US Vaccine Research Articles

The social shaping of biotechnological innovation. The case of Covid-19 protein vaccine in Cuba and the US

AbstractLike other technologies, vaccines are socially shaped by socio-economic, political and organisational factors. Property rights, value capture strategies and public innovation policies guide research teams in the biochemical design of vaccines, with inevitable consequences for their price and accessibility. The Covid-19 pandemic provided an opportunity to analyse this institutional shaping process and its consequences for global public health from a political economy perspective. Indeed, the same type of invention, a recombinant protein vaccine, was simultaneously and originally developed in the US and Cuban biopharmaceutical industries and in the field of philanthropic Open Innovation. The article shows, through empirical research that collected direct testimony from scientists and privileged observers of the vaccine development fields, how certain norms and values characteristic of the US industry (financialization, assetization and de-risk) created a path dependency in the use of proprietary and experimental biotechnologies that made the US vaccine Nuvaxovid more expensive and complex to produce, but no more effective and safe than Abdala, Soberana 02 and Corbevax. In addition, the institutional constraints of the US biopharmaceutical industry on radical innovation, even within a mature biotechnology platform such as protein vaccines, would have resulted in a competitive disadvantage for Nuvaxovid, which was as expensive as an mRNA vaccine but less rapid to market and less reliable in delivery. The case of protein vaccines against Covid-19 thus shows how the institutional architectures of techno-scientific capitalism create not only inequalities but also inefficiencies, and that an innovation path with excellent results is possible even in competition where the market is not the dominant order of worth.

Fast Bayesian Inference for Spatial Mean-Parameterized Conway–Maxwell–Poisson Models

Count data with complex features arise in many disciplines, including ecology, agriculture, criminology, medicine, and public health. Zero inflation, spatial dependence, and non-equidispersion are common features in count data. There are currently two classes of models that allow for these features—the mode-parameterized Conway–Maxwell–Poisson (COMP) distribution and the generalized Poisson model. However both require the use of either constraints on the parameter space or a parameterization that leads to challenges in interpretability. We propose spatial mean-parameterized COMP models that retain the flexibility of these models while resolving the above issues. We use a Bayesian spatial filtering approach in order to efficiently handle high-dimensional spatial data and we use reversible-jump MCMC to automatically choose the basis vectors for spatial filtering. The COMP distribution poses two additional computational challenges—an intractable normalizing function in the likelihood and no closed-form expression for the mean. We propose a fast computational approach that addresses these challenges by, respectively, introducing an efficient auxiliary variable algorithm and pre-computing key approximations for fast likelihood evaluation. We illustrate the application of our methodology to simulated and real datasets, including Texas HPV-cancer data and US vaccine refusal data. Supplementary materials for this article are available online.

June 2024 ACIP Meeting Update: Influenza, COVID-19, RSV, and Other Vaccines.

The Advisory Committee on Immunization Practices (ACIP), a group of medical and public health experts that provides advice to the Centers for Disease Control and Prevention, normally meets 3 times per year to develop US vaccine recommendations. The ACIP met June 26 through 28, 2024. This update summarizes the proceedings of this meeting, with an emphasis on topics that are most relevant to the pediatric population. Major updates for pediatric clinicians include COVID-19 and influenza vaccine recommendations for the 2024 to 2025 season, meningococcal vaccination considerations, information regarding preferred Haemophilus influenzae type B containing vaccines for American Indian and Alaskan Native infants, and updates regarding implementation and effectiveness of RSV immunization in pregnant people and infants.

Spatial Accessibility and Uptake of Pediatric COVID-19 Vaccinations by Social Vulnerability.

