Ongoing Vaccine Research Articles

Preparing for Mpox Resurgence: Surveillance Lessons From Outbreaks in Toronto, Canada.

With many global jurisdictions, Toronto, Canada, experienced an mpox outbreak in spring/summer 2022. Cases declined following implementation of a large vaccination campaign. A surge in early 2023 led to speculation that asymptomatic and/or undetected local transmission was occurring in the city. Mpox cases and positive laboratory results are reported to Toronto Public Health. Epidemic curves and descriptive risk factor summaries for the 2022 and 2023 outbreaks were generated. First- and second-dose vaccination was monitored. Mpox virus wastewater surveillance and whole genome sequencing were conducted to generate hypotheses about the source of the 2023 resurgence. An overall 515 cases were reported in spring/summer 2022 and 17 in the 2022-2023 resurgence. Wastewater data correlated with the timing of cases. Whole genome sequencing showed that 2022-2023 cases were distinct from 2022 cases and closer to sequences from another country, suggesting a new importation as a source. At the start of the resurgence, approximately 16% of first-dose vaccine recipients had completed their second dose. This investigation demonstrates the importance of ongoing surveillance and preparedness for mpox outbreaks. Undetected local transmission was not a likely source of the 2022-2023 resurgence. Ongoing preexposure vaccine promotion remains important to mitigate disease burden.

Злокачественный коклюш у паллиативного пациента

Whooping cough is a highly contagious respiratory disease. despite ongoing vaccination, the disease is endemic in developing and developed countries. newborns and children who are not vaccinated or partially immunized become most severely ill. The severity of symptoms depends on factors such as the patient's age, the strength of the immune response, and the degree of systemic bacterial dissemination. The most severe form of pertussis is malignant pertussis, which is characterized by large leukocytosis, refractory hypoxemia, pulmonary hypertension and cardiopulmonary impairment. This article is devoted to the clinical observation of a patient with a malignant course of whooping cough.

Effective Targeting of Evolutions in Concerns Underpinning COVID Vaccine Hesitancy in Patients with Sickle Cell Disease across the Lifespan of the COVID19 Pandemic

COVID vaccine hesitancy among patients with sickle cell disease (SCD) was prevalent during the pandemic. This subset of vaccine hesitancy within the SCD population is of particular concern due to the elevated risk of severe illness associated with COVID-19 in individuals with SCD. Numerous factors contribute to vaccine hesitancy in this context, including concerns specific to SCD, such as potential interactions with disease-modifying therapies, uncertainty regarding vaccine efficacy in this population, mistrust in healthcare systems, and historical disparities in healthcare access and delivery. Underlying psychological factors, such as fear and anxiety, may also influence vaccine hesitancy in patients with SCD. We sought to survey our patients' feelings towards the COVID19 vaccination in the peak of the pandemic (Sept-Dec 2021), as we had noted that some patients had declined the offer of vaccination and others had had a one or two doses, then stopped. 54 patients with SCD were surveyed anonymously and data analysed in excel and NVivo. 27.8% had had no doses and only 14.8% had had the 3 doses as recommended at that time leaving 57.4% partially vaccinated. Breaking this down by age, the younger patients (<16y) were more likely to have had no doses (0%) with progressive rise in uptake to the older age group (>35) where 13.9% had had no doses. Even in this older age group, only 19.4% were fully vaccinated however (A). Qualitative analysis of text responses (B) revealed themes of concern regarding: Lack of trust in the new and ‘untested’ vaccine:Fear of side effects and complications, particularly concerns about the vaccine's compatibility with their conditions and medications.Mistrust in the vaccine's efficacy and necessityLack of long-term research and unknown effectsInfluence of social media and misinformationPersonal choice and autonomyDesire for more information and communication We then undertook semi structured interviews with volunteers to understand these concerns in greater depth and progressively developed a toolkit of resources around commonly reported concerns to inform shared decision making. Discussion of these resources with patients increased our understanding of the concerns in greater depth and permitted iterative improvements to the resource such that it reduced hesitancy in all respondents, garnering a self-reported reduction of 61% on a 1 to 5 Likert scale. More recently, we have noted a significant cohort of patients who, although they were happy to accept the initial offer of 2-3 doses, have not assented to have further booster doses. We therefore re-surveyed (July 2023). 44 patients replied. 20.5% had had no doses and only 11.4% had had the 5 doses recommended leaving 68.2% partially vaccinated (C). A similar age dependent increase in acceptance was seen (60% of under 16s unvaccinated vs.16.7% of 35 & overs). Only 36.4% had accepted the offer of a broader coverage booster (D). There was an evolution in qualitative themes (E) Mistrust in/scepticism about vaccine technologyDoubts about vaccine efficacySide effects experiencedAnger at being singled out/‘forced’ to get boostersBoosters reminding of the pandemic's impact on mental health Most worryingly, there are statements regarding dissatisfaction with healthcare providers' responses regarding the vaccine and suggestions that continuing to promote the vaccine in the face of deep-rooted objections is eroding the doctor-patient relationship and level of trust and confidence in the team which is frequently hard won and highly prized by patients with SCD. Appreciating the causes of the underlying concerns and development of tailored interventions are necessary to develop targeted educational campaigns that address SCD-specific concerns, effective communication strategies that involve healthcare providers and patient advocacy groups, and the provision of accurate and transparent information. The more recent set of themes are more challenging to develop targeted resources towards, but they contain critical learning for physicians regarding the potential damage caused by promoting the vaccine too strongly to those who remain sceptical. By more fully understanding the sources of ongoing vaccine hesitancy among patients with SCD we can best support our patients to mitigate the potentially devastating consequences of the disease in this vulnerable population whilst maintaining the fragile therapeutic alliance.

