Introduction Of Vaccine Research Articles

Characteristics of Invasive Pneumococcal Diseases Cases Among U.S. Children With Hematologic Malignancies Before and After Introduction of Thirteen-valent Pneumococcal Conjugate Vaccine, 2005–2019

Characteristics of Invasive Pneumococcal Diseases Cases Among U.S. Children With Hematologic Malignancies Before and After Introduction of Thirteen-valent Pneumococcal Conjugate Vaccine, 2005–2019

Strategies for introducing and implementing vaccines for adults into national immunization programs in Europe: Good practices and key insights of the adult immunization board meeting.

In April 2024, the Adult Immunization Board convened a technical meeting to explore the latest strategies and identify exemplary approaches regarding the implementation of vaccines for adults into Europe's National Immunization Programs (NIPs). The meeting was built around three pillars: decision making for introducing a new vaccine, implementation, monitoring, and evaluation. The increasing number of new vaccines available in a context of competing health priorities warrants transparent and evidence-based decision-making processes for vaccine introduction. In Europe, burden of disease, vaccine efficacy or effectiveness, and safety are universally used decision-making criteria. While economic evaluations and the quality of evidence are being increasingly considered, public acceptance, equity, and operational criteria remain underutilized. Vaccine implementation requires planning and coordination. Implementation activities discussed during the meeting were vaccine program goals, target population identification, communication, training of healthcare professionals, and involvement of pharmacists. Once operational, NIPs are to be monitored in terms of safety, effectiveness, and impact. Implementation science as well as behavioral and cultural insights can be used to identify tangible interventions to improve uptake. Meeting discussions allowed to identify adult vaccine implementation barriers and possible strategies to overcome them. Enhanced cooperation and coordination throughout the Europe region were recognized as critical components of progress.

Determinants of Rotavirus Vaccine Acceptance in an Area of Southern Italy with Low Vaccination Coverage: A Case-Control Study by the Health Belief Model Questionnaire

Background/Objectives: Rotavirus (RV) is the primary cause of gastroenteritis in children worldwide, contributing significantly to morbidity and mortality, particularly among children under five years of age. The introduction of Rotavirus vaccines (RVV) has markedly reduced RV-related childhood deaths, especially in Europe, where substantial reductions in hospitalizations and disease prevalence have been observed. Despite these advances, RVV uptake in Italy remains below the desired targets, with notable regional disparities. In Sicily, vaccination rates have fluctuated, with current coverage failing to meet national goals. Safety concerns and insufficient parental awareness are major barriers to RVV acceptance. Methods: This case-control study was conducted in Southern Italy to identify factors influencing parental acceptance of RVV. Data were collected from parents using a structured questionnaire that assessed socio-demographic factors, vaccine knowledge, and attitudes based on the Health Belief Model (HBM). Results: Overall, 226 parents were enrolled. Higher perceived benefit of RVV was significantly associated with increased vaccine adherence (Odds Ratio = 13.65; 95% Confidence Interval = 6.88–27.09; p < 0.001). Conclusions: These results highlight the need for targeted interventions to improve vaccine coverage and address regional and socio-economic barriers to RVV acceptance. Furthermore, tailored educational campaigns and univocal information from healthcare providers could play pivotal roles in achieving higher vaccine uptake.

Resilience and emergence of pneumococcal serotypes and lineages in adults post-PCV13 in Spain: A multicentre study.

