Systematic Vaccination Research Articles

A Bayesian spatio-temporal model for cluster detection: identifying HPV suboptimal vaccine coverage

AbstractHuman papillomavirus (HPV) is a common sexually transmitted virus responsible for several types of cancer. HPV vaccines have been included in the systematic vaccination of the Valencia Region since 2008. Despite clinical agreement on the safety and effectiveness of the vaccines, vaccination coverage remains suboptimal in many areas. In order to facilitate the implementation of targeted strategies to enhance vaccination coverage, we develop here an easy-to-implement spatio-temporal clustering model that identifies groups of health districts that share similar behaviour. Namely, health districts are clustered twice. First, they are grouped into spatial clusters based on their underlying vaccination coverage that remains constant over time. Second, they are clustered according to their evolution of annual vaccination rates. A feature of our model is that it does not impose that geographically neighboring areas are assigned to the same spatial cluster or the same temporal trend. This flexibility allows us to explore different spatial and temporal structures. Suboptimal HPV vaccination coverage was found in some health districts. The results reveal the presence of three spatial clusters, with estimated coverage ranging between 82 and 97%, for 14-year-old girls and five clusters for 12-year-old girls, with coverage ranging between 61 and 96%. However, most health districts in this age group show an increasing vaccination trend. The need for future efforts to identify factors causing suboptimal vaccination coverage so that they can be acted upon specifically is highlighted.

The Silent Threat: Unraveling the Impact of Rabies in Herbivores in Brazil.

Rabies, a zoonotic viral disease, poses a significant threat due to its adaptability to diverse environments. Herbivore rabies, predominantly affecting cattle, horses, and goats in Brazil, remains a concern, results in substantial losses in the livestock industry, and poses risks to public health. Rabies virus transmission, primarily through hematophagous bats in Latin America, underscores the need for effective strategies, and vaccination plays a crucial role in controlling herbivorous rabies, with systematic vaccination beingly the primary method. Efforts to control rabies in herbivores include vaccination campaigns, public awareness programs, and the enhancement of surveillance systems. Despite these initiatives, rabies persists and imposes an economic burden and a significant health risk. Economic impacts include losses in the livestock industry, trade restrictions on livestock products, and financial burdens on governments and farmers owing to control measures. Despite the considerable costs of campaigns, surveillance, and control, investing in rabies vaccination and control not only safeguards livestock, but also preserves public health, reduces human cases, and strengthens the sustainability of the livestock industry. Mitigating the impact of herbivorous rabies in Brazil requires integrated approaches and continuous investments in vaccination, surveillance, and control measures to protect public health and ensure the sustainability of the livestock industry, thus contributing to food and economic security.

Measles Vaccine in Kano, Northern Nigeria: Past, Present and Future

Rubeola, the primary agent for measles, is extremely contagious and has contributed significantly to the disruption of the health system in northern Nigeria—Kano state, specifically. Because this virus is infectious and only reacts well to medical support rather than specific antiviral treatment, it is exceedingly complicated and difficult to treat. Consequently, before the development of a vaccine, measles caused a great deal of mortality. Despite the introduction of systematic vaccination programs throughout Africa, particularly in Nigeria, Kano with no exception, no area has been declared measles-free. Deliberate coverage tactics, on one hand, have shown to be effective, in order to reach every part of the community. This is done regionally, compared to 9% when handled locally. This strategy achieved 95% coverage. Nevertheless, parents in Kano worry about their children’s safety and are caught between misinformation and worries. As a result, the health organization has a responsibility to guarantee that parents and guardians receive sufficient information about the benefits of early and regular vaccination.

Vaccination against seasonal flu in childhood and adolescence. Recommendations of the Advisory Committee on Vaccines and Immunizations of the Spanish Association of Pediatrics (CAV-AEP) for the 2024–2025 season

