Vaccination Coverage Levels Research Articles

COVID-19 vaccine hesitancy and resistance: Correlates in a nationally representative longitudinal survey of the Australian population.

High levels of vaccination coverage in populations will be required even with vaccines that have high levels of effectiveness to prevent and stop outbreaks of coronavirus. The World Health Organisation has suggested that governments take a proactive response to vaccine hesitancy 'hotspots' based on social and behavioural insights. Representative longitudinal online survey of over 3000 adults from Australia that examines the demographic, attitudinal, political and social attitudes and COVID-19 health behavior correlates of vaccine hesitance and resistance to a COVID-19 vaccine. Overall, 59% would definitely get the vaccine, 29% had low levels of hesitancy, 7% had high levels of hesitancy and 6% were resistant. Females, those living in disadvantaged areas, those who reported that risks of COVID-19 was overstated, those who had more populist views and higher levels of religiosity were more likely to be hesitant or resistant while those who had higher levels of household income, those who had higher levels of social distancing, who downloaded the COVID-Safe App, who had more confidence in their state or territory government or confidence in their hospitals, or were more supportive of migration were more likely to intend to get vaccinated. Our findings suggest that vaccine hesitancy, which accounts for a significant proportion of the population can be addressed by public health messaging but for a significant minority of the population with strongly held beliefs, alternative policy measures may well be needed to achieve sufficient vaccination coverage to end the pandemic.

Characterisation of a G2P[4] Rotavirus Outbreak in Western Australia, Predominantly Impacting Aboriginal Children

In May, 2017, an outbreak of rotavirus gastroenteritis was reported that predominantly impacted Aboriginal children ≤4 years of age in the Kimberley region of Western Australia. G2P[4] was identified as the dominant genotype circulating during this period and polyacrylamide gel electrophoresis revealed the majority of samples exhibited a conserved electropherotype. Full genome sequencing was performed on representative samples that exhibited the archetypal DS-1-like genome constellation: G2-P[4]-I2-R2-C2-M2-A2-N2-T2-E2-H2 and phylogenetic analysis revealed all genes of the outbreak samples were closely related to contemporary Japanese G2P[4] samples. The outbreak samples consistently fell within conserved sub-clades comprised of Hungarian and Australian G2P[4] samples from 2010. The 2017 outbreak variant was not closely related to G2P[4] variants associated with prior outbreaks in Aboriginal communities in the Northern Territory. When compared to the G2 component of the RotaTeq vaccine, the outbreak variant exhibited mutations in known antigenic regions; however, these mutations are frequently observed in contemporary G2P[4] strains. Despite the level of vaccine coverage achieved in Australia, outbreaks continue to occur in vaccinated populations, which pose challenges to regional areas and remote communities. Continued surveillance and characterisation of emerging variants are imperative to ensure the ongoing success of the rotavirus vaccination program in Australia.

Levels of vaccination coverage among HIV-exposed children in China: a retrospective study

BackgroundVaccination is crucial for human immunodeficiency virus (HIV)-exposed children because of their increased risk of morbidity and mortality from various vaccine-preventable diseases. However, studies have shown that they are at high risk of incomplete vaccination. Although China has developed prevention of mother-to-child transmission (PMTCT) of HIV programs substantially over the past decades, few studies have investigated the immunization levels of Chinese HIV-exposed children. Therefore, we aimed to evaluate vaccination coverage and its associated factors among HIV-exposed children in China during 2016‒2018.MethodsWe conducted a retrospective cohort review of all cases of Chinese HIV-exposed children born between July 1, 2016 and June 30, 2018 recorded in the Chinese information system on PMTCT. The vaccination coverage indicators refer to the percentage of children who received recommended basic vaccines, including Bacillus Calmette-Guérin (BCG), hepatitis B (HepB), polio, measles-containing vaccine (MCV), and diphtheria-tetanus-pertussis-containing (DTP) vaccine. Univariate and multivariate logistic regression analyses expressed as crude odds ratios (cORs) and adjusted odds ratios (aORs), each with 95% confidence intervals (95% CI), were performed to compare the proportional differences of factors associated with vaccine coverage.ResultsAmong the enrolled 10 033 children, the vaccination rate was 54.1% for BCG, 84.5% for complete HepB vaccination, 54.5% for complete polio vaccination, 51.3% for MCV, and 59.5% for complete DTP vaccination. Children with perinatally acquired HIV (PHIV) were 2.46‒3.82 times less likely to be vaccinated than HIV-exposed uninfected children. Multivariate logistic regression indicated that children of Han ethnicity (aOR = 1.33‒2.04), children with early infant diagnosis (EID) of HIV (aOR = 1.86‒3.17), and children whose mothers had better education (college or above, aOR = 1.63‒2.51) had higher odds of being vaccinated. Most of the deceased children (aOR = 4.28‒21.55) missed vaccination, and PHIV (aOR = 2.46‒3.82) significantly affected immunization.ConclusionsChinese HIV-exposed children had low vaccination coverage, which is a serious health challenge that needs to be addressed thoroughly. Interventions should be developed with a focus on minority HIV-exposed children whose mothers do not have formal education. Particularly, more attention should be paid to EID to increase access to immunization.Graphical abstract

