Routine Vaccination Program Research Articles

Short term impact of the COVID-19 pandemic on incidence of vaccine preventable diseases and participation in routine infant vaccinations in the Netherlands in the period March-September 2020

We aimed to assess the impact of the COVID-19 pandemic on the incidence of vaccine-preventable diseases (VPDs) and participation in the routine infant vaccination programme in the Netherlands. The incidence of various VPDs initially decreased by 75–97% after the implementation of the Dutch COVID-19 response measures. The participation in the first measles-mumps-rubella vaccination among children scheduled for vaccination in March-September 2020 initially dropped by 6–14% compared with the previous year. After catch-up vaccination, a difference in MMR1 participation of −1% to −2% still remained. Thus, the pandemic has reduced the incidence of several VPDs and has had a limited impact on the routine infant vaccination programme.

Serological study of Japanese encephalitis virus (JEV) among acute encephalitis syndrome cases at Chandrapur, Maharashtra

Japanese encephalitis Virus (JEV) a flaviviridae family member (genus Flavivirus) is the main cause of meta-zoonotic viral encephalitis in many Asian countries. The disease was primarily reported in 1952 from Nagpur territory of Maharashtra recording nearly 16 deaths of an unknown viral encephalitis which was later awarded to be JEV; just nearer to Chandrapur reporting the present catastrophes.Hence we have undertaken present study to make a countable move not only towards the diagnosis of the diseases but also to restrict its future spread in Indian continent. Which will also aid medical practitioners to combat with this metazoonotic disorder.Amongst total suspected population nearly these 20 males and 22 females were positive. Considering monthly distribution most number of suspected cases were seen in the month of July. Most number of JEV affected population was seen more in the age group of 1 to 5 years of children and with advancement of the age reduction in the number of seropositive cases were observed. Human blood or CSF to be the reservoir Source from which isolation of opportunistic infections could be made possible. Also important role played by vaccinations could also be cross checked in JE epidemic areas. Hence role of JE Vaccine in routine vaccination programme in JEV epidemic areas could also be proved to be beneficial.

Incidence, Persistence, and Factors Associated With HPV Infection Among Male Adolescents With and Without Perinatally Acquired HIV Infection.

Infection with high-risk human papillomavirus (HR-HPV) has been shown to be more prevalent and persistent in female adolescents with HIV. However, data among male adolescents with perinatally acquired HIV (PHIV) are limited. We investigated the incidence and persistence of HR-HPV in anogenital compartments and associated factors among PHIV in comparison to HIV-uninfected (HU) male adolescents in Thailand. PHIV and HU males aged 12-24 years were enrolled. At baseline and 3 subsequent annual visits, specimens from the scrotum, penis, and anal area were obtained for HPV and other testing. From June 2013 to October 2017, 49 PHIV and 47 HU male adolescents with a median age of 18 (interquartile range 17-20) years were enrolled. PHIV had higher incidence of any HR-HPV infection than HU adolescents {33.05 [95% confidence interval (CI): 20.82 to 52.46] vs. 15.73 [95% CI: 8.18 to 30.22] per 100 person-years, P = 0.04}. The persistence of any HR-HPV genotypes (detected at ≥2 annual visits) was not different by group (PHIV 27% vs. HU 23%, P = 0.75). Having ≥3 sex partners in past 6 months (adjusted prevalence ratio 2.39, 95% CI: 1.14 to 5.05; P = 0.02) and co-infection with other sexually transmitted infections (syphilis, chlamydia, and/or gonorrhea) were associated with persistent HR-HPV infection (adjusted prevalence ratio 6.21, 95% CI: 2.87 to 13.41; P < 0.001). Thai PHIV male adolescents had a higher incidence of HR-HPV infection than those without HIV. Having multiple sex partners and co-infection with sexually transmitted infections was associated with persistent HR-HPV infection. These data demonstrate the need to prioritize PHIV male adolescents in routine and catch-up HPV vaccination programs.