Breakthrough COVID-19 infections and perceived vaccine effectiveness

IntroductionWhile SARS-CoV-2 vaccines provide significant protection against severe COVID-19 illness, breakthrough infections have sparked confusion among patients about the effectiveness of vaccination. It’s unclear if (or to what extent) breakthrough infection experiences impact public perceptions of COVID-vaccine effectiveness, though the answer may have significant implications for public health communications and ongoing vaccine acceptance. MethodsWe conducted a survey of 2,500 adults in the United States (February 27 – March 9, 2023) in order to better understand the relationship between breakthrough COVID-19 infections and perceived vaccine effectiveness. Survey respondents were selected using a stratified, quota sampling approach to ensure representativeness; analysis was conducted on responses from 1,928 participants who received a COVID-19 vaccine. FindingsAmong those who tested positive for COVID-19 after being vaccinated, 21.18 % said that COVID-19 vaccines had been “less effective” than they initially expected, compared with 10.0 % of those who did not experience any breakthrough infections (X2 = 75.551; φ = 0.198; p ≤ 0.001). Those who experienced their own breakthrough infection were 1.37 times less likely to report perceived vaccine efficacy, while those whose family members experienced a breakthrough infection were 1.64 times less likely to report the same, ceteris paribus. The largest effect was observed among those who experienced both a personal and familial breakthrough infection. This group was almost two times less likely to describe COVID-19 vaccines as “very effective”. DiscussionBreakthrough infections correlated with lower overall levels of perceived vaccine effectiveness, even after accounting for demographic and political considerations. Moving forward, public officials and health professionals should work proactively to ensure that breakthrough infections are understood in the broader context of overall vaccine effectiveness.

The relationship between the number of COVID-19 vaccines and infection with Omicron ACE2 inhibition at 18-months post initial vaccination in an adult cohort of Canadian paramedics

The coronavirus disease 2019 (COVID-19) pandemic, caused by the SARS-CoV-2 virus, has rapidly evolved since late 2019, due to highly transmissible Omicron variants. While most Canadian paramedics have received COVID-19 vaccination, the optimal ongoing vaccination strategy is unclear. We investigated neutralizing antibody (NtAb) response against wild-type (WT) Wuhan Hu-1 and Omicron BA.4/5 lineages based on the number of doses and past SARS-CoV-2 infection, at 18 months post-initial vaccination (with a Wuhan Hu-1 platform mRNA vaccine [BNT162b2 or mRNA-1273]). Demographic information, previous COVID-19 vaccination, infection history, and blood samples were collected from paramedics 18 months post-initial mRNA COVID-19 vaccine dose. Outcome measures were ACE2 percent inhibition against Omicron BA.4/5 and WT antigens. We compared outcomes based on number of vaccine doses (two vs. three) and previous SARS-CoV-2 infection status, using the Mann-Whitney U test. Of 657 participants, the median age was 40 years (IQR 33–50) and 251 (42 %) were females. Overall, median percent inhibition to BA.4/5 and WT was 71.61 % (IQR 39.44–92.82) and 98.60 % (IQR 83.07–99.73), respectively. Those with a past SARS-CoV-2 infection had a higher median percent inhibition to BA.4/5 and WT, when compared to uninfected individuals overall and when stratified by two or three vaccine doses. When comparing two vs. three WT vaccine doses among SARS-CoV-2 negative participants, we did not detect a difference in BA.4/5 percent inhibition, but there was a difference in WT percent inhibition. Among those with previous SARS-CoV-2 infection(s), when comparing two vs. three WT vaccine doses, there was no observed difference between groups. These findings demonstrate that additional Whttps://www.covid19immunitytaskforce.ca/citf-databank/#accessing https://www.covid19immunitytaskforce.ca/citf-databank/#accessinguhan Hu-1 platform mRNA vaccines did not improve NtAb response to BA.4/5, but prior SARS-CoV-2 infection enhances NtAb response.

Information Consumption, Trust Dynamics and COVID-19 Vaccine Hesitancy among Older Adults: Implications for Health Messaging.

