Vaccine Shortage Research Articles

Securing the Future: Strategies for Global Polio Vaccine Security Amid Eradication Efforts

Background/Objectives: As we commemorate 50 years of the Expanded Programme on Immunization (EPI), the global mission to eradicate polio stands at a critical juncture. While remarkable progress has been made over the past decades, ensuring a steady supply of polio vaccines remains a significant challenge that could undermine these achievements. This manuscript aims to address the complexities of polio vaccine security within the context of the Immunization Agenda 2030 (IA2030) and the Global Polio Eradication Strategy 2022–2029, proposing actionable strategies to strengthen the vaccine supply. Methods: This manuscript analyzes obstacles to vaccine security, including supply disruptions and market uncertainties. It presents the Polio Vaccine Security Framework as a key strategy for addressing these challenges. Data were gathered from Global Polio Eradication Initiative (GPEI) reports, consultations with key stakeholders, and analyses of past vaccine shortages. Results: The findings indicate that the primary risks to vaccine security include the lack of a coherent long-term policy framework on polio vaccination, the absence of a clear polio vaccine development roadmap, and insufficient long-term, predictable forecasting. Additionally, stronger coordination is needed between stakeholders involved in vaccine supply, polio containment, and research, as well as addressing challenges related to financing and access to resources. Conclusions: A robust, adaptable, and sustainable approach to vaccine security, proposed in the Polio Vaccine Security Framework, is critical to achieving and sustaining polio eradication. Collaboration among policymakers, manufacturers, and stakeholders to implement it is essential to ensure the uninterrupted supply of polio vaccines, protecting the progress made over the past half century, and preventing a resurgence of poliovirus in the future.

The Effect of Interventions Based on the Information-Motivation-Behavioral Skills Model on the Human Papillomavirus Vaccination Rate Among 11-13-Year-Old Girls in Central and Western China: Protocol for a Randomized Controlled Trial.

Persistent infection of high-risk human papillomavirus (HPV) can lead to cervical intraepithelial neoplasia, cervical cancer, and even death. HPV vaccination for girls aged 9-14 years can effectively prevent the occurrence of cervical cancer. Some Chinese provinces and cities have launched free HPV vaccination programs for school-age girls; however, due to the lack of supportive government policies, the high price and supply shortage of HPV vaccines, and vaccine hesitancy, some parents refuse to vaccinate their daughters. This protocol reports the design of a randomized controlled trial (RCT) aiming to explore the efficacy of a digital HPV vaccination education intervention based on the information-motivation-behavioral skills (IMB) model in improving the HPV vaccination rate among 11-13-year-old girls in central and western China. A multicenter intervention study based on an online applet will be conducted in December 2024, and about 750 eligible parents of 11-13-year-old girls will be assigned in a 1:1 ratio to an intervention group receiving 7-day digital HPV vaccination education based on the IMB model or a control group using non-HPV publicity materials. Free HPV vaccination pilot projects will be carried out among this population by our research team in central and western China (some parents might refuse to vaccinate their daughters). All participants will be asked to complete online questionnaires at baseline; postintervention; and 1 week, 1 month, and 3 months after the intervention. The primary outcome of this study will be receipt of the first HPV vaccination within 3 months. Data will be analyzed based on an intention-to-treat approach, and Stata 16.0 will be used for statistical analysis. This study aims to improve the HPV vaccination rate among 11-13-year-old girls and will examine the impact of a digital HPV vaccination education intervention based on the IMB model. The findings of this study may offer promising intervention measures for HPV vaccine hesitancy in low-health-resource areas in the future. Chinese Clinical Trial Registry, ChiCTR2300067402; https://tinyurl.com/v5zt4hc9. PRR1-10.2196/58873.