Geographic accessibility predicts pediatric preventive care utilization, including vaccine uptake. However, spatial inequities in the pediatric coronavirus disease 2019 (COVID-19) vaccination rollout remain underexplored. We assessed the spatial accessibility of vaccination sites and analyzed predictors of vaccine uptake. In this cross-sectional study of pediatric COVID-19 vaccinations from the US Vaccine Tracking System as of July 29, 2022, we described spatial accessibility by geocoding vaccination sites, measuring travel times from each Census tract population center to the nearest site, and weighting tracts by their population demographics to obtain nationally representative estimates. We used quasi-Poisson regressions to calculate incidence rate ratios, comparing vaccine uptake between counties with highest and lowest quartile Social Vulnerability Index scores: socioeconomic status (SES), household composition and disability (HCD), minority status and language (MSL), and housing type and transportation. We analyzed 15 233 956 doses administered across 27 526 sites. Rural, uninsured, white, and Native American populations experienced longer travel times to the nearest site than urban, insured, Hispanic, Black, and Asian American populations. Overall Social Vulnerability Index, SES, and HCD were associated with decreased vaccine uptake among children aged 6 months to 4 years (overall: incidence rate ratio 0.70 [95% confidence interval 0.60-0.81]; SES: 0.66 [0.58-0.75]; HCD: 0.38 [0.33-0.44]) and 5 years to 11 years (overall: 0.85 [0.77-0.95]; SES: 0.71 [0.65-0.78]; HCD: 0.67 [0.61-0.74]), whereas social vulnerability by MSL was associated with increased uptake (6 months-4 years: 5.16 [3.59-7.42]; 5 years-11 years: 1.73 [1.44-2.08]). Pediatric COVID-19 vaccine uptake and accessibility differed by race, rurality, and social vulnerability. National supply data, spatial accessibility measurement, and place-based vulnerability indices can be applied throughout public health resource allocation, surveillance, and research.

Exploring SARS-CoV-2 infection and vaccine-induced immunity in chronic myeloid leukemia patients: insights from real-world data in Brazil and the United States

This study investigates COVID-19 outcomes and immune response in chronic myeloid leukemia (CML) patients post-SARS-CoV-2 vaccination, comparing effectiveness of various vaccine options. Data from 118 CML patients (85 in Brazil, 33 in the US) showed similar infection rates prior (14% Brazil, 9.1% US) and post-vaccination (24.7% vs. 27.3%, respectively). In Brazil, AstraZeneca and CoronaVac were the most commonly used vaccine brands, while in the US, Moderna and Pfizer-BioNTech vaccines dominated. Despite lower seroconversion in the Brazilian cohort, all five vaccine brands analyzed prevented severe COVID-19. Patients who received mRNA and recombinant viral vector vaccines (HR: 2.20; 95%CI 1.07–4.51; p < .031) and those that had achieved at least major molecular response (HR: 1.51; 95% CI 1.01–3.31; p < .0001) showed higher seroconversion rates. Our findings suggest that CML patients can generate antibody responses regardless of the vaccine brand, thereby mitigating severe COVID-19. This effect is more pronounced in patients with well-controlled disease.

February 2024 ACIP Meeting Update: Meningococcal, RSV, COVID-19, and Other Vaccines.

The Advisory Committee on Immunization Practices, a group of medical and public health experts that provides advice to the Centers for Disease Control and Prevention, normally meets 3 times per year to develop US vaccine recommendations. The Advisory Committee on Immunization Practices met February 28 to 29, 2024, to discuss coronavirus disease 2019 vaccines, chikungunya vaccines, diphtheria-tetanus vaccine, influenza vaccines, polio vaccines, respiratory syncytial virus vaccines, meningococcal vaccines, pneumococcal vaccines, and Vaxelis (Diphtheria, Tetanus, Pertussis, Inactivated Poliovirus, Haemophilus influenzae b Conjugate, and Hepatitis B Vaccine). This update summarizes the proceedings of these meetings, with an emphasis on topics that are most relevant to the pediatric population. Major updates for pediatric clinicians include information about changes on influenza vaccine composition, meningococcal vaccination considerations, updated guidance for children with a contraindication to pertussis-containing vaccines, and recommendations of the world's first chikungunya vaccine for certain populations.

Quantifying in vitro B. anthracis growth and PA production and decay: a mathematical modelling approach

Protective antigen (PA) is a protein produced by Bacillus anthracis. It forms part of the anthrax toxin and is a key immunogen in US and UK anthrax vaccines. In this study, we have conducted experiments to quantify PA in the supernatants of cultures of B. anthracis Sterne strain, which is the strain used in the manufacture of the UK anthrax vaccine. Then, for the first time, we quantify PA production and degradation via mathematical modelling and Bayesian statistical techniques, making use of this new experimental data as well as two other independent published data sets. We propose a single mathematical model, in terms of delay differential equations (DDEs), which can explain the in vitro dynamics of all three data sets. Since we did not heat activate the B. anthracis spores prior to inoculation, germination occurred much slower in our experiments, allowing us to calibrate two additional parameters with respect to the other data sets. Our model is able to distinguish between natural PA decay and that triggered by bacteria via proteases. There is promising consistency between the different independent data sets for most of the parameter estimates. The quantitative characterisation of B. anthracis PA production and degradation obtained here will contribute towards the ambition to include a realistic description of toxin dynamics, the host immune response, and anti-toxin treatments in future mechanistic models of anthrax infection.