Streptococcus pneumoniae causes invasive pneumococcal disease (IPD) in adults. The introduction of pneumococcal conjugate vaccines (PCVs) has reduced vaccine serotypes but has also led to the rise of non-vaccine serotypes. The aim of this study was to analyse pneumococcal lineages and their association with recent changes in IPD among adults in Spain. Data from adult IPD cases (≥18 years) were collected from six Spanish hospitals in 2019-2021. Strains were serotyped, tested for antibiotic susceptibility and subjected to whole genome sequencing (WGS). Findings were compared with data from previous periods (2008-2016). A total of 655 IPD episodes were examined. Pneumonia was the main focus (515/655), and 366 episodes occurred in adults over 64 years. Although IPD incidence decreased during COVID-19 pandemic, the burden of disease caused by PCV13 serotypes was significant. Notably, serotype 3 persisted (GPSC12-ST180 and GPSC83-ST260), and a new serotype 4 lineage emerged (GPSC162-ST13022). Among non-PCV13 serotypes, serotype 8 expanded (GPSC3-ST53) and a new serotype 12 F lineage emerged (GPSC55-ST8060). Most serotypes presented a dominant Global Pneumococcal Sequencing Cluster (GPSC) like GPSC16-ST67 of 9 N or GPSC19-ST433 of 22 F. Nevertheless, some GPSCs were associated with several serotypes, the most numerous were GPSC3 (serotypes 8, 11 A, and 33 F) and GPSC6 (serotypes 11 A and 14). The overall penicillin non-susceptibility rate was 17.0 %, 14.6 % resistance for meningitis and 1.6 % for pneumonia (15.1 % susceptible at increased exposure [SIE]). Serotypes 11 A and 14 (GPSC6-ST156/6521) and 19 A (GPSC1-ST320) had penicillin MICs above 1 mg/L. Acquired resistance genes associated with macrolide and/or tetracycline resistance were present in 19.4 % of isolates, particularly among serotypes 6 C (GPSC47-ST386/4310) and 19 A (GPSC1-ST320). The burden of PCV13 serotypes in adult IPD remains significant, and serotype 3 is the primary contributor. However, the rise of stable lineages associated with non-PCV13 serotypes, particularly 8, 9 N, and 22 F highlights a shifting epidemiology. The persistence of multidrug-resistant lineages, such as GPSC6-ST156 and GPSC1-ST320, emphasizes the need for continued surveillance. Vaccination of high-risk adults with current and broader coverage PCVs would help to control the burden of pneumonia and IPD among adults.

IMPORTÂNCIA DOS ENSAIOS FÍSICO-QUÍMICOS NO CONTROLE DE QUALIDADE DE VACINAS

IMPORTANCE OF PHYSICAL-CHEMICAL TESTS IN VACCINE QUALITY CONTROL. The National Immunization Program (NIP), established in 1973, is recognized nationally and internationally as one of the largest vaccination programs in the world, integrated into the Unified Health System (SUS). Over the years, the NIP has faced challenges in vaccine quality control, leading to significant evolution, especially since 1983 when the National Institute of Quality Control in Health (INCQS) centralized this control. INCQS conducts biological, microbiological, and physicochemical assays, such as pH, appearance, aluminum content, and thiomersal, the latter present in multidose vaccines as a preservative. Retrospective analysis of physicochemical assays reveals variations in analysis quantities, often correlated with specific vaccination campaigns. The introduction of new vaccines in the NIP, such as the pentavalent and inactivated polio vaccines, impacted quality control. Regarding the pH and appearance of vaccines, assays demonstrate improvements over time, including the adoption of more sensitive and specific techniques. The implementation of visual inspection aspect analysis as a preventive measure after occurrences of unsatisfactory lots underscores the commitment to vaccine safety. Public laboratories, like INCQS, play a crucial role in this process, ensuring the safety of immunobiological for the entire Brazilian population. The current challenge lies in the need to keep up with technological advancements to maintain vaccine quality.

Changes in population genetic structure of serotype 19A Streptococcus pneumoniae after universal childhood use of the 10-valent pneumococcal conjugate vaccine in Brazil.