Staying well informed about the evolving COVID-19 pandemic and vaccine recommendations is vital for older adults, especially for low-income older adults, who have been disproportionately impacted by the pandemic. However, the overwhelming infodemic poses a significant challenge, affecting vaccine decision-making. This study explores how a group of predominantly low-income older adults navigate health information and how their trust in information and vaccines evolves throughout the pandemic. Our objective is to provide insights that will guide future public health messaging for this demographic. Analyzing qualitative data from 77 older adults (aged 65 to 94) collected through focus groups and interviews, our findings reveal that participants' experiences with information overload eroded their trust in authority, leading to vaccine hesitancy. Moreover, the need for a booster has affected belief in vaccine safety and efficacy. As participants lost faith in the media and authoritative sources, they increasingly leaned on personal networks for guidance. These results underscore the urgent necessity for clear, unambiguous ongoing vaccine guidance to restore institutional trust among older adults. Additionally, recognizing the influential role of direct networks in vaccine decisions, integrating care workers, service providers, and peer-to-peer support into health messaging mechanisms could prove valuable.

Advancing Syphilis Research: Exploring New Frontiers in Immunology and Pharmacological Interventions

In recent years, the global resurgence of syphilis has posed significant challenges to public health. This sexually transmitted infection, caused by the bacterium Treponema pallidum, can have severe consequences if left untreated, including neurological and cardiovascular complications. Diagnosing syphilis is complex due to its diverse clinical presentations, necessitating a multifaceted approach, including serological, molecular, and direct techniques such as dark-field microscopy. Penicillin remains the primary and effective treatment, but emerging macrolide-resistant strains have spurred investigations into alternative antibiotics. Syphilis vaccine development faces unique hurdles, yet promising strategies are under investigation. Targeted prevention strategies focus on high-risk populations such as men who have sex with men, pregnant women, and individuals with multiple sexual partners. The integration of syphilis services into primary healthcare enhances accessibility, early detection, and treatment. Innovative point-of-care diagnostics offer rapid, sensitive testing, while ongoing vaccine research holds the potential for long-term prevention. Addressing the global burden of syphilis requires a multifaceted approach, encompassing immunological advancements, innovative diagnostics, targeted prevention, and primary healthcare integration. Collaborative efforts between governments, healthcare systems, researchers, and communities are essential to effectively combat syphilis, striving toward a syphilis-free future that promotes better sexual health and overall well-being.

Risk factors and titers of COVID-19 infection in a longitudinal statewide seroepidemiology cohort

BackgroundVirginia is a large state in the USA, yet it remains unclear what percentage of the population has had natural COVID-19 infection and whether risk factors for infection have changed over time.MethodsUsing a longitudinal cohort, from December 2021-July 2022 we performed follow up serology and a questionnaire on 784 individuals from across Virginia who had previously participated in a statewide COVID-19 seroepidemiology study in 2020. Children were also invited to participate and an additional 62 children also completed the study. Serology was performed using Roche nucleocapsid and spike serological assays.ResultsThe majority of participants were white (78.6%), over 50 years old (60.9%), and reported having received COVID-19 vaccine (93.4%). 28.6% had evidence of prior COVID-19 infection (nucleocapsid positive). Reweighted by region, age, and sex to match the Virginia census data, the seroprevalence of nucleocapsid antibodies was estimated to be 30.6% (95% CI: 24.7, 36.6). We estimated that 25–53% of COVID-19 infections were asymptomatic. Infection rates were lower in individuals > 60 years old and were higher in Blacks and Hispanics. Infection rates were also higher in those without health insurance, in those with greater numbers of household children, and in those that reported a close contact or having undergone quarantine for COVID-19. Participants from Southwest Virginia had lower seropositivity (16.2%, 95% CI 6.5, 26.0) than other geographic regions. Boosted vaccinees had lower infection rates than non-boosted vaccinees. Frequenting indoor bars was a risk factor for infection, while frequently wearing an N95 mask was protective, though the estimates of association were imprecise. Infection rates were higher in children than adults (56.5% vs. 28.6%). Infection in the parent was a risk factor for child infection. Spike antibody levels declined with time since last vaccination, particularly in those that were vaccinated but not previously infected. Neutralizing antibody positivity was high (97–99%) for wild type, alpha, beta, gamma, delta, and omicron variants. Neutralizing antibody levels were higher in the follow-up survey compared to the first survey in 2020 and among individuals with evidence of natural infection compared to those without.ConclusionsIn this longitudinal statewide cohort we observed a lower-than-expected COVID-19 infection rate as of August 2022. Boosted vaccinees had lower infection rates. Children had higher infection rates and infections tracked within households. Previously identified demographic risk factors for infection tended to persist. Even after the omicron peak, a large number of Virginians remain uninfected with COVID-19, underscoring the need for ongoing vaccination strategies.

Barriers and enablers to implementation of COVID-19 vaccine programs in a rural and regional Queensland: A provider perspective.