Recombinant Rift Valley fever viruses encoding bluetongue virus (BTV) antigens: Immunity and efficacy studies upon a BTV-4 challenge

Many ruminant diseases of viral aetiology can be effectively prevented using appropriate vaccination measures. For diseases such as Rift Valley fever (RVF) the long inter-epizootic periods make routine vaccination programs unfeasible. Coupling RVF prophylaxis with seasonal vaccination programmes by means of multivalent vaccine platforms would help to reduce the risk of new RVF outbreaks. In this work we generated recombinant attenuated Rift Valley fever viruses (RVFVs) encoding in place of the virulence factor NSs either the VP2 capsid protein or a truncated form of the non-structural NS1 protein of bluetongue virus serotype 4 (BTV-4). The recombinant viruses were able to carry and express the heterologous BTV genes upon consecutive passages in cell cultures. In murine models, a single immunization was sufficient to protect mice upon RVFV challenge and to elicit a specific immune response against BTV-4 antigens that was fully protective after a BTV-4 boost. In sheep, a natural host for RVFV and BTV, both vaccines proved immunogenic although conferred only partial protection after a virulent BTV-4 reassortant Morocco strain challenge. Though additional optimization will be needed to improve the efficacy data against BTV in sheep, our findings warrant further developments of attenuated RVFV as a dual vaccine platform carrying heterologous immune relevant antigens for ruminant diseases in RVF risk areas.

Systematic literature review of the impact and effectiveness of monovalent meningococcal C conjugated vaccines when used in routine immunization programs

BackgroundMonovalent meningococcal C conjugate vaccine (MCCV) was introduced into the routine immunization program in many countries in Europe and worldwide following the emergence of meningococcal serogroup C (MenC) in the late 1990s. This systematic literature review summarizes the immediate and long-term impact and effectiveness of the different MCCV vaccination schedules and strategies employed.MethodsWe conducted a systematic literature search for peer-reviewed, scientific publications in the databases of MEDLINE (via PubMed), LILACS, and SCIELO. We included studies from countries where MCCV have been introduced in routine vaccination programs and studies providing the impact and effectiveness of MCCV published between 1st January 2001 and 31st October 2017.ResultsForty studies were included in the review; 30 studies reporting impact and 17 reporting effectiveness covering 9 countries (UK, Spain, Italy, Canada, Brazil, Australia, Belgium, Germany and the Netherlands). Following MCCV introduction, significant and immediate reduction of MenC incidence was consistently observed in vaccine eligible ages in all countries with high vaccine uptake. The reduction in non-vaccine eligible ages (especially population > 65 years) through herd protection was generally observed 3–4 years following introduction. Vaccine effectiveness (VE) was mostly assessed through screening methods and ranged from 38 to 100%. The VE was generally highest during the first year after vaccination and waned over time. The VE was better maintained in countries employing catch-up campaigns in older children and adolescents, compared to routine infant only schedules.ConclusionsMCCV were highly effective, showing a substantial and sustained decrease in MenC invasive meningococcal disease. The epidemiology of meningococcal disease is in constant transition, and some vaccination programs now include adolescents and higher valent vaccines due to the recent increase in cases caused by serogroups not covered by MCCV. Continuous monitoring of meningococcal disease is essential to understand disease evolution in the setting of different vaccination programs.

How Australia's commitment and activities for measles control achieved rubella elimination