Pertussis immunity in pregnant women and factors associated with seronegative status

Despite high level of vaccination coverage, pertussis remains a serious problem of modern medicine. Pertussis cases are registered among infants, adolescents, and adults. Infants younger than three months of age have the highest rate of serious clinical pertussis course. Transplacental transfer of pertussis-specific antibodies induce protection against infection. The available data regarding anti-pertussis antibody level in pregnant women in Russia remain sparce. To evaluate the humoral immunity to Bordetella pertussis in pregnant women and factors associated with seronegative status, we performed a cross-sectional study with 388 participants. SeroPertussis IgG (Israel) ELISA kit was used to quantitate antibodies against pertussis toxin/hemagglutinin. Binary logistic regression analysis was performed to assess factors associated with seronegative status. The median age of the subjects was 30 years old, more than half of which (51.3%) provided no verified pertussis vaccination data so that their children will not receive transplacental anti-infectious immunity. Gestational age was significantly associated with seronegative status. Compared to women tested during the first trimester, participants in the third trimester of pregnancy were more likely to be seronegative against pertussis. The odds of being susceptible rose with increased gestational period (p 0.01 for linear trend). Age, number of pregnancies and vaccination status revealed no impact on significant differences between seropositive and seronegative subjects. Pertussis booster vaccinations for preschool children, adolescents and healthcare workers dealing with pregnant women and neonates as well as cocoon vaccination strategy and vaccination during pregnancy were necessary to be implemented to protect infants against pertussis.

Individualism or Collectivism: A Reinforcement Learning Mechanism for Vaccination Decisions

Previous studies have pointed out that it is hard to achieve the level of herd immunity for the population and then effectively stop disease propagation from the perspective of public health, if individuals just make vaccination decisions based on individualism. Individuals in reality often exist in the form of groups and cooperate in or among communities. Meanwhile, society studies have suggested that we cannot ignore the existence and influence of collectivism for studying individuals’ decision-making. Regarding this, we formulate two vaccination strategies: individualistic strategy and collectivist strategy. The former helps individuals taking vaccination action after evaluating their perceived risk and cost of themselves, while the latter focuses on evaluating their contribution to their communities. More significantly, we propose a reinforcement learning mechanism based on policy gradient. Each individual can adaptively pick one of these two strategies after weighing their probabilities with a two-layer neural network whose parameters are dynamically updated with his/her more and more vaccination experience. Experimental results on scale-free networks verify that the reinforcement learning mechanism can effectively improve the vaccine coverage level of communities. Moreover, communities can always get higher total payoffs with fewer costs paid, comparing that of pure individualistic strategy. Such performance mostly stems from individuals’ adaptively picking collectivist strategy. Our study suggests that public health authorities should encourage individuals to make vaccination decisions from the perspective of their local mixed groups. Especially, it is more worthy of noting that individuals with low degrees are more significant as their vaccination behaviors can more sharply improve vaccination coverage of their groups and greatly reduce epidemic size.