Vaccines formed the core of Australia's National COVID-19 Plan in combination with other public health measures. Vaccine rates varied geographically, and lower uptake was seen in some regional and remote areas. Explore barriers and enablers to implementing COVID-19 vaccine programs and recommendations for improvement from a vaccine provider perspective in rural and regional Queensland (QLD). Participants included eleven healthcare personnel (HCP) from rural (45%) and regional (55%) settings in the Wide Bay region, QLD, Australia. Semi-structured interviews were conducted to identify barriers and enabling factors HCP experienced implementing COVID-19 programs, in addition to their recommendations to optimise ongoing implementation of vaccine programs. Braun and Clarke's reflexive thematic analysis of interview transcripts was performed, and over-arching themes were identified. Four barrier themes were identified: 1. operational barriers, 2. communication issues, 3. financial constraints, and 4. leadership and coordination. Four enabler themes were also identified: 1. adaptability; 2. prior experience and knowledge; 3. collaboration and teamwork; and 4. community engagement. Recommendations for optimising ongoing vaccine rollout included reducing the administrative burden on providers, increasing involvement of primary care and the private sector in planning and decision making, improving communication methods, reviewing financial remuneration for private providers, and decentralising decision-making. There were multiple barriers and enablers to implementation of COVID-19 programs experienced by rural and regional HCP in the Wide Bay region of QLD which were consistent with existing literature. A range of actionable recommendations were identified that could optimise the COVID-19 vaccine program and future vaccine programs in rural and regional areas.

SARS-CoV-2 infection following booster vaccination: Illness and symptom profile in a prospective, observational community-based case-control study

Booster COVID-19 vaccines have shown efficacy in clinical trials and effectiveness in real-world data against symptomatic and severe illness. However, some people still become infected with SARS-CoV-2 following a third (booster) vaccination. This study describes the characteristics of SARS-CoV-2 illness following a third vaccination and assesses the risk of progression to symptomatic disease in SARS-CoV-2 infected individuals with time since vaccination. This prospective, community-based, case-control study used data from UK-based, adult (≥18 years) users of the COVID Symptom Study mobile application, self-reporting a first positive COVID-19 test between June 1, 2021 and April 1, 2022. To describe the characteristics of SARS-CoV-2 illness following a third vaccination, we selected cases and controls who had received a third and second dose of monovalent vaccination against COVID-19, respectively, and reported a first positive SARS-CoV-2 test at least 7 days after most recent vaccination. Cases and controls were matched (1:1) based on age, sex, BMI, time between first vaccination and infection, and week of testing. We used logistic regression models (adjusted for age, sex, BMI, level of social deprivation and frailty) to analyse associations of disease severity, overall disease duration, and individual symptoms with booster vaccination status. To assess for potential waning of vaccine effectiveness, we compared disease severity, duration, and symptom profiles of individuals testing positive within 3 months of most recent vaccination (reference group) to profiles of individuals infected between 3 and 4, 4-5, and 5-6 months, for both third and second dose. All analyses were stratified by time period, based on the predominant SARS-CoV-2 variant at time of infection (Delta: June 1, 2021-27 Nov, 2021; Omicron: 20 Dec, 2021-Apr 1, 2022). During the study period, 50,162 (Delta period) and 162,041 (Omicron) participants reported a positive SARS-CoV-2 test. During the Delta period, infection following three vaccination doses was associated with lower odds of long COVID (symptoms≥ 4 weeks) (OR=0.83, CI[0.50-1.36], p<0.0001), hospitalisation (OR=0.55, CI[0.39-0.75], p<0.0001) and severe symptoms (OR=0.36, CI[0.27-0.49], p<0.0001), and higher odds of asymptomatic infection (OR=3.45, CI[2.86-4.16], p<0.0001), compared to infection following only two vaccination doses. During the Omicron period, infection following three vaccination doses was associated with lower odds of severe symptoms (OR=0.48, CI[0.42-0.55], p<0.0001). During the Delta period, infected individuals were less likely to report almost all individual symptoms after a third vaccination. During the Omicron period, individuals were less likely to report most symptoms after a third vaccination, except for upper respiratory symptoms e.g. sneezing (OR=1.40, CI[1.18-1.35], p<0.0001), runny nose (OR=1.26, CI[1.18-1.35], p<0.0001), sore throat (OR=1.17, CI[1.10-1.25], p<0.0001), and hoarse voice (OR=1.13, CI[1.06-1.21], p<0.0001), which were more likely to be reported. There was evidence of reduced vaccine effectiveness during both Delta and Omicron periods in those infected more than 3 months after their most recent vaccination, with increased reporting of severe symptoms, long duration illness, and most individual symptoms. This study suggests that a third dose of monovalent vaccine may reduce symptoms, severity and duration of SARS-CoV-2 infection following vaccination. For Omicron variants, the third vaccination appears to reduce overall symptom burden but may increase upper respiratory symptoms, potentially due to immunological priming. There is evidence of waning vaccine effectiveness against progression to symptomatic and severe disease and long COVID after three months. Our findings support ongoing booster vaccination promotion amongst individuals at high risk from COVID-19, to reduce severe symptoms and duration of illness, and health system burden. Disseminating knowledge on expected symptoms following booster vaccination may encourage vaccine uptake.

