Vaccination Campaigns Research Articles

Navigating the Waves: A Comprehensive Analysis of India's COVID-19 Journey from 2019 to the Arrival of JN.1 Subvariant in 2023

COVID-19, caused by the SARS-CoV-2 virus, has emerged as a global threat. The journey of COVID-19, from its origins in Wuhan in 2019 to the emergence of various variants, including the recent JN.1 subvariant, is a complex narrative marked by global efforts to control the pandemic. The progression of the virus in India, as illustrated by data from 2020 to 2023, reflects both the challenges faced and the resilience exhibited by different states. The decline in cases in 2023, compared to the previous year, is attributed to factors such as extensive vaccination campaigns, the emergence of less severe variants, and changing immune responses. The inclusion of comprehensive WHO recommendations emphasizes the ongoing importance of preventive measures. The evolving scenario also highlights the need for continued vigilance, international collaboration, and public health initiatives to minimize the impact of the virus. The advent of JN.1 serves as a reminder of the virus's adaptability and the significance of remaining in advance of emerging variants as the globe struggles with COVID-19's unexpected nature.

Optimal Allocation of Multi-Type Vaccines in a Two-Dose Vaccination Campaign for Epidemic Control: A Case Study of COVID-19

As a typical case of the optimal planning for the provision of restricted medical resources, widespread vaccination is considered an effective and sustainable way to prevent and control large-scale novel coronavirus disease 2019 (COVID-19) outbreaks. However, an initial supply shortage of vaccines is inevitable because of the narrow production and logistical capacity. This work focuses on the multi-type vaccine resource allocation problem in a two-dose vaccination campaign under limited supply. To address this issue, we extended an age-stratified susceptible, exposed, infectious, and recovered (SEIR) epidemiological model to incorporate a two-dose vaccination campaign involving multiple vaccine types to fully characterize the various stages of infection and vaccination. Afterward, we integrated the proposed epidemiological model into a nonlinear programming (NLP) model to determine the optimal allocation strategy under supply capacity and vaccine hesitancy constraints with the goal of minimizing the cumulative number of deaths due to the pandemic over the entire planning horizon. A case study based on real-world data from the initial mass vaccination campaign against COVID-19 in the Midlands, England, was taken to validate the applicability of our model. Then, we performed a comparative study to demonstrate the performance of the proposed method and conducted an extensive sensitivity analysis on critical model parameters. Our results indicate that prioritizing the allocation of vaccines to elderly persons is an effective strategy for reducing COVID-19-related fatalities. Furthermore, we found that vaccination alone will not be sufficient for epidemic control in the short term, and appropriate non-pharmacological interventions are still important for effective viral containment during the initial vaccine rollout. The results also showed that the relative efficacy of the first dose is a vital factor affecting the optimal interval between doses. It is always best to complete the two-dose vaccination schedule as soon as possible when the relative efficacy of the first dose is low. Conversely, delaying the second dose of a vaccine as long as possible to increase the proportion of the population vaccinated with a single dose tends to be more favorable when the relative efficacy of the first dose is high. Finally, our proposed model is general and easily extendable to the study of other infectious disease outbreaks and provides important implications for public health authorities seeking to develop effective vaccine allocation strategies for tackling possible future pandemics.

All-cause mortality according to COVID-19 vaccination status: An analysis of the UK office for National statistics public data

Background The mass vaccination campaign against COVID-19 has been commonly considered the best response to the global COVID-19 pandemic crisis. However, to assess its real-world overall effects, the best way can be the analysis of all-cause mortality by vaccination status. The UK is perhaps the only country which has made publicly available all-cause mortality data by vaccination status. Methods Data from April 2021 to May 2023 published by the UK Office for National Statistics (ONS) were retrospectively analyzed by age groups and vaccination status; the standardized mortality ratio (SMR) for all-cause and non-COVID-19 mortality was calculated against the corresponding unvaccinated groups. Results We found that across all age groups, all-cause mortality SMRs increased from a certain date, dependent on the age group. Across all age groups, all-cause mortality SMRs were initially much lower than 1. However, due to their increase, by a certain date for the 18-39, 80-89 and 90+ age groups they exceeded the reference value. For the other age groups, the date at which the SMR would reach 1 can be predicted, provided the trend is maintained. Non-COVID-19 SMRs’ trends were very similar. Their initial values much lower than 1 are suggestive of significant biases in the ONS dataset, leading to underestimate the risks for the vaccinated people, as it is implausible that COVID-19 vaccines protect against non-COVID-19 deaths. Conclusions The increase over time in all-cause death SMRs in vaccinated people compared to unvaccinated, and their excess from the reference values for certain age groups, should be carefully considered to understand the underlying factors. It would be desirable for other major countries to systematically collect all-cause mortality by vaccination status and, in the meantime, a moratorium on promoting mass vaccination campaigns should be implemented.

