Simultaneous Administration Of Vaccines Research Articles

Reactogenicity of Simultaneous COVID-19 mRNA Booster and Influenza Vaccination in the US

COVID-19 and seasonal influenza vaccines are essential in preventing respiratory infections and their potentially severe complications. Simultaneous administration of vaccines is efficient and may improve coverage with each vaccine. However, the safety of simultaneous administration of COVID-19 and influenza vaccines has not been well described. To evaluate adverse events and health impacts associated with simultaneously administered COVID-19 mRNA booster and seasonal influenza vaccines in the US population. In this retrospective cohort study, self-reported vaccine data were collected on days 0 to 7 after vaccination from September 22, 2021, through May 1, 2022, through v-safe, a voluntary smartphone-based monitoring system established by the Centers for Disease Control and Prevention. Participants were persons who voluntarily registered in v-safe following COVID-19 vaccination. Receipt of simultaneously administered COVID-19 mRNA booster and seasonal influenza vaccines or COVID-19 mRNA booster alone. Local injection site and systemic reactions (eg, fatigue, headache, and myalgia) and health impacts reported by v-safe respondents in the week following COVID-19 mRNA booster vaccination. Adjusted odds ratios (aORs) were estimated for simultaneous administration compared with booster dose alone, controlling for sex, age, and week of vaccination. Of a total of 981 099 persons aged 12 years or older registered with v-safe, simultaneous administration of COVID-19 mRNA booster and seasonal influenza vaccines was reported by 92 023 (9.4%) v-safe respondents; of these respondents, 54 926 (59.7%) were female, 36 234 (39.4%) were male, and sex was unknown for 863 (0.9%). In the week following vaccination, any systemic reactions were reported by 36 144 (58.9%) of 61 390 respondents who simultaneously received Pfizer-BioNTech booster and influenza vaccines and 21 027 (68.6%) of 30633 respondents who simultaneously received Moderna booster and influenza vaccines. Respondents who simultaneously received influenza and Pfizer-BioNTech booster vaccines (aOR, 1.08; 95% CI, 1.06-1.10) or influenza and Moderna booster vaccines (aOR, 1.11; 95% CI, 1.08-1.14) were slightly more likely to report any systemic reaction in the week following simultaneous vaccination than respondents who received only a COVID-19 mRNA vaccine booster. In this study, compared with administration of COVID-19 mRNA booster vaccines alone, simultaneous administration of COVID-19 mRNA booster and seasonal influenza vaccines was associated with significant increases in reports of systemic reactions during days 0 to 7 following vaccination. These results may help better characterize the outcomes associated with simultaneously administered COVID-19 booster and influenza vaccines in the US population.

Risk for Shoulder Conditions After Vaccination: A Population-Based Study Using Real-World Data.

Although shoulder conditions have been reported as an adverse event after intramuscular vaccination in the deltoid muscle, epidemiologic data on shoulder conditions after vaccination are limited. To estimate the risk for shoulder conditions after vaccination and assess possible risk factors. Retrospective cohort study. Kaiser Permanente Southern California, a large integrated health care organization. Kaiser Permanente Southern California members aged 3 years or older who had an intramuscular vaccination administered in the deltoid muscle between 1 April 2016 and 31 December 2017. A natural language processing (NLP) algorithm was used to identify potential shoulder conditions among vaccinated persons with shoulder disorder diagnosis codes. All NLP-identified cases were manually chart confirmed on the basis of our case definition. The characteristics of vaccinated persons with and without shoulder conditions were compared. Among 3758764 administered vaccinations, 371 cases of shoulder condition were identified, with an estimated incidence of 0.99 (95% CI, 0.89 to 1.09) per 10000 vaccinations. The incidence was 1.22 (CI, 1.10 to 1.35) for the adult (aged ≥18 years) and 0.05 (CI, 0.02 to 0.14) for the pediatric (aged 3 to 17 years) vaccinated populations. In the adult vaccinated population, advanced age, female sex, an increased number of outpatient visits in the 6 months before vaccination, lower Charlson Comorbidity Index, and pneumococcal conjugate vaccine were associated with a higher risk for shoulder conditions. Among influenza vaccines, quadrivalent vaccines were associated with an increased risk for shoulder conditions. Simultaneous administration of vaccines was associated with a higher risk for shoulder conditions among elderly persons. Generalizability to other health care settings, use of administrative data, and residual confounding. These population-based data suggest a small absolute risk for shoulder conditions after vaccination. Given the high burden of shoulder conditions, clinicians should pay attention to any factors that may further increase risks. Centers for Disease Control and Prevention.