The impact of COVID-19 on routine child immunisation in South Africa

BackgroundThe COVID-19 pandemic disrupted immunisation programs worldwide, reversing gains that had brought vaccine-preventable diseases largely under control. This study explored the impact of COVID-19 on the uptake of routine child immunisation services in South Africa.MethodsWe conducted qualitative research using in-depth interviews with 51 purposively selected parents/caregivers of children below the age of five who missed or delayed one or more scheduled immunisation doses in 2020–2022 and with 12 healthcare providers who provided public immunisation services during the pandemic.ResultsDuring the pandemic lockdowns, most caregivers perceived the risk of their child being infected with COVID-19 during a clinic visit as more salient than the risk of missing immunisation doses. Caregivers reported minimal exposure to routine immunisation communication, as well as shortages of routine vaccines for children at public health facilities, healthcare workers experienced anxiety and burnout. There was a post-pandemic shift to more active decision-making about immunisation, which had previously been an almost automatic behaviour, leading some caregivers to delay vaccinating their children. There was also evidence of a “bad vaccine” mental model among some caregivers regarding COVID vaccinations, which could lead to doubts about the safety of routine childhood vaccinations.DiscussionThe shift from default to active decision-making highlights a risk that routine immunisation will backslide in future pandemics. Governments should build resilient health systems at all levels and communicate clearly about the benefits and availability of RIs and the safety of vaccinations in general, alongside supply-side interventions.ConclusionRoutine immunisation is widely accepted in South Africa, driven by generational norms and provider recommendations. During the COVID-19 pandemic, many caregivers faced the dilemma of balancing COVID-19 exposure risk with the risk of their child developing a deadly VPD, leading to missed RI visits. This shift to active decision-making highlights a future pandemic risk. Governments should build resilient health systems and focus on understanding and engaging procrastinating and doubtful caregivers. Clear communication about RI benefits and vaccine safety is crucial, as misinformation can lead to distrust in new vaccines.

RTS, S malaria vaccination among children aged 24–59 months in the Sunyani Municipality, Ghana; 2023

BackgroundFollowing the successful pilot of RTS,S malaria vaccine, it has been recommended by the WHO for prevention of Plasmodium falciparum malaria in children living in endemic areas. Despite the proven benefits of the malaria vaccine, uptake especially of the fourth dose, remains relatively low. We assessed complete uptake of RTS,S malaria vaccine among children 24–59 months and associated factors in the Sunyani Municipality of Ghana. MethodsA cross-sectional study was conducted among 361 caregivers of children aged 24–59 months in the Sunyani Municipality, who had received at least one dose of RTS,S malaria vaccine. Structured questionnaires were administered to caregivers and relevant vaccination information was extracted from the maternal and child health record books. Binary logistic regression analysis was used to determine factors associated with complete uptake of the vaccine at 95 % confidence interval (CI). ResultsApproximately 45 % (164/361) of the children had completed the RTS,S malaria vaccination schedule. Children aged 48–59 months (AOR:0.26, 95 %CI:0.09–0.76), those with caregivers who believed that children were being used for experiment (AOR:0.29, 95 %CI:0.16–0.54) or doubted the safety of the vaccine (AOR:0.27, 95 %CI:0.14–0.52) were less likely to complete the four doses. On the other hand, children of caregivers who reported vaccine shortages and travelled long distances to access immunization services (AOR:3.15, 95 %CI:1.17–8.47), and those with adequate knowledge on the malaria vaccine (AOR:1.89, 95 %CI:1.08–3.29) were more likely to complete the vaccination schedule. ConclusionLess than half of the children who started RTS,S malaria vaccination completed the full schedule. Age of child, caregiver knowledge and perception of the malaria vaccine, and access to immunization service were associated with complete uptake of the RTS,S malaria vaccine. Strengthening caregiver education and access to immunization services could improve uptake of the subsequent doses and coverage of the fourth dose.

To vaccinate or not to vaccinate? Experiences of COVID-19 vaccine uptake among people living with non-communicable diseases in Ghana: A qualitative study.