The Influence of Altitude, Urbanization, and Local Vaccination Centers on Vaccine Uptake within an Italian Health District: An Analysis of 15,000 Individuals Eligible for Vaccination.

In Italy, free vaccinations for Herpes Zoster (HZ), pneumococcal (PCV), and influenza (FLU) are recommended each year for individuals turning 65. Despite this, achieving optimal vaccination coverage remains challenging. This study assesses coverage rates for HZ, PCV, and FLU in Forlì, Northern Italy, and examines how altitude, urban planning, and health organization variables (such as the presence of a vaccination center) impact vaccine uptake. Vaccination coverages were calculated for birth cohorts between 1952 and 1958 for each municipality in the Forlì area as of 1 March 2024. The geographical factors influencing the vaccination uptake were extracted from the Italian National Institute of Statistics (ISTAT) records and evaluated through a multivariate analysis. The sample analyzed included 15,272 vaccine campaign targets from Forlì's province (185,525 citizens); the vaccine uptake rates for HZ, PCV, and FLU were 26.9%, 36.7%, and 43.5%, respectively. Gender did not appear to influence vaccine uptake. Living in a flat area appeared to increase vaccine uptake in a statistically significant way for all the vaccinations when compared to a mountainous area (HZ: OR: 1.50, PCV: OR: 1.33, FLU: OR: 1.67). The presence of a vaccine service in low-urbanized areas was shown to increase vaccine uptake for all vaccinations (HZ: OR: 1.65, PCV: OR: 1.93, FLU: OR: 1.53) compared with low-urbanized areas without a vaccination center or more urbanized areas with a vaccination center. This study emphasizes the significance of the territorial context, along with the ease of access to vaccinations and geographic barriers, as key determinants in achieving vaccination targets. Local health authorities should consider these factors when implementing vaccination campaigns.

COVID-19 infection and 2-year mortality in nursing home residents who survived the first wave of the pandemic

BackgroundDuring the first COVID-19 pandemic wave (1st CoPW), nursing homes (NHs) experienced a high rate of COVID-19 infection and death. Residents who survived the COVID-19 infection may have become frailer. This study aimed to determine the predictive value of having a COVID-19 infection during the 1st CoPW for 2-year mortality in NH residents.MethodsThis was a retrospective study conducted in three NHs. Residents who had survived the 1st CoPW (March to May 2020) were included. The diagnosis of COVID-19 was based on the results of a positive reverse transcriptase-polymerase chain reaction test. The collected data also included age, sex, length of residence in the NH, disability status, legal guardianship status, nutritional status, need for texture-modified food, hospitalization or Emergency Department visits during lockdown and SARS-COV2 vaccination status during the follow-up. Non-adjusted and adjusted Cox models were used to analyse factors associated with 2-year post-1st CoPW mortality.ResultsAmong the 315 CoPW1 survivors (72% female, mean age 88 years, 48% with severe disability), 35% presented with COVID-19. Having a history of COVID-19 was not associated with 2-year mortality: hazard ratio (HR) [95% confidence interval] = 0.96 [0.81–1.13], p = 0.62. The factors independently associated with 2-year mortality were older age (for each additional year, HR = 1.05 [1.03–1.08], p < 0.01), severe disability vs. moderate or no disability (HR = 1.35 [1.12–1.63], p < 0.01) and severe malnutrition vs. no malnutrition (HR = 1.29 [1.04–1.60], p = 0.02). Considering that vaccination campaign started during the follow-up, mortality was associated with severe malnutrition before and severe disability after the start of the campaign. Vaccination was independently associated with better survival (HR 0.71 [0.55–0.93], p = 0.02).ConclusionsHaving survived a COVID-19 infection during the 1st CoPW did not affect subsequent 2-year survival in older adults living in NHs. Severe malnutrition and disability remained strong predictor of mortality in this population, whereas vaccination was associated to better survival.