The introduction of the 10-valent pneumococcal conjugate vaccine (PCV10) for nationwide childhood immunization in 2010 led to a significant reduction in colonization and invasive pneumococcal disease (IPD) by vaccine serotypes in young. However, non-vaccine serotypes have emerged, and serotype 19A is now the leading cause of IPD in Brazil. We analyzed 32 serotype 19A isolates of Streptococcus pneumoniae recovered from children and adults who attended different health facilities in the state of Rio de Janeiro, Brazil, between 2010 and 2023. The capsular types of the isolates were determined by sequential multiplex PCR or by cpsB gene sequencing. All isolates were subjected to antimicrobial susceptibility testing and MLST. Of the 32 serotype 19A isolates, 29 (90.6%) isolates were recovered from children aged ≤5years and three (9.4%) isolates were recovered from adults. Nineteen (59.4%) isolates were associated with colonization, and 13 (40.6%) isolates were from diseases. All isolates were susceptible to chloramphenicol, levofloxacin, linezolid, rifampin, and vancomycin. The highest frequencies of non-susceptibility (intermediate + resistant) were observed for sulfamethoxazole-trimethoprim (n=30; 93.8%), penicillin (n=24; 75%), and erythromycin (n=23; 71.9%). Twenty-two (68.8%) isolates were multidrug resistant (MDR). MICs for penicillin among penicillin-non-susceptible pneumococci (PNSP) ranged from 0.12 to 8.0μg/mL. MICs for erythromycin ranged from 0.064 to >256μg/mL. MICs for ceftriaxone ranged from 0.023 to 4μg/mL. The most common genetic lineages were ST733 (n=7; 21.9%), mostly found before and in the early years of PCV10 introduction, and CC320 (n=25; 78.1%), mostly found in the late-PCV10 period. All 25 isolates within CC320 were PNSP and mostly (n=22; 88%) MDR. We observed a shift in antimicrobial susceptibility profiles and genetic lineages after long-term use of PCV, mostly PCV10, for routine childhood immunization, characterized by clonal expansion of the MDR lineage CC320.

A Study on the Persistence of Immunity Following Two-Dose Varicella Vaccination With Varying Intervals in Chinese Children Aged 2-7 years.

Varicella, a highly contagious disease caused by the varicella-zoster virus (VZV), remains prevalent in China despite the introduction of the varicella vaccine in 1997. The current vaccination protocol in China involves a voluntary, self-funded single-dose regimen. This study aims to investigate the longevity of immune response in Chinese children following two-dose varicella vaccination administered at different intervals, with the objective of optimizing vaccination strategies. This 4-year prospective cohort observational study categorized participants into three groups based on the interval between the two varicella vaccine doses: 1-, 3-, and 5-year intervals. Antibody detection was performed using enzyme-linked immunosorbent assay (ELISA). The temporal evolution of IgG antibody levels following the two-dose vaccination was analyzed using a binary logistic regression model with restricted cubic splines (RCS). The study revealed a significant decline in both seropositivity rates and geometric mean concentrations (GMC) over time following the two-dose vaccination. Seropositivity rates decreased from 100.0% to 79.8%, while GMC dropped from 575.1 to 251.9 mIU/mL. No statistically significant differences were observed in seropositivity rates or GMC among the different interval groups (p > 0.05). The RCS-fitted model demonstrated an "inverted U-shaped" relationship between the time since the last vaccination and seropositivity. Antibody levels peaked approximately 22 months after the second dose, with the odds ratio (OR) for antibody concentrations ≥ 50 mIU/mL exhibiting a nonlinear trend in relation to time post-immunization (poverall < 0.001, pnonlinear ≤ 0.001). While the interval between vaccine doses did not significantly impact long-term immune response, a critical turning point in antibody levels was observed at approximately 22 months postvaccination. Furthermore, enhanced long-term monitoring of postvaccination immune responses, particularly beyond the identified turning point, is recommended to facilitate the evaluation and optimization of existing vaccination protocols.

Pediatric Varicella-related Hospitalization in Turkey Between 2008 and 2018: Impact of Universal Single Dose Varicella Vaccine (VARICOMP Study).