Reliability of information available on popular websites about vaccination of pregnant women.

To analyze the reliability of information available on popular websites about vaccination of pregnant women according to the recommendations of the Brazilian Ministry of Health. Descriptive and comparative study. For data collection, a checklist composed of information on recommended, contraindicated, and indicated vaccines in special situations during pregnancy, according to the Ministry of Health, was elaborated. None of the analyzed websites presented all the recommended information. Contraindications, most common adverse events, simultaneous administration of vaccines, information on the DT vaccine, and recommended vaccines in special situations were presented by a minority of websites. Information available on websites about the vaccination of pregnant women is not always based on the recommendations and misinformation may interfere with the acceptance of this practice. The importance of the professionals of the multidisciplinary team as information mediators, particularly the nurse, is emphasized, as is the need for regulating the production and dissemination of information on the internet.

Investigation of specific activity and harmlessness of simultaneous administration of vaccines in complex immunoprophylaxis of dangerous infectious diseases

Experimental study of specific activity and harmlessness of simultaneous application of five vaccines (abdominal, Zonne dysentery, viral hepatitis A, meningococcal and live yellow fever vaccine) in complex immunoprophylaxis of dangerous infectious diseases was carried out. It has been found that the simultaneous administration of these vaccines is safe and has high immunogenicity and protective efficacy for each infection not inferior to, and in some cases superior to, vaccines administered separately. In particular, the immunogenicity of vaccines against typhoid fever and viral hepatitis A administered jointly was four times higher than with their separate administration, which may indicate the presence of a certain adjuvant effect on the part of other vaccines, as well as the absence of antagonism in their joint use. It was revealed that complex vaccinations do not negatively affect the functional state of cells involved in the initial stage of immunogenesis. The absence of a negative effect of complex vaccinations on the components of nonspecific resistance of the body was almost completely confirmed in the conditions of infection of immunized animals with influenza virus, that is, in modeling heterologous infection. In addition, immunization with a complex of vaccines does not lead to allergic animals, which is confirmed by the absence of any manifestations of allergic reactions or anaphylactic activity.

What time interval is needed between the administration of live attenuated vaccines?

A mother consults you for her daughter’s 12-month-old measles–mumps–rubella (MMR) vaccination. The girl’s vaccination record reveals she had a Bacillus-Calmette-Guerin (BCG) vaccine 2 weeks prior because the family is planning to travel to India. You wonder what duration is needed between the administration of live attenuated vaccines to avoid diminishing vaccine responses. What time interval is needed between the administration of live attenuated vaccines to avoid interfering with the immune response to either vaccine? In February 2020, MEDLINE (1946 to present) was searched without any language limitations using the Ovid interface with the search terms detailed in the online supplementary data. ### Supplementary data [archdischild-2020-320091supp001.pdf] Our search identified 4592 studies. Of these, 16 fulfilled the inclusion criteria of studies in humans investigating interference on immunogenicity of two or more live attenuated vaccines administered simultaneously or consecutively (table 1; online supplementary results and table 1). References were hand-searched for additional publications, and no further relevant studies were found. One study was excluded because insufficient details were provided.1 View this table: Table 1 Findings of studies that have investigated the interference on vaccine immunogenicity of two or more different live attenuated vaccines administered consecutively Generally, simultaneous administration of vaccines on the same day is recommended to avoid missing opportunities for vaccination and to increase the probability that a child is …

A review of combined immunization: current research situation and its promising future

Combined immunization consists of combined vaccines (including polyvalent vaccines) and simultaneous administration of vaccines, aiming to reduce unnecessary inoculating times for children, and to broaden immunization coverage and a significant larger group of population would be benefit from the Expanded Program on Immunization. In this review, we have summarized a list of research papers focused on combined immunization. By scrutinizing the safety and effectiveness outcomes of combined immunization, we provide some suggestions about upgrading the current immunization program as well as research and development of new combined vaccines.