The politics of flu vaccines: international collaboration and political partisanship

Abstract While vaccine hesitancy has become a salient issue, few studies have examined the influence of international collaboration and vaccine developments on people's attitudes towards vaccines. The international collaboration especially with China has been an integral part of the field of influenza. In recent years, attitudes towards vaccines and China are both heavily politicized in the USA with a deepening partisan divide. Republicans are more likely than Democrats to be vaccine hesitant, and they are also more likely to view China negatively. At the same time, the USA has economic, security, and medical collaboration with Japan and most Americans display a very positive view of the country. Thus, does a more international collaboration or more country-specific vaccine development have an influence on US vaccine hesitancy? This study conducts a survey-embedded question-wording experiment to assess the roles of US–China and US–Japan collaboration and partisanship in people's willingness to get the flu vaccine. Despite the previously successful and effective US–China collaboration, this study finds that respondents especially Republicans are much less likely to receive a US–China flu vaccine than a US–Japan or USA alone. Interestingly, both Democrats and Republicans are as willing to receive a US–Japan vaccine as USA alone. These results point to critical roles of partisanship and international relations.

Risk of myocarditis after three doses of COVID-19 mRNA vaccines in the United States, 2020-2022: A self-controlled case series study.

Myocarditis is a recognized safety concern following COVID-19 mRNA vaccination. However, there is limited research quantifying the risk associated with the third dose or comparing the risk between the three doses. The US Vaccine Adverse Event Reporting System (VAERS) is a passive surveillance system that monitors rare adverse events after US-licensed vaccination. However, studies analyzing VAERS data have often faced criticism for underreporting cases and lacking a control group to assess the increase in baseline risk. The temporal association between myocarditis onset and COVID-19 vaccination was studied. To overcome limitations, a novel modified self-controlled case series method was employed, explicitly modeling the case reporting process in VAERS data. We found an increased risk of myocarditis during the 1- to 3-day period following the second and third doses of both the BNT162b2 vaccine and the mRNA-1273 vaccine. Following the second dose, the relative incidence (RI) was 4.89 (95% confidence interval (CI), 2.39-10.08) for the BNT162b2 vaccine and 2.86 (95% CI: 1.18-7.03) for the mRNA-1273 vaccine. Similarly, following the third dose, the RI was 9.04 (95% CI: 2.79-40.99) for the BNT162b2 vaccine and 4.71 (95% CI: 1.42-19.09) for the mRNA-1273 vaccine. No significant increase in risk was observed during other periods. Notably, our analysis also identified a similar increased risk of myocarditis among individuals aged below 30. These findings raise safety concerns regarding COVID-19 mRNA vaccines, provide insights into the quantification of myocarditis risk at different postvaccination periods, and offer a novel approach to interpreting passive surveillance system data.

The Impact of the COVID-19 Pandemic on the Incidence of Herpes Zoster: A Narrative Literature Review.

Coronavirus disease 2019 (COVID-19) has had a broad impact on health services and health outcomes. During the pandemic, there were numerous reports of herpes zoster (HZ) in people with COVID-19 and in COVID-19 vaccine recipients. The aim of this review is to elucidate the global effects of the COVID-19 pandemic on HZ. It is postulated that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection produces an immunosuppressive state that favours varicella zoster virus (VZV) reactivation. Three large cohort studies (a multinational study and studies from the USA and Spain) that excluded individuals vaccinated against HZ reported significantly increased risk of HZ following COVID-19 infection, especially in people aged ≥ 50years. In contrast, a large study from Israel that did not consider HZ vaccination status reported no such increase. Cases of HZ following COVID-19 vaccination have been reported and may be the result of attenuated cell-mediated immunity. This phenomenon appears to vary by vaccine type. Some (but not all) large analyses have reported a significant positive relationship between receipt of mRNA vaccines for COVID-19 and development of HZ. These include analyses of health records databases in Israel and Hong Kong and of spontaneous case reports in the US Vaccine Adverse Event Reporting System (VAERS) database. Routine vaccinations, including shingles vaccine programmes, were disrupted by the COVID-19 pandemic. It is estimated that missed shingles vaccinations may have resulted in 63,117 avoidable HZ cases in the USA. Now that the World Health Organization has declared an end to the COVID-19 pandemic as a health emergency and routine vaccination services have resumed, there is a need to increase awareness of HZ and HZ vaccination.Graphical abstract available for this article.

