Infectious Disease Response Research Articles

Association of hypoalbuminemia with hospitalization and mortality in hemodialysis patients with COVID-19.

Hypoalbuminemia is associated with poor nutritional status and inflammatory response in infectious diseases. It is commonly observed in COVID-19 patients. The aim of this study is to assess the association of serum albumin with hospitalization and mortality in dialysis patients with COVID-19. We retrospectively collected 250 dialysis patients, with and without COVID-19. Demographic characteristics, clinical symptoms, and laboratory tests on admission or the confirmation of COVID-19 were collected. Univariate logistic regression model was used to evaluate the association of various factors with hospitalization and death in these patients. A total of 250 patients were included between December 1, 2022, and February 1, 2023, in our dialysis center. Among them, 218 were dialysis patients with COVID-19, and 32 were without COVID-19. Ten patients died due to COVID-19, and 8 patients had clinical data. In dialysis patients with COVID-19, a significant difference in serum albumin levels was observed between outpatients (37.28 ± 4.01 g/L) and hospitalized patients (33.42 ± 3.82 g/L), as well as between survivors (37.12 ± 4.07 g/L) and non-survivors (31.92 ± 2.52 g/L). Univariate logistic regression showed that the reduced albumin levels were associated with an increased risk of hospitalization and mortality in dialysis patients with COVID-19. Our study revealed that reduced serum albumin is associated with an increased risk of hospitalization and mortality in dialysis patients with COVID-19. Low serum albumin levels suggest a poor prognosis and nutritional support may improve clinical outcomes.

Recent Developments in Infectious Disease Research

The field of infectious disease research is rapidly evolving and advancing, driven by the demand to address both current and emerging threats to global health. The recent COVID-19 pandemic underscored the criticality of infectious disease outbreak preparedness and response, while factors such as climate change, migration, and globalization continue to influence disease transmission dynamics. Innovative approaches to infectious disease research are more essential than ever to prevent future pandemics and the spread of vectorborne diseases. This comprehensive review article investigates some recent pertinent developments in infectious disease research, including the development of a novel serosurveillance platform, modeled after the one designed during the COVID-19 pandemic, aimed at tackling the growing global threat of arboviruses. Also investigated in this article is the repurposing and application of mRNA vaccine technology, initially developed during the pandemic, to address the complex challenge of tick-borne Lyme disease. Finally, we outline several novel and cutting-edge strategies aimed at tackling the ever-mounting crisis of antimicrobial resistance (AMR). Each of these innovations marks a significant step forward in global health security and preparedness, offering promising solutions to the challenges of a rapidly evolving world, while drawing on the lessons learned from past outbreaks and epidemics.

The role of calcium homeostasis in modulating the immune response in cancer and infectious diseases

Calcium homeostasis is a pivotal determinant of physiological processes, particularly in cellular signaling and immune system regulation. This balance is crucial for modulating immune responses in the context of both infectious and oncological diseases. Disruptions in calcium homeostasis have been shown to influence disease progression, immune efficacy, and treatment outcomes. Our study investigates the critical role of calcium homeostasis in shaping the immune response to cancer and infectious diseases through a comprehensive literature review. The electronic databases Scopus, Google Scholar, and PubMed were utilized to gather relevant studies, identified using key terms such as "calcium homeostasis," "immune response," "cancer," and "infectious diseases." Emerging evidence underscores that calcium levels directly impact immune cell function, including the activation of immune effector cells, cytokine production, and the orchestration of the overall immune response. These processes are critical to the body's ability to combat infections and malignancies. Aberrant calcium signaling may lead to compromised immune defense mechanisms, negatively affecting the outcomes of therapeutic interventions. In cancer, for example, altered calcium homeostasis can suppress immune surveillance, while in infectious diseases, it can hinder the immune system's capacity to clear pathogens. Our review highlights that the pathophysiology of both cancer and infectious diseases is tightly interwoven with calcium regulation, suggesting a promising avenue for therapeutic targeting. Modulating calcium homeostasis may enhance immune functionality, thereby improving treatment efficacy. By restoring calcium balance, novel therapeutic approaches could be developed to optimize immune responses and bolster clinical outcomes across a range of diseases. Further research is warranted to elucidate the precise molecular mechanisms linking calcium homeostasis and immune regulation, with the goal of refining future therapeutic strategies. Maintaining calcium equilibrium is thus essential for the advancement of effective treatments in both cancer and infectious disease contexts.