Following the development of a vaccine for COVID-19, the expectation was instantaneous widespread distribution and uptake to halt further spread, severe illness and deaths from the virus. However, studies show very low uptake, especially in resource-poor settings, and little is documented about the drivers of vaccine uptake in populations classified as high-risk. In this study, we explored access and uptake of COVID-19 vaccines among people living with non-communicable diseases (PLWNCDs) in Ghana. A qualitative study using in-depth interviews and focus group discussions was conducted among adults (>18 years) PLWNCDs stratified by sex, age, and type of non-communicable diseases (NCDs) at the community level (non-users of the health service) and health facility levels. Purposive sampling was used to select eligible participants. Topic guides were used to facilitate the face-to-face in-depth interviews and focus group discussions. The interviews and discussions were all digitally audio recorded. All transcripts and field notes were thematically analysed. Overall, 62 participants were recruited for this study. Family members, friends/peers, health workers and media were identified as the main sources of information for COVID-19 vaccines. Several barriers that mediated access to the COVID-19 vaccines in Ghana were reported including mistrust of vaccine efficacy and fears of vaccine side-effects, long distance to and waiting hours at vaccination centres, shortages of vaccines at vaccination centres and non-prioritization of NCD patients for the vaccine. To improve uptake, intensified education and sensitization, house-to-house vaccination, expansion of vaccination centers and increased supply of vaccines were recommended by participants. Compared to studies elsewhere, misinformation and disinformation were not major causes of vaccine hesitancy. If policymakers can improve community-based vaccine delivery, reduce queues and waiting times, prioritize PLWNCDs and other vulnerable groups, and improve sensitization and communication-our findings suggest there will be major improvements in COVID-19 vaccine coverage in Ghana.

A profile of emergency departments in Baghdad hospitals.

To assess the structure as well as availability of essential equipment and medicine at emergency departments in Baghdad hospitals. The descriptive, cross-sectional study was conducted from March to June 2021 after approval from the ethics review committee pf the College of Medicine, Mustansiriyah University, Baghdad, Iraq, and comprised emergency departments of general and teaching hospitals in the city. Evaluations were done using the World Health Organisation checklist and the guidelines of the Australasian College for Emergency Medicine related to Emergency Department Design. Of the 26 secondary care hospitals in Baghdad, 13(50%) were evaluated. Triage was not available in 8(62%) hospitals, resuscitation room in 10(77%) and waiting room in all the 13(100%). An obvious shortage of medicines and vaccines was noted in 11(85%) hospitals. Coronary care unit and intensive care unit were not close to the emergency department in 7(54%) hospitals, and liaison psychiatry and social work links were not available in all 13(100%) hospitals. There is a need to improve service delivery at emergency departments functioning at hospitals in Baghdad.

Two-agent proportionate flowshop scheduling with deadlines: polynomial-time optimization algorithms

Volatility in the supply chain of critical products, notably the vaccine shortage during the pandemic, influences livelihoods and may lead to significant delays and long waiting times. Considering the capital- and time-intensive nature of capacity expansion plans, strategic operational production decisions are required best to address the supply-demand mismatches given the limited production resources. This research article investigates the production scenarios where the demand of one agent must be completed within a specified due date, hereinafter referred to as the deadline, while minimizing the maximum or total completion time of another agent's demand. For this purpose, the Two-Agent Proportionate Flowshop Scheduling Problem with deadlines is introduced. Two polynomial-time optimization algorithms are developed to solve these optimization problems. This study will serve as a basis for further developing this practical yet understudied scheduling problem.

Comparison of Adverse Events and Antibody Responses Among Different COVID-19 Vaccination Schedules.

Global investment in developing COVID-19 vaccines has been substantial, but vaccine hesitancy has emerged due to misinformation. Concerns about adverse events, vaccine shortages, dosing confusion, mixing vaccines, and access issues contribute to hesitancy. Initially, the WHO recommended homologous vaccination (same vaccine for both doses), but evolving factors led to consideration of heterologous vaccination (different vaccines). The study compared reactogenicity and antibody response for both viral protein spike (S) and nucleocapsid (N) in 205 participants who received three vaccination regimens: same vaccine for all doses (Pfizer), two initial doses of the same vaccine (CoronaVac or AstraZeneca), and a Pfizer booster. ChAdOx1 and BNT162b2 vaccines were the most reactogenic vaccines, while CoronaVac vaccine was the least. ChAdOx1 and BNT162b2 achieved 100% of S-IgG seropositivity with one dose, while CoronaVac required two doses, emphasizing the importance of the second dose in achieving complete immunization across the population with different vaccine regimes. Pfizer recipients showed the highest S-IgG antibody titers, followed by AstraZeneca recipients, both after the first and second doses. A third vaccine dose was essential to boost the S-IgG antibodies and equalize the antibody levels among the different vaccine schedules. CoronaVac induced N-IgG antibodies, while in the Pfizer and AstraZeneca groups, they were induced by a natural infection, reinforcing the role of N protein as a biomarker of infection.