A single-dose varicella vaccine at 12 months of age was introduced to the National Immunization Program in February 2013 in Turkey. This study aimed to evaluate varicella-related hospitalization in children and the impact of a single-dose live attenuated varicella vaccine over the first 5.5 years of introducing a universal varicella vaccination. We analyzed data collected from the medical records of children <18 years old who required hospitalization due to varicella in 17 cities representing 50% of the childhood population in Turkey between 2008 and 2018. We calculated the rate of hospitalization for varicella per 100,000 children during the study period. The main objective of this study was to determine the yearly rate of hospitalization due to varicella and to compare these rates in the pre-vaccine and post-vaccine periods. The secondary objective was to compare demographic features, varicella-related complications, and outcomes between the pre-vaccine and post-vaccine periods. A total of 4373 children (2458 boys and 1915 girls; 72.3% previously healthy) were hospitalized for varicella over a 10-year period, including 2139 children during the pre-vaccine period and 2234 children during the post-vaccine period. Overall, varicella hospitalization rates decreased significantly after the introduction of varicella vaccination [pre-vaccine vs. post-vaccine period; 3.79 vs. 2.87 per 100,000 per year; P < 0.001; odds ratio 0.75; 95% confidence interval 0.64-0.88]. The incidence of varicella-related hospitalization among children between 1 and 5 years of age was significantly lower in the post-vaccine era than in the pre-vaccine era, with a 60.2% decrease in hospitalizations (2.43 vs. 6.12 per 100,000 children; P < 0.001, odds ratio 0.39; 95% confidence interval 0.34-0.46). In both the <1-year and 6- to 10-year age groups, the incidence of varicella-related hospitalizations was similar in the pre-vaccine and post-vaccine periods. The incidence of varicella-related hospitalization was higher in the post-vaccine era among 11-15 years and >15-year-old groups ( P < 0.01 and P < 0.05). The mean age was higher during the post-vaccine period than during the pre-vaccine period ( P < 0.001). The absolute number of secondary bacterial infections ( P < 0.01), respiratory complications ( P < 0.01), and neurological complications ( P < 0.001) was significantly lower during the post-vaccine period. The incidence of severe varicella was lower during the post-vaccine period than during the pre-vaccine period ( P < 0.001). After 5.5 years of routine single-dose varicella vaccine use, we observed the impact of varicella vaccination on the incidence of varicella-related hospitalizations, especially in the target age group. However, we did not observe herd protection in the other age groups. The implementation of a second dose of the varicella vaccine in the National Immunization Program would help control disease activity.

Epidemiology of viral gastroenteritis in children and genetic diversity of rotavirus strains in Kolkata, West Bengal after introduction of rotavirus vaccine.

Despite global rotavirus vaccination efforts, rotavirus remains a leading cause of childhood deaths from acute gastroenteritis. Post-vaccination studies in India, particularly in eastern India, have been limited, despite high prevalence of rotavirus in this region prior to vaccine introduction. This study was conducted to assess the impact of rotavirus vaccine on the epidemiology of rotavirus and other enteric viruses, as well as the changes in the diversity of rotavirus strains among children (≤5years) with acute gastroenteritis. A total of 877 stool samples from children hospitalized with acute diarrhea during 2022-2023, were screened for enteric viruses using multiplex PCR. Rotavirus positive samples were genotyped by sequencing and phylogenetic analysis of VP4 and VP7 genes were done. Out of 877 diarrheal cases, 47% tested positive for at least one enteropathogenic virus. Rotavirus was most prevalent (25.9%), followed by norovirus (11.4%), adenovirus-F (10.6%), and astrovirus (5.3%). Among mixed infections, rotavirus and norovirus co-infections were the most common. Rotavirus infection was highest in children aged 12-24months, while other enteric viruses were more common in the 6-24month age group. Clinical severity was higher among rotavirus-infected patients compared to those infected with other enteric viruses. The G3P[8] genotype of rotavirus predominated, with notable increase in G2P[4] and the detection of rare strains like G3P[6] and G11P[25]. G3P[6] was identified for the first time in this region showing Wa-like genome constellation. Unlike pre-vaccine period, G9 genotype was not detected. Mutations in antigenic epitope of circulating strains compared to vaccine strains may affect vaccine efficacy. The study highlights the persistent burden of childhood diarrhea despite rotavirus vaccination. Subtle alterations in the proportion of other enteric viruses and diversity of circulating rotavirus genotypes in the post-vaccination period were observed. Continuous long-term surveillance is required to evaluate the impact of vaccine in this region.

The Second Round of a Population-Based Seroprevalence Study of Anti-SARS-CoV-2 Antibodies and COVID-19 Vaccination Assessment in the Republika Srpska, Bosnia and Herzegovina.