The flu is a constant threat that can sometimes cause severe forms of disease. The highest incidence rates by age group occur in children under 15 years of age, especially in those under 5 years, in whom the rate of hospitalization is also similar to the population aged 65 years and older. In addition, children are the main transmitters of the infection. In Spain, 5 influenza vaccines are authorized for the paediatric age group: three inactivated tetravalent vaccines harvested from fertilised eggs, one tetravalent inactivated vaccine obtained from cell cultures and one attenuated tetravalent vaccine for intranasal administration, which will become trivalent in the 2024−2025 season by excluding the B Yamagata lineage as recommended by the WHO. The CAV-AEP recommends systematic vaccination in children aged 6–59 months, children and adolescents belonging to risk groups, people who can transmit the flu to groups at risk of complicated flu, and household contacts or close family of infants under 6 months. From 2 years of age, the intranasal attenuated vaccine is preferred due to its greater acceptability and thus contribution to greater vaccination coverage. The CAV-AEP also considers that vaccination against influenza of healthy children and adolescents aged 5–18 years is advisable, as it provides individual protection and promotes protection at the family and community levels. It is especially important to vaccinate all health care professionals against influenza as well as pregnant women at any time during pregnancy.

Burden and indirect cost of vaccine-preventable cancer mortality in Europe

Background The economic and mortality burden of cancer is high worldwide. In Europe, cancer was responsible for 1.3 million deaths in 2020 and incurred an estimated cost of €50 billion from premature mortality. Human papillomavirus (HPV) and hepatitis B virus (HBV) are among the leading causes of infection-related cancers despite the availability of effective vaccines against these infections. This analysis estimated the mortality and productivity loss of HBV- and HPV-associated cancers that could be preventable through vaccination across European regions. Materials and methods Institute for Health Metrics Evaluation (IHME) data were used to estimate mortality, years of life lost (YLL), and the value of years of life lost (VYLL) from five HBV- and HPV-related cancers (oral cavity, oropharynx, larynx, cervical, and liver cancers) across 40 European countries in 2019. Preventable deaths and YLL were estimated based on fractions attributable to infections. Data from the World Bank on GDP per capita were used to estimate the VYLL. The robustness of these results was explored with sensitivity and scenario analyses. Results In 2019, 31,906 cancer deaths resulted in an economic burden of €18,521,614,725 due to productivity losses across Europe. HPV-related cervical cancer had the highest mortality (19,473 deaths) and economic burden (€10,706,253,185). HBV-related liver cancer and HPV-related larynx, oral cavity, and oropharynx cancers also had a substantial burden, particularly in males. Eastern Europe had the highest YLL (308,179; 39%) and Western Europe was responsible for the greatest VYLL (€8,281,306,504; 45%), although the highest VYLL per death was in Northern Europe (€923,638). HPV-related oropharynx cancer had the highest VYLL per death (€656,607). Conclusion HPV- and HBV-related cancer deaths are associated with substantial mortality and productivity losses in Europe, which could be reduced by the continued prioritization and implementation of prophylactic public health measures including systematic awareness, vaccination, and screening efforts.

The Effect of Global Spread, Epidemiology, and Control Strategies on the Evolution of the GI-19 Lineage of Infectious Bronchitis Virus.

The GI-19 lineage of infectious bronchitis virus (IBV) has emerged as one of the most impactful, particularly in the "Old World". Originating in China several decades ago, it has consistently spread and evolved, often forming independent clades in various areas and countries, each with distinct production systems and control strategies. This study leverages this scenario to explore how different environments may influence virus evolution. Through the analysis of the complete S1 sequence, four datasets were identified, comprising strains of monophyletic clades circulating in different continents or countries (e.g., Asia vs. Europe and China vs. Thailand), indicative of single introduction events and independent evolution. The population dynamics and evolutionary rate variation over time, as well as the presence and intensity of selective pressures, were estimated and compared across these datasets. Since the lineage origin (approximately in the mid-20th century), a more persistent and stable viral population was estimated in Asia and China, while in Europe and Thailand, a sharp increase following the introduction (i.e., 2005 and 2007, respectively) of GI-19 was observed, succeeded by a rapid decline. Although a greater number of sites on the S1 subunit were under diversifying selection in the Asian and Chinese datasets, more focused and stronger pressures were evident in both the European (positions 2, 52, 54, 222, and 379 and Thai (i.e., positions 10, 12, 32, 56, 62, 64, 65, 78, 95, 96, 119, 128, 140, 182, 292, 304, 320, and 323) strains, likely reflecting a more intense and uniform application of vaccines in these regions. This evidence, along with the analysis of control strategies implemented in different areas, suggests a strong link between effective, systematic vaccine implementation and infection control. However, while the overall evolutionary rate was estimated at approximately 10-3 to 10-4, a significant inverse correlation was found between viral population size and the rate of viral evolution over time. Therefore, despite the stronger selective pressure imposed by vaccination, effectively constraining the former through adequate control strategies can efficiently prevent viral evolution and the emergence of vaccine-escaping variants.