Herpetic anterior uveitis following COVID-19 vaccines: a case series.

To report a case series of herpetic uveitis following COVID-19 vaccinations. Demographic, clinical and treatment-related data of herpetic anterior uveitis cases was collected at five tertiary eye hospitals between January 2021 and June 2022. A retrospective database review at one of the centers comparing the number of cases of herpetic eye disease before and after the introduction of COVID-19 vaccination was performed as well. Twenty-four patients (9 female, 15 male) with a mean age of 54 years (range 28-83 years) were diagnosed with herpetic uveitis, reporting an onset of symptoms 3-42 days after the first, second or third dose of COVID-19 vaccination. Median time between vaccination and onset of herpetic eye disease was 10 days (mean 12.7 ± 10.15 days) days. The administered vaccines were BNT162b2, mRNA-1273, BBIBP-CorV and Ad26.COV2.S. The cases included 11 HSV, 10 VZV and 1 CMV anterior uveitis, 2 were not further specified. There was an equal number of first episodes (n = 12, 50%) and recurrent episodes (n = 12, 50%). Response to established regimens was generally good. The retrospective database review revealed the exact same incidence of herpetic uveitis during the pandemic and ongoing vaccination compared to prior SARS-CoV-2. This report includes 24 cases of herpetic anterior uveitis in a temporal relationship to various COVID-19 vaccines. This study supports the potential risk of herpetic eye disease following COVID-19 vaccines, but proof of a direct, causal relationship is missing.

Annual immunisation coverage report 2021.

We analysed Australian Immunisation Register (AIR) data as at 3 April 2022 for children, adolescents and adults for the calendar year 2021, with data on trends from previous years also presented. 'Fully vaccinated' coverage in Australian children in 2021 was 0.6-0.8 of a percentage point lower than in 2020 at the 12-month (94.2%) and 60-month (94.0%) age assessment milestones, but stable at the 24-month milestone (92.1%). Due to the lag time involved in assessment at milestone ages, 'fully vaccinated' coverage figures for 2020 and 2021 predominantly reflect vaccinations due in 2019 and 2020, respectively, and hence show a small impact on childhood coverage in the first year of the coronavirus disease 2019 (COVID-19) pandemic. 'Fully vaccinated' coverage in Aboriginal and Torres Strait Islander (hereafter respectfully referred to as Indigenous) children was 0.7-1.5 percentage points lower in 2021 than 2020 at the 12-month (91.6%), 24-month (90.1%) and 60-month (96.3%) milestones, although 2.3 percentage points higher than children overall at 60 months. Influenza vaccination coverage in children aged 6-59 months was approximately 20 percentage points lower in 2021 than 2020, both for children overall (26.5%) and for Indigenous children (22.5%). 'On time' vaccination (within 30 days of the recommended age) was up to two percentage points lower in 2021 than 2020 for vaccines due at 4 and 6 months of age, suggesting possible pandemic impacts, but was similar or higher for vaccines due at 12 months of age. While on-time vaccination in Indigenous children has improved progressively since 2012, it remained 6-13 percentage points lower than in children overall in 2021. 'Fully vaccinated' coverage at the earlier milestones (3 months after due date of last scheduled vaccine) of 9, 15, 21 and 51 months was 1.5-2.8 percentage points lower for children living in the least advantaged residential area quintile than the most advantaged, a similar disparity as in 2020. Coverage at the earlier milestones was 2.3-10.0 percentage points lower for Indigenous children living in remote areas than in major cities and regional areas, with disparity at 21 months of age 2.1-2.2 percentage points higher in 2021 than in 2020, and 1.2-2.1 percentage points higher at 51 months. In 2021, a total of 80.3% of girls and 77.2% of boys (and 73.3% and 66.2% of Indigenous girls and boys) had completed the human papillomavirus (HPV) vaccination schedule by 15 years of age, 0.2-0.4 of a percentage point lower than 2020 (1.7-1.8 percentage points for Indigenous), reflecting vaccinations due in school programs prior to the pandemic with possible pandemic impact on catch-up vaccination. However, the proportion of adolescents completing the two-dose HPV vaccination schedule within a calendar year was 15.3 percentage points lower in 2021 than 2020 and 26.9 percentage points lower than in 2019, likely due to pandemic-related disruption to school-based programs. Additionally, 87.3% of adolescents (83.8% for Indigenous) had received the recommended booster dose of diphtheria-tetanus-acellular pertussis (dTpa) vaccine by 15 years, and 76.1% (66.7% for Indigenous) the recommended meningococcal ACWY vaccine dose by 17 years of age. Zoster vaccine coverage in 2021 remained relatively low, at just over 30%, in adults aged 70 years, but increased to 47% in those aged 71-79 years, reflecting ongoing catch-up vaccination. Coverage of 13vPCV was low in 2021, reaching 17.2% in adults aged 70 years and 20.1% in those aged 71-79 years. Influenza vaccination coverage in adults in 2021 was progressively higher with increasing age, reaching 62.1% in the 65-74 years age group (64.6% in Indigenous) and 68.5% in the 75+ years age group (67.7% in Indigenous). Influenza vaccine coverage for other National Immunisation Program (NIP)-eligible Indigenous adult age groups was only 22.0% for those aged 20-49 years, and 43.5% for those aged 50-64 years. By the end of 2021, a total of 91.6% of people in Australia aged 16+ years had received a second dose of a COVID-19 vaccine (71.8% for Indigenous), with over 99% of those aged 70+ years having received a second dose. Vaccination coverage in children and adolescents remained relatively high in 2021, although with some evidence of COVID-19 pandemic impacts, particularly on receipt of two doses of HPV vaccine within the same calendar year. It will be important to ensure catch-up vaccination in children and adolescents occurs. A strengthened focus on adult vaccination is needed, as coverage remained suboptimal in 2021. The impact of mandatory reporting of all NIP vaccinations from mid-2021, on completeness of AIR data, has not yet been formally evaluated.