283. Potentially Achievable Hepatitis A Vaccination Coverage with Simultaneous Administration of Vaccines Among Young Children in the United States

BackgroundThe Advisory Committee on Immunization Practices recommends simultaneous administration of all age-appropriate doses of vaccines. We estimated the vaccination coverage for ≥2 doses of hepatitis A vaccine (≥2 HepA) that could have been achieved if opportunities for simultaneous administration with other recommended childhood vaccines had not been missed.MethodsWe analyzed National Immunization Survey-Child data for 2008–2017 in the United States. We defined potentially achievable ≥2 HepA coverage by age 24 months as the possible coverage if opportunities for simultaneous administration with other age-appropriate doses of vaccines for children by age 24 months had not been missed. We compared potentially achievable vaccination coverage to reported ≥2 HepA vaccination coverage by birth years 2007 to 2015. For children born in 2015, we stratified estimates by state and by selected socio-demographic factors. Both potentially achievable and reported ≥2 HepA coverage were evaluated using a Kaplan–Meier survival procedure to account for censoring of vaccination status.ResultsCompared with reported vaccination coverage, potentially achievable coverage for ≥2 HepA was at least 10 percentage points higher across birth years 2007 to 2015 and would have surpassed the 85% target of Healthy People 2020 for children born in 2015 (Figure 1). For the 2015 birth cohort, potentially achievable ≥2 HepA coverage exceeded the 85% Healthy People 2020 target in ten states (Figure 2). In addition, potentially achievable vaccination coverage was higher than reported coverage across all selected socio-demographic factors, with differences ranging from 20.1 percentage-points (private insurance only) to 31.7 percentage-points (non-Hispanic Black) (Table 1).ConclusionPotentially achievable coverage with ≥2 HepA consistently exceeded reported coverage for children from nine recent birth cohorts and across all selected socio-demographic characteristics. Coverage could increase substantially if missed opportunities were eliminated. Evidence-based interventions such as establishment of standing orders, use of provider reminders, and use of immunization information systems are recommended to increase HepA coverage among young children. Disclosures All authors: No reported disclosures.

Vaccines Safety in Children and in General Population: A Pharmacovigilance Study on Adverse Events Following Anti-Infective Vaccination in Italy

Background: The concern for adverse events following immunization (AEFI) and anti-vaccination movements that lacked scientific evidence-based supports may reduce vaccine uptake in the general population. Thus, the aims of the present study were to characterize AEFI in general population (all age groups), in terms of frequency, preventability, and seriousness and to define predictors of their seriousness in children. Methods: A retrospective study was performed on suspected AEFI reports for children and adults who received any form of vaccinations, collected in Tuscany, Italy, between 1 January and 31 December 2017. Patients’ characteristics, suspected vaccines, and AEFI description were collected. Causality and preventability were assessed using WHO and Schumock and Thornton algorithms, respectively. Logistic regression was used to estimate the reporting odds ratios of potential predictors of AEFI seriousness in children. Results: A total of 223 suspected AEFI reports were collected, and the majority of them were defined as non-serious (76.7%). Reports were mostly related to one vaccine, and to a median of two to five strains/toxoids. The total number of simultaneously administered strains/toxoids and the presence of allergens did not correlate with AEFI seriousness. Considering vaccines with a high number of administered doses (≥60,000 doses), the rates estimated for serious AEFI reports were always very low, ranging between 0.01 and 0.2/1,000 doses. Twenty-four vaccines (8,993 doses) were not related to any AEFI. Conclusion: Results of present study showed that AEFI were very rare; the vast majority of them was non-serious and, despite the claims of anti-vaccination movements, the simultaneous administration of vaccines was safe and did not influence the risk of reporting a serious AEFI, particularly in children.

Effect of simultaneous administration of foot-and-mouth disease (FMD) and anthrax vaccines on antibody response to FMD in sheep.

PurposeFoot-and-mouth disease (FMD) and anthrax are important diseases in sheep. Vaccination is a favorable strategy against both infections. Simultaneous administration of vaccines does generally not impede the immune responses of each other, although there are some exceptions, and it may help reduce the labor and costs of vaccination as well as distress on animals. Although oil adjuvant FMD vaccine has been tried with live anthrax vaccine in cattle, there are no reports on the simultaneous use of both vaccines in sheep.Materials and MethodsIn this study, FMD seronegative sheep were used to investigate the impact of the simultaneous vaccination of FMD and anthrax on FMD antibody titers of sheep. Virus neutralization test and liquid phase blocking enzyme-linked immunosorbent assay were used to determine the antibody response to the FMD vaccine.ResultsThe results demonstrated that both vaccines can be used simultaneously without any interference with the FMD response. Moreover, the simultaneous administration with anthrax vaccine had a stimulating effect on the early (day 7 post-vaccination) virus neutralization antibody response to the FMD vaccine.ConclusionThe simultaneous use of the FMD and anthrax vaccines did not hinder the response to the FMD vaccine in sheep.