Towards elimination of chronic viral hepatitis in French Polynesia: results from a national population-based survey

In French Polynesia, hepatitis B virus (HBV) infection appears as a major risk factor for hepatocellular carcinoma (HCC), which detection rate in the Austral archipelago is among the highest in the world. Through a nationally representative cross-sectional survey of the adult population, this study aimed at assessing the prevalence of HBV, but also hepatitis C virus (HCV), and hepatitis delta virus (HDV). A total of 1942 blood samples from participants aged 18-69 years were tested for anti-HBc, anti-HBs, HBsAg, anti-HCV IgG, and HDV RNA. Complete genome sequencing of detected HBV strains was performed. Among participants, 315/1834, 582/1834, 33/1834, 0/1857, and 0/33 tested positive for anti-HBc, anti-HBs, HBsAg, anti-HCV IgG, and HDV RNA, respectively. The population prevalence of HBsAg was estimated at 1.0% (95% CI: 0.6-1.7). All HBsAg carriers were born in French Polynesia before vaccination at birth became mandatory. In multivariate analyses, identified factors associated with HBsAg carriage included: the archipelago of residence (p<0.0001), age (p<0.0001), and education level (p=0.0077). HBV genotypes B, C, and F were detected. French Polynesia has a low endemicity level of HBV and its population may be considered at low risk for HCV and HDV infection. However, prevalence of HBsAg was found concerning in Austral (3.8%; 95% CI: 1.9-7.5) and Marquesas (6.5%; 95% CI: 3.8-11) archipelagoes. In the Austral archipelago, the presence of genotype C may account for the elevated rate of HCC. Our findings warrant more efforts to improve access to detection, prevention and care to people born before the systematic vaccination policy application, and residing in higher-risk areas, to achieve HBV elimination in French Polynesia. Research Delegation of French Polynesia.

A systematic review and meta-analysis on ChatGPT and its utilization in medical and dental research

BackgroundSince its release, ChatGPT has taken the world by storm with its utilization in various fields of life. This review's main goal was to offer a thorough and fact-based evaluation of ChatGPT's potential as a tool for medical and dental research, which could direct subsequent research and influence clinical practices. Methods: Different online databases were scoured for relevant articles that were in accordance with the study objectives. A team of reviewers was assembled to devise a proper methodological framework for inclusion of articles and meta-analysis. Results: 11 descriptive studies were considered for this review that evaluated the accuracy of ChatGPT in answering medical queries related to different domains such as systematic reviews, cancer, liver diseases, diagnostic imaging, education, and COVID-19 vaccination. The studies reported different accuracy ranges, from 18.3 % to 100 %, across various datasets and specialties. The meta-analysis showed an odds ratio (OR) of 2.25 and a relative risk (RR) of 1.47 with a 95 % confidence interval (CI), indicating that the accuracy of ChatGPT in providing correct responses was significantly higher compared to the total responses for queries. However, significant heterogeneity was present among the studies, suggesting considerable variability in the effect sizes across the included studies. Conclusion: The observations indicate that ChatGPT has the ability to provide appropriate solutions to questions in the medical and dentistry areas, but researchers and doctors should cautiously assess its responses because they might not always be dependable. Overall, the importance of this study rests in shedding light on ChatGPT's accuracy in the medical and dentistry fields and emphasizing the need for additional investigation to enhance its performance.© 2017 Elsevier Inc. All rights reserved.