Pairs of independent nationally representative vaccination coverage surveys conducted within one year of each other: A global overview covering 2000–2019

BackgroundPopulation-based surveys play an important role in measuring vaccination coverage. Surveys measuring vaccination coverage may be commissioned by the Expanded Programme on Immunization (EPI surveys) or part of multi-domain non-EPI surveys such as Demographic and Health Surveys (DHS) or Multiple Indicator Cluster Surveys (MICS). Surveys conducted too close in time to each other may not only be an inefficient use of resources but may also create problems for programme staff when results suggest inconsistent patterns of programme performance for similar time periods. ObjectiveTo summarize the occurrence of vaccination coverage surveys conducted close in time during 2000–2019 and compare results of EPI and non-EPI coverage surveys when the surveys were conducted within one year of each other. MethodsUsing a database of published national-level vaccination coverage survey results compiled by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF), the authors abstracted information on survey field work dates, sample size, percentage of children with documented history of vaccination and the percent coverage, as well as published uncertainty intervals from DHS and MICS, for the first and third doses of diphtheria-tetanus toxoid-pertussis containing vaccine (DTP1, DTP3) and first dose of measles containing vaccine (MCV1). Survey results of EPI and non-EPI surveys were compared. ResultsThe authors identified 646 surveys with final reports and estimates of national-level vaccination coverage for DTP1, DTP3, or MCV1 from a total of 687 surveys with data collection start date from 2000 to 2019. Of the 140 countries with at least one vaccination coverage survey, a median of four surveys was observed. Most countries were Gavi-eligible and located in the WHO Africa Region. Sixty-six survey dyads were identified where an EPI survey occurred within one year of a non-EPI survey. For the 66 dyads, in 49 of 59 with information available, EPI surveys reported higher proportion of documented evidence of vaccination and EPI survey results tended to suggest higher levels of vaccination coverage compared to the non-EPI surveys; quite often, differences were substantial. Surveys that found higher proportions of children with documented vaccination evidence tended to also find higher proportions of children who had been vaccinated. SummaryOpportunities exist to improve overall planning of vaccination coverage measurement in population-based household surveys so that both EPI and non-EPI surveys are more comparable and survey coverage estimates are more appropriately spaced in time. When surveys occur too close in time, careful attention is warranted to ensure comparability and assess sources of documented evidence of vaccination and related coverage differences.

The effect of screening for vaccine hesitancy on the subsequent development of hesitancy: a randomized controlled trial, Houston, TX

ABSTRACT Vaccine hesitancy remains a global health threat. Addressing parental vaccine hesitancy is essential to maintaining high vaccine coverage levels and preventing disease outbreaks; however, it is unknown if administering a vaccine hesitancy screening tool negatively impacts parental vaccine beliefs. We conducted a stratified randomized controlled trial in pediatric primary care practices. English-speaking parents ≥18 years of age seeking routine care for infants <3 months of age were eligible. Participants were randomized to receive 1 of 2 surveys – the Parent Attitudes about Childhood Vaccines (PACV) survey or a placebo survey. Six months after initial enrollment, all participants were asked to complete the PACV, regardless of initial randomization group. Our primary outcome was the proportion of hesitant to non-hesitant parents at 6-months between randomization groups. We examined associations between vaccine hesitancy and participant characteristics. We also evaluated the change in the proportion of vaccine-hesitant parents in the PACV group between baseline and 6-month follow up. We enrolled 1705 parents at baseline. At 6-month follow up, 819 parents completed the PACV (50.2% from PACV group vs. 54.1% from placebo group). The proportion of hesitant parents at 6 months did not differ between PACV and placebo groups (6.6% vs. 6.1%; p = .78) and the odds of hesitancy among PACV group participants was not higher than those in the placebo group (OR = 1.10; 95% CI: 0.63–1.93; p = .743). Race was the only characteristic significantly associated with vaccine hesitancy at 6-month follow up (p = .003). Overall, administration of the PACV did not trigger vaccine hesitancy in this study population.

Association of basic vaccination with cognitive and learning ability among children: insights from the India Human Development Survey, 2004-05 and 2011-12.

Basic vaccination is important to protect children from infectious diseases and illnesses. Adequate levels of vaccination coverage reduce the morbidity and mortality burden among children and promote their physical and mental development. This study aimed to assess the association between basic childhood vaccination and the cognitive and learning ability of school children in India. Nationally representative follow-up data on 6183 children from the Indian Human Development Surveys conducted in 2004-05 and 2011-12 (IHDS I & II) were analysed. Children aged 8-10 years who had received all basic vaccines by the age 12 months performed better in a maths test than partially vaccinated or unvaccinated children (OR: 1.87, 95% CI: 1.48, 2.35). Similarly, fully vaccinated children performed better in writing tasks than partially vaccinated or unvaccinated children (OR: 1.77, 95% CI: 1.44, 2.18). Likewise, fully vaccinated children had better reading skills than fully unvaccinated children (OR: 1.60, 95% CI: 1.23, 2.09). The results suggest that enhancing child vaccination coverage can have significant benefits beyond health and can potentially improve the long-term educational outcomes of children.