Effectiveness of historical smallpox vaccination against mpox clade II in men in Denmark, France, the Netherlands and Spain, 2022.

BackgroundIn 2022, a global monkeypox virus (MPXV) clade II epidemic occurred mainly among men who have sex with men. Until early 1980s, European smallpox vaccination programmes were part of worldwide smallpox eradication efforts. Having received smallpox vaccine > 20 years ago may provide some cross-protection against MPXV.AimTo assess the effectiveness of historical smallpox vaccination against laboratory-confirmed mpox in 2022 in Europe.MethodsEuropean countries with sufficient data on case vaccination status and historical smallpox vaccination coverage were included. We selected mpox cases born in these countries during the height of the national smallpox vaccination campaigns (latest 1971), male, with date of onset before 1 August 2022. We estimated vaccine effectiveness (VE) and corresponding 95% CI for each country using logistic regression as per the Farrington screening method. We calculated a pooled estimate using a random effects model.ResultsIn Denmark, France, the Netherlands and Spain, historical smallpox vaccination coverage was high (80-90%) until the end of the 1960s. VE estimates varied widely (40-80%, I2 = 82%), possibly reflecting different booster strategies. The pooled VE estimate was 70% (95% CI: 23-89%).ConclusionOur findings suggest residual cross-protection by historical smallpox vaccination against mpox caused by MPXV clade II in men with high uncertainty and heterogeneity. Individuals at high-risk of exposure should be offered mpox vaccination, following national recommendations, regardless of prior smallpox vaccine history, until further evidence becomes available. There is an urgent need to conduct similar studies in sub-Saharan countries currently affected by the MPXV clade I outbreak.

Application of modern spatio-temporal analysis technologies to identify and visualize patterns of rabies emergence among different animal species in Kazakhstan.

During the period 2013-2023, 917 cases of rabies among animals were registered in the Republic of Kazakhstan. Out of these, the number of cases in farm animals amounted to 515, in wild animals to 50 and in pets to 352. Data on rabies cases were obtained from the Committee for Veterinary Control and Supervision of Kazakhstan, as well as during expeditionary trips. This research was carried out to demonstrate the use of modern information and communication technologies, geospatial analysis technologies in particular, to identify and visualize spatio-temporal patterns of rabies emergence among different animal species in Kazakhstan. We also aimed to predict an expected number of cases next year based on time series analysis. Applying the 'space-time cube' technique to a time series representingcases from the three categories of animals at the district-level demonstrated a decreasing trend of incidence in most of the country over the study period. We estimated the expected number of rabies cases for 2024 using a random forest model based on the space-time cube in Arc-GIS. This type of model imposes only a few assumptions on the data and is useful when dealing with time series including complicated trends. The forecast showed that in most districts of Kazakhstan, a total of no more than one case of rabies should beexpected, with the exception of certain areas in the North and the East of the country, where the number of cases could reach three. The results of this research may be useful to the veterinary service in mapping the current epidemiological situation and in planning targeted vaccination campaigns among different categories of animals.

Trust in institutions affects vaccination campaign outcomes.

Trust is an important driver of various outcomes, but little is known about whether trust in institutions affects actual vaccination campaign outcomes rather than only beliefs and intentions. We used nationally representative, individual-level data for 114 countries and combined them with data on vaccination policies and rates. We measured the speed of the vaccination campaign for each country using the estimated growth rate of a Gompertz curve. We then performed country-level regressions in the global sample and explored heterogeneity across World Bank development groups. Globally, higher trust in institutions significantly increased vaccination rates (p<0.01) and vaccination speed (p<0.01). The effect was strong in low- and middle-income countries but statistically not significant in high-income countries. Our findings have implications for the design of vaccination campaigns for national governments and international organizations. The findings highlight the importance of trust in institutions when designing communication strategies around vaccination campaigns in low- and middle-income countries.

Assessing the resilience of child immunisation programmes using geospatial modelling and interrupted time series analysis in Ethiopia and Kenya amidst the COVID-19 pandemic: tracking coverage and identifying key challenges

IntroductionThe COVID-19 pandemic disrupted healthcare provision and access in sub-Saharan Africa. Lockdowns and travel restrictions, coupled with fear of contracting the virus, disrupted services, especially for women’s and children’s health,...