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

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

Safety and immunogenicity of a next-generation live-attenuated yellow fever vaccine produced in a Vero cell line in the USA: a phase 1 randomised, observer-blind, active-controlled, dose-ranging clinical trial

Recent outbreaks between 2015-17 and production delays have led to a yellow fever vaccine shortage. Therefore, there is an urgent need for new yellow fever vaccines with improved production scalability. A next-generation live-attenuated yellow fever vaccine candidate (vYF), produced in a Vero cell line has shown similar immunogenicity to licensed yellow fever vaccines in preclinical studies. In this study, we aimed to report the safety and immunogenicity of vYF in human clinical trial participants. In this first in-human, phase 1 randomised, observer-blind, active-controlled, dose-ranging clinical trial conducted at a single centre in the USA (Walter Reed Army Institute of Research, Silver Spring, MD, USA), 72 healthy adults (aged 18-60 years), without a known history of flavivirus infection or vaccination were randomly assigned (1:1:1:1) using interactive response technology to receive one dose of either vYF at 4, 5 or 6 Log CCID50 or the licensed YF-VAX (18 individuals per group). The primary outcomes were safety, neutralising antibody (NAb) titres through D180 post-vaccination in the per-protocol analysis set (comprised of yellow fever-naive participants who received their intended vaccine and provided a valid post-vaccination blood sample), and occurrence, and level of yellow fever viraemia in each vaccine group through D14 post-vaccination. All vYF doses had a safety and tolerability profile similar to YF-VAX. The most frequently reported solicited injection site reactions (vYF groups vs YF-VAX group) were pain (22% [12 of 54 participants, 95% CI 12-36] vs 28% [five of 18 participants, 10-54]), and erythema (13% [seven of 54 participants, 5-25] vs 39% [seven of 18 participants, 17-64]), with headache (32% [17 of 54 participants, 20-46] vs 44% [eight of 18 participants, 22-69]) and malaise (26% [14 of 54 participants, 15-40] vs 33% [six of 18 participants, 13-59]) as the most frequently reported solicited systemic reactions. One grade 3 solicited reaction (erythema) reported in the YF-VAX group resolved spontaneously. No serious unsolicited adverse events or deaths were reported. Viraemia was transiently detected in 50 participants between D4 and D10 in all groups and was observed in more participants or for a longer time in the vYF 6 Log CCID50 and YF-VAX groups. All yellow fever-naive vaccine recipients across the study groups seroconverted yielding four-fold increase from baseline in yellow fever NAb titres measured by yellow fever microneutralisation assay by D28 and were seroprotected with yellow fever NAb titres of at least 10 [1/dil]). Overall, 100% (18 of 18 participants, 95% CI 82-100), 89% (16 participants, 65-99), 100% (18 participants, 82-100), and 94% (17 participants, 73-100) of participants in the vYF 4 Log, vYF 5 Log, vYF 6 Log CCID50 groups, and YF-VAX group, respectively, remained seroprotected through D180. vYF has a similar safety and immunogenicity profile to YF-VAX. In general, the vYF 5 Log CCID50 dose appeared to show optimal viraemia, safety, and immunogenicity, and was chosen for subsequent development. Sanofi.

A nanoparticle vaccine displaying varicella-zoster virus gE antigen induces a superior cellular immune response than a licensed vaccine in mice and non-human primates.

