Priority For Vaccination Research Articles

Preparing for the Coronavirus Disease (COVID-19) Vaccination: Evidence, Plans, and Implications.

The formation of herd immunity through vaccination is a key point in overcoming the coronavirus disease 2019 (COVID-19) pandemic. To acquire herd immunity, a high vaccination rate is required, which is necessary to instill confidence in the public regarding the effectiveness and safety of the vaccine. In the real-world setting, thorough preparation of components, such as priority setting, vaccine delivery, logistics, and side-effect monitoring is necessary to overcome vaccine hesitancy. Each country prioritizes vaccination since healthcare workers, nursing facility residents, and the elderly population, and similar trends are found between countries. Vaccination is performed at large centers and medical institutions operated by the country, and variations are dependent on the environment of each country. The transport of mRNA vaccines is a challenging task, and to this end, each government is striving for safe distribution. In addition, each authority operates a surveillance system to monitor the safety of vaccines, and Korea needs to produce evidence for monitoring effects and side effects with expertise. Even after the acquisition of herd immunity, COVID-19 is highly likely to remain an endemic infectious disease, and a higher immunity level may be required because of variants of the virus. If the spread of variants of concern continues, a booster vaccination may be required. Therefore, non-pharmaceutical interventions, such as social distancing, wearing a mask, and epidemiological investigation should be maintained.

Constructing an ethical framework for priority allocation of pandemic vaccines

BackgroundAllocation of scarce resources during a pandemic extends to the allocation of vaccines when they eventually become available. We describe a framework for priority vaccine allocation that employed a cross-disciplinary approach, guided by ethical considerations and informed by local risk assessment. MethodsPublished and grey literature was reviewed, and augmented by consultation with key informants, to collate past experience, existing guidelines and emerging strategies for pandemic vaccine deployment. Identified ethical issues and decision-making processes were also included. Concurrently, simulation modelling studies estimated the likely impacts of alternative vaccine allocation approaches. Assembled evidence was presented to a workshop of national experts in pandemic preparedness, vaccine strategy, implementation and ethics. All of this evidence was then used to generate a proposed ethical framework for vaccine priorities best suited to the Australian context. FindingsPublished and emerging guidance for priority pandemic vaccine distribution differed widely with respect to strategic objectives, specification of target groups, and explicit discussion of ethical considerations and decision-making processes. Flexibility in response was universally emphasised, informed by real-time assessment of the pandemic impact level, and identification of disproportionately affected groups. Model outputs aided identification of vaccine approaches most likely to achieve overarching goals in pandemics of varying transmissibility and severity. Pandemic response aims deemed most relevant for an Australian framework were: creating and maintaining trust, promoting equity, and reducing harmful outcomes. InterpretationDefining clear and ethically-defendable objectives for pandemic response in context aids development of flexible and adaptive decision support frameworks and facilitates clear communication and engagement activities.

Risk factors associated with COVID-19-induced death in patients hospitalized in intensive care units (ICUs) in a city in Southern Brazil.

The aim of this research was to address risk factors associated with death after hospitalization in intensive care units (ICUs) in 728 COVID-19 patients in Londrina, the second most populated city in the State of Paraná - Brazil, between March and December 2020. Statistical analysis, including multiple logistic regression was performed to identify risk factors associated with death in these patients. The results showed that age (60 years or more, O.R. = 3.13, C.I. 95% [2.02; 4.84]), days in the ICU (11 days or more, O.R. = 1.76, C.I. 95% [1.16; 2.66]), neurological diseases (O.R. = 2.15, C.I. 95% [1.07; 4.31]), pneumopathy (O.R = 2.19, C.I. 95% [1.01; 4.82]), diabetes (O.R. = 1.55, C.I. 95% [1.03; 2.32]), and kidney disease (O.R. = 2.27, C.I. 95% [1.18; 4.70]) were associated with increased risk for death from COVID-19. Knowing the risk factors associated with death after ICUs hospitalization is useful for identifying the most vulnerable groups, as well as for defining vaccination priorities, considering its scarcity in many parts of the world, mainly in underdeveloped countries, including Brazil.