Exploring Shigella vaccine priorities and preferences: Results from a mixed-methods study in low- and middle-income settings

BackgroundShigella is the leading bacterial cause of diarrheal mortality in children and can cause long-term effects on growth and development. No licensed Shigella vaccines currently exist but several promising candidates are in development and could be available in the next five years. Despite Shigella being a well-known public health target of the World Health Organization for decades, given current burden estimates and competing preventable disease priorities in low-income settings, whether the availability of an effective Shigella vaccine will lead to its prioritization and widespread introduction among countries at highest risk is unknown. MethodsWe conducted a mixed-methods study of national stakeholders and healthcare providers in five countries in Asia and Africa and regional stakeholders in the Pan American Health Organization to identify preferences and priorities for forthcoming Shigella vaccines. ResultsIn our study of 89 individuals, diarrhea was the most frequently mentioned serious health concern for children under five years. Antimicrobial resistance (AMR) was more often considered very concerning than diarrhea or stunting. Shigella awareness was high but not considered a serious health concern by most stakeholders. Most participants were willing to consider adding a new vaccine to the routine immunization schedule but expressed reservations about a Shigella vaccine because of lower perceived burden relative to other preventable diseases and an already crowded schedule; interest was highest among national stakeholders in countries receiving more financial support for immunization. The priority of a Shigella vaccine rose when participants considered vaccine impacts on reducing stunting and AMR. Participants strongly preferred oral and combination vaccines compared to injectable and a single-antigen presentations, citing greater perceived community acceptability. ConclusionsThis study provides a critical opportunity to hear directly from country and regional stakeholders about health priorities and preferences around new vaccines. These findings should inform ongoing Shigella vaccine development efforts and eventual vaccine introduction and implementation planning.

Results of Validating the Proprietary Method of Establishing Personal Levels of Vaccination Adherence

Introduction: Vaccination is the most efficient and cost-effective way to prevent infectious diseases. In recent years, despite the proven positive role of vaccination, there has been an ambiguous attitude towards ongoing vaccination campaigns in the world. Objective: To test and validate the proprietary method of establishing personal levels of vaccination adherence. Materials and methods: The authors have elaborated a method of assessing vaccination adherence using a specially developed questionnaire consisting of four groups (scales) and including 36 both direct and indirect statements related to immunization and serving as indicators. In April–June 2023, we conducted a questionnaire-based survey of 300 people aged 19 to 75 years. The respondents were asked to rate their level of agreement with the statements using the Likert scale. Each indicator was a value calculated for a particular respondent, expressed in points. The scoring was done manually or automatically. The data were then analyzed in SPSS Statistics 23.0 using methods of correlation analysis and descriptive statistics. Results: The vaccination adherence level was moderate in 179 (59.7 %), low in 9 (3.0 %), and high in 112 (37.3 %) respondents. The Spearman’s rank correlation analysis revealed statistically significant correlations between the responses and the actual level of commitment to vaccination. Our method has demonstrated compliance with standard requirements for internal consistency, factor validity of scales, and statistical significance of test parts (Cronbach’s α-coefficient = 0.830; the factor analysis allowed us to distinguish four components). Conclusion: Testing and subsequent validation of the own method have made it possible to determine the level of vaccination adherence as moderate as the questionnaire scales correspond to significant factors influencing the choice of a behavioral strategy. This method can be recommended both for research purposes and for practical application in healthcare institutions.