Updated 2024 US vaccine recommendations from the Advisory Committee on Immunization Practices

Updated 2024 US vaccine recommendations from the Advisory Committee on Immunization Practices

Disparities in Influenza, Pneumococcal, COVID-19 Vaccine Coverage in High-Risk Adults Aged 19 to 64 Years in Southeastern Minnesota, 2010-2021

Despite effective vaccines against influenza, pneumococcus, and COVID-19, uptake has been suboptimal. Although disparities in vaccination by race and ethnicity have been observed, what is the role of other sociodemographic factors in US vaccine uptake? We conducted a population-based study using the Rochester Epidemiology Project (REP), a comprehensive medical records linkage system, to assess effects of sociodemographic factors including race, ethnicity, individual-level socioeconomic status (SES) via the housing-based socioeconomic status index, education, population density (urban or nonurban), and marital status with uptake of influenza, pneumococcal, and COVID-19 vaccination in high-risk adults. Adults at high risk of invasive pneumococcal disease residing in four counties in southeastern Minnesota who were aged 19 to 64 years were identified. Vaccination data were obtained from the Minnesota Immunization Information Connection and REP from January 1, 2010, through December 31,2021. We identified 45,755 residents. Most were White (82%), non-Hispanic (94%), married (56%), and living in an urban setting (81%), with three-quarters obtaining at least some college education (74%). Although 45.1%were up to date on pneumococcal vaccines, 60.1%had completed the primary COVID-19 series. For influenza and COVID-19, higher SES, living in an urban setting, older age, and higher education positively correlated with vaccination. Magnitude of differences in race, education, and SES widened with booster vaccines. This high-risk population is undervaccinated against preventable respiratory diseases, especially influenza and pneumococcus. Although national data reported improvement of disparities in COVID-19 vaccination uptake observed early in the pandemic, our data demonstrated gaps related to race, education level, SES, and age that widened with booster vaccines. Communities with high social vulnerabilities often show increased risk of severe disease outcomes, yet demonstrate lower uptake of preventive services. This highlights the need to understand better vaccine compliance and access in rural, lower SES, less-educated, Black, Hispanic, and younger populations, each of which were associated independently with decreased vaccination.

Fall 2023 ACIP Update on Meningococcal, RSV, COVID-19, and Other Pediatric Vaccines.

The Advisory Committee on Immunization Practices (ACIP), a group of medical and public health experts that provides advice to the Centers for Disease Control and Prevention, normally meets 3 times per year to develop US vaccine recommendations. The ACIP met October 25 to 26, 2023, to discuss meningococcal vaccines, mpox vaccines, respiratory syncytial virus (RSV) vaccines, influenza vaccines, coronavirus disease 2019 (COVID-19) vaccines, and the combined pediatric and adult immunization schedules for 2024. The ACIP also held special meetings on September 12 and September 22 to discuss COVID-19 2023-2024 vaccine recommendations and RSV immunization in pregnant women. This update summarizes the proceedings of these meetings that are most relevant to the pediatric population. Major updates for pediatric clinicians include recommendations for XBB monovalent COVID-19 immunization for the 2023-2024 respiratory season, the recently licensed pentavalent meningococcal conjugate vaccine and mpox vaccination in high-risk young adults, and discussion regarding the parallel strategies of protection against RSV disease in infants via maternal immunization during pregnancy or direct prophylaxis of infants with nirsevimab.

Activities, Motivations and Demographics of Provaccine Advocates.