Assessing vaccine hesitancy and vaccine literacy among the European prison population and staff: A multicentre observational study

Vaccination is the most efficient and cost-effective public health intervention. Prison population, for its low social distancing, constant turnover, and high percentage of migrants, should be an important target of vaccination campaign. However, vaccination coverage in prison is low. In this study we estimated vaccine hesitancy and vaccine literacy among the prison population and staff and assessed their correlation.We conducted a cross-sectional study in 13 prisons of 4 European countries. The sample included 847 people living in prison and 755 staff members. Through a structured questionnaire we assessed vaccine hesitancy, vaccine literacy, general health literacy, previous vaccine refusal and socio-demographic characteristics of participants. Exploratory factor analysis was used to extract three components of vaccine hesitancy. Logistic regression was applied to assess the association between previous vaccine refusal and vaccine hesitancy; linear regression was applied to assess the association between vaccine hesitancy and vaccine and general health literacy. All analyses were adjusted for socio-demographic variables.We identified three components of vaccine hesitancy explaining 49% of the total variance: Mistrust, Concern and Conspiracy. In both people living in prison and staff, all the components were associated to previous vaccine refusal (p-value < 0.001) and presented good internal consistency (Cronbach’s alpha = 0.90, 0.73 and 0.78). Young participants presented the highest levels of vaccine hesitancy; migrant people living in prison had the lower levels of Mistrust and the higher level of Concern; all three factors were lower among participants with the highest degree of education. Mistrust and Concern were inversely associated with vaccine literacy while all three subscales were inversely associated with general health literacy (all p-values < 0.001).This study suggests that educational interventions aimed at increasing vaccine literacy in people living and working in prison could decrease vaccine hesitation and consequently increase vaccination uptake among the prison population and staff.

Seroprevalence of immunity to hepatitis A and hepatitis B among gay, bisexual and other men who have sex with men (GBMSM) attending sexual health clinics in London and Leeds, England, 2017–2018

ObjectivesAlthough hepatitis A virus (HAV) and hepatitis B virus (HBV) immunisation is recommended in the UK for gay, bisexual and other men who have sex with men (GBMSM), data on...

A Study on the Institutional Context and Dynamics Surrounding the Emergence of SARS-CoV-2

This dissertation presents an in-depth analysis of the institutional context and dynamics surrounding the emergence of SARSCoV-2, the virus responsible for the COVID-19 pandemic. Focusing on the case of Brazil, the study employs a multi-disciplinary approach that integrates mathematical economics, epidemiology, and public health policy analysis. Key aspects include examining the initial outbreak in Wuhan, the virus's rapid global spread, and the specific impacts and responses in Brazil. The research employs mathematical models to understand the dynamics of virus transmission, the effectiveness of various public health interventions, and the socio-economic consequences of the pandemic. Special attention is given to Brazil's vaccination campaigns and their role in pandemic control. The findings offer valuable insights into the complexities of managing a public health crisis in a socio-economically diverse country like Brazil and underscore the importance of timely and coordinated responses to global health emergencies.

Multiplex array analysis of circulating cytokines and chemokines in COVID-19 patients during the first wave of the SARS-CoV-2 pandemic in Milan, Italy

BackgroundThe systemic inflammatory syndrome called “cytokine storm” has been described in COVID-19 pathogenesis, contributing to disease severity. The analysis of cytokine and chemokine levels in the blood of 21 SARS-CoV-2 positive patients throughout the phases of the pandemic has been studied to understand immune response dysregulation and identify potential disease biomarkers for new treatments. The present work reports the cytokine and chemokine levels in sera from a small cohort of individuals primarily infected with SARS-CoV-2 during the first wave of the COVID-19 pandemic in Milan (Italy).ResultsAmong the 27 cytokines and chemokines investigated, a significant higher expression of Interleukin-9 (IL-9), IP-10 (CXCL10), MCP-1 (CCL2) and RANTES (CCL-5) in infected patients compared to uninfected subjects was observed. When the change in cytokine/chemokine levels was monitored over time, from the hospitalization day to discharge, only IL-6 and IP-10 showed a significant decrease. Consistent with these findings, a significant negative correlation was observed between IP-10 and anti-Spike IgG antibodies in infected individuals. In contrast, IL-17 was positively correlated with the production of IgG against SARS-CoV-2.ConclusionsThe cytokine storm and the modulation of cytokine levels by SARS-CoV-2 infection are hallmarks of COVID-19. The current global immunity profile largely stems from widespread vaccination campaigns and previous infection exposures. Consequently, the immunological features and dynamic cytokine profiles of non-vaccinated and primarily-infected subjects reported here provide novel insights into the inflammatory immune landscape in the context of SARS-CoV-2 infection, and offer valuable knowledge for addressing future viral infections and the development of novel treatments.