From data to action: Empowering COVID-19 monitoring and forecasting with intelligent algorithms

The COVID-19 pandemic has profoundly impacted every aspect of our lives, from economic to the social facets of contemporary society. While the new COVID-19 waves may not be anticipated to be as severe as previous ones, it would be unreasonable to assume that they will cease any time soon. Consequently, forecasting the number of future infections, recovered patients, and death cases remains a very much logical step in trying to fight against further waves, in conjunction with ongoing vaccination efforts. In this paper, we investigate the efficiency of three intelligent machine learning algorithms, namely GMDH, Bi-LSTM, and GA + NN, for COVID-19 forecasting, with an application to Iran and the United Kingdom. The experimental results show that the algorithms can be used to forecast the next six months of COVID-19 in terms of confirmed, recovered, and death cases, which gives a more ample timeframe for using the results to make better practical yet strategic decisions and take appropriate actions or measures to deploy resources effectively to contain or curb the spread of the coronavirus. Despite the distinct dynamics observed in the data, our analysis proves the robustness of the employed models.

Cholera and COVID-19 pandemic prevention in multiple hotspot districts of Uganda: vaccine coverage, adverse events following immunization and WASH conditions survey

BackgroundBetween March, 2020 and December, 2021 due to cholera and coronavirus disease 2019 (COVID-19) pandemics, there were 1,534 cholera cases with 14 deaths and 136,065 COVID-19 cases with 3,285 deaths reported respectively in Uganda. This study investigated mass vaccination campaigns for the prevention of the two pandemics namely: oral cholera vaccine (OCV) and COVID-19 vaccine coverage; adverse events following immunization (AEFI); barriers and enablers for the vaccine uptake and assessed water, sanitation and hygiene (WASH) conditions in the six cholera and COVID-19 hotspot districts of Uganda.MethodsA household survey was conducted between January and February, 2022 in the six cholera hotspot districts of Uganda which had recently conducted OCV mass vaccination campaigns and had ongoing COVID-19 mass vaccination campaigns. The survey randomly enrolled 900 households with 4,315 persons of whom 2,085 were above 18 years. Data were collected using a data entry application designed in KoBoToolbox and analysed using STATA version 14. Frequencies, percentages, odds ratios, means, confidence intervals and maps were generated and interpreted.ResultsThe OCV coverage for dose one and two were 85% (95% CI: 84.2—86.4) and 67% (95% CI: 65.6—68.4) respectively. Among the 4,315 OCV recipients, 2% reported mild AEFI, 0.16% reported moderate AEFI and none reported severe AEFI. The COVID-19 vaccination coverage for dose one and two were 69.8% (95% CI: 67.8–71.8) and 18.8% (95% CI: 17.1–20.5) respectively. Approximately, 23% (478/2,085) of COVID-19 vaccine recipient reported AEFI; most 94% were mild, 0.6% were moderate and 2 cases were severe. The commonest reason for missing COVID-19 vaccine was fear of the side effects. For most districts (5/6), sanitation (latrine/toilet) coverage were low at 7.4%—37.4%.ConclusionThere is high OCV coverage but low COVID-19 vaccine and sanitation coverage with high number of moderate cases of AEFI recorded due to COVID-19 vaccines. The low COVID-19 vaccine coverage could indicate vaccine hesitancy for COVID-19 vaccines. Furthermore, incorporation of WASH conditions assessment in the OCV coverage surveys is recommended for similar settings to generate data for better planning. However, more studies are required on COVID-19 vaccine hesitancy.

Parental acceptance of typhoid conjugate vaccine for children aged 6 months to 15 years in an outbreak setting of Lyari Town Karachi, Pakistan

BackgroundThis study aimed to evaluate the parental acceptance of Typhoid Conjugate Vaccine (TCV) and to determine the predictors of TCV vaccination status among children in an outbreak setting of extensively drug resistant (XDR) typhoid fever in Karachi, Pakistan. MethodsA cross-sectional survey using the WHO recommended rapid vaccine coverage assessment technique was conducted. Out of 11, four union councils (UCs) in Lyari Town were randomly selected. A parent or primary caretaker from the eligible household was interviewed. Data were collected using a locally validated vaccine attitudes scale (VAS). Sum of scores was calculated for VAS. A higher score denoted negative attitudes and perceptions regarding TCV and vice versa. Multivariable logistic regression was performed to determine the predictors of TCV vaccination status. ResultsBased on the 14-item parental VAS, 78.0 % of the parents had a score between 0 to <40 and 22 % had a score ≥40. VAS score of <40 was significantly associated with higher odds of receiving TCV during the campaign setting (adjusted Odds Ratio (aOR): 1.30; 95 % Confidence Interval (CI): 1.02, 1.66). The odds of receiving TCV vaccination were higher among children whose parents were aware of the ongoing vaccination campaign in the area (aOR: 4.57; 95 % CI: 2.93, 7.12) and expressed willingness to get their child vaccinated against typhoid fever (aOR: 2.54; 95 % CI: 1.82, 3.55). ConclusionParental awareness of the ongoing vaccination campaign, positive perception and attitudes towards vaccine were found to be significantly associated with TCV vaccination among children. Appropriately structured pre-vaccination awareness campaigns focused on childhood vaccination targeted towards parents are necessary to improve parental awareness, attitude and behavior towards vaccination.