Torque teno viruses exhaust and imprint the human immune system via the HLA-E/NKG2A axis.

The ubiquitous Torque teno virus (TTV) establishes a chronically persistent infection in the human host. TTV has not been associated with any apparent disease, but, as part of the human virome, it may confer a regulatory imprint on the human immune system with as yet unclear consequences. However, so far, only few studies have characterized the TTV-specific immune responses or the overall immunological imprints by TTV. Here, we reveal that TTV infection leads to a highly exhausted TTV-specific CD8+ T-cell response, hallmarked by decreased IFN-γ production and the expression of the inhibitory NKG2A-receptor. On a functional level, we identified a panel of highly polymorphic TTV-encoded peptides that lead to an expansion of regulatory NKG2A+ natural killer, NKG2A+CD4+, and NKG2A+CD8+ T cells via the stabilization of the non-classical HLA-E molecule. Our results thus demonstrate that TTV leads to a distinct imprint on the human immune system that may further regulate overall human immune responses in infectious, autoimmune, and malignant diseases.

Focus, vigilance, resilience: towards stronger infectious disease surveillance, threat detection and response in the EU/EEA.

This perspective summarises and explains the long-term surveillance framework 2021-2027 for infectious diseases in the European Union/European Economic Area (EU/EEA) published in April 2023. It shows how shortcomings in the areas of public health focus, vigilance and resilience will be addressed through specific strategies in the coming years and how these strategies will lead to stronger surveillance systems for early detection and monitoring of public health threats as well as informing their effective prevention and control. A sharper public health focus is expected from a more targeted list of notifiable diseases, strictly public-health-objective-driven surveillance standards, and consequently, leaner surveillance systems. Vigilance should improve through mandatory event reporting, more automated epidemic intelligence processing and increased use of genomic surveillance. Finally, EU/EEA surveillance systems should become more resilient by modernising the underlying information technology infrastructure, expanding the influenza sentinel surveillance system to other respiratory viruses for better pandemic preparedness, and increasingly exploiting potentially more robust alternative data sources, such as electronic health records and wastewater surveillance. Continued close collaboration across EU/EEA countries will be key to ensuring the full implementation of this surveillance framework and more effective disease prevention and control.

Infectious disease responses to human climate change adaptations.

Many recent studies have examined the impact of predicted changes in temperature and precipitation patterns on infectious diseases under different greenhouse gas emissions scenarios. But these emissions scenarios symbolize more than altered temperature and precipitation regimes; they also represent differing levels of change in energy, transportation, and food production at a global scale to reduce the effects of climate change. The ways humans respond to climate change, either through adaptation or mitigation, have underappreciated, yet hugely impactful effects on infectious disease transmission, often in complex and sometimes nonintuitive ways. Thus, in addition to investigating the direct effects of climate changes on infectious diseases, it is critical to consider how human preventative measures and adaptations to climate change will alter the environments and hosts that support pathogens. Here, we consider the ways that human responses to climate change will likely impact disease risk in both positive and negative ways. We evaluate the evidence for these impacts based on the available data, and identify research directions needed to address climate change while minimizing externalities associated with infectious disease, especially for vulnerable communities. We identify several different human adaptations to climate change that are likely to affect infectious disease risk independently of the effects of climate change itself. We categorize these changes into adaptation strategies to secure access to water, food, and shelter, and mitigation strategies to decrease greenhouse gas emissions. We recognize that adaptation strategies are more likely to have infectious disease consequences for under-resourced communities, and call attention to the need for socio-ecological studies to connect human behavioral responses to climate change and their impacts on infectious disease. Understanding these effects is crucial as climate change intensifies and the global community builds momentum to slow these changes and reduce their impacts on human health, economic productivity, and political stability.

The point of no return: Crisis management lessons from US adults' infectious disease risk (IDR) perception and response to the Flu‐and‐COVID dual threat

The point of no return: Crisis management lessons from US adults' infectious disease risk (IDR) perception and response to the Flu‐and‐COVID dual threat

TOLL-LIKE RECEPTORS AND BRONCHIAL ASTHMA: PART 2

For the last decade, the attention of researchers has been attracted by Toll-like receptors that provide recognition of pathogens and trigger an immune response to them. As participants in acute infectious processes, with inadequate stimulation associated with mutation of genes regulating expression of the receptors, they cause the initiation or exacerbation of asthma in predisposed individuals. At the same time, the reduced function of the receptors leads to an insufficient immune response in respiratory infectious diseases, which also leads to an exacerbation of bronchial asthma. In addition, Toll-like receptors are direct elements of the pathogenesis of bronchial asthma, supporting or reducing inflammation. Thus, Toll-like receptors can not only aggravate the course of asthma, but also prevent exacerbations of the disease. Knowledge of the role of these receptors in the pathophysiology of bronchial asthma is necessary to improve diagnostic methods and timely detection of the disease. Using data on the effects realized by the receptors, medicines are being developed that are antagonists or agonists of a Toll-like receptors. The use of medicines acting on receptors in the treatment and prevention of asthma in the future may lead to increased control over the course of the disease.