Background: The global measles and rubella strategic plan 2012–20 has a target for measles and rubella elimination in five WHO regions by the end of 2020. Only one region has eliminated rubella. The WHO Strategic Advisory Group of Experts on Immunization advised rubella control was lagging and recommended rubella vaccination be introduced into all country immunisation programmes as soon as possible. We describe the impact enhanced measles control activities, using measles-mumps-rubella (MMR) vaccines, had on rubella incidence in Australia and how these activities lead to the successful elimination of both viruses. Methods and materials: We reviewed rubella notifications from Australia's National Notifiable Disease Surveillance System (1991–2018) and stratified by age, sex and vaccination status. Three-year cumulative incidences were calculated by birth-cohort to assess the impact of two major measles immunisation activities in Australia; the 1998 Measles Control Campaign (MCC), targeted children 5–12 years; and the 2001 Young Adult MMR immunisation program (YA-MMR), targeted adults 18–30 years. MMR immunisation coverage estimates were extracted and compared with notification data. Aggregate national serological survey data (1999, 2002, 2007 and 2012) was assigned to birth-cohorts and the mean, median and ranges of age-group estimates were calculated. Results: The MCC attained 96% coverage, the three-year cumulative incidence of rubella declined by 90% compared with the three years preceding. This effect was also seen following the YA-MMR with a 73% decline in pre-and-post three-year periods, however vaccine coverage during this campaign was considerably lower. Serological surveys displayed a high and constant level of immune protection among females, but males were estimated to have 4–13% lower immunity. Rubella immunity significantly benefited by a direct 17% boost in serological immunity in those 6–11 years of age in the 1999 pre-and-post serological survey. Conclusion: The use of combined MMR vaccines to address measles immunity concerns in Australia demonstrated a symbiotic benefit in not only controlling and eliminating measles transmission but rubella as well. Although the coverage of the YA-MMR was considered to be “sub-optimal”, it effectively closed the rubella immunity gap in Australia, and demonstrates that utilising combination MR-containing vaccines in routine and mass vaccination programs is effective in eliminating the transmission of both viruses.

Impact of immunization campaign triggered by meningococcal outbreak – Tuscany, 2014-2018

Abstract In 2015-2016, an outbreak of invasive meningococcal disease due to Neisseria meningitidis C/cc11 occurred in Tuscany, Italy, and caused 62 cases. Regional Health Authority launched an immunization campaign using quadrivalent meningococcal conjugate vaccine (MEN) in April 2015. We assessed the impact of meningococcal outbreak on population vaccination coverage, considering a pre-outbreak (2014), outbreak (2015-2016) and a post-outbreak period (2017-2018) for MEN and other vaccinations (HPV and MMR). We included all individuals (&amp;gt;1 year) resident in Tuscany, who received at least one vaccination dose (MEN, HPV, MMR) in the study period. We sourced anonymous data from the regional centralised register on vaccine administered, date, place and dose (for multiple-dose vaccines); birth cohort; city of residence. We analysed vaccine administration by age, time, vaccine type. We modelled MEN vaccination rate as a function of number of cases in the previous month by a quasi-Poisson model (2015-2018), and HPV and MMR vaccination using an interrupted time series analysis (2014-2018). MEN vaccinations increased significantly in 2015-2016 (average doses/month were 3400 in 2014; 25492 in 2015; 47290 in 2016). MEN immunization coverage increased during the outbreak period, peaking for age class 20-45: from 3,7% in 2014 to 10,7% in 2015 and 20,7% in 2016. MEN vaccination uptake showed a 50% increase (95% CI = 37 to 65%, P &amp;lt; 0.001) in the rate for each new case diagnosed in the previous month. HPV vaccination rate showed statistically significant decreasing trend in before the campaign (-3% per month, 95% CI = -1 to -5%, P = 0.004) disappearing afterwards (0%, 95% CI = -2 to 1%, P = 0.96); with no trend for MMR. The campaign successfully increased MEN coverage mostly among young adults, although vaccination demand was associated with occurrence of cases. The campaign did not affect routine vaccination programmes, and likely contributed positively to HPV uptake. Key messages The immunization campaign triggered by meningococcal outbreak in Tuscany in 2015-2016 successfully increased coverage, mostly among young adults, without affecting routine vaccination programmes. During response campaign triggered by meningitis outbreak in Tuscany in 2015-2016, meningococcal vaccine uptake was influenced by the occurrence of cases.