The aim of the study was to assess the seroprevalence of SARS-CoV-2 in the Republika Srpska, Bosnia and Herzegovina, after five waves of COVID-19 and 1 year after introduction of vaccination to better understand the true extent of the COVID-19 pandemic in the population of the Republika Srpska and role of vaccination in achieving herd immunity. The population-based study was conducted from December 2021 to February 2022 in a group of 4463 individuals in the Republika Srpska. Total anti-SARS-CoV-2 antibodies were determined in serum specimens using the Wantai total antibody ELISA assay. Quantitative analysis, using Kantaro IgG assays, was performed in subsamples (1273 specimens) to asses and compare levels of IgG among vaccinated, recovered and participants with hybrid immunity. To adjust for age and gender distribution in sample, poststratification method is applied. The overall cumulative seroprevalence was 94.6% (95% CI = 93.9-95.3). Significantly higher seroprevalence rates were observed among vaccinated 97.8% (95% CI = 97.3-98.4) comparing to unvaccinated participants (89.5%, 95% CI = 88.0-91.0). Seroprevalence increases with the number of received doses. Among various professions, the highest seroprevalence was found in the service industry (98.1%), education (98.0%) and healthcare (96.9%). We found that 2.2% of vaccinated and 3.6% of participants with SARS-CoV-2 positivity during 2021 had no detectable IgG antibodies. Both seroprevalence (98.6%) and antibody titres (1094.4 AU/mL) were significantly higher among people with hybrid immunity. Our findings reveal a 2.3-fold increase in seroprevalence of SARS-CoV-2 antibodies due to infection and vaccination, comparing to the first study performed 1 year earlier. This study provides better understanding of the SARS-CoV-2 transmission and highlights the important role of the vaccination in achieving the population immunity. Periodically conducted population-based seroprevalence studies are important to understand temporal trends and assess surveillance system performance and public compliance with vaccination policies.

Epidemiology of norovirus disease in the first 2 years of life: A prospective multisite cohort study in Lima, Peru.

Norovirus is associated with 18% of acute gastroenteritis (AGE) cases worldwide. We aim to document the norovirus-related AGE incidence in peri-urban areas of Lima (Peru), evaluating the potential impact of a norovirus vaccine introduction. A prospective, community-based pediatric cohort study was established at two sites in Lima. Healthy children between 5 and 18 months were contacted weekly for AGE detection during a 6-month period. Stool samples from AGE cases were tested for norovirus by RT-PCR. Incidence and coinfection of norovirus-associated AGE were analyzed. All norovirus-positive samples were genotyped by Sanger DNA sequencing. Among 498 enrolled children, 461 (93%) completed the follow-up period. We detected 799 AGE cases, yielding 676 valid stool samples. Norovirus was detected in 216 samples (32%), with an incidence of 7.7 episodes per 100 child-months (95% CI: 6.7-8.8). Genotypes GII.4 (31%) and GII.6 (22%) were frequent. Campylobacter (43%) and Salmonella spp. (15%) were the most common coinfections with norovirus. Ninety-five percent of study children had received an oral rotavirus vaccine. Norovirus was the second most frequent cause of AGE in this Peruvian cohort with high rotavirus vaccine coverage. An effective norovirus vaccine would have an important public health benefit in this population.

Evolution of global polio eradication strategies: targets, vaccines, and supplemental immunization activities (SIAs)

ABSTRACT Background Despite multiple revisions of targets and timelines in polio eradication plans since 1988, including changes in supplemental immunization activities (SIAs) that increase immunity above routine immunization (RI) coverage, poliovirus transmission continues as of 2024. Methods We reviewed polio eradication plans and Global Polio Eradication Initiative (GPEI) annual reports and budgets to characterize key phases of polio eradication, the evolution of poliovirus vaccines, and the role of SIAs. We used polio epidemiology to provide context for successes and failures and updated prior modeling to show the contribution of SIAs in achieving and maintaining low polio incidence compared to expected incidence for the counterfactual of RI only. Results We identified multiple phases of polio eradication that included shifts in targets and timelines and the introduction of different poliovirus vaccines, which influenced polio epidemiology. Notable shifts occurred in GPEI investments in SIAs since 2001, particularly since 2016. Modeling results suggest that SIAs play(ed) a key role in increasing (and maintaining) high population immunity to levels required to eradicate poliovirus transmission globally. Conclusions Shifts in polio eradication strategy and poliovirus vaccine usage in SIAs provide important context for understanding polio epidemiology, delayed achievement of polio eradication milestones, and complexity of the polio endgame.