137 Macroalgae Extracts Limits Marek’s Disease Virus Load and Dissemination in Vitro

Abstract Marek’s disease (MD) is a highly contagious lymphoproliferative disease of chickens caused by an alphaherpesvirus, Marek’s disease virus (MDV). Marek’s disease is presently controlled by systematic vaccination of animals, which protects efficiently against clinical disease, However, MDV vaccines do not prevent the multiplication and spread of MDV field strains generating immunosuppression. They may also favor the emergence of strains with increased virulence. Therefore, MDV persists to be a major problem for the poultry industry generating economic losses estimated at 1 to 2 billion dollars per year. The development of new sustainable alternative strategies to control MDV is needed. Macroalgae extracts have previously been shown to exert antiviral and immunomodulatory activities that could support the animals to better resist to this challenge. The objective of the study was to explore the effect of sulphated green macroalgae (Ulva.sp) extract (MSPIMMUNITY) on MDV infection in vitro. To determine the impact on MDV lytic replication, CEFs were infected and treated with increasing doses of algae extract. The viral load was quantified at 24, 48, 72, and 96 hours post infection (hpi) by qPCR. The results showed the treatments significantly decreased MDV lytic replication in CEFs in a dose-dependent manner with the strongest effect observed with concentrations of 1mL/L. From 24 hpi, the viral load was reduced by about 80% with the algae extract at a concentration of 2mL/L and this is maintained over time and reached 94% at 96 hpi, A substantial decrease in MDV plaque size (from 2- to 3-fold) was demonstrated suggesting that macroalgae extract impede MDV cell-to-cell spread in vitro. This study provides the first evidence that the use of macroalgae extracts could be a good alternative to limit MDV infection in poultry. It could be used in in feed or in drinking water formulation to support the fight of the animal to viral challenges.

Epidemic and Epizootic Situation on Brucellosis in the Kyrgyz Republic

The aim of the study was to perform the epidemiological and epizootic analysis of the situation on brucellosis in the Kyrgyz Republic. Materials and methods. When assessing the incidence of brucellosis in the Kyrgyz Republic over the period between 1983 and 2021, official data of the Republican Center of Quarantine and Particularly Dangerous Infections, the Department of Disease Prevention and State Sanitary and Epidemiological Surveillance of the Ministry of Health of the Kyrgyz Republic, the State Inspectorate for Veterinary and Phytosanitary Safety of the Kyrgyz Republic, and the National Statistical Committee of the Kyrgyz Republic were used. The obtained materials were processed applying Microsoft Excel 2010. Results and discussion. It is shown that the adverse situation on brucellosis among the population persists in the country: during the study period, the average incidence rate was 29.3 cases per 100 000 of the population. It is associated with constantly occurring epizootics among farm animals, especially small ruminants, which are the main source of human infection. A pronounced summer seasonality of brucellosis cases is noted, due to the participation of people in lambing and calving of animals. Since 2008, there has been a gradual decrease in the incidence of brucellosis among people, after the start of systematic mass vaccination against brucellosis in small ruminants. It is necessary to carry out the entire complex of anti-brucellosis measures and social mobilization of the population to stabilize the epidemic and epizootic situation in the country. The realization of the task will be facilitated by the development of the State Program to combat brucellosis for the interdepartmental integration of all efforts to prevent this dangerous infectious disease.

WINTER SPECIALIZED IMMUNOLOGY SCHOOL, “INBORN ERRORS OF IMMUNITY”

On December 15–17, 2022, the Winter Specialized Immunology School, “Inborn Errors of Immunity,” was held in Uzhgorod of Zakarpattia Region with the support of Danylo Halytsky Lviv National Medical University, the International Interdisciplinary Association of Medical Professionals, the All-Ukrainian Association of Pediatric Immunology NGO, and the International European University. This school aims to analyze new approaches to the early diagnosis of primary/congenital disorders of the immune response in the context of the multidisciplinary approach, as well as to discuss the strategy of therapeutic tactics of such patients. The scientific event was held in the case marathon and direct communication formats. At the beginning of the event, a round table was held with the participation of regional experts in pediatric and adult immunology from different parts of Ukraine. More active cooperation with European colleagues and the creation of a national registry of immunodeficient patients with impaired antibody synthesis were noted. More than 20 speeches by clinical immunologists/pediatric immunologists were presented during two days of intensive work. During this school, results of Biopharma activities, a domestic producer of immunoglobulins, and plans for the future were presented in the field of domestic immunology development and diagnosis of patients with inborn errors of immunity. Discussions during the Winter School revealed the need to actively protect persons with congenital disorders of the immune system against infections by means of timely systematic seasonal vaccination, replacement immunoglobulin therapy, prophylactic antimicrobial therapy, and coordinated activities of specialists from various fields to provide immunological aid to patients in war conditions. At the end of the “Inborn Errors of Immunity” Winter School, organizers expressed confidence that most efforts and ideas highlighted during the professional meeting will be successfully implemented.