Haemophilus influenzae type b capsular polysaccharide antibody levels in Japanese young patients with hematological malignancies and asplenia

Individuals with immunosuppressive condition have a high risk of invasive Haemophilus influenzae type b (Hib) infection. In Japan, routine Hib vaccination program for children under 5 years old was introduced in December 2008. However, the national policy does not make provision for individuals aged ≥5 years who have medical conditions associated with a high risk of invasive Hib disease to receive Hib vaccine. We measured serum anti-polyribosylribitol phosphate specific (anti-PRP) antibodies to Hib in patients aged ≥5 years with hematological malignancies and asplenia and evaluated their levels of anti-PRP antibodies in post administration of Hib vaccine era. A total of 65 patients (48 with hematological malignancies, and 17 with asplenia) were included in this study, of which 84% had not received Hib vaccine. In addition, 95.4% had short-term protective levels of anti-PRP antibodies (defined as ≥0.15 μg/mL) and 41.5% had long-term protective levels of anti-PRP antibodies (defined as ≥1.0 μg/mL). Five patients had low anti-PRP antibody levels despite a history of Hib vaccination. Our results suggest that young patients with underlying diseases such as hematological malignancies and asplenia may be at risk of invasive Hib disease. Hence, we recommend they should receive Hib vaccines even if they are over the age limit for routine Hib vaccination program.

Clinical, molecular and cytopathological characterization of a Newcastle disease virus from an outbreak in Baghdad, Iraq

BackgroundThe frequent outbreaks of Newcastle disease virus (NDV) in Iraq pose a constant threat to commercial poultry, despite the introduction of routine vaccination programmes. Several factors, particularly stress factors and coinfections, might play a role in increasing NDV outbreaks in poultry species.ObjectivesThe current study was aimed to characterize an NDV isolate from an outbreak in North Baghdad, Iraq.MethodsClinical pathogenicity of the isolate was determined experimentally in chickens. In vitro studies included cytopathological examination, as well as molecular and phylogenetic analyses.ResultsBased on the clinical studies and pathogenicity indices (mean death time and intracerebral and intravenous pathogenicity indices), the isolate was characterized as velogenic (highly virulent). Reverse transcriptase polymerase chain reaction targeting the partial fusion protein gene of the NDV genome confirmed the detection. Partial sequencing of the hypervariable region of the fusion gene identified the presence of an avirulent (lentogenic) fusion protein motif (GRQGRL). Phylogenetic analysis of the new isolate along with previously known regional isolates revealed that the new isolate was related to genotype II strains. Additionally, sequence analysis indicated a distinct genetic lineage of the new isolate, which was related to some of the lineages identified in previous outbreaks in the Middle East.ConclusionThe current study offers essential information on the epidemiology, characteristics and diagnosis of NDV for disease control in Iraq. The isolate was found to belong to genotype II and possess an avirulent fusion protein motif.

Immunogenicity persistence in children of hepatitis A vaccines Healive® and Havrix®: 11 years follow-up and long-term prediction

ABSTRACT Background: Hepatitis A vaccine has been used in mass and routine public vaccination programs in China. Long-term follow-up studies are required to determine the duration of protection and the need for booster vaccinations. Methods: A prospective, randomized, open-label clinical trial was performed to compare the geometric mean concentration (GMC) and seroprotection rates of anti-Hepatitis A virus (HAV) antibodies elicited by the inactivated vaccines Healive and Havrix. 400 healthy children were randomly assigned 3:1 ratio to receive two doses of Healive or Havrix at 0 and 6 months. Persistence of anti-HAV antibodies for 5 years post immunization has been reported The current study reports new data at 11 years post immunization for the purpose of showing antibody persistence. Sensitivity analyzes were performed to assess the results. In addition, predictions for long-term antibody persistence were performed using a statistical model. Two different serological assays were used that were shown to be 98.3% concordant for detecting anit-HAV antibody. Results: GMCs were significantly higher following Healive compared to Havrix at 1, 6, 7, 66, 112 and 138 months post-vaccination. In addition, the GMCs obtained using sensitivity analysis were very similar to those obtained using the original models. Prediction analysis indicated that the duration of protection for both vaccines was at least 30 years after immunization, with a lower limit of the 95% confidence interval for GMC of greater than 20mIU/mL. Conclusions: Healive is more immunogenic than Havrix in children at 11 years post full immunization. Prediction analysis indicated at least 30 years of antibody persistence for both vaccines.

Vaccination Programs for Adults in Europe, 2019.