Predictors of maternal pertussis vaccination acceptance among pregnant women in Norway

ABSTRACT Maternal vaccination against pertussis is safe and provides effective protection against pertussis for the newborn, but the vaccine coverage rate remains generally low. Norway is currently planning for introduction of routine maternal pertussis vaccination. To assess maternal pertussis vaccination acceptance among pregnant Norwegian women, we surveyed women at 20–40 weeks gestation in 2019. Among the 1,148 pregnant women participating in this cross-sectional study, 73.8% reported they would accept pertussis vaccination during pregnancy if it was recommended, 6.9% would not accept and 19.2% were undecided. Predictors for low likelihood of accepting pertussis vaccination during pregnancy included low confidence in health authorities and in maternal pertussis vaccination safety and effectiveness, low awareness and adherence to influenza vaccination during pregnancy, and low awareness of pertussis vaccination. The major reasons reported for not accepting or being undecided about maternal pertussis vaccination were lack of information on vaccine safety for both mother and child. Most women reported that they would consult their general practitioner or a midwife for information if they were offered maternal pertussis vaccination. General practitioners and midwives were also regarded as the most trustworthy sources of information if the women were in doubt about accepting vaccination. We conclude that information addressing safety concerns and raising awareness about maternal pertussis vaccination could increase acceptance of maternal pertussis vaccination. Our findings highlight the pivotal role of the antenatal and primary health care services in providing such information to pregnant women.

Rotavirus rewires host cell metabolic pathways toward glutamine catabolism for effective virus infection

ABSTRACT Rotavirus (RV) accounts for 19.11% of global diarrheal deaths. Though GAVI assisted vaccine introduction has curtailed RV induced mortality, factors like RV strain diversity, differential infantile gut microbiome, malnutrition, interference from maternal antibodies and other administered vaccines, etc. often compromise vaccine efficacy. Herein emerges the need of antivirals which can be administered adjunct to vaccination to curb the socio-economic burden stemming from frequent RV infection. Cognisance of pathogen-perturbed host cellular physiology has revolutionized translational research and aided precision-based therapy, particularly for viruses, with no metabolic machinery of their own. To date there has been limited exploration of the host cellular metabolome in context of RV infection. In this study, we explored the endometabolomic landscape of human intestinal epithelial cells (HT-29) on RV-SA11 infection. Significant alteration of host cellular metabolic pathways like the nucleotide biosynthesis pathway, alanine, aspartate and glutamate metabolism pathway, the host citric acid cycle was observed in RV-SA11 infection scenario. Detailed study further revealed that RV replication is exclusively dependent on glutamine metabolism for their propagation in host cells. Glutamine metabolism generates glutamate, aspartate, and asparagine which facilitates virus infection. Abrogation of aspartate biogenesis from glutamine by use of Aminooxyacetic acid (AOAA), significantly curbed RV-SA11 infection in-vitro and in-vivo. Overall, the study improves our understanding of host-rotavirus interactome and recognizes host glutamine metabolism pathway as a suitable target for effective therapeutic intervention against RV infection.

Genomic analysis of DS-1-like human rotavirus A strains uncovers genetic relatedness of NSP4 gene with animal strains in Manhiça District, Southern Mozambique

Post rotavirus vaccine introduction in Mozambique (September 2015), we documented a decline in rotavirus-associated diarrhoea and genotypes changes in our diarrhoeal surveillance spanning 2008–2021. This study aimed to perform whole-genome sequencing of rotavirus strains from 2009 to 2012 (pre-vaccine) and 2017–2018 (post-vaccine). Rotavirus strains previously detected by conventional PCR as G2P[4], G2P[6], G3P[4], G8P[4], G8P[6], and G9P[6] from children with moderate-to-severe and less-severe diarrhoea and without diarrhoea (healthy community controls) were sequenced using Illumina MiSeq® platform and analysed using bioinformatics tools. All these G and P-type combinations exhibited DS-1-like constellation in the rest of the genome segments as, I2-R2-C2-M2-A2-N2-T2-E2-H2. Phylogenetic analysis revealed that strains from children with and without diarrhoea clustered together with other Mozambican and global strains. Notably, the NSP4 gene of strains G3P[4] and G8P[4] in children with diarrhoea clustered with animal strains, such as bovine and caprine, with similarity identities ranging from 89.1 to 97.0% nucleotide and 89.5-97.0% amino acids. Our findings revealed genetic similarities among rotavirus strains from children with and without diarrhoea, as well as with animal strains, reinforcing the need of implementing studies with One Health approach in our setting, to elucidate the genetic diversity of this important pathogen.