COVID-19: Agent-based simulation-optimization to vaccine center location vaccine allocation problem

This article presents an agent-based simulation-optimization modeling and algorithmic framework to determine the optimal vaccine center location and vaccine allocation strategies under budget constraints during an epidemic outbreak. Both simulation and optimization models incorporate population health dynamics, such as susceptible (S), vaccinated (V), infected (I) and recovered (R), while their integrated utilization focuses on the COVID-19 vaccine allocation challenges. We first formulate a dynamic location–allocation Mixed-Integer Programming (MIP) model, which determines the optimal vaccination center locations and vaccines allocated to vaccination centers, pharmacies, and health centers in a multi-period setting in each region over a geographical location. We then extend the agent-based epidemiological simulation model of COVID-19 (Covasim) by adding new vaccination compartments representing people who take the first vaccine shot and the first two shots. The Covasim involves complex disease transmission contact networks, including households, schools, and workplaces, and demographics, such as age-based disease transmission parameters. We combine the extended Covasim with the vaccination center location-allocation MIP model into one single simulation-optimization framework, which works iteratively forward and backward in time to determine the optimal vaccine allocation under varying disease dynamics. The agent-based simulation captures the inherent uncertainty in disease progression and forecasts the refined number of susceptible individuals and infections for the current time period to be used as an input into the optimization. We calibrate, validate, and test our simulation-optimization vaccine allocation model using the COVID-19 data and vaccine distribution case study in New Jersey. The resulting insights support ongoing mass vaccination efforts to mitigate the impact of the pandemic on public health, while the simulation-optimization algorithmic framework could be generalized for other epidemics.

Attempts to Develop Vaccines Against Alzheimer's Disease: A Systematic Review of Ongoing and Completed Vaccination Trials in Humans.

In this systematic review, we evaluate the safety, tolerability, and immunogenicity of vaccination efforts against Alzheimer's disease (AD) in human subjects from both ongoing and completed vaccination trials. Databases like PubMed, Embase, and Scopus were used to identify relevant articles on completed vaccination trials whereas the clinicaltrials.gov database was used for identifying ongoing clinical trials for vaccination against AD in humans until January 2022. Only interventional randomized or non-randomized clinical trials which reported on the safety and immunogenicity of vaccine against AD in humans were included. Cochrane risk of bias tool-2 (RoB-2) or risk of bias in non-randomized studies- of intervention (ROBINS-I) was used for risk of bias assessment as appropriate. A narrative descriptive synthesis of the findings was done. Sixteen randomized/non-randomized clinical trials (phase I: six and phase II: 10) for seven different types of vaccines against AD were identified comprising a total of 2080 participants. Apart from the development of meningoencephalitis in 6% of patients receiving AN1792 in an interrupted phase II trial, the rest of the trial reported promising results on the safety and immunogenicity of vaccines. While only a subset of reported adverse events was treatment related, none of the fatalities reported during the trial were considered related to vaccine administration. The serological response rate ranged from 100% (4/16 trials) to 19.7% in an interrupted trial. Although current trials show promising results, adequately powered phase III studies are needed to conclusively establish the safety, immunogenicity and therapeutic efficacy of vaccines.

Impact of the COVID-19 Pandemic on Attitudes toward Vaccination: Representative Study of Polish Society.

The study explored the association between individuals' attitudes toward vaccination and their actual vaccination behavior. We also examined the impact of the coronavirus disease 2019 (COVID-19) pandemic and the ongoing vaccination debate on changing attitudes towards vaccination, specifically within different demographic groups. The survey was conducted among a representative sample of Poles (N = 805) using computer-assisted web interview (CAWI) technology. As demonstrated, those who identified themselves as strong vaccine supporters were statistically significantly more frequently to be vaccinated with COVID-19 booster doses, to follow a physician's recommendation on any vaccine without hesitation, and to be strengthened in their confidence in vaccines during the COVID-19 pandemic (p < 0.001 for all). However, over half of the responders declared themselves as moderate vaccine supporters/opponents, the groups whose further attitudes are likely to be affected by (mis)communication. Importantly, more than half of moderate vaccine supporters declared that their vaccine confidence was weakened during the COVID-19 pandemic, while 43% were not vaccinated against COVID-19. In addition, the study demonstrated that older and better-educated individuals were more likely to be COVID-19-vaccinated (p < 0.001 and p = 0.013, respectively). The results of this study imply that, in order to improve vaccine acceptance, it is essential to strengthen public health communication and avoid communication errors conducted during the COVID-19 pandemic.