Vaccine hesitancy is a growing public health concern and has been classified as a major threat to global health by the World Health Organization. While there has been extensive research on the attitudes of vaccine-hesitant individuals, little is known about provaccination advocates. Our objectives were to describe the characteristics, attitudes, activities and motivations of provaccination advocates. An internet survey was conducted in July-November 2019. US vaccine advocacy groups were invited to partner in survey distribution. Participants were recruited from a convenience sample of their members. Advocacy activities were categorized as policy related, in-person or online. Respondents (n = 1239) were mostly female (82%), White (87%) and highly educated (90%). Most reported Democratic political affiliation (66%). The most common occupation was health care practitioner (38%). Most respondents (90%) agreed that a policy that did not allow patients to refuse or spread-out vaccines would encourage them to choose that clinic. The most common policy-related activity was contacting an elected official about vaccines. The most common in-person activity was speaking with a friend or family member about vaccines. The most reported online activity was using social media to advocate for vaccines. The most common motivation for vaccine advocacy was a sense of responsibility as a community member. Provaccine individuals engaged in a variety of advocacy activities and were motivated by responsibility to their community in addition to other factors. Continued work to better understand and motivate vaccine advocates may inform efforts to bolster vaccine confidence and influence those who accept vaccines to become advocates.

Sex differences in COVID-19 mortality: A large US-based cohort study (2020–2022)

&lt;sec&gt;&lt;title&gt;Background&lt;/title&gt;&lt;p&gt;In the present study, we aim to assess the trend in mortality in COVID-19 by time and sex in a large cohort using Datavant's Death Index database. The main objectives of this study are to analyze mortality cases over time, which are categorized by sex and age, and to identify potential reasons for the observed differences.&lt;/p&gt;&lt;/sec&gt;&lt;sec&gt;&lt;title&gt;Methods&lt;/title&gt;&lt;p&gt;This is a retrospective cohort containing information on deceased individuals in the United States and Canada (n = 4,384,265). We included adult male and female patients with a clinical diagnosis of COVID-19 (January–December 2022) (ICD-10 code: U07.1). Mortality cases for males and females were presented over a three-year period of COVID-19 pandemic. Sex ratios presenting the change of mortality cases over time was also computed as the number of diagnosed males over female patients. Sex-differences in the mortality rates were illustrated by age groups.&lt;/p&gt;&lt;/sec&gt;&lt;sec&gt;&lt;title&gt;Results&lt;/title&gt;&lt;p&gt;In 2020, mortality cases increased to reach up to 200,000 cases per day and fluctuated due to social and/or cultural events in the US. In 2021, mortality cases reached the highest peak over the time period despite the US vaccine rollout due to holiday gatherings during November and December 2021, as well as the spread of a more contagious strain of the virus. In 2022, mortality cases decreased due to widespread vaccinations and a rise in natural immunity following the first Omicron surge. Furthermore, the proportion of COVID-19 cases in males and females remained stable during the pandemic; however, the number of diagnosed male patients markedly increased during the first months of 2022. Gender discrepancies suggest the role of various factors such as occupation, underlying comorbidities, and behavioral and immunological factors.&lt;/p&gt;&lt;/sec&gt;&lt;sec&gt;&lt;title&gt;Conclusion&lt;/title&gt;&lt;p&gt;Our study highlights higher mortality rates observed among males, suggesting that several factors may contribute to such differences, including social, behavioral, and biological factors. Our findings highlight the importance of implementing sex-specific treatment approaches in COVID-19 patients.&lt;/p&gt;&lt;/sec&gt;

Effect of Covid19 Pandemic on Preventive Vaccinations Among Patients with The End Stage Kidney Disease At New York Harbor VA Medical Center