Status of Measles Antibody Protection and Immune Memory Evaluation for Teenagers in Taiwan

Measles virus is a highly contagious virus that can still cause death in developing or unvaccinated countries. The Taiwanese government fully implemented the measles vaccine in 1978. Due to the high vaccinated rate of measles vaccination and the high development of medical care, measles cases have fallen sharply. However, World Health Organization statistics report also pointed out that the number of global measles cases increased by more than 110,000 in 2018, and 89 measles confirmed cases were discovered in Taiwan in the first five months of 2019. The measles antibody efficacy data of 969 healthy MV-vaccinated adolescents were collected and analyzed. This study explores the proportion of effective measles antibody protection in MV-vaccinated generations born in the period between 1998 and 2002 to their age of 16 and 17-years-old. Overall, the prevalence of measles antibody was 57.48% to their aged 16 years and 6 months to 17 years and 5 months old. This study observed the rate of measles antibody protection in modern adolescents is not sufficient even in the country with a high level of vaccination coverage; this may explain the possibility of measles outbreak and can be a basis for future evaluation of adult measles vaccination policy.

Faktori povezani sa imunizacijom protiv sezonskog gripa među osobama sa hroničnim bolestima

Annually, at a global level, 3 to 5 million people present severe clinical forms of seasonal influenza and up to 650 000 people die of influenza-related complications. People with chronic diseases, such as cardiovascular, pulmonary, renal, hepatic, neurologic, hematologic and metabolic diseases or those reciveing immunosuppressive therapy, constitute a high-risk population group for the development of influenza-related complications, more severe clinical course and poorer health-related outcomes. Due to all of the above, people with chronic diseases are of high priority to receive the influenza vaccine. Immunization represents the key strategy to prevent influenza both in terms of effectiveness and health care costs. Based on the World Health Organization (WHO) recommendations, adequate seasonal influenza immunization coverage among people with chronic diseases is set at 75%. However, few countries achieve this threshold. Understanding predictive factors of vaccination, at different levels of health care delivery (such as individuals, service providers, health policy), is essential to secure acceptance of influenza immunization and achieve the recommended level of vaccination coverage. In this mini review, all the available evidence regarding seasonal influenza vaccination coverage is summarized, alongside factors associated with vaccine uptake in people with chronic diseases as a whole, as well as according to specific diseases such as: cardiovascular and pulmonary disorders, diabetes and cancer. Based on the reviewed empirical evidence, a wide spectrum of factors associated with immunization against influneza was found in people who have chronic diseases. Although diverse, these factors can be systematized into 4 distinctive groups: socio-demographic characteristics, individual attitudes and beliefs, health promoting behaviors and factors related to the health care system. Further efforts are needed to improve the seasonal influenza vaccination coverage. The immunization strategy needs to include the health care system and the community to support people with chronic diseases to continously accept the influenza vaccine.

Projeto S: A Stepped-Wedge Randomized Trial to Assess CoronaVac Effectiveness in Serrana, Brazil