Harnessing technology for infectious disease response in conflict zones: Challenges, innovations, and policy implications.

Epidemic outbreaks of infectious diseases in conflict zones are complex threats to public health and humanitarian activities that require creativity approaches of reducing their damage. This narrative review focuses on the technology intersection with infectious disease response in conflict zones, and complexity of healthcare infrastructure, population displacement, and security risks. This narrative review explores how conflict-related destruction is harmful towards healthcare systems and the impediments to disease surveillance and response activities. In this regards, the review also considered the contributions of technological innovations, such as the improvement of epidemiological surveillance, mobile health (mHealth) technologies, genomic sequencing, and surveillance technologies, in strengthening infectious disease management in conflict settings. Ethical issues related to data privacy, security and fairness are also covered. By advisement on policy that focuses on investment in surveillance systems, diagnostic capacity, capacity building, collaboration, and even ethical governance, stakeholders can leverage technology to enhance the response to infectious disease in conflict settings and, thus, protect the global health security. This review is full of information for researchers, policymakers, and practitioners who are dealing with the issues of infectious disease outbreaks in conflicts worn areas.

Measurement of Vitamin D Level among Covid-19 Patients and its Correlation with Severity of the Disease

Abstract Background Coronavirus disease 2019 (covid-19) is defined as illness caused by a novel coronavirus now called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which was first identified among an outbreak of respiratory illness cases in Wuhan City, China. Vitamin D is known to play a key role in the maintenance of bone health and calcium–phosphorus metabolism, yet many other functions of this vitamin have been recently postulated, such as modulation of the immune response in both infectious and autoimmune diseases. Different studies showed that severity of covid-19 infection is directly related to vitamin D level. Methods This is an observational cross-sectional study, which includes 80 COVID-19 patients, and admitted in the ward and ICU of EL Medany Hospital, EL Demerdash and EL Obour specialized hospital. All patients had positive PCR for COVID-19. Chest CT without contrast was done for all patients and categorized according to CORAD staging. Serum vitamin D level was measured, besides laboratory inflammatory markers (CRP, ferritin, d-dimer), kidney and liver function tests, and complete blood picture. Results Our study included 80 patients; 33 males and 47 females with mean age of (51±10.5 years). Measured Vitamin D level range was (10±9 ng/mL). It was found that male patients had higher level of serum vitamin D (12.6±8.6 ng/mL) than female patients (11.5±9.5 ng/mL) but with no statistically significant difference. The commonest presentations were sore throat (97.5%), and fever (93.75%). COVID-19 patients presenting with cough and fever had highly significantly lower levels of vitamin D than patients not presenting by these symptoms (P-value 0.006, 0.032) respectively. In the current study, patients with CORAD 5 in chest CT had the lowest vitamin D level (9.6±7.8 ng/mL), compared to patients with CORAD 3 (13.6±9.7 ng/mL), and CORAD 4 (11.8 ±8.8 ng/mL). According to the correlation analysis, a decrease in vitamin D levels was associated with more severe COVID-19 cases, with significantly higher blood levels of inflammatory markers CRP and ferritin (P-value 0.02, 0.01). No correlation was found between vitamin D levels and hemoglobin level, white cell count, platelet count, or D-Dimer. Conclusion Our findings suggest that the COVID-19-positive individuals with lower vitamin D levels, had significantly higher blood levels of inflammatory markers (Ferritin and CRP), and increased frequencies of ground-glass opacity appearance in chest CT scans. Accordingly, vitamin D deficiency may be a marker of poor prognosis in COVID-19 patients.

Validating the Delone and Mclean’s model in a developing country’s infectious disease pandemic context.