Attitudes and beliefs related to childhood vaccinations among parents of 6 years old children in Zagreb, Croatia

The Croatian Immunization Programme is a mandatory prevention programme in which vaccines are offered free of charge and little is known about parental vaccine-related beliefs and attitudes. We aimed to describe beliefs and attitudes towards childhood vaccination of parents in Zagreb, estimate the proportion of parents with positive attitudes towards vaccination, and to identify the possible predictors of positive attitudes. Using a self-administered questionnaire, we performed a cluster sampling survey among parents of 6-years-old children in Zagreb. In total 542 questionnaires were collected, 80% (n = 430/542) of respondents were mothers. Even though 72.6% (n = 385/531; 95%CI: 69–76) respondents feel that childhood vaccination should remain mandatory, 36.3% (n = 192/528; 95%CI: 58.3–65.3) considered that simultaneous administration of vaccines can have negative effect to their child’s health. In addition, 38% (n = 202/532; 95%CI: 33.2–43.1%) feared that vaccines may harm their child. Of total, parents mostly reported positive attitude towards vaccination (61.8%; 95% CI: 34.7–42). Parents with positive attitudes were more likely to state their child experienced mild or no adverse reaction after vaccination, report not delaying vaccination and provide additional non-mandatory vaccines to their child (p < 0.05). Gender, age, education and marital status of parent were not significantly associated with the positive attitude towards vaccination. Our results suggest the need for educational interventions and communication strategies that could foster better knowledge on immunization with a focus on parental misconceptions, perceived constraints and safety issues about vaccine.

Evaluation of potentially achievable vaccination coverage with simultaneous administration of vaccines among children in the United States

BackgroundRoutine administration of all age-appropriate doses of vaccines during the same visit is recommended for children by the National Vaccine Advisory Committee (NVAC) and the Advisory Committee on Immunization Practices (ACIP). MethodsEvaluate the potentially achievable vaccination coverage for ≥4 doses of diphtheria and tetanus toxoids and acellular pertussis vaccine (4+DTaP), ≥4 doses of pneumococcal conjugate vaccine (4+PCV), and the full series of Haemophilus influenzae type b vaccine (Hib-FS) with simultaneous administration of all recommended childhood vaccines. Compare the potentially achievable vaccination coverage to the reported vaccination coverage for calendar years 2001 through 2013; by state in the United States and by selected socio-demographic factors in 2013. The potentially achievable vaccination coverage was defined as the coverage possible for the recommended 4+DTaP, 4+PCV, and Hib-FS if missed opportunities for simultaneous administration of all age-appropriate doses of vaccines for children had been eliminated. ResultsCompared to the reported vaccination coverage, the potentially achievable vaccination coverage for 4+DTaP, 4+PCV, and Hib-FS could have increased significantly (P<0.001), the vaccination coverage would have achieved the 90% target of Healthy People 2020 for the three vaccines beginning in 2005, 2008, and 2011 respectively. In 2013, the potentially achievable vaccination coverage increased significantly across all selected socio-demographic factors, potentially achievable vaccination coverage would have reached the 90% target for more than 51% of the states in the United States. ConclusionsThe findings in this study suggest that fully utilization of all opportunities for simultaneous administration of all age-eligible childhood doses of vaccines during the same vaccination visit is a critical strategy for achieving the vaccination coverage target of Healthy People 2020. Encouraging providers to deliver all recommended vaccines that are due at each visit by implementing client reminder and recall systems might decrease missed opportunities for simultaneous administration of childhood vaccines.

Increased Immune Response Variability during Simultaneous Viral Coinfection Leads to Unpredictability in CD8 T Cell Immunity and Pathogenesis.