A Serological Survey of Measles and Rubella Antibodies among Different Age Groups in Eastern China.

Measles and rubella are vaccine-preventable diseases targeted for elimination in most World Health Organization regions, and China is considered to have momentum towards measles elimination. Therefore, this study aimed to assess the population immunity levels against measles and rubella in Zhejiang Province in China in order to provide valuable insights for informing future public health measures and contributing to the ongoing global campaign against these diseases. A cross-sectional serological survey was conducted in 2022. A total of 2740 blood samples were collected from healthy individuals spanning the age range of 0-59 years, representing diverse demographic strata across 11 prefectures in Zhejiang Province in China. The sera were tested for measles and rubella IgG antibodies to determine positivity rates and geometric mean concentrations (GMCs). The overall positivity rate for the measles IgG antibody was 85.3%, with a GMC of 588.30 mIU/mL. The positivity rate for the rubella IgG antibody was 70.9%, and the GMC was 35.30 IU/mL. Measles IgG antibody positivity rates across the 0-11 months, 12-23 months, 24-35 months, 3-5 years, 6-9 years, 10-14 years, 15-19 years, 20-29 years, and 30-59 years age groups were 63.1%, 92.5%, 97.0%, 94.0%, 85.8%, 77.3%, 86.9%, 84.9%, and 88.7%, respectively (trend χ2 = 118.34, p < 0.001). Correspondingly, rubella antibody positivity rates for these same age brackets were 55.9%, 87.9%, 94.7%, 88.2%, 69.9%, 54.2%, 72.6%, 67.5%, and 74.3% (trend χ2 = 199.18, p < 0.001). Both univariate and multivariate analyses consistently demonstrated that age, immunization history, and differing economic levels were significant factors contributing to variations in antibody levels. The seroprevalence of measles and rubella was lower than that required for herd immunity. Periodic vaccination campaigns should be launched to increase immunity.

Integrating Genomic, Climatic, and Immunological Factors to Analyze Seasonal Patterns of Influenza Variants

Influenza, often referred to as the flu, is an extremely contagious respiratory illness caused by influenza viruses, impacting populations globally with significant health consequences annually. A hallmark of influenza is its seasonal patterns, influenced by a mix of geographic, evolutionary, immunological, and environmental factors. Understanding these seasonal trends is crucial for informing public health decisions, including the planning of vaccination campaigns and their formulation. In our study, we introduce a genotype-structured infectious disease model for influenza transmission, immunity, and evolution. In this model, the population of infected individuals is structured according to the virus they harbor. It considers a symmetrical fitness landscape where the influenza A and B variants are considered. The model incorporates the effects of population immunity, climate, and epidemic heterogeneity, which makes it suitable for investigating influenza seasonal dynamics. We parameterize the model to the genomic surveillance data of flu in the US and use numerical simulations to elucidate the scenarios that result in the alternating or consecutive prevalence of flu variants. We show that the speed of virus evolution determines the alternation and co-circulation patterns of seasonal influenza. Our simulations indicate that slow immune waning reduces how often variants change, while cross-immunity regulates the co-circulation of variants. The framework can be used to predict the composition of future influenza outbreaks and guide the development of cocktail vaccines and antivirals that mitigate influenza in both the short and long term.