BackgroundThis study aimed at validating the updated DeLone and McLean’s information systems success model (D&MISS) in a developing country’s infectious disease pandemic preparedness and response context. The findings from this study are relevant to inform policies and actions for enhancing developing countries’ the Health Information System’s (HIS) performance, and specifically to improve their future pandemic readiness and response. The study sought to respond to a key research question: to what extent can the D&MISS model provide evidence to enhance the HIS’s infectious disease pandemic readiness and response in developing countries?MethodA cross-sectional study design that involved a multi-stage probability sampling approach to select eligible healthcare workers was applied. Conducted in Nigeria and Liberia, 576 primary healthcare workers, out of the proposed 600, participated, representing a response rate of 96%. The D&MISS model served as the theoretical underpinning for this study, and nine hypothesized relationships were stated before the study based on the interconnectedness of the model’s six dimensions. Structural Equation Modelling (SEM) data analysis using the Partial Least Square approach was used to determine if hypothesized relationships were supported.Results70% of the observed variance in the Net Benefit construct was explained by the predictive influence of the Use and User Satisfaction constructs. The Use construct had a slightly more substantial predictive influence than the User Satisfaction construct. Eight of the nine hypothesized relationships were supported, except for the relationship between Information Quality and Use. The relationships between System Quality and Use and User Satisfaction and Net Benefit had the highest beta coefficient, statistically significant at p < 0.05.Conclusion and relevanceThe D&MISS model demonstrated its relevance in providing evidence on the gaps of the HISs regarding future pandemic preparedness and response. However, from a future research opportunity, its enhancement and modifications with context-specific dimensions peculiar to developing countries will improve its ability to provide more context-specific evidence to improve pandemic preparedness and response for developing countries.

17 Why High Consequence Infectious Disease responses need an industrial hygienist, and preparing the industrial hygienist to respond

17 Why High Consequence Infectious Disease responses need an industrial hygienist, and preparing the industrial hygienist to respond

Optimizing the detection of emerging infections using mobility-based spatial sampling

Timely and precise detection of emerging infections is imperative for effective outbreak management and disease control. Human mobility significantly influences the spatial transmission dynamics of infectious diseases. Spatial sampling, integrating the spatial structure of the target, holds promise as an approach for testing allocation in detecting infections, and leveraging information on individuals’ movement and contact behavior can enhance targeting precision. This study introduces a spatial sampling framework informed by spatiotemporal analysis of human mobility data, aiming to optimize the allocation of testing resources for detecting emerging infections. Mobility patterns, derived from clustering point-of-interest and travel data, are integrated into four spatial sampling approaches at the community level. We evaluate the proposed mobility-based spatial sampling by analyzing both actual and simulated outbreaks, considering scenarios of transmissibility, intervention timing, and population density in cities. Results indicate that leveraging inter-community movement data and initial case locations, the proposed Case Flow Intensity (CFI) and Case Transmission Intensity (CTI)-informed spatial sampling enhances community-level testing efficiency by reducing the number of individuals screened while maintaining a high accuracy rate in infection identification. Furthermore, the prompt application of CFI and CTI within cities is crucial for effective detection, especially in highly contagious infections within densely populated areas. With the widespread use of human mobility data for infectious disease responses, the proposed theoretical framework extends spatiotemporal data analysis of mobility patterns into spatial sampling, providing a cost-effective solution to optimize testing resource deployment for containing emerging infectious diseases.

A meta-analysis on global change drivers and the risk of infectious disease.

Anthropogenic change is contributing to the rise in emerging infectious diseases, which are significantly correlated with socioeconomic, environmental and ecological factors1. Studies have shown that infectious disease risk is modified by changes to biodiversity2-6, climate change7-11, chemical pollution12-14, landscape transformations15-20 and species introductions21. However, it remains unclear which global change drivers most increase disease and under what contexts. Here we amassed a dataset from the literature that contains 2,938 observations of infectious disease responses to global change drivers across 1,497 host-parasite combinations, including plant, animal and human hosts. We found that biodiversity loss, chemical pollution, climate change and introduced species are associated with increases in disease-related end points or harm, whereas urbanization is associated with decreases in disease end points. Natural biodiversity gradients, deforestation and forest fragmentation are comparatively unimportant or idiosyncratic as drivers of disease. Overall, these results are consistent across human and non-human diseases. Nevertheless, context-dependent effects of the global change drivers on disease were found to be common. The findings uncovered by this meta-analysis should help target disease management and surveillance efforts towards global change drivers that increase disease. Specifically, reducing greenhouse gas emissions, managing ecosystem health, and preventing biological invasions and biodiversity loss could help to reduce the burden of plant, animal and human diseases, especially when coupled with improvements to social and economic determinants of health.