What will it take? Perspectives from five low- and middle-income countries on opportunities and challenges of introducing new maternal vaccines.

New vaccines for pregnant women have recently been introduced in some high-income countries to protect infants in early life. Implementing maternal immunisation (MI) successfully in low- and middle-income countries will require planning and adaptations to immunisation and maternal health programs. To inform cost of MI delivery studies, we gathered perspectives from key stakeholders in five countries (Bangladesh, Ghana, Kenya, Mozambique, and Nepal) regarding health system requirements, opportunities, and challenges to introducing new maternal vaccines into routine health programs. We convened national stakeholders for country workshops to deliberate potential delivery strategies, opportunities, and constraints for implementing new MI interventions. Divided into thematic areas, participants discussed health system adaptations needed to establish or strengthen an MI platform. Stakeholders felt that existing programs that administer vaccines to pregnant women, primarily tetanus-containing vaccines, provide a proven path for the delivery of additional maternal vaccines. Maternal health and immunisation program integration was perceived strongest at the health care provision level and weakest at the national level. Concerted coordination at the national level was identified as critical to the success of introducing new interventions. Stakeholders perceived that most health workforce providing immunisation and antenatal care services undergo similar training and have transferrable skills, however developing operational guidelines with clear roles and responsibilities was deemed critical for ownership and accountability. Human resource constraints were cited as a challenge for some countries. The importance of raising awareness of disease burden and new MI interventions was also highlighted across countries. Sustainable financing was a recurring challenge cited, especially with transitions from Gavi support. The workshops enabled country stakeholders to deliberate needs to support the introduction of new maternal vaccines. While circumstances and needs differed, stakeholders across countries were optimistic about the capability of their health systems to integrate new maternal vaccines.

A study on mumps infection in children aged 1-12 years in a tertiary care hospital, South India: a cross-sectional study

Background: Mumps is a highly contagious disease effecting children globally with disease presentation varying from being asymptomatic to unilateral or bilateral parotid gland enlargement. It causes serious complications like orchitis, aseptic meningitis, pancreatitis etc. During introduction of MR vaccine in NIS by the Government of India, Mumps vaccine was not included due to lack of enough data representing actual burden of the disease in our country. Methods: This study was done from January 2024 to August 2024 following a surge in Mumps cases in children aged 1 to 12 years attending paediatrics department, Rangaraya Medical College, Kakinada. Results: A total of 76 children were included in the study. Children were mostly in the age group 6-10 years (44). Both male (37) and female (36) children were equally affected. Most of the children were from rural areas (67%). 75 (98.7%) children were completely vaccinated with the majority being vaccinated in the Government sector (86.85%). Only 9 (11.85%) children received mumps vaccine. Contact with an individual with mumps was seen in 51 children (67.11%). The majority of the cases were reported during the months of March-April (89.47%). All 76 children presented with parotid swelling either unilateral (22) or bilateral (52) with 2 children having both parotid and submandibular gland swellings. Mumps-related complications like pancreatitis, aseptic meningitis and both were seen in 6 cases,4 cases and 2 cases respectively. Conclusions: The government of India is to take necessary action to include the mumps vaccine in the UIP along with the MR vaccine to prevent mumps and its complications.

Assessment of Simplified Surveillance for Congenital Rubella Syndrome in Sudan, 2014-2017.