Background: The COVID-19 pandemic revealed challenges and barriers in achieving high preventive vaccination rates. This study aimed to explore the effects of the pandemic on vaccination rates in patients with end stage kidney disease (kidney dialysis) patients in New York City. These patients compose a challenging cohort as their transplant optimization includes routine vaccinations including pneumococcal, flu, Hepatitis A and B, meningococcal, H flu, HPV, Tdap, RZV, and Covid. Materials and Methods: This study population consisted of 142 participants from two Veteran Affairs hospitals in New York City. Vaccination and demographic information were compiled via EMR and compared to long term US vaccination rates using exact binomial tests. Secondary analysis using generalized estimating equations was used to compare vaccination rates pre- and post-pandemic within the Brooklyn VA population controlling for demographic variables. Results: The combined vaccination rate for the post-pandemic period was found to be significantly lower than the pre-pandemic rate in the general US population for several vaccines, including Hepatitis A (CI: 0.088, 0.098; p&lt;0.001), Influenza (CI: 0.68, 0.69, p&lt;0.001), Meningococcal (CI: 0.34, 0.35; p&lt;0.001), MMR (, CI: 0.51, 0.52; p=0.001), and TDAP (CI: 0.18, 0.20; p&lt;0.001). Secondary analysis using generalized estimating equations controlling for age, race, and time on dialysis within the Brooklyn VA population revealed increases in post-pandemic vaccination rates for Shingles (subunit; B=1.03; 95% Wald CI: .178, 1.87; p=.018) and Hepatitis B (B=-.739; 95% Wald CI: .084, 1.39; p=.027), while a significant decrease was observed for Hep A (B=-2.65; 95% Wald CI: -4.4, -.90; p=.003). Conclusion: This data demonstrates that post-pandemic vaccination rates in VA dialysis patients is lower than the past 10-year US average for several vaccines including Hepatitis A, Influenza, Meningococcal, MMR, and TDAP. Mixed effects of pre- and post-pandemic vaccination rates within the Brooklyn VA were also found with a decreased vaccination rate for Hepatitis A, and increased rates for Shingles and Hepatitis B. Further study is needed to evaluate pandemic’s effect on these rates, disease prevention, and identify the reasons contributing to vaccine hesitancy vs. acceptance.

U.S. state health agencies and organizational learning: An exploratory analysis of website accessibility during COVID-19

The COVID-19 pandemic has exposed the inaccessibility of government information and communication technologies (ICTs) for members of the disability community. Organizational learning around ICT accessibility can be impacted by factors influencing strategies and assumptions or values and norms. Using data collected over two time periods in 2021, we study how the accessibility of US state health agencies COVID-19 information and vaccine websites improve over time. We examine how time, state policies, and partisanship influence organizational learning around website accessibility. Our analysis determines that the longer a COVID-19 related website exists on the Internet, the less accessible the website. We also find that more extensive internal state accessibility policies are more correlated with websites that meet fundamental accessibility requirements. Additionally, we find that partisanship plays an unexpected role in meeting fundamental accessibility demands, although both state policies and politics do not influence if an ICT meets the best practices standards of accessibility. Our paper initiates a discussion around the factors that influence organizational learning about government website accessibility and points to future research questions where the primary ICT function is not influenced by a rapidly evolving pandemic.

1146. Cost-effectiveness of the Pentavalent Meningococcal Vaccine (MenABCWY): A steady-state cohort modelling approach

Abstract Background Invasive meningococcal disease (IMD) is associated with a high case fatality rate and serious long-term sequelae (LTS). The current US vaccination platform targets serogroups ACWY with a routine recommendation in adolescents (11-12 years, with a booster at 16 years) and serogroup B (16-23 years) based on shared clinical decision making. A novel pentavalent meningococcal vaccine (MenABCWY) may improve protection against all five serogroups and simplify vaccination schedule. The study objective was to assess the cost-effectiveness of MenABCWY from a societal perspective in the US. Methods A steady-state model was developed to estimate the impact of various vaccination strategies on IMD cases, LTS, and deaths. Cohorts of 11- and 16-year-olds were simulated over a lifetime (up to 100 years of age) after vaccination. The same vaccine uptake rate was applied to all strategies. Costs included vaccination acquisition and administration, and IMD direct and indirect costs. Disutilities of IMD and LTS were applied to estimate losses of quality-adjusted life years (QALYs). Incremental cost-effectiveness ratio (ICER) was calculated as the difference in costs over QALY gained comparing a strategy of implementing the MenABCWY vaccine with the current standard of care (SoC). Extensive scenario analyses were conducted. Results In the base case, compared with the SoC (one dose of a MenACWY vaccine at 11 years with a booster at 16 years, and two doses of a MenB vaccine at 16 years), introducing two doses of the MenABCWY vaccine at 11 years followed by a booster at 16 years (2+1 schedule) would prevent 63 IMD cases, 17 IMD cases with LTS, and 6 IMD-related deaths while providing savings (dominant ICERs). Results on ICERs, IMD cases, and IMD-related deaths were robust in scenario analyses when inputs most likely to influence the public health impact (i.e., IMD incidence and case fatality rate) were modified over plausible ranges. Conclusion The MenABCWY vaccine fits the current vaccination platform. Results of the cost-effectiveness analysis demonstrate that the 2+1 schedule could offer the most public health benefits by providing the full protection against all five serogroups at an early age, while being a dominant economic strategy. Disclosures Katharina Schley, Dr., Pfizer Pharma GmbH: Employee|Pfizer Pharma GmbH: Employee|Pfizer Pharma GmbH: Stocks/Bonds|Pfizer Pharma GmbH: Stocks/Bonds Jessica V. Presa, MD, Pfizer Inc.: Stocks/Bonds|Pfizer Inc.: Stocks/Bonds Vincenza Snow, MD, Pfizer Vaccines: employee|Pfizer Vaccines: Stocks/Bonds Alejandro D. Cane, MD, PhD, Pfizer: Stocks/Bonds Paula Peyrani, MD, Pfizer, Inc: Employee|Pfizer, Inc: Stocks/Bonds Ray Farkouh, PhD, Pfizer: Stocks/Bonds Shannon M. Sullivan, PhD, Evidera: I am an employee of Evidera that is a consultancy to multiple pharma companies|Pfizer: Advisor/Consultant Hossein Zivaripiran, PhD, Pfizer: Advisor/Consultant|Pfizer: I am an employee of Evidera that is a consultancy to multiple pharma companies Diana Teloian, MA, Merck &amp; Co., Inc: Grant/Research Support Jörgen Möller, MSc, Evidera: I am an employee of Evidera that is a consultancy to multiple pharma companies|Pfizer: Advisor/Consultant J. Jaime Caro, MDCM, FRCPC, FACP, Evidera: I am an employee of Evidera, a consultancy serving the pharmaceutical industry.|Pfizer: Advisor/Consultant