Detection of human papillomavirus in archival bladder and ovarian cancer samples

ProblemHuman papillomavirus (HPV) is a well-established causative agent of cervical cancer. However, its role in the development of bladder and ovarian cancer is under debate. Current study evaluated the role of high-risk HPV genotypes 16 and 18 in triggering bladder and ovarian carcinomas. MethodsA total of 80 formalin-fixed and paraffin-embedded (FFPE) archival tissue specimens of both bladder (n = 40) and ovarian carcinoma (n = 40) were tested for the presence of HPV integrants and HPV 16 genotype and HPV 18 genotype. Results and conclusionThe PCR results showed that 5% (2/40) of bladder cancer samples were HPV positive with equal prevalence of HPV 16 in both sexes (1:1) while 22.5% (9/40) of ovarian cancer samples came positive for HPV with only one positive for HPV 16. These results indicate association of HPV with bladder and ovarian carcinomas, HPV 16 genotype being more prevalent than 18. The study emphasizes that HPV is a serious issue in low- and middle-income countries where existing methods of prevention are still inadequate or costly. Timely HPV screening can help lower the burden of HPV-induced carcinomas. Furthermore, systematic HPV vaccination program among the young population is paramount.

Yellow Fever Vaccination in Hemodialysis Patients: A Systematic Review

Introduction: Yellow fever is an infectious disease endemic to Africa, and Central and South America with a significant impact on public health, causing outbreaks and epidemics. Clinical manifestations can vary from asymptomatic to more severe and lethal disease outcomes. The primary prevention of yellow fever occurs through the vaccination of individuals, which confers immunity for life. Patients with chronic kidney disease, especially those undergoing dialysis, have low vaccination and seroconversion rates. As mentioned above, this research aimed to perform a systematic review of the yellow fever vaccination protocol in hemodialysis patients. Methods: A systematic review on vaccination against yellow fever in hemodialysis patients using databases, PubMed and Biblioteca Virtual em Saúde (BVS), was performed. For data collection, combinations were made using the following descriptors: protocols, vaccination, yellow fever, kidney dialysis, chronic kidney failure, chronic kidney disease, and group risk included in the title and abstract description. Articles with no subject related to the search were excluded and also if they were duplicated. Results: In this review, 90 scientific articles were identified in both databases. After applying exclusion criteria, a total of 3 articles were selected. Conclusion: We recommend carefully assessing the risk-benefit and contraindications for the patient, emphasizing the risk groups. There is an evident lack of studies on the subject, and there is a need to broaden investigations related toimmunization for patients on dialysis. The review is registered in the PROSPERO system with the number 323550.

백신 부작용과 국가책임

Vaccines remain an unstable and controversial technology in South Korean society, as evidenced by the adverse event debate during the COVID-19 vaccine rollout. The Korean government's primary policy response to this has been to implement a comprehensive immunization compensation system that provides state-level compensation to those who experience harm, even if a direct causal link to vaccination cannot be proven. Although South Korea's immunization compensation system was enacted in 1994 and fully implemented in 1995, government, medical, and public debates surrounding it have been ongoing since the mass vaccination campaigns of Korea. This study examines how attempts to manage vaccine adverse events in Korea have been shaped by conflicts between government, medical professionals, and the public over vaccination, particularly over adverse events. At the same time, the technical limitations of each vaccine led to questions of safety, and these limitations shaped the public's perceptions of effectiveness and trust in individual vaccines. This study focuses on three of the most widely recognized vaccine-related adverse reactions: the typhoid vaccine of the 1960s, the DPT vaccine of the 1970s, and the Japanese encephalitis vaccine of the 1990s. These cases reveal that state-oriented disease control initiatives were not always successful in mobilizing the public and medical personnel unilaterally, but rather that there were various resistances and backlash, requiring detailed policies such as “no-fault” compensation systems to manage them. Furthermore, these cases suggest that for future systematic vaccine policy formulation, it is necessary to build a historical understanding of the technical limitations of individual vaccines and the experiences and responses to their adverse effects, rather than analyzing vaccine policy as a single entity.