Background: While all European countries implement vaccination programs for children, there are gaps in terms of vaccination programs for adults. Methods: We studied the 2019 vaccination policies for adults in 42 European countries. Results: Vaccination programs for adults were in place in all countries. However, there were considerable differences between countries in terms of number of vaccinations, target populations and frame of implementation (recommended or mandatory vaccinations). In particular the following vaccination policies were in place: influenza (42 countries), tetanus (31), diphtheria (30), pneumococcus (29), hepatitis B (20), pertussis (18), measles (14), human papilloma virus (14), meningococcus tetravalent A,C,W,Y (14), rubella (13), hepatitis A (11), mumps (11), poliomyelitis (10), herpes zoster (9), varicella (8), tick-born encephalitis (8), meningococcus B (6), rabies (6), Haemophilus influenzae type b (5), tuberculosis (3), typhoid fever (3), meningococcus C (2), and yellow fever (1). Seventeen countries implement mandatory vaccinations, mainly against diphtheria, tetanus and hepatitis B. Conclusions: There are significant differences in vaccination programs for adults in Europe. Routine vaccination programs for adults need to be strengthened. A consensus-based vaccination program is needed.

Vaccination against HPV: Theoretical Aspects and Practical Results of Cervical Cancer Prevention

Relevance.Cervical cancer (CC) continues to be the focus of attention of oncologists all over the world due to the fact that the incidence of it over the past decades has not tended to decrease. The steady increase in morbidity, high mortality rates, and the tendency to «rejuvenate» the disease, the relatively low detection rate of the early stages of the disease due to poor results of cytological screening predetermine the search for new scientifically based approaches to solving cervical cancer problems. A promising direction for the prevention of squamous cell carcinoma and adenocarcinoma associated with human papillomavirus (HPV) is prophylactic vaccination against HPV, the need for which is due to the role of HPV infection in carcinogenesis processes.The aimof this article is to summarize the currently available data on advances in the prevention of precancerous lesions and cervical cancer, primarily through vaccination against HPV infection.Conclusions.The creation of vaccines for the prevention of oncogenic HPV types is a significant achievement in the biomedical research area. The successful development of a group of vaccines, which can confidently be called the vaccines of the 21st century, gives us hope that modern medicine has the potential to reduce population cancer risk and reduce the likelihood of early onset of cervical cancer. Demonstration of the efficacy and feasibility of routine HPV vaccination programs in a number of countries demonstrates encouraging progress in solving cervical cancer problems. Vaccination against HPV will not only ensure epidemiological well-being, but also lead to a decrease in morbidity and mortality from such a terrible complication of human papillomavirus infection – cervical cancer.

The estimated impact of the 5-year national vaccination program on the trend of 23-valent pneumococcal polysaccharide vaccine vaccination rates in the elderly in Japan, 2009–2018

Pneumonia is the third most common cause of death in Japan. Low vaccination rates are thought to be related to low levels of public subsidy. Since 2014, the Japanese government has offered subsidies through a 5-year national routine vaccination program of the 23-valent pneumococcal polysaccharide vaccine (PPV23) for older adults at age ≥65 years with 5-year age intervals. We previously reported that, 2 years into the 5-year program, the estimated vaccination rate was 40.6% at the end of 2015, a significant increase compared with periods before the program introduced. Here, we present an update on the estimated vaccination coverage of the 5-year national routine vaccination program at the end of 2018. The PPV23 vaccination rates were calculated by dividing the cumulative amount shipped to each municipality by the population aged ≥65 years. At the end of 2018, the completion of the 5-year national immunization program, the estimated cumulative vaccination rate was 74%. Stepwise regression analysis revealed that the annual PPV23 vaccination rate significantly increased after 2014 (from 2 to 5% prior to 2014, to 10–11% after 2014), and remained steady for 2014–2018. Our findings suggest that the 5-year national routine vaccination subsidy program was successful in achieving a steady and higher vaccination rate of PPV23 in Japan.

Seroprevalence of some viral and bacterial zoonoses in domestic ruminants in Medina.