Sex differences in CD8+ T cell responses during adaptive immunity.

Biological sex is an important variable that influences the immune system's susceptibility to infectious and non-infectious diseases and their outcomes. Sex dimorphic features in innate and adaptive immune cells and their activities may help to explain sex differences in immune responses. T lymphocytes in the adaptive immune system are essential to providing protection against infectious and chronic inflammatory diseases. In this review, T cell responses are discussed with focus on the current knowledge of biological sex differences in CD8+ T cell mediated adaptive immune responses in infectious and chronic inflammatory diseases. Future directions aimed at investigating the molecular and cellular mechanisms underlying sex differences in diverse T cell responses will continue to underscore the significance of understanding sex differences in protective immunity at the cellular level, to induce appropriate T cell-based immune responses in infection, autoimmunity, and cancer. This article is categorized under: Immune System Diseases > Molecular and Cellular Physiology Infectious Diseases > Molecular and Cellular Physiology.

450 Developing Methods for High-Resolution Characterization of Plasma Cells

OBJECTIVES/GOALS: Antibodies play an important role in the pathogenesis of a wide range of diseases, including cancer, autoimmune diseases, and infections. There are currently no reliable methods to isolate and study specific plasma cell subpopulations as antibody production sources. We aim to develop methods to study plasma cells in high resolution. METHODS/STUDY POPULATION: We will use molecular cloning to engineer fusion proteins that would bind plasma cell proteins to study these cells based on their surface features. The first phase of our study consists of assessing the efficacy of this plasma cell isolation method in established cell lines (e.g., RPMI 8226) and also antibody-secreting cell lines that we are establishing as a part of this study. In the second phase of the study, we will assess the efficacy of this method by studying antigen-specific plasma cell populations in the bone marrow aspiration samples of 20 healthy volunteers using various assays, including ELISPOT, flow cytometry, and fluorescent microscopy. RESULTS/ANTICIPATED RESULTS: We have designed the constructs and have completed the cloning. The final plasmids have been verified using various restriction enzymes and Sanger sequencing. Following the transfection of Freestyle HEK 293F cells and isolation of respective proteins, we expect to be able to utilize these engineered proteins to differentiate various antibody-secreting plasma cells. We will use cell lines for proof-of-concept experiments and will subsequently move this method to human bone marrow samples. We expect to be able to visualize multiple specific antibody-secreting plasma cell populations using fluorescent microscopy and utilize this method to isolate them by cell sorting via flow cytometry. DISCUSSION/SIGNIFICANCE: We expect to be able to use this method to target specific plasma cell clones in the advancement of precision medicine regarding the treatment of plasma cell disorders (e.g., multiple myeloma) and also expand its use in other areas, such as antibody discovery and the assessment of the humoral immune responses in infectious diseases.

Infectious Disease Preparedness for Homeless Populations: Recommendations from a Community–Academic Partnership

Abstract: Background: People experiencing homelessness are at increased risk of infectious disease transmission due to congregate living conditions, barriers to healthcare, and excess burden of underlying chronic disease. Objectives: We are a multisectoral community–academic partnership working to address the intersecting crises of homelessness and health disparities in Tippecanoe County, Indiana. We offer key recommendations for infectious disease preparedness and risk mitigation for homeless populations based on our ongoing community-based participatory research and lessons learned through COVID-19 response and Monkeypox preparations. Lessons Learned: Infectious disease preparedness and response in homeless populations requires strong local partnerships; ongoing training and support for staff and volunteers of homeless shelters and service agencies; tailored outreach, education, and communication with people experiencing homelessness; and standardized processes for creating, disseminating, enforcing, and evaluating public health policies in homeless shelters. Consistency and open communication are key to a successful community-academic partnership. Conclusions: Community–academic partnerships are critical to effective infectious disease preparedness in homeless populations. The lessons learned from community-based participatory research with homeless communities and multisectoral partners on the frontline can improve future outbreak and pandemic response for people experiencing homelessness and other vulnerable communities in the United States.