Bacterial Infection in the Sickle Cell Population: Development and Enabling Factors.

The high frequency of bacterial infections represents a major threat to public health. In developing countries, they are still responsible for significant morbidity and mortality in pediatric populations with sickle cell disease, particularly in children under 5 years of age. Indeed, they have an increased susceptibility to bacterial infections due to their immune deficiency. This susceptibility is even greater for pneumococcal and salmonella infections. In addition, the underdevelopment of some countries and socio-economic factors increases this condition. This review examines the common and specific factors leading to infections in people with sickle cell disease in different types of developed and undeveloped countries. The threat of bacterial infections, particularly those caused by S. pneumoniae and Salmonella, is of increasing concern due to the rise in bacterial resistance to antibiotics. In light of this disturbing data, new strategies to control and prevent these infections are needed. Solutions could be systematic penicillin therapy, vaccinations, and probabilistic antibiotic therapy protocols.

Incidence and clinical and microbiological features of invasive and probable invasive streptococcal group A infections in children and adults in the Brussels-Capital Region, 2005–2020

Assess the incidence, risk factors, clinical and microbiological features, and outcome of both probable invasive and invasive group A Streptococcus (GAS) infections in children and adults in the BrusselsCapital Region between 2005 and 2020. A retrospective, multicentric study was performed in three university hospitals in Brussels. Patients were identified through the centralized laboratory information system. Epidemiological and clinical data were collected from patients' hospital records. A total of 467 cases were identified. Incidence has increased from 2.1 to 10.9/100,000 inhabitants between 2009 and 2019 in non-homeless adults while it was above 100/100,000 on homeless in years with available denominators. Most of GAS were isolated from blood (43.6%), and the most common clinical presentation was skin and soft tissue infections (42.8%). A third of all the patients needed surgery, a quarter was admitted to the intensive care unit, and 10% of the adult patients died. Wounds and chickenpox disease were the main risk factors for children. Tobacco, alcohol abuse, wounds or chronic skin lesion, being homeless, and diabetes were identified as major predisposing factors for adults. The most common emm clusters were D4, E4, and AC3; 64% of the isolates were theoretically covered by the 30-valent M-protein vaccine. The burden of invasive and probable invasive GAS infections is on the rise in the studied adult population. We identified potential interventions that could contribute to decrease this burden: appropriate care of wounds, specifically among homeless and patients with risk factors such as diabetes and systematic chickenpox vaccination for children.

Universal childhood influenza vaccination in Spain: Has the time come?

Influenza vaccination is the most effective strategy to prevent influenza infection. The timehas come to include systematic influenza vaccination in the childhood and get over ourunfinished assignment with society. The debate is no longer about if we should vaccinatechildren or not, the consensus effort should be aimed in determining at which age rangeshould we implement vaccination and what types of flu vaccines we must use.

Herpes zoster: carga de enfermedad y estrategias actuales de prevención en España

Herpes zoster, as we all know, is produced by the Varicella-Zoster Virus and appears after the reactivation of the virus due to a situation of immunosuppression, either due to an illness or after 60 years of age, related to the phenomenon of immunosenescence, This happens when that person has suffered a primary infection that produces chickenpox, given that subsequently, this virus has the capacity to remain in the dorsal ganglia of the spinal cord or cranial pairs for long periods of time and reactivate in the aforementioned situations producing a lesion that we call herpes zoster. Although it can occur in any age group, the main triggering factor is the decrease in immunity measured by cells associated with natural immunosenescence due to aging and/or immunosuppression due to oncological and chronic pathologies and/or immunosuppressive drug treatments. It is estimated that up to 30% of the population will develop a clinical picture of herpes zoster during their lifetime. It is known that the burden of disease caused by herpes zoster in the population &gt;50 years of age is so high that it would justify routine vaccination of the population. These patients have a higher risk of reactivation of the virus, higher probability of PHN, higher risk of hospitalization and worse quality of life, especially in immunocompromised patients and in those over 60-65 years of age. This burden of disease represents a high health expenditure and consumption of resources. It is therefore necessary to support the vaccination strategies implemented by the health authorities and to implement systematic vaccination, at least in &gt;65 years of age, as the population group at greatest risk, as the main preventive measure to avoid the appearance of cases requiring hospitalization.

