effectiveness in improving immunization rates in children awaiting transplant.

Looking back: Pharmacists share COVID-19 vaccination lessons one year later

Looking back: Pharmacists share COVID-19 vaccination lessons one year later

“Vaccination needs to be easy for the people, right ?”: a qualitative study of the roles of physicians and pharmacists regarding vaccination in Switzerland

ObjectiveVaccination in pharmacies has been a key component of national vaccination strategies to facilitate vaccination access. Qualitative data on the perspectives of professional stakeholders on vaccination in pharmacies and on...

Ethical Aspects of Vaccination

Vaccinations are among the most effective and cost-effective means to reduce the burden of serious infectious diseases. As vaccination rates remain too low to realize the full potential to reduce morbidity and mortality, strategies to increase immunization rates are ethically and economically mandated. Questions to be addressed in this framework are: Which restrictions to individual decisions are ethically acceptable in order to achieve a sufficient protection of the community? Does the individual have an ethical obligation to get vaccinated? Which requirements do vaccines have to fulfill to be ethically acceptable? Five criteria are presented: Proven efficacy/effectiveness, favorable benefit-risk ratio, acceptable benefit-cost ratio, minimized restrictions of the individual, and fair and transparent decision procedures. Depending on how far the five ethical requirements are met, different strengths of recommendations result, from level 1 (do not offer vaccination) to level 5 (vaccination required by law). Ethical issues on the vaccination of children arise if the human right of parents to care for their child are in contrast to the human right of children to receive optimal protection from disease.

Advances in treatment and prevention of hepatitis B.

Chronic hepatitis B (CHB) continues to contribute to worldwide morbidity and mortality significantly. Scientists, clinicians, pharmaceutical companies, and health organizations have dedicated substantial Intellectual and monetary resources to finding a cure, increasing immunization rates, and reducing the global burden of CHB. National and international health-related organizations including the center for disease control, the national institute of health, the American Association for the study of liver disease (AASLD), The European association for the study of the Liver (EASL), The Asia Pacific association for the study of the Liver (APASL) and the world health organization release periodic recommendations for disease prevention and treatment. Our review of the most recent guidelines by EASL, AASLD, APASL, and Taiwan Association for the Study of the Liver revealed that an overwhelming majority of cited studies were published before 2018. We reviewed Hepatitis B-related literature published 2018 onwards to identify recent developments and current barriers that will likely direct future efforts towards eradicating hepatitis B. The breakthrough in our understanding of the hepatitis B virus life cycle and resulting drug development is encouraging with significant room for further progress. Data from high-risk populations, most vulnerable to the devastating effects of hepatitis B infection and reactivation remain sparse. Utilization of systems approach, optimization of experimental models, identification and validation of next-generation biomarkers, and precise modulation of the human immune response will be critical for future innovation. Within the foreseeable future, new treatments will likely complement conventional therapies rather than replace them. Most Importantly, pragmatic management of CHB related population health challenges must be prioritized to produce real-world results.