COVID-19 mRNA Based Vaccine Immune-Response Assessment for Public Health Decision

Background: The Nursing Home Residents (NHR) has been targeted as a vaccination priority due to their higher risk of worse outcome after Covid-19 disease. The mRNA based vaccine BTN2b2 was the first approved in Europe for NHRs. The assessment of the specific vaccine immune response (both humoral and cellular) at long term in NHRs has not been addressed yet.Methods: A representative sample of 624 NHR subjects in North region of Spain was studied to assess immune response against full vaccination with BTN2b2. The anti-S1 antibody levels and specific T cells were measured at 2 and 6 months after vaccination.Results: A 24·4% of NHR had a previous infection prior vaccination. The remaining NHR were included in full vaccination assessment group (FVA). After 2 months, a 94·9% of the FVA presented anti-S1 antibodies whereas those seronegative without specific cellular response were 2·54%. At long-term, the frequency of NHR within the FVA group with anti-S1 antibodies at six months were 86·3% and the seronegative subjects without specific cellular response was 6·11%.Conclusions: The cellular immune assays complement to humoral test in the immune vaccine response assessment. Therefore, the cellular immune assessment in NHRs allows to fine tune those seronegative subjects with potential competent immune response against the vaccine.Funding Information: This work was partially supported by grant from Cantabrian Government #2020 UIC22-PUB-0019.Declaration of Interests: The authors declare no conflict of interest based on ICMJE guidelines.Ethics Approval Statement: The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Regional Ethics Committee (CEIm, internal code 2020.167, 14 May 2020) and with the support of Public Health Service of Cantabrian Governement

COVID-19 Vaccine Priority Access for Adults and Children with Congenital Heart Disease: A Statement of the Italian Society of Pediatric Cardiology

COVID-19 pandemic continues to strike across the world with increasing number of infected patients, severe morbidity and mortality, social life and economy disruption. Universal access to vaccine prophylaxis will be pivotal in controlling this infection and providing individual level protection. However, mismatch between vaccine request and vaccine availability, as well as constraints in logistics of vaccine campaign is creating a transition phase of progressive but still incomplete inclusion of group of individuals in the vaccination process. Selected patients living with chronic and multisystemic disease may present increased propensity of adverse outcome, should Sars-Cov-2 infection develop. In these patients, expedite access to COVID-19 vaccination may be considered. The Italian Society of Pediatric Cardiology National Board is providing a viewpoint to inform policy makers and public authorities during vaccine allocation strategies development, to consider higher priority and expedite access for selected groups of patients living with congenital heart disease.

Allocating a COVID-19 Vaccine: Balancing National and International Responsibilities.

Policy Points In this paper we propose a middle-ground policy for the distribution of an effective COVID-19 vaccine, between a cosmopolitan approach that rejects entirely nation-state priority and unbridled vaccine nationalism that disregards obligations to promote an equitable global allocation of an effective vaccine over time. Features of the COVAX partnership, a collaboration among the Global Alliance for Vaccines and Immunizations (GAVI), the Coalition for Epidemic Preparedness Innovations (CEPI), and the World Health Organization (WHO) to develop and distribute COVID-19 vaccines make it an appropriate framework for a middle-ground policy.

The epidemiology of community-acquired respiratory viruses during the SARS-CoV-2 pandemic.

In regions of high COVID‐19 endemicity, the incidence of other respiratory viral illnesses is depressed, which may reflect biologic displacement of other pathogens or the impact of preventive strategies to reduce transmission of SARS‐CoV‐2.

Seroprevalence of Novel Coronavirus SARS-CoV-2 at a Community Hospital Emergency Department and Outpatient Laboratory in Northern Orange County, California.

IntroductionThe severe acute respiratory syndrome related coronavirus 2 (SARS-CoV-2) has infected more than 20 million people worldwide, and the spread is most prevalent in the USA, where California had accounted over 240,000 cases in the initial 5 months of the pandemic. To estimate the number of infected persons in our community, we conducted a cross-sectional study to estimate seroprevalence of SARS-CoV-2 infection.MethodsThis cross-sectional study evaluated the presence of immunoglobulin G, antibody for SARS-CoV-2 during the time period of July 15, 2020, to July 27, 2020. Testing was done on serum samples from patients who had visited affiliated outpatient clinics or our emergency department. Additionally, we collected age, gender, ethnicity, race, and location of testing.ResultsEight hundred sixty-five tests were included in the study. The outpatient clinics cohort accounted for 56% of results and emergency department (ED) contributed 44%. The positive percentage of SARS-CoV-2 test was 9.4% (95% CI: 0.08–0.12). The positivity rates of the outpatient (5.6%) and ED (14.2%) setting differed. The prevalence of SARS-CoV-2 IgG was greatest in those that identified as Hispanic/Latino, 18.1% versus 13.4% in other groups. Specifically compared to the non-Hispanic/Latino population, the prevalence was significantly higher, with a relative risk of 2.73 (95% CI: 1.8–4.1), p < 0.0001.ConclusionThe low antibody positivity rate in the community indicates the need for a vaccine. The Hispanic/Latino patient population should be considered for increased education on preventing transmission and acquisition of COVID-19 as well as being considered as a priority for vaccination once a vaccine is available.