Background: A stepped-wedge trial is an approach for assessing vaccine effectiveness in the real world. By the end of the study, all participants could receive the intervention, eliminating the ethical dilemma of placebo, especially during a pandemic. Methods: We evaluated the effectiveness of CoronaVac in Serrana, Brazil, amid an uncontrolled community Covid-19 epidemic using a stepped-wedge randomized trial. The city was separated into 25 subareas, divided into four groups, and randomized to receive CoronaVac in a two-dose scheme with a four-week interval. Intervention was initiated in each group with a one-week interval. The primary endpoint was the incidence of symptomatic cases in fully immunized individuals. The secondary endpoints were Covid-19-related hospitalizations and deaths and incidence according to immunization coverage. Findings: The study occurred during epidemiological weeks 6 to 19 in 2021. Up to 27,406 participants received the first dose of the study vaccine, corresponding to 81·3% of the adults and 60·9% of the urban population. Among fully immunized individuals, the vaccine effectiveness was 80·5 (95% CI, 75·1 to 84·7) for preventing symptomatic Covid-19 cases, 95% (95% CI, 86·9 to 98·1) and 94·9% (95% CI, 76·4 to 98·9) for preventing Covid-19-related hospitalizations and deaths, respectively. There was a significant indirect protective effect in unvaccinated people when 52% of the adult population was fully vaccinated. The Gamma variant was dominant during the study. Interpretation: CoronaVac effectively prevented symptomatic Covid-19 cases and protected against severe disease and death during Gamma variant circulation. Unvaccinated individuals benefited from high vaccine coverage levels. Trial Registration: This study was registered with (ClinicalTrials.gov Identifier, NCT04747821) Funding: Fundacao Butantan and Sao Paulo Research Foundation (FAPESP). Declaration of Interest: MCB, BMC, GJV, NNF, PMMG, RH, BALF, and RTC received research funding from Butantan Institute during the conduct of this study. RP, MTRPC, APB, JPS, and ROP were employees of Butantan Institute during the conduct of this study. HAB, EGP, GGP, SCSV and DC are employees of Butantan Institute. All other authors declare no competing interests Ethical Approval: The study was reviewed and approved by the Ethics Committee of the Clinical Hospital, Ribeirao Preto Medical School, University of Sao Paulo (CAAE 42390621.1.0000.5440).

P162 Pneumococcal and influenza vaccination coverage level: data from a cystic fibrosis centre

P162 Pneumococcal and influenza vaccination coverage level: data from a cystic fibrosis centre

The Value of Vaccination in Older Adults: The Why

The incidence of vaccine-preventable diseases remains high among older adults in the US, despite longstanding immunization recommendations, and is projected to increase as the population ages. The impact of US population aging on the burden of four vaccine-preventable diseases (influenza, pneumococcal disease, shingles, and pertussis) was modeled over a 30-year time horizon, with cumulative direct and indirect costs increasing from $378 billion over 10 years to $1.28 trillion over 30 years. Compared to current levels of vaccination coverage, increasing coverage was predicted to avert over 33 million cases of disease and greater than $96 billion in disease-associated costs, with a corresponding increase in vaccination costs of approximately $83 billion over the entire 30-year time period. Specific examples of cost-effectiveness analyses that assess the epidemiologic and economic impact of vaccination against shingles and pertussis in older adults will be discussed. Part of a symposium sponsored by the Health Behavior Change Interest Group.

From cervical cancer elimination to eradication of vaccine-type human papillomavirus: Feasibility, public health strategies and cost-effectiveness

The Director-General of the World Health Organization has called for global action towards elimination of cervical cancer as a public health problem. Cervical cancer is caused by human papillomavirus (HPV), an infectious agent with no non-human reservoir. One way to achieve this is through very high levels of vaccine coverage that could enable global eradication of vaccine-type HPV. Using the case study of India, we show that HPV eradication can meet all the Dahlem and Strüngmann criteria for feasibility of eradication. It can be achieved with 90% gender-neutral HPV vaccine coverage together with 95% coverage in high-risk groups such as female sex workers. Such a strategy would likely be cost-effective compared to no vaccination. Although it would be more costly in the short-term than achieving cervical cancer elimination alone, it would save costs in the long-term by removing or at least sharply reducing the need for preventive measures.

Potential impact of COVID-19 pandemic on vaccination coverage in children: A case study of measles-containing vaccine administration in the United States (US)

BackgroundThe COVID-19 pandemic and stay-at-home orders have caused an unprecedented decrease in the administration of routinely recommended vaccines. However, the impact of this decrease on overall vaccination coverage in a specific birth cohort is not known. MethodsWe projected measles vaccination coverage for the cohort of children becoming one year old in 2020 in the United States, for different durations of stay-at-home orders, along with varying catch-up vaccination efforts. ResultsA 15% sustained catch-up rate outside stay-at-home orders (compared to what would be expected via natality information) may be necessary to achieve projected vaccination coverage similar to previous years. Permanent decreases in vaccine administration could lead to projected vaccination coverage levels below 80%. ConclusionModeling measles vaccination coverage under a range of scenarios provides useful information about the potential magnitude and impact of under-immunization. Sustained catch-up efforts are needed to assure that measles vaccination coverage remains high.