Active offer of Tdap vaccination in a cohort of healthcare workers of Maternal and Neonatal Department: Data from a large hospital in Southern Italy

Pertussis is a vaccine-preventable respiratory disease. Pertussis vaccination is currently mandatory for all children in Italy, and is administered in three doses at the beginning of the third, fifth, and twelfth month of life, respectively. Booster doses are also recommended at five-six years, at eleven-twelve years, and then once every ten years. Healthcare workers (HCWs) are a high-risk population for pertussis. Strategies to increase HCWs’ compliance to this vaccination have not been investigated in depth. Our study investigates the determinants of acceptance of a “soft nudge” vaccination campaign in a large hospital in Apulia (Southern Italy).HCWs from the Gynaecology and Neonatology Units of Bari’s Policlinico General Hospital were screened in June 2023 for pertussis vaccination. Non-vaccinated subjects were offered a vaccination appointment. Vaccination determinants were studied, and a logistic regression model was built to identify determinants that significantly influence vaccination acceptance.At the time of screening, only 31.34% of target HCWs (68/217) had already been vaccinated. After the active call intervention, vaccine coverage rose to 70.00% (152/217). Significantly higher coverage was found in the Neonatology Unit (30/43, 69.77%) than in the Gynaecology unit (54/106, 50.94%) (Chi2: 4.41; p-value: 0.036). A logistic regression model confirmed a higher compliance to vaccination in HCWs staffed in the Neonatology Unit (Chi2: 2.08; 95%CI: 1.04 – 4.73; p-value: 0.038).Our intervention increased vaccination coverage in a high-risk cohort. The solicitation was effective, as communication with a trained specialist might have improved the subjects’ perception of vaccination and individual risk of contagion and transmission to others. A synergistic approach, mixing active call with a vaccination mandate, might have greater effectiveness.

Rabies Realities: Navigating Barriers to Rabies Control in Rural Zambia-A Case Study of Manyinga and Mwansabombwe Districts.

Rabies persists as a longstanding issue in Zambia, despite being preventable. The current control measures, including dog vaccination, population control, and movement restriction, guided by 'The Control of Dogs Act Chapter 247 of the Laws of Zambia', have not yielded the desired impact in many areas of the country including Manyinga and Mwansabombwe districts. These two districts continue to report low dog vaccination rates, unrestricted dog movements, and escalating cases of animal and human rabies, along with dog bites. Aligned with global aspirations to achieve zero human rabies cases by 2030, this study scrutinizes the determinants and obstacles hampering the execution of rabies control initiatives in Manyinga and Mwansabombwe. Spanning approximately 11 months, this cross-sectional study gathered pre- and post-vaccination data from 301 households in Manyinga and 100 households in Mwansabombwe. Questionnaires probed knowledge, attitudes, and practices related to rabies prevention and control. A transect survey, key informant interviews, and assessment of rabies vaccination and dog bite records complemented the data collection. Findings revealed that 88.0% of respondents from both districts possessed knowledge about rabies, confirming affected species and transmission. Moreover, 76.8% in Manyinga and 88.6% in Mwansabombwe were acquainted with rabies prevention and control methods. Concerning dog owners, 89.0% were aware of rabies, 66.0% understood its prevention and control, and the majority identified bites as the primary mode of transmission. Despite the high level of knowledge recorded during the survey, the implementation of preventive measures was low, which was attributed to low levels of law enforcement by the local government authority, inadequate staffing in the veterinary department, unwillingness to pay for dog vaccinations, and unavailability of rabies vaccine at the veterinary office in both districts. Vaccination coverage stood at 64.0% in Manyinga and 21.0% in Mwansabombwe. Notably, education and occupation exhibited a positive significant association with rabies knowledge. In terms of dog bite cases, Manyinga recorded 538 dog bite cases from 2017 to June 2022, while Mwansabombwe recorded 81 dog bite and 23 jackal bite cases from 2021 to June 2022. The study underscores critical knowledge gaps in rural areas and emphasizes the imperative for enhanced public education and awareness programs, improved rabies surveillance, free mass vaccination campaigns, and community engagement to augment vaccination coverage and knowledge about rabies.

Bronchiolitis Obliterans Organizing Pneumonia After Breast Radiation Therapy

Presented here is a case report of a 77-year-old woman affected by rheumatoid arthritis who underwent breast-conserving surgery followed by radiation therapy (RT) for left-breast cancer and developed bronchiolitis obliterans organizing pneumonia (BOOP) after RT and during a COVID-19 vaccination campaign. BOOP incidence is an uncommon morbidity after breast RT (1.2%-2.9%); however, specific predisposing factors can play a role. In this patient, both rheumatoid arthritis and the vaccine may have predisposed her to an increased risk of organizing pneumonia, probably by triggering a proinflammatory cascade. Our report highlights the importance of factors that influence the occurrence of uncommon radiation-induced morbidities, such as BOOP, in specific subsets of patients. Further studies are necessary to evaluate factors increasing radiation sensitivity.