Age and frailty in COVID-19 vaccine development

Age and frailty in COVID-19 vaccine development

Influenza and COVID-19: What does co-existence mean?

The COVID‐19 pandemic caused by the novel coronavirus SARS‐CoV‐2 continues to have a major impact on healthcare and social systems throughout the world. As the clinical and epidemiological features of COVID‐19 have many parallels with influenza, it is important to ensure optimal management of both respiratory diseases as we anticipate their continued co‐circulation. In particular, there is a need to ensure that effective surveillance and diagnostic capacities are in place to monitor these and other respiratory viruses, as this will underpin decisions on the appropriate clinical management of the respective diseases. As such, we propose a series of key recommendations for stakeholders, public health authorities, primary care physicians and surveillance bodies that will help mitigate the combined risks of concurrent influenza epidemics and the COVID‐19 pandemic. We advocate the judicious use of influenza vaccines and antivirals, particularly among groups at high risk of complications, with healthcare workers also considered a priority for vaccination. It is likely that the increased use of emerging technologies such as telemedicine and contact tracing will permanently change our approach to managing infectious disease. The use of these technologies, alongside existing pharmaceutical strategies, will ensure that we achieve a holistic approach to the global public health measures needed to deal with the combined threat of influenza and COVID‐19. Ensuring that this approach is optimal will be key as we move from a reactive pandemic response towards preparing for the long‐term management of the remarkable clinical burden associated with these respiratory pathogens.

The Optimal Vaccination Strategy to Control COVID-19: A Modeling Study Based on the Transmission Scenario in Wuhan City, China

Background: The optimal vaccination is an essential public health strategy to control the pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This study aims to simulate the optimal vaccination strategy to control the virus epidemic by developing an age-specific model based on the transmission of coronavirus disease 2019 (COVID-19) in Wuhan City, China.Methods: An age-specific mathematical model based on the data of COVID-19 cases in Wuhan City from December 2, 2019 to March 16, 2020 was developed, with two scenarios for controlling transmission and reducing severity to estimate the effectiveness of SARS-CoV-2 vaccination strategy.Findings: Before the lockdown of the Wuhan City, the highest transmissibility of SARS-CoV-2 was among 14-44 years old (effective reproduction number, Reff = 4·28), followed by 14-44 to 45-64 years old (Reff = 2·61), and 14-44 to ≥ 65 years old (Reff = 1·69). We found that the first priority for controlling transmission should be to vaccinate nearly 90% individuals of 14-44 years old, followed by 90% individuals of 45-64 years old. However, the optimal vaccination strategy for reducing severity defined individuals ≥ 65 years old in vaccination priority groups, followed by 14-44 years old groups.Interpretation: The scenario analyses suggested that the optimal vaccination strategy aimed at controlling the transmission of COVID-19 might be to vaccinate about 90% of 15-44 years old individuals; while for reducing severity, the vaccination priority should focus on the older population. Furthermore, we also presented evidence about the heterogeneity of age-specific transmission and vaccination in different areas.Funding Statement: Bill & Melinda Gates Foundation, and the Science and Technology Program of Fujian Province.Declaration of Interests: The authors declare no competing interests.

Is It Lawful and Ethical to Prioritize Racial Minorities for COVID-19 Vaccines?