Herpes zoster (HZ), also known as shingles, remains a significant global health issue and most commonly seen in elderly individuals with an early exposure history to varicella-zoster virus (VZV). Currently, the licensed vaccine Shingrix, which comprises a recombinant VZV glycoprotein E (gE) formulated with a potent adjuvant AS01B, is the most effective shingles vaccine on the market. However, undesired reactogenicity and increasing global demand causing vaccine shortage, prompting the development of novel shingles vaccines. Here, we developed novel vaccine candidates utilising multiple nanoparticle (NP) platforms to display the recombinant gE antigen, formulated in an MF59-biosimilar adjuvant. In naïve mice, all tested NP vaccines induced higher humoral and cellular immune responses than Shingrix, among which, the gEM candidate induced the highest cellular response. In live attenuated VZV (VZV LAV)-primed mouse and rhesus macaque models, the gEM candidate elicited superior cell-mediated immunity (CMI) over Shingrix. Collectively, we demonstrated that NP technology remains a suitable tool for developing shingles vaccine, and the reported gEM construct is a highly promising candidate in the next-generation shingles vaccine development.

Predicting Efficacies of Fractional Doses of Vaccines by Using Neutralizing Antibody Levels: Systematic Review and Meta-Analysis.

With the emergence of SARS-CoV-2 variants that have eluded immunity from vaccines and prior infections, vaccine shortages and vaccine effectiveness pose unprecedented challenges for governments in expanding booster vaccination programs. The fractionation of vaccine doses might be an effective strategy for helping society to face these challenges, as fractional doses may have efficacies comparable with those of the standard doses. This study aims to investigate the relationship between vaccine immunogenicity and protection and to project efficacies of fractional doses of vaccines for COVID-19 by using neutralizing antibody levels. In this study, we analyzed the relationship between in vitro neutralization levels and the observed efficacies against both asymptomatic infection and symptomatic infection, using data from 13 studies of 10 COVID-19 vaccines and from convalescent cohorts. We further projected efficacies for fractional doses, using neutralization as an intermediate variable, based on immunogenicity data from 51 studies included in our systematic review. In comparisons with the convalescent level, vaccine efficacy against asymptomatic infection and symptomatic infection increased from 8.8% (95% CI 1.4%-16.1%) to 71.8% (95% CI 63%-80.7%) and from 33.6% (95% CI 23.6%-43.6%) to 98.6% (95% CI 97.6%-99.7%), respectively, as the mean neutralization level increased from 0.1 to 10 folds of the convalescent level. Additionally, mRNA vaccines provided the strongest protection, which decreased slowly for fractional dosing with dosages between 50% and 100% of the standard dose. We also observed that although vaccine efficacy increased with the mean neutralization level, the rate of this increase was slower for vaccine efficacy against asymptomatic infection than for vaccine efficacy against symptomatic infection. Our results are consistent with studies on immune protection from SARS-CoV-2 infection. Based on our study, we expect that fractional-dose vaccination could provide partial immunity against SARS-CoV-2 and its variants. Our findings provide a theoretical basis for the efficacy of fractional-dose vaccines, serving as reference evidence for implementing fractional dosing vaccine policies in areas facing vaccine shortages and thereby mitigating disease burden. Fractional-dose vaccination could be a viable vaccination strategy comparable to full-dose vaccination and deserves further exploration.

Time to be seen and heard: Including children's and adolescents' voices in the South African TB response.

Ciara Goslett's account of childhood tuberculosis (TB) sheds light on the challenges faced by children diagnosed with TB in South Africa (SA). Children are particularly vulnerable to TB infection and to dangerous forms of disseminated TB such as TB meningitis, which can cause death or major lifelong disability. They have distinct challenges with diagnosis, and TB treatment for adults is not necessarily child- friendly. In the absence of a child-friendly formulation, adult tablets are broken into the correct dosage and used to treat children. Crushed and dissolved in water, the pieces are not very palatable for children. There are therefore issues that may be neglected if the voices of children are not included in the TB response in SA. These include delays in the development and accessibility of child-friendly medication, vaccine shortages and a lack of educational support for hospitalised children under school-going age. Some positive progress has been made through the establishment of the paediatric working group in the TB Think Tank, and SA's contribution to pivotal childhood TB research studies. Additional steps could be the inclusion of children's feedback in community-led monitoring efforts and engagement between child TB activists and the SA TB Caucus, a collective of parliamentarians.