T cell memory is usually studied in the context of infection with a single pathogen in naive mice, but how memory develops during a coinfection with two pathogens, as frequently occurs in nature or after vaccination, is far less studied. Here, we questioned how the competition between immune responses to two viruses in the same naive host would influence the development of CD8 T cell memory and subsequent disease outcome upon challenge. Using two different models of coinfection, including the well-studied lymphocytic choriomeningitis (LCMV) and Pichinde (PICV) viruses, several differences were observed within the CD8 T cell responses to either virus. Compared to single-virus infection, coinfection resulted in substantial variation among mice in the size of epitope-specific T cell responses to each virus. Some mice had an overall reduced number of virus-specific cells to either one of the viruses, and other mice developed an immunodominant response to a normally subdominant, cross-reactive epitope (nucleoprotein residues 205 to 212, or NP205). These changes led to decreased protective immunity and enhanced pathology in some mice upon challenge with either of the original coinfecting viruses. In mice with PICV-dominant responses, during a high-dose challenge with LCMV clone 13, increased immunopathology was associated with a reduced number of LCMV-specific effector memory CD8 T cells. In mice with dominant cross-reactive memory responses, during challenge with PICV increased immunopathology was directly associated with these cross-reactive NP205-specific CD8 memory cells. In conclusion, the inherent competition between two simultaneous immune responses results in significant alterations in T cell immunity and subsequent disease outcome upon reexposure. Combination vaccines and simultaneous administration of vaccines are necessary to accommodate required immunizations and maintain vaccination rates. Antibody responses generally correlate with protection and vaccine efficacy. However, live attenuated vaccines also induce strong CD8 T cell responses, and the impact of these cells on subsequent immunity, whether beneficial or detrimental, has seldom been studied, in part due to the lack of known T cell epitopes to vaccine viruses. We questioned if the inherent increased competition and stochasticity between two immune responses during a simultaneous coinfection would significantly alter CD8 T cell memory in a mouse model where CD8 T cell epitopes are clearly defined. We show that some of the coinfected mice have sufficiently altered memory T cell responses that they have decreased protection and enhanced immunopathology when reexposed to one of the two viruses. These data suggest that a better understanding of human T cell responses to vaccines is needed to optimize immunization strategies.

Immune response to simultaneous administration of a recombinant DNA hepatitis B vaccine and multiple compulsory vaccines in infancy

The reactogenicity and immunogenicity of simultaneous administration of recombinant DNA hepatitis B vaccine with diphtheria and tetanus toxoids (DT) and oral poliovirus vaccine (OPV) in 111 infants were compared with those of DT and OPV alone in a control group of 21 infants. All subjects received three doses of the vaccine according to one of three different schedules of vaccination. Reactions following simultaneous administration of vaccines were all but absent, with mild pain reported for four out of 111 subjects, compared with one of 21 in the control group. Seroconversion rates of 98–100% and high anti-HBs geometric mean titres (GMTs) were observed in all study groups after three doses of hepatitis B vaccine. Significantly higher anti-HBs were seen in Group III, where six months is allowed between the second and the third hepatitis B vaccine doses, compared with Group I and II, where only 1–2 months separate the second and third doses. A fourth dose of vaccine was needed in both these groups to obtain anti-HBs levels as high as seen in Group III after three vaccine doses at 3, 4 and 10 months of age. The immune response to DT and OPV was similar in the study groups and the control group. It is concluded that a course of 10 μg doses of recombinant hepatitis B vaccine given simultaneously with DT and OPV elicits a strong anti-HBs response and does not interfere with the immune response to the other antigens.

The Timing of Tuberculin Tests in Relation to Immunization With Live Viral Vaccines

The validity of the recommendation that routine screening for tuberculosis precede the administration of live viral vaccines was tested in a field study. One hundred and ten children already known to be tuberculin-positive, mostly on the basis of prior vaccination with BCG, were immunized with live viral vaccine and retested with tuberculin at the same time. Reversion to a negative tine test occurred in 3% of children given measles, mumps, or rubella vaccine, and 3.6% of controls who received no vaccine but had the tuberculin test repeated at the same interval. Very few Mantoux reactions (two of 68) reverted to negative in children given one of the three vaccines, singly or in combination; some became smaller, but there was no significant difference in the changes in the size of the Mantoux reaction between the vaccinated group and the control group, with the exception of an unexplained increase in the size of the reaction in many of those who received rubella vaccine. Screening for tuberculosis by tine or Mantoux test is not invalidated by simultaneous administration of vaccines against measles, mumps, or rubella, given singly or in combination, as part of preventive care programs.