Confirmation of the Rabbit Hemorrhagic Disease Virus Type 2 (GI.2) Circulation in North Africa

Abstract Rabbit hemorrhagic disease (RHD) is a highly contagious viral disease that causes fatal acute hepatitis in domestic and wild lagomorphs. It has taken on major economic importance in countries like Morocco. In addition to the classical virus (RHDV), a novel emerged genotype (RHDV2) is circulating, especially in the north shore of the Mediterranean basin since 2010. Many small animal farmers reported clinical cases from several rabbitries in Agadir (Morocco) despite systematic vaccination against the RHDV. The main objective was to characterize the current RHDV strains circulating in the studied area to help to choose an adequate vaccine. For that, we extracted viral RNA from rabbit livers, carried out the PCR analyses, and we sequenced the viral structural capsid protein (VP60) of the RHDV. The phylogenetic analysis results allowed us to state that the novel genotype (RHDV2) is circulating in the studied geographical area, and to characterize the isolated sequences. As a conclusion, we recommend updating RHD epidemiological relating data and reviewing the vaccine protocols by both targeting RHDV (GI.1) and RHDV2 (GI.2) in any future preventive program.

S54 Improving Influenza and Pneumococcal Vaccination Rates in an Inflammatory Bowel Disease Clinic at Tan Tock Seng Hospital, Singapore

Background: Despite a higher risk of infections (such as influenza and pneumococcal disease) with or without immunosuppressive or biologic therapies, vaccination rates remain low among inflammatory bowel disease (IBD) patients in Tan Tock Seng Hospital. Specifically, our 3 months’ retrospective data revealed that ≤15% of patients had completed their influenza and pneumococcal vaccinations. Hence, in January 2021, a team comprising of 3 IBD physicians and 2 new IBD nurses came together to work on a quality improvement (QI) project and streamline the vaccination processes. The primary aim was to improve vaccination rates through a nurse-led vaccination screening, assessment and referral exercise as well as addressing vaccination hesitancy. Methods: A cause and effect QI tool (fish-bone diagram) was adopted to assess and study areas for improvement. Through this root cause analysis, the team was able to identify gaps which contributed to poor vaccination uptake. They included system (unavailability of IBD vaccination protocol, no written education materials for IBD patients, inconvenient vaccination access), physician (limited physician time consult, incomplete vaccination screening or assessment) and patient factors (patient’s perceived lack of benefit, vaccine misconceptions, fear of side effects). In order to address aforementioned factors causing the poor vaccination rates, vaccination guidelines were first protocolised based on national and international clinical guidelines. An information pamphlet was also prepared to help patients better understand the importance and benefits of vaccinations. At each outpatient appointment, IBD nurses would first establish the patient’s vaccination eligibility based on age, disease activity, use of immunosuppressive therapy and vaccination history. Where appropriate, vaccination counselling and pamphlet will be provided to the patient. With patient’s consent, patients would then be referred to the treatment room at the clinic for vaccination administration, all within the same clinical setting. Results: There were 246 patients attended IBD clinic from June to November 2021. Our 6-months post-intervention study reported the following: 1. Clear and systematic vaccination screening and assessment- Vaccination documentation in electronic health records increased from 30% to 100% - a 70% increase compared to pre-intervention 2. Influenza vaccination- 60% of IBD patients fulfilled vaccination eligibility - Influenza vaccination completion increased from 13% to 55% – a 42% increase compared to pre-intervention 3. Pneumococcal vaccination- 28% of IBD patients fulfilled vaccination eligibility - Pneumococcal vaccination completion increased from 2% to 48% - a 46% increase compared to pre-intervention. Conclusion(s): The role of vaccination screening and recommendations were traditionally performed by physicians and pharmacists. However, with the implementation of nurse-led vaccination exercise, it had helped to improve and better identify eligible patients for vaccination in a systematic and concise manner in this one-stop service. It further empowered the 2 new IBD nurses in exercising their clinical judgement skills while freeing up time for physicians to address patients who may have higher medical needs requiring longer consultations. Most importantly, with increasing vaccination rates, IBD patients could be better protected against these vaccines-preventable diseases. We believe that we can achieve higher rates of vaccinations in due time through education and being a vaccine(s) advocate to further reduce vaccine hesitancy.