Objective:The study aimed to explore the seroprevalence of some bacterial (Brucella spp., Chlamydia abortus) and viral [Rift Valley fever virus (RVFV), foot and mouth disease virus (FMDV)] zoonoses in domestic ruminants in Medina.Materials and Methods:A total of 1,000 blood samples from 665 sheep, 228 goats, and 107 camels were collected from the central slaughterhouse, private farms, and veterinary clinics affiliated to the Ministry of Agriculture. The samples were screened using the Enzyme-Linked Immunosorbent Assay (ELISA). The results were statistically analyzed using Statistical Package for the Social Sciences version 20.Results:Brucella was found in 7.7%, 8.8%, and 6.5% of sheep, goats, and camel’s sera, respectively. In humans, Brucella abortus and Brucella melitensis had higher frequencies in males (61.3%, 59.8%) than in females (38.7%, 40.2%). Chlamydia abortus was reported only in sheep at a rate of 0.75%. RVFV was prevalent in sheep (10.7%) and goats (17.9%). FMDV was reported in 27.8% of sheep and 7.9% of goats. There was a highly statistical significance between Brucella, RVFV, and FMDV seropositivity and locally bred animals (p < 0.01). Multiple seropositivities have been reported among sheep and goats. Brucella was commonly observed in mixed infection with other bacterial and viral agents under study.Conclusion:The surveyed viral and bacterial agents were prevalent in ruminants in the Medina region. Since Medina is an important destination for pilgrims from all over the world, therefore, an integrated approach involving strict control measures and routine vaccination programs should be adopted to reduce the possibility of global epidemics.

Seroprevalence and risk factors of bovine respiratory syncytial virus in cattle in the Nineveh Governorate, Iraq.

Background and Aim:Bovine respiratory syncytial virus (BRSV) is one of the main causes of severe pneumonia, interstitial edema, and emphysema in cattle. The current study investigated the prevalence and risk factors of BRSV in cattle in the Nineveh Province, Iraq.Materials and Methods:Between September 2017 and September 2018, 450 serum samples were collected from non-vaccinated cattle of different ages and breeds for BRSV testing. The epidemiological information of the animals was recorded. The prevalence of the disease was determined using an indirect enzyme-linked immunosorbent assay kit.Results:The prevalence of BRSV was 83.11%, and it was significantly (p<0.05) higher in cattle aged greater than 7 months-1.5 years than in older animals; in imported cattle than in Native animals; and in animals originating from large herds (100 animals) than in those from smaller herds (40 animals). There was no significant difference between BRSV prevalence in male and female animals. When samples from different regions of the Nineveh Governorate were compared, the northern region was associated with the highest prevalence of the disease. Samples harvested in the winter displayed the highest BRSV titer, compared to those collected during the other seasons.Conclusion:BRSV is prevalent in cattle from the Nineveh Governorate. Risk factors such as animal age, origin, herd size, and the herd’s geographical location are associated with an increased prevalence of the disease in this region. Routine vaccination programs should be adopted to reduce the prevalence of BRSV.

Cost-effectiveness of bivalent versus monovalent vaccines against hand, foot and mouth disease