Characteristics and courses of COVID-19 in patients from the first through fifth waves of the disease: Focused on a single public health center in Tokyo, Japan

Objective Coronavirus disease 2019 (COVID-19) became a global public health threat, and local public health centers in Japan implemented an infectious disease response to support patients. The response was subsequently modified to meet the needs for each of the five waves of infection. The study aim was to analyze the characteristics and courses of the disease in patients with COVID-19 at a single public health center. The study period included the first through fifth waves of the disease.Methods We utilized a descriptive epidemiological design in this study and data of patients with COVID-19 from one administrative district in Tokyo, Japan. We analyzed age, gender, nationality, symptoms at diagnosis, the route of infection, the recovery environment, and associated morbidity intervals, including case fatality rate, days from symptom onset to diagnosis, days from diagnosis to hospitalization, and recovery time for each of the first through fifth waves.Results From February 2020 to November 2021, 11,252 patients were diagnosed with COVID-19. Specifically, in the first wave, 151 patients were diagnosed, followed by 803 in the second wave, 2,406 in the third wave, 1,480 in the fourth wave, and 6,412 in the fifth wave. Hospitalization was the primary recovery environment during the first wave, while home recovery became the primary approach from the third wave onward. The case fatality rate was highest during the first wave, likely because of limited testing and treatment options for severe cases. The median time from onset to diagnosis was seven days in the first wave, significantly longer than for the other waves. The median time from diagnosis to hospitalization was one day in the first through fourth waves but three days in the fifth wave. The extension of this interval suggests that hospitalization was delayed in this wave as the number of severe patients increased rapidly, likely because of the novel COVID-19 variant.Conclusion This study of patients testing positive for COVID-19 provides valuable insights into the characteristics and courses of the pandemic within this district. These findings can inform regarding the development of effective strategies to manage the ongoing COVID-19 pandemic and other future emerging infectious diseases.

Lessons Learned From Implementation of Mpox Surveillance During an Outbreak Response in Tennessee, 2022.

Mpox surveillance was integral during the 2022 outbreak response. We evaluated implementation of mpox surveillance in Tennessee during an outbreak response and made recommendations for surveillance during emerging infectious disease outbreaks. To understand surveillance implementation, system processes, and areas for improvement, we conducted 8 semistructured focus groups and 7 interviews with 36 health care, laboratory, and health department representatives during September 9-20, 2022. We categorized and analyzed session transcription and notes. We analyzed completeness and timeliness of surveillance data, including 349 orthopoxvirus-positive laboratory reports from commercial, public health, and health system laboratories during July 1-August 31, 2022. Participants described an evolving system and noted that existing informatics platforms inefficiently supported iterations of reporting requirements. Clear communication, standardization of terminology, and shared, adaptable, and user-friendly informatics platforms were prioritized for future emerging infectious disease surveillance systems. Laboratory-reported epidemiologic information was often incomplete; only 55% (191 of 349) of reports included patient address and telephone number. The median time from symptom onset to specimen collection was 5 days (IQR, 3-6 d), from specimen collection to laboratory reporting was 3 days (IQR, 1-4 d), from laboratory reporting to patient interview was 1 day (IQR, 1-3 d), and from symptom onset to patient interview was 9 days (IQR, 7-12 d). Future emerging infectious disease responses would benefit from standardized surveillance approaches that facilitate rapid implementation. Closer collaboration among informatics, laboratory, and clinical partners across jurisdictions and agencies in determining system priorities and designing workflow processes could improve flexibility of the surveillance platform and completeness and timeliness of laboratory reporting. Improved timeliness will facilitate public health response and intervention, thereby mitigating morbidity.

How Do Past Immunization Strategies Compare With the COVID-19 Immunization Rollout: A New Zealand Analysis.

The aim of this study was to compare past New Zealand immunization strategies with the New Zealand coronavirus disease 2019 (COVID-19) immunization roll-out. Using the READ document analysis method, 2 New Zealand immunization strategies (for influenza and measles) were analyzed for how the disease, context, vaccine supply and demand, ethical principles (equity, individual autonomy, and maximizing benefits), and the Treaty of Waitangi impacted the immunization programs. The findings were compared with the ongoing COVID-19 mass immunization program in New Zealand, as of October 15, 2021. Several themes common to the case-studies and the COVID-19 pandemic were identified including the importance of equity, obligations under the Treaty of Waitangi, ethical mandates, and preparedness. Future emergency planning should integrate learnings from other infectious disease responses and immunization programs to avoid repeating mistakes and to create better health outcomes. This study has provided a basis for ongoing research into how an appropriate immunization plan can be developed that incorporates ethical values, the Treaty of Waitangi (in the NZ context), and evidence-based research to increase trust, equity, health, and preparedness for future outbreaks.