Examining Current Vaccination Practices for Neonates, Including Healthcare Provider and Parental Attitudes and the Challenges of Implementing Vaccination Schedules: A Clinical Study.

Vaccination of neonates is crucial for preventing infectious diseases and ensuring public health. However, understanding the attitudes of healthcare providers and parents towards neonatal vaccination and the challenges in implementing vaccination schedules is essential for optimizing vaccination strategies. A clinical study was conducted involving healthcare providers and parents of neonates. Surveys were administered to assess attitudes towards neonatal vaccination, perceived barriers, and adherence to vaccination schedules. Data analysis was performed using statistical methods to identify trends and associations. Among healthcare providers (n = 200), 85% expressed strong support for neonatal vaccination, citing its importance in disease prevention. However, concerns regarding vaccine safety (62%) and parental hesitancy (48%) were identified as significant barriers. Among parents (n = 500), 78% reported willingness to vaccinate their neonates, with 60% adhering strictly to vaccination schedules. Common reasons for non-adherence included fear of adverse reactions (42%) and misinformation (28%). Challenges in vaccine administration, such as access issues (20%) and vaccine shortages (15%), were also reported. Healthcare providers generally endorse neonatal vaccination, recognizing its benefits in preventing infectious diseases. However, addressing concerns about vaccine safety and parental hesitancy is crucial for improving vaccination rates. Strategies aimed at enhancing education, promoting vaccine confidence, and addressing logistical challenges are essential for the successful implementation of neonatal vaccination schedules.

Vaccine shortages worsen the deadliest cholera outbreaks in years

Vaccine shortages worsen the deadliest cholera outbreaks in years

Two-stage approach for COVID-19 vaccine supply chain network under uncertainty using the machine learning algorithms: A case study

Healthcare systems worldwide have been facing a scarcity in COVID-19 vaccine rationing as a severe challenge. This research presents a two-stage optimization mathematical model to design a COVID-19 vaccine supply chain network under uncertain demand and lead time. The first stage aims to minimize the lead time by focusing on the suppliers' goals. In contrast, four objective functions, namely minimization of the gap of service level, the waiting time in the queue, and costs, and maximization of the related assignment, are considered in the second stage considering the government's goals. The popular supervised machine learning approaches are adopted to estimate COVID-19 vaccine demand. The boosted neural networks method as a superior mechanism is selected to estimate the demand as input parameters to the model. Additionally, since the lead time is an inherently uncertain parameter, a fuzzy method by Gaussian membership function is employed. Then, a rolling horizon planning mechanism along with an iterative procedure is proposed to prevent the shortage of vaccines. The applicability of the proposed model and solution method is demonstrated based on a real-case study from Iran. The results indicate that when demand exceeds supply, priority grouping becomes essential. Additionally, fairly allocating vaccines among people is a severe challenge during an epidemic, and preferences among the government and suppliers can make the problem more complex. The computational results illustrate that implementing the proposed model and approaches achieves the goals and reduces the shortage in the network compared to the existing condition.

Evaluation of pre-exposure vaccine effectiveness against mpox during the 2022–2023 mpox outbreak in the Madrid region (Spain): a test-negative design

IntroductionAn appropriate vaccination approach is critical to control the current outbreak of mpox but there is little research providing information on its effectiveness, particularly under circumstances of limited vaccine availability.MethodsPre-exposure...

Efficacy of Shen Cao Gan Jiang Tang on Non-severe COVID-19 Patients: A Multicenter, Randomized, Open-Label Clinical Trial.