Comparison of static and dynamic models of maternal immunization to prevent infant pertussis in Brazil

BackgroundThis paper compares cost-effectiveness results from two models of maternal immunization to prevent pertussis in infants in Brazil, one static, one dynamic, to explore when static models are adequate for public health decisions and when the extra effort required by dynamic models is worthwhile. MethodsWe defined two scenarios to explore key differences between static and dynamic models, herd immunity and time horizon. Scenario 1 evaluates the incremental cost/DALY of maternal acellular pertussis (aP) immunization as routine infant vaccination coverage ranges from low/moderate up to, and above, the threshold at which herd immunity begins to eliminate pertussis. Scenario 2 compares cost-effectiveness estimates over the models’ different time horizons. Maternal vaccine prices of $9.55/dose (base case) and $1/dose were evaluated. ResultsThe dynamic model shows that maternal immunization could be cost-saving as well as life-saving at low levels of infant vaccination coverage. When infant coverage reaches the threshold range (90–95%), it is expensive: the dynamic model estimates that maternal immunization costs $2 million/DALY at infant coverage > 95% and maternal vaccine price of $9.55/dose; at $1/dose, cost/DALY is $200,000. By contrast, the static model estimates costs/DALY only modestly higher at high than at low infant coverage. When the models’ estimates over their different time horizons are compared at infant coverage < 90–95%, their projections fall in the same range. ConclusionsStatic models may serve to explore an intervention’s cost-effectiveness against infectious disease: the direction and principal drivers of change were the same in both models. When, however, an intervention too small to have significant herd immunity effects itself, such as maternal aP immunization, takes place against a background of vaccination in the rest of the population, a dynamic model is crucial to accurate estimates of cost-effectiveness. This finding is particularly important in the context of widely varying routine infant vaccination rates globally. Clinical Trial registryClinical Trial registry name and registration number: Not applicable.

Measles-mumps-rubella vaccine at 6\u2009months of age, immunology, and childhood morbidity in a high-income setting: study protocol for a randomized controlled trial

BackgroundMeasles is a highly contagious and serious infection. Before the introduction of vaccination, measles caused yearly epidemics putting vulnerable children at risk of brain damage and death. Despite safe and cost-effective vaccines, measles remains a leading cause of death in children globally. Due to insufficient vaccine coverage and low levels of in utero transferred antibodies from vaccinated mothers, outbreaks of measles in Denmark and other high-income countries are observed at increasing frequency.The current vaccine was introduced in Denmark in 1987 as a one-shot measles-mumps-rubella vaccine at 15 months, a timing chosen to avoid inhibition of the infant’s immune response by maternal antibodies. One generation later, the MMR vaccinated mothers have lower antibody levels compared to the naturally infected, and their infants are already susceptible at 6 months of age or earlier, thus increasing the risk of epidemics.MethodsThe Danish MMR trial is a double-blind randomized clinical trial recruiting between March 2019 and December 2021 with last patient last visit in February 2022. Altogether N = 6500 infants aged 6 months will be randomly assigned to intramuscular vaccination with routine MMR (M-M-R VaxPro) or placebo (solvent only). According to the Danish Childhood vaccination program, all infants will receive a routine MMR vaccination at 15 months of age. At randomization, 1 month later, and 1 month after routine MMR vaccination at 15 months of age, a blood sample is drawn from app. 10% (N = 600) of the population. Additionally, hair, saliva, and urine are sampled at randomization. The co-primary study outcomes are immunogenicity 1 month after MMR vaccination at 6 months of age assessed as plaque-reduction neutralization test, and incidence of infectious disease hospitalizations from randomization to 12 months of age. Six weeks post randomization, all participants are interviewed regarding adverse events.Trial registrationThe trial is registered in the EU Clinical Trials Registry. EudraCT registration number: 2016-001901-18. Registered on 14 February 2017.

Epidemiological Investigation and Virus Tracing of a Measles Outbreak in Zhoushan Islands, China, 2019.