Coronavirus disease 2019 (COVID-19) has disproportionately affected racial minorities in the United States resulting in higher rates of infection, hospitalization, and death. With a limited supply after the initial approval of a safe and effective vaccine, difficult legal and ethical choices will have to be made on priority access for individuals. The National Academies of Sciences, Engineering, and Medicine (NASEM) has recommended prioritization of racial minorities who are “worse off” socioeconomically and epidemiologically. TheWorld Health Organization (WHO) similarly cautioned that “colorblind” allocation frameworks could perpetuate or exacerbate existing injustices. Both NASEM and WHO urge policy makers to allocate vaccines in ways that reduce unjust health disparities. The ethics and legality of race-based policies in the United States have been fraught with controversy. This Viewpoint considers how COVID-19 vaccine priority allocations could be implemented ethically and legally.

Seasonal flu, vaccinations and COVID-19

Seasonal flu, vaccinations and COVID-19

Shouting at each other into the void: A linguistic network analysis of vaccine hesitance and support in online discourse regarding California law SB277.

In 2015, California passed Senate Bill 277 and became the third state in the United States to ban all nonmedical exemptions from school immunization requirements, effectively prohibiting religious and personal belief exemptions. This attracted grassroots opposition and considerable debate among vaccine hesitant factions online. This mixed-methods study used quantitative linguistic analysis, semantic network analysis, and content analysis techniques to examine 2424 online documents drawn from newspapers, blogs, health websites, government information pages, web forums, personal websites, Facebook groups, among others. The study examined which words and phrases were used most frequently by vaccine skeptics, vaccine defenders, and more neutral media accounts to illuminate how groups with different attitudes towards vaccination discuss and disseminate information about vaccines and vaccine policy online. We proposed an innovative methodology for examining online discourse surrounding vaccine hesitance, as well as for studying the online dissemination of misinformation about vaccines. Our findings highlighted discrepancies in the narratives between what vaccine supporters believe causes vaccine skepticism and the issues that vaccine skeptics actually discuss within their own digital spaces. For example, in these exchanges, the importance of parental rights overshadowed that of children's rights; supporters of vaccines brought up autism in more distinct documents than skeptics do; distrust of government regulators and researchers seemed to unite vaccine skeptics and defenders; and politicians, doctors, and even celebrities often served as proxies in heated exchanges about factual evidence, believability, and the importance of expertise in public discourse.

On the influenza vaccination policy through mathematical modeling

ObjectivesAimed at mitigating influenza transmission, this study assessed the timing of the vaccination program and took vaccine capacity, strain mismatch and priority group into consideration. MethodsAn age-structured dynamic transmission model was fitted to the laboratory data of the national influenza surveillance system to reconstruct a baseline scenario with which the vaccination scenarios of interest could be compared. Outcome measures were defined as the impacts on the seasonal epidemic: decompression of the epidemic peak, reduction of the epidemic burden and change of the epidemic peak time. ResultsIt was found that vaccine capacity building, although indispensable, could not guarantee substantial impact on the seasonal influenza epidemic. Vaccine mismatch might greatly offset vaccine capacity building. Notably, advance vaccine distribution could compensate for some vaccine underperformance. In the case of a well-matched vaccine, advance vaccine distribution could even exploit its utility. ConclusionsThis study indicated that timely vaccine distribution should be put high on the agenda of seasonal influenza control policies. It provided a tangible platform for the policymakers to evaluate health policy impacts and to enhance risk communication with the public through mathematical modeling.

Is It Time to Reevaluate the Priority for a West Nile Vaccine?

Is It Time to Reevaluate the Priority for a West Nile Vaccine?

MUC1 plays an essential role in tumor immunity of colorectal cancer stem cell vaccine

Increasing knowledge of colorectal cancer stem cells (CCSCs) and tumor microenvironment improves our understanding of cellular mechanisms involved in the immunity against colorectal cancer (CRC). Tumor associated antigens were evaluated via RNA-seq and bioinformatics analysis, evoking promising targets for tumor immunotherapy. MUC1 has been demonstrated to participate in the maintenance, tumorigenicity, glycosylation and metastasis of CCSCs, which may provide a new priority for CSC vaccination. In the present study, the vaccination with CCSCs with high expression of MUC1 was evaluated in a murine model for the vaccine’s immunogenicity and protective efficacy against CRC. CD133+ CCSCs were isolated from SW620 cell line using a magnetic-activated cell sorting system, and shMUC1 was further used to knock down the expression of MUC1 in CD133+ CCSCs. Mice were subcutaneously immunized with the cell lysates of CCSCs and shMUC1 CCSCs, followed by a challenge with SW620 cells at ten days after final vaccination. The results indicated CCSC vaccine significantly reduced the tumor growth via a target killing of CCSCs as evidenced by a decrease of CD133+ cells and ALDH+ cells in tumors. Moreover, CCSC vaccine resulted in the elevated NK cytotoxicity, production of perforin, granzyme B, IFN-γ, memory B cells, and anti-MUC1 antibodies. Of note, MUC1 knockdown partly impaired the anti-tumor efficacy of CCSC vaccine. Importantly, the CCSC vaccine has no toxic damage to organs. Overall, CCSC vaccine could serve as a potent and safe vaccine for CRC treatment, and MUC1 might play an essential role in CCSC vaccine.