ObjectivesEnterovirus 71 (EV71) and coxsackievirus A16 (CA16) were responsible for 43.3% (235 123/543 243) and 24.8% (134 607/543 243) of all laboratory-confirmed hand, foot and mouth disease (HFMD) cases during 2010–2015 in China. Three monovalent EV71 vaccines have been licensed in China while bivalent EV71/CA16 vaccines are under development. A comparative cost-effectiveness analysis of bivalent EV71/CA16 versus monovalent EV71 vaccination would be useful for informing the additional value of bivalent HFMD vaccines in China. MethodsWe used a static model parameterized with the national HFMD surveillance data during 2010–2013, virological HFMD surveillance records from all 31 provinces in mainland China during 2010–2013 and caregiver survey data of costs and health quality of life during 2012–2013. We estimated the threshold vaccine cost (TVC), defined as the maximum additional cost that could be paid for a cost-effective bivalent EV71/CA16 vaccine over a monovalent EV71 vaccine, as the outcome. The base case analysis was performed from a societal perspective. Several sensitivity analyses were conducted by varying assumptions governing HFMD risk, costs, discounting and vaccine efficacy. ResultsIn the base case, choosing the bivalent EV71/CA16 over monovalent EV71 vaccination would be cost-effective only if the additional cost of the bivalent EV71/CA16 compared with the monovalent EV71 vaccine is less than €4.7 (95% CI 4.2–5.2). Compared with the TVC in the base case, TVC increased by up to €8.9 if all the test-negative cases were CA16-HFMD; decreased by €1.1 with an annual discount rate of 6% and exclusion of the productivity loss; and increased by €0.14 and €0.3 with every 1% increase in bivalent vaccine efficacy against CA16-HFMD and differential vaccine efficacy against EV71-HFMD, respectively. ConclusionsBivalent EV71/CA16 vaccines can be cost-effective compared with monovalent EV71 vaccines, if suitably priced. Our study provides further evidence for determining the optimal use of HFMD vaccines in routine paediatric vaccination programme in China.

Seroprevalence and risk factor associated with respiratory viral pathogens in dual-purpose cattle of Aguachica, Rio de Oro, and La Gloria municipalities in Cesar department, Colombia.

Aim:The research was conducted to determine the seroprevalence and risk factor associated with respiratory viral pathogens in dual-purpose cattle of Aguachica, Rio de Oro and La Gloria municipalities in Cesar department, Colombia.Materials and Methods:The seroprevalence study was done from the random sampling (n=1000) of blood collected from 29 dual-purpose herds, located in three municipalities (Aguachica, Rio de Oro, and La Gloria) of Cesar department. The presence of antibodies against bovine herpesvirus type 1 (BHV-1), bovine respiratory syncytial virus (BRSV), bovine viral diarrhea virus (BVDV), and bovine parainfluenza-3 virus (BPI-3V) in the samples was detected by indirect enzyme-linked immunosorbent assay. Epidemiological data were obtained using a questionnaire administered to the owner or manager of each herd.Results:The overall highest seroprevalence was observed for BHV-1 (94.7%), followed by BRSV (98.6%), BVDV (35.2%), and BPI-3V (47.1%). Regarding the seroprevalence by municipalities, there was a statistical association (p<0.05) for BVDV; however, for BRSV, BHV-1, and BPI-3V, no statistical association was found (p>0.05) between seropositive values and the municipalities, indicating that animal was seropositive in similar proportions in the three municipalities. Female sex and older animals (>24 months) were a significant risk factor for BHV-1 and BPI-3V infection. Regarding the clinical signs, there was a statistical association (p<0.05) between the seropositive values of BVDV and most of clinical signs observed, except for abortion.Conclusion:This research confirms the high seroprevalence of the respiratory viral pathogens in nonvaccinated cattle within the study areas. Therefore, appropriate sanitary management practices and routine vaccination programs should be adopted to reduce the seroprevalence of these infectious agents.

Bacille Calmette-Guerin (BCG) complications in children with severe combined immunodeficiency (SCID)

Background: Bacille Calmette-Guerin (BCG) is included in the routine vaccination program in Gaza and the West Bank. Although safe, complications can occur and include local, extra-regional and disseminated BCG infection. Therefore it is contraindicated in immunodeficiencies. However, most infants are immunized prior to diagnosis of immunodeficiency. We report clinical and immunological characteristics of patients referred with severe combined immunodeficiency (SCID) who suffered from BCG complications.Methods: Files of patients referred for evaluation of immunodeficiency from January 2008 to February 2016 were retrieved. All patients have received BCG. Cell surface markers of peripheral blood mononuclear cells (PBMCs) were measured by immunofluorescent staining and flow cytometry. Serum concentrations of immunoglobulins were measured using nephelometry. Genetic diagnosis of SCID was made by direct Sanger sequencing of candidate genes. BCG complications were classified as: a) local; b) regional; c) distant; and d) disseminated disease.Results: Twenty-one children were diagnosed with SCID. BCG complications were diagnosed in 12 (57.1%). Eight patients developed local and regional disease (67%) and 4 (33%) had disseminated infection. Patients received at least three drugs: isoniazid, ethambutol and rifampicin. Outcome was relatively favorable with eight patients surviving (66.6%). No death related to BCG infection was observed. Disseminated disease was associated with reduced numbers of total lymphocytes, CD3 and CD8 levels (p < .05).Conclusions: Although high rates of BCG complications were observed, mortality was not increased and outcomes were good. Increased awareness in countries where BCG vaccine is not routinely administered and newborn screening programs for SCID could reduce complication rates.