Background: Measles transmissions due to case importations challenge public health systems globally and herd immunities in all countries. In 2019, an imported measles case and its subsequently outbreak was found in the Zhoushan Islands. Here, the process of epidemiological investigation and virus tracing were summarized to provide references for the prevention and control of measles in the future.Materials and methods: The data on the demographic, epidemiological, and clinical manifestation of measles cases in this outbreak were collected. The 450 bp fragments of the measles virus (MeV) N gene were amplified and sequenced. The genome of the first imported case was further isolated. Then, the maximum-likelihood and time-scaled phylogenetic analysis was conducted.Results: A total of 28 measles cases were confirmed. Their onsets were between March 13 and May 18, 2019. The first patient was from the Ukraine. He was confirmed at the Fever Clinic in Zhoushan hospital on March 15, 2019 and at the same time, another patient had visited the hospital due to another illness and 10 days later, this second case had onset (March 25, 2019). The epidemic curve shows sustained community transmission. The majority of the following cases (19/26) were clustered on the Donggang street which was close to where the second case worked. The 22 measles virus strains successfully isolated from this outbreak all belonged to the D8.2a sub-cluster and clustered with the KY120864/MVs/GirSomnath.IND/42.16/[D8] which was the predominant genotype in the Ukraine during 2018-2019. The analysis of the complete D8 genotype genome pointed to the fact that this prevailing strain originated from India in 2015 and its substitution rate was estimated as 6.91 × 10−4 (5.64–7.98 × 10−4) nucleotide substitutions/site/year.Conclusion: This outbreak was caused by an imported case from the Ukraine. There was a possible nosocomial infection between the first case and the second case. Then, the second case played an important role in the spread of virus due to her occupation. The molecular phylogenetic analysis could help to track the origin of the virus. Increasing and maintaining the high level of vaccination coverage (≥95%) and an efficient response to imported cases are essential to prevent and control the recurrence and outbreak of measles virus.

Flu Vaccinations in Pharmacies-A Review of Pharmacists Fighting Pandemics and Infectious Diseases.

The phenomenon of population ageing observed over recent years involves growing healthcare needs and the limited staffing and financing of healthcare systems, and as such demands some functional changes in the healthcare model in many countries. This situation is particularly significant in the face of a pandemic, e.g., flu, and currently COVID-19.As well as social education, preventive vaccinations are the most effective method of fighting the infectious diseases posing a special threat to seniors. Despite this, the vaccination coverage level in most European countries is relatively low. This is largely due to patients having limited access to vaccinations. In some countries, implementing vaccinations in pharmacies and by authorized pharmacists has significantly improved vaccination coverage rates and herd immunity, while lowering the cost of treating infections and the resulting complications, as well as minimizing the phenomenon of inappropriate antibiotic therapies. This article presents the role of pharmacists in the prevention of infectious diseases, pointing out the measurable effects of engaging pharmacists in conducting preventive vaccinations, as well as analyzing the models of implementing and conducting vaccinations in pharmacies in selected countries, and depicting recommendations regarding vaccinations developed by international organizations. The presented data is used to suggest requirements for the implementation of preventive vaccinations in community pharmacies.

Pertussis in Italy: how to protect the “unprotectable”?

ABSTRACT Whooping cough continues to be an important public health issue despite high levels of vaccination coverage with acellular pertussis vaccine. Young unimmunized infants represent the most vulnerable group with the highest rates of complications and death. As infant-specific pertussis epidemiologic data, especially among neonates, in Italy were limited, a retrospective observational study of hospitalizations for whooping cough in Italian infants aged <12 months between 2007 and 2018 was conducted to address this knowledge gap. The temporal trend of rates, also stratified for age classes according to the expected age for the administration of vaccine doses, were analyzed by the slope of the regression line. The mean age at the time of admission was 92 d (±64). A clear seasonal pattern in the occurrence of pertussis hospitalizations with a summer peak was observed. Infants younger than 3 months old had the highest hospitalization rates (169 x 100000 infants on average), with a significant rising trend of 9 x 100000 infants on average per year. Limiting the analysis to Bordetella pertussis-related hospitalizations such trend was even more evident. In the other age classes, hospitalization rates were considerably lower and gradually decreased with increasing age. This study demonstrated that pediatric populations, too young to be protected by vaccination, had a greater risk of contracting pertussis. Thus, it is necessary to promote additional immunization strategies besides one booster dose in adolescents, including vaccination during pregnancy.