Summer 2023 ACIP Update: RSV Prevention and Updated Recommendations on Other Vaccines.

The Advisory Committee on Immunization Practices (ACIP), a group of medical and public health experts that provides advice to the Centers for Disease Control and Prevention (CDC), normally meets three times per year to develop US vaccine recommendations. The ACIP met June 21-23, 2023, to discuss respiratory syncytial virus (RSV) vaccines, influenza vaccines, pneumococcal vaccines, meningococcal vaccines, and COVID-19 vaccines. The ACIP also held a special meeting on August 3, 2023 to discuss RSV prophylaxis in infants. This update summarizes the proceedings of these meetings that are most relevant to the pediatric population. Major updates for pediatric clinicians include a new recommendation for the monoclonal antibody nirsevimab for prevention of RSV disease in all infants, recommendations regarding use of 20-valent pneumococcal conjugate vaccine (PCV20), and discussion of potential forthcoming changes to meningococcal and COVID-19 vaccination recommendations.

Comparative Cost-Effectiveness Analysis of Respiratory Syncytial Virus Vaccines for Older Adults in Hong Kong.

Two respiratory syncytial virus (RSV) vaccines (AREXVY® and ABRYSVO®) were recently approved for older adults in the US. This study aimed to evaluate the cost-effectiveness of AREXVY® and ABRYSVO® from the Hong Kong public healthcare provider's perspective. A two-year decision-analytical model was developed to examine the outcomes of a single RSV vaccination (AREXVY® or ABRYSVO®) compared to no vaccination. Primary outcomes included RSV-related health outcomes, direct medical costs, quality-adjusted life-year (QALY) loss, and incremental cost per QALY (ICER). RSV vaccines are not yet marketed in Hong Kong, base-case analysis, therefore, benchmarked US RSV vaccine prices at 4 levels (25%, 50%, 75%, 100%). AREXVY® and ABRYSVO® (versus no vaccination) gained 0.000568 QALY and 0.000647 QALY, respectively. ICERs of ABRYSVO® (26,209 USD/QALY) and AREXVY® (47,485 USD/QALY) were lower than the willingness-to-pay threshold (49,594 USD/QALY) at 25% US vaccine price. The RSV attack rate was a common influential factor at all vaccine price levels. The probabilities of AREXVY® and ABRYSVO® to be most cost-effective were 0.10% and 97.68%, respectively, at 25% US vaccine price. Single vaccination of ABRYSVO® or AREXVY® for older adults appears to gain QALYs over 2 years in Hong Kong. The cost-effectiveness of AREXVY® and ABRYSVO® is subject to vaccine price and RSV attack rate.