Intra-lymph node crosslinking of antigen-bearing polymers enhances humoral immunity and dendritic cell activation.

Lymph node (LN)-resident dendritic cells (DCs) are a promising target for vaccination given their professional antigen-presenting capabilities and proximity to a high concentration of immune cells. Direct intra-LN injection has been shown to greatly enhance the immune response to vaccine antigens compared to traditional intramuscular injection, but it is infeasible to implement clinically in a vaccination campaign context. Employing the passive lymphatic flow of antigens to target LNs has been shown to increase total antigen uptake by DCs more than inflammatory adjuvants, which recruit peripheral DCs. Herein, we describe a novel vaccination platform in which two complementary multi-arm poly(ethylene glycol) (PEG) polymers-one covalently bound to the model antigen ovalbumin (OVA)-are injected subcutaneously into two distinct sites. These materials then drain to the same LN through different lymphatic vessels and, upon meeting in the LN, rapidly crosslink. This system improves OVA delivery to, and residence time within, the draining LN compared to all control groups. The crosslinking of the two PEG components also improves humoral immunity without the need for any pathogen-mimicking adjuvants. Further, we observed a significant increase in non-B/T lymphocytes in LNs cross-presenting the OVA peptide SIINFEKL on MHC I over a dose-matched control containing alum, the most common clinical adjuvant, as well as an increase in DC activation in the LN. These data suggest that this platform can be used to deliver antigens to LN-resident immune cells to produce a stronger humoral and cellular immune response over materials-matched controls without the use of traditional adjuvants.

Adverse Events of COVID-19 Vaccines in the United States: Temporal and Spatial Analysis.

The COVID-19 pandemic, caused by SARS-CoV-2, has had a profound impact worldwide, leading to widespread morbidity and mortality. Vaccination against COVID-19 is a critical tool in controlling the spread of the virus and reducing the severity of the disease. However, the rapid development and deployment of COVID-19 vaccines have raised concerns about potential adverse events following immunization (AEFIs). Understanding the temporal and spatial patterns of these AEFIs is crucial for an effective public health response and vaccine safety monitoring. This study aimed to analyze the temporal and spatial characteristics of AEFIs associated with COVID-19 vaccines in the United States reported to the Vaccine Adverse Event Reporting System (VAERS), thereby providing insights into the patterns and distributions of the AEFIs, the safety profile of COVID-19 vaccines, and potential risk factors associated with the AEFIs. We conducted a retrospective analysis of administration data from the Centers for Disease Control and Prevention (n=663,822,575) and reports from the surveillance system VAERS (n=900,522) between 2020 and 2022. To gain a broader understanding of postvaccination AEFIs reported, we categorized them into system organ classes (SOCs) according to the Medical Dictionary for Regulatory Activities. Additionally, we performed temporal analysis to examine the trends of AEFIs in all VAERS reports, those related to Pfizer-BioNTech and Moderna, and the top 10 AEFI trends in serious reports. We also compared the similarity of symptoms across various regions within the United States. Our findings revealed that the most frequently reported symptoms following COVID-19 vaccination were headache (n=141,186, 15.68%), pyrexia (n=122,120, 13.56%), and fatigue (n=121,910, 13.54%). The most common symptom combination was chills and pyrexia (n=56,954, 6.32%). Initially, general disorders and administration site conditions (SOC 22) were the most prevalent class reported. Moderna exhibited a higher reporting rate of AEFIs compared to Pfizer-BioNTech. Over time, we observed a decreasing reporting rate of AEFIs associated with COVID-19 vaccines. In addition, the overall rates of AEFIs between the Pfizer-BioNTech and Moderna vaccines were comparable. In terms of spatial analysis, the middle and north regions of the United States displayed a higher reporting rate of AEFIs associated with COVID-19 vaccines, while the southeast and south-central regions showed notable similarity in symptoms reported. This study provides valuable insights into the temporal and spatial patterns of AEFIs associated with COVID-19 vaccines in the United States. The findings underscore the critical need for increasing vaccination coverage, as well as ongoing surveillance and monitoring of AEFIs. Implementing targeted monitoring programs can facilitate the effective and efficient management of AEFIs, enhancing public confidence in future COVID-19 vaccine campaigns.