PC-FACS: COVID-19

PC-FACS (FastArticleCriticalSummaries forClinicians inPalliativeCare) provides hospice and palliative care clinicians with concise summaries of the most important findings from more than 100 medical and scientific journals. If you have colleagues who would benefit from receiving PCFACS, please encourage them to join the AAHPM at aahpm.org. Comments from readers are welcomed at pcfacs@aahpm.org.

Psychological reactance impacts ratings of pediatrician vaccine-related communication quality, perceived vaccine safety, and vaccination priority among U.S. parents

ABSTRACT Physician communication surrounding vaccination is important in driving patient compliance with schedules and recommendations, but patient psychological factors suggest that communication strategies may have differential effects on patients. This paper investigates how psychological reactance, defined as an individuals’ propensity to restore their autonomy when they perceive that others are trying to impose their will on them, impacts perceptions about physician communication and perceptions and prioritizations of vaccination. We propose and describe the results of a study that was conducted to assess the relationship between individual differences in reactance, perceived quality of pediatrician communication, perceptions of vaccination safety, and vaccination prioritization using a sample of parents. We recruited 300 parent participants via the online platform Prolific Academic in which they completed a computer-mediated survey. Results show that compared to those who are low in psychological reactance, those high in psychological reactance place less of a priority on vaccination, and that this relationship is driven by evaluations of physician communication quality and perceived vaccine safety. Our findings suggest that physicians should not adopt a one-size-fits-all approach when interacting with patients and should tailor messaging to patients based on psychological factors including reactance.

Schoolteachers\u2019 experiences of implementing school-based vaccination programs against human papillomavirus in a Chinese community: a qualitative study

BackgroundCervical cancer was the fourth most common cancer among women worldwide in 2012 and was the eighth most common cancer in 2014 and the eighth greatest cause of female cancer deaths in Hong Kong in 2015. Human papillomavirus (HPV) vaccination has been clinically documented to have a high efficacy in reducing HPV-related cervical intraepithelial neoplasia incidence. Therefore, receiving vaccination is a crucial public health measure to reduce disease burden. Significant others, such as schools and schoolteachers, have prominent influence in shaping adolescents’ health perceptions and behavior. Therefore, the perspective of schools and schoolteachers regarding vaccination can significantly influence students’ acceptance and accessibility of the vaccine. However, few studies have analyzed the perceptions of schoolteachers toward HPV vaccination, and even fewer have concerned how schoolteachers’ perceptions influence their schools’ motivation in implementing school-based HPV vaccination programs. This study was thus conducted to fill this literature gap.MethodsWith a Chinese community as the field site of this study, a qualitative approach of five focus group interviews was conducted with 35 schoolteachers from five primary and eight secondary schools in Hong Kong between July 2014 and January 2015. Thematic content analysis was used for data analysis.ResultsPerceptual, institutional, student and parental, and collaborator barriers interacted to discourage the sampled schoolteachers from organizing school-based HPV vaccination programs. Lack of knowledge regarding HPV vaccination, perception of HPV vaccination as inappropriate given the students’ age, violation of traditional cultural values, lack of perceived needs and perceived risk, opposition from schools, low priority of HPV vaccination over other health education topics, lack of government support, lack of interest from parents and students, and lack of confidence in implementing organizations, all were the mentioned barriers.ConclusionsThe sampled schoolteachers were demotivated to organize school-based HPV vaccination programs because of their perceptions and various social and cultural factors. As significant influencers of adolescent students, schoolteachers and schools should receive more support and information on organizing school-based HPV vaccination programs in the future.