Congenital rubella syndrome (CRS) is a constellation of serious multi-organ birth defects following rubella virus infection during early pregnancy. Countries in which rubella vaccination has not yet been introduced can have a high burden of this disease. Data on CRS burden and epidemiology are needed to guide the introduction of a rubella vaccine and monitor progress for rubella elimination, but the multi-system nature of CRS manifestations and required specialized testing creates a challenge for conducting CRS surveillance in developing settings such as Sudan. To enhance data quality, we designed and tested a simplified approach for CRS surveillance in Sudan. Seven CRS surveillance sentinel sites were set up at general pediatric, eye, and cardiology hospitals in Sudan, using standard definitions for reporting and classifying infants with CRS clinical manifestations. Between 2014 and 2017, we evaluated the system using WHO CRS surveillance monitoring indicators, comparing simplified approaches against a comprehensive one. The simplified approaches included (1) an ophthalmic-focused approach; (2) a heart-focused approach; and (3) a cataract-only approach. Surveillance identified 179 infants with suspected CRS via the comprehensive approach, with 25 infants classified as laboratory-confirmed and 6 as clinically compatible. Surveillance sensitivity was highest for the simplified ophthalmic approach, while cataract-based surveillance had the highest proportion of confirmed cases. Simplified CRS surveillance, particularly focusing on detecting cataracts, can significantly contribute to monitoring the impact of rubella vaccine introduction. It could serve as an initial step towards comprehensive CRS surveillance, providing robust evidence to support rubella and CRS elimination efforts.

Prioritizing vaccine introduction to China’s National Immunization Program: a multi-criteria decision analysis

BackgroundTo prioritize the introducing of new vaccines into China’s National Immunization Program (NIP) among 10 candidate vaccines across four classes.MethodsWe developed a vaccine value framework using Multi-Criteria Decision Analysis (MCDA) to simulate the introduction of new vaccines into NIP, covering 21 criteria encompassing six dimensions: safety, effectiveness, economy, innovation, accessibility, and appropriateness. Two decision scenarios were considered: Scenario One prioritized the four classes of vaccines, while Scenario Two identified specific vaccines within each class.ResultsIn the vaccine value framework, safety received the highest weight, while innovation received the lowest. The Human Papillomavirus (HPV) vaccine was identified as a top priority for inclusion in NIP, followed by Pneumococcal Conjugate Vaccine (PCV), Haemophilus Influenzae Type B (HIB), and Rotavirus (RV) vaccines. The specific types are domestic bivalent HPV vaccine, imported 13-valent PCV vaccine, domestic HIB vaccine, and domestic RV vaccine. The results of the one-way and probabilistic sensitivity analysis demonstrated robustness.ConclusionsThis study provides a transparent, comprehensive, and quantifiable vaccine value framework to aid decision-making for introducing new vaccines into China’s NIP. According to the MCDA results, HPV should be considered the top vaccine candidate for the NIP.

Prevention of Invasive Pneumococcal Disease Among Black or African American Children With and Without Sickle Cell Disease in the United States After Introduction of 13-Valent Pneumococcal Conjugate Vaccine, 2005 Through 2019.

Administration of pneumococcal vaccines and oral penicillin prophylaxis has been recommended for children with sickle cell disease (SCD) to reduce the risk of invasive pneumococcal disease (IPD). Characterizing changes in IPD cases among children with SCD after 13-valent pneumococcal conjugate vaccine (PCV13) introduction could help inform the need for additional prevention measures. Using data from Active Bacterial Core surveillance, we characterized IPD cases among Black or African American (Black) children aged less than 18years with SCD, non-SCD IPD risk factors, and no IPD risk factors across three time periods (pre-PCV13 [2005-2009], early-PCV13 [2010-2014], and late-PCV13 [2015-2019]), and assessed proportion of IPD cases caused by serotypes in new pneumococcal conjugate vaccines (PCV15, PCV20) recommended after 2019. We analyzed IPD incidence among children with and without SCD. From 2005 to 2019, 1725 IPD cases were reported among Black children (6.9% with SCD). IPD incidence among children with SCD declined by 50% between pre-PCV13 and late-PCV13 periods (from 332 to 167 per 100,000), although IPD incidence among children with SCD was 42 times that of children without SCD in late-PCV13 period. During late-PCV13 period, greater than 95% of IPD cases among children with SCD were non-PCV13 serotypes; PCV15/non-PCV13 and PCV20/non-PCV15 serotypes caused 19% and 22% of cases, respectively. Increase in penicillin-nonsusceptible IPD cases was not observed. Despite reductions in IPD incidence after PCV13 introduction, children with SCD are at increased risk of IPD compared to children without SCD. Use of higher valency PCVs may help reduce remaining IPD burden.