Background In the face of the escalating COVID-19 pandemic amid shortages of medications and vaccines, a Vietnamese herbal formula known as Shen Cao Gan Jiang Tang (SCGJT) has been put into use for non-severe COVID-19 patients. This study aims to assess its efficacy and safety. Methods A multicenter, open-label, randomized controlled trial was conducted on 300 patients with non-severe COVID-19, randomly assigned into two groups: 150 receiving standard care (control group) and 150 receiving additional SCGJT for 10 days (SCGJT group). Time to resolution of symptoms, symptom severity, disease progression, time to discharge, the National Early Warning Score 2 (NEWS2) score, usage of Western drugs, time to viral clearance, and safety outcomes were continuously monitored. Results The SCGJT group exhibited faster symptom resolution (median: 9 vs. 13 days) and improved symptom severity, including cough, fatigue, hypogeusia, muscle aches, nasal congestion, runny nose, and sore throat, compared to the control group. Although there was a lower rate of severe progression in the SCGJT group (0.7% vs. 4.7%), the difference was not statistically significant. The time to discharge was significantly shorter in the SCGJT group (median: 7 vs. 8 days). Changes in the NEWS2 score did not show significant differences between groups. SCGJT has been demonstrated to reduce the need for symptomatic relief medications and hasten SARS-CoV-2 viral clearance. No adverse events were reported, and routine tests showed no significant differences. Conclusions SCGJT is safe and has potential clinical efficacy in non-severe COVID-19 patients. However, data regarding preventing severe progression remains inconclusive. Further studies should be conducted in light of the current state of the COVID-19 pandemic.

National survey for pediatricians in Argentina: Vaccination in daily practice, perception of knowledge and barriers.

Introduction. The decline in vaccination coverage has been very significant in the past decade. Pediatricians play a key role in catching-up coverage and increasing confidence in vaccination. Objectives. To describe pediatricians' perceptions of vaccine knowledge and practices and to identify barriers to access. Methods. Observational, analytical study using an online survey. Variables related to professional profile, training and barriers to vaccination were included. Results. A total of 1696 pediatricians participated (response rate: 10.7%). Their mean age was 50.4 years; 78.7% were women; 78.2% had ≥ 10 years of experience; 78.4% provided outpatient care and 56.0%, in the private subsector; and 72.5% received training in the past 2 years. Respondents described themselves as "trained" in convey the following aspects to their patients: benefits of vaccines: 97.2%; campaign objectives: 87.7%; contraindications: 82.4%; adverse effects: 78.9%; catch- up vaccination: 71.2%; reporting of events supposedly attributable to vaccination or immunization: 59.5%. The proportion was statistically higher in all aspects, among pediatricians with ≥ 10 years of experience and those who received training recently (p ≤ 0.01). The barriers identified in access to vaccination were false contraindications (62.3%), temporary vaccine shortage (46.4%), cultural reasons (41.4%), and restricted vaccination center hours (40.6%). Conclusions. The perception of the level of training varied depending on the vaccination-related aspect. Pediatricians with more years of professional experience and those who received recent updates perceived themselves as more trained. Multiple barriers associated with access to vaccination were identified.

Childhood immunization in Ghana: Tracing the history and projecting the future

AbstractChildhood immunization has contributed significantly to child survival globally. Ghana adopted the Expanded Program on Immunization (EPI) in the year 1972, and since then Ghana's immunization program has chalked huge successes in disease prevention, particularly the drastic reduction in the incidence of the six childhood killer diseases. Despite these successes, there are shortfalls that affect childhood vaccinations in Ghana. Here, we look at the evolution of childhood vaccine adoption in Ghana, the disease burden in the pre‐vaccination era and the vaccination era, the benefits of the immunization program, and the identified shortfalls. More importantly, the impact of childhood immunization on the current state of vaccine‐preventable diseases and the prospects the future holds for vaccine development and disease prevention in Ghana were discussed. Undoubtedly, Ghana has made significant progress in vaccine adoption and expansion of immunization program, resulting in a significant reduction in vaccine‐preventable deaths particularly in children. However, challenges pertaining to vaccine coverage, periodic shortages of vaccine, untimely immunization, and logistics constraints persist, which need redress. Moreover, there is currently no continuous post‐vaccine surveillance to evaluate long‐term vaccine impact. Additionally, Ghana lacks the technology and skill to manufacture its own vaccines. Following the establishment of the National Vaccine Institute, Ghana should be in the position to start the production of established vaccines such as those covered under EPI, whereas collaborative research is needed to discover new vaccines. Finally, it is critical to network childhood immunization records across the nation to ensure enhanced data for planning.