What is the cost of delivering routine vaccinations at GP practices in England? A comparative time-driven activity-based costing analysis

ABSTRACT Background: The expansion of available vaccines in recent years has increased the overall costs of the vaccine program and put pressure on providers responsible for vaccination. In England in 2016–17, GP practices responsible for vaccinating their local population were paid £227 million. However, the costs to general practice of delivering the program and the factors influencing these costs are unknown. Therefore, the aim of this study was to evaluate the costs of delivering the routine vaccination program at GP practices in England, to identify organizational factors impacting costs, and to compare these to the funding received. Methods: Time Driven Activity Based Costing was undertaken at a convenience sample of nine geographically and socio-economically diverse GP practices in 2017–2018. Cost data were gathered for the preceding year using a survey and clinical and administrative staff kept activity logs for a 2-week period. Results: The mean cost of delivering a childhood vaccination appointment was £18.20 (range £9.71-£25.97) and an adult appointment cost £14.05 (range £7.59-£20.88), of which 75% was for staff, 24% for facility costs and 1% for consumables. Organizational factors contributing to lower costs include: shorter length of allocated appointment; greater use of administrative and reception staff; lower working time for practice manager and practice nurse; and use of health-care assistants for adult vaccinations. The costs identified are lower than payments at all practices. Conclusions: Funding received for vaccination activities was higher than costs at included practices. Several organizational factors have been identified that impact on program delivery costs that could be modified.

Modelling the population effectiveness of the national seasonal influenza vaccination programme in Scotland: The impact of targeting all individuals aged 65years and over.

BackgroundFor the last 17 years, the UK has employed a routine influenza vaccination programme with the aim of reducing the spread of seasonal influenza. In mid‐2000, the programme moved from a purely risk‐based approach to a risk and age group‐targeted approach with all those aged 65+ years being included. To date, there has been no assessment of the population effectiveness of this age‐targeted policy in Scotland.ObjectivesStatistical modelling techniques were used to determine what impact the routine vaccination of those aged 65+ years has had on influenza‐related morbidity and mortality in Scotland.MethodsTwo Poisson regression models were developed using weekly counts of all‐cause mortality, cause‐specific mortality and emergency hospitalisations for the period 1981‐2012, one using week‐in‐year and the other using temperature to capture the seasonal variability in mortality/hospitalisations. These models were used to determine the number of excess deaths/hospitalisations associated with the introduction of the local risk and age‐based vaccination programme in 2000.ResultsRoutinely vaccinating those aged 65+ years is associated with a reduction in excess all‐cause mortality, cardiovascular and COPD‐related mortality and COPD‐related hospitalisations. Our analysis suggests that using the week‐in‐year model, on average, 732 (95% CI 66‐1398) deaths from all causes, 248 (95% CI 10‐486) cardiovascular‐related deaths, 123 (95% CI 28‐218) COPD‐related deaths and 425 (95% CI 258‐592) COPD‐related hospitalisations have been prevented each flu season among the those aged 65+. Similar results were found using the temperature model. There was no evidence to suggest that the change in policy was associated with reductions in influenza/pneumonia‐related mortality or influenza/cardiovascular‐related hospitalisations.ConclusionsRoutinely vaccinating those aged 65+ years appears to have reduced influenza‐related morbidity and mortality in Scotland. With the childhood vaccination programme well underway, these data provide an importance benchmark which can be used to accurately assess the impact of this new seasonal influenza vaccination programme.