Vaccine In South Africa Research Articles

Willingness to pay for COVID‐19 test and vaccine in South Africa and Ghana: A contingent valuation study

AbstractAlthough from a public health perspective, governments are expected to finance the cost of testing and vaccination against the COVID‐19 pandemic, most African countries do not have the resources to do these. Individuals' willingness to pay (WTP) for COVID‐19 testing and vaccination is thus crucial. We employ the Contingent Valuation Method to assess WTP for COVID‐19 testing and vaccine and also investigate factors associated with WTP in South Africa and Ghana. On average, respondents in South Africa are willing to pay US$16.29 for COVID‐19 testing, whereas those in Ghana are willing to pay US$9.69. In terms of the COVID‐19 vaccine, South Africans are willing to pay twice (US$41.83) as high as the amount Ghanaians are willing to pay (US$20.36). The results from the probit and tobit estimations on factors associated with WTP show that WTP for COVID‐19 testing and vaccine are correlated with income, education, employment, gender, having tested for COVID‐19, travel experience, and low satisfaction with the government's COVID‐19 measures. These findings suggest that the private sector can play a crucial role in COVID‐19 testing and the deployment of COVID‐19 vaccines because people are willing to pay. However, there may be a need for subsidisation for the poor.

COVID-19 vaccine hesitancy and response to a simple educational intervention in patients attending an outpatient dialysis unit in Johannesburg, South Africa

Background: Patients living with kidney failure are at risk of severe COVID-19 disease. However, vaccination reduces transmission and severity of disease. The uptake of COVID-19 vaccination in South Africa remains poor, suggesting a requirement for novel recruitment strategies. We examined COVID-19 vaccine hesitancy in an urban dialysis population in Johannesburg, South Africa, and investigated the efficacy of an educational intervention on vaccination intention. Methods: One hundred and four participants were recruited from outpatient haemo- and peritoneal dialysis units at the Helen Joseph Hospital. Participants completed anonymous, self-administered questionnaires analysing their acceptance of and concerns regarding COVID-19 vaccination before and after dissemination of the South African Nephrology Society SARS-CoV-2 vaccine information brochure. Results: Seventy-two participants (69%) were unvaccinated against SARS-CoV-2; 23 (22%) indicated unwillingness to undergo vaccination. Vaccine side effects, safety and perceived risk of SARS-CoV-2 transmission by vaccination were important factors in hesitancy. A small proportion believed that COVID-19 was not a serious threat to personal health. News media was an important information source for vaccine-hesitant respondents; prior healthcare worker counselling reduced hesitancy (OR 0.175, 95% CI 0.039–0.784; P = 0.023). The information brochure reduced concerns about vaccine side effects (P = 0.028), increasing vaccination intention to 84%. In-centre vaccination was additionally identified as a strategy to reduce hesitancy (OR 0.053, 95% CI 0.012–0.221; P < 0.001). Conclusions: This first analysis in an urban dialysis population in South Africa highlights factors contributing to vaccine hesitancy. Simple educational interventions capitalising on trust in healthcare workers and improved vaccine accessibility may increase vaccine uptake. Keywords: COVID-19, vaccine hesitancy, dialysis

Religious perspectives on Vaccination: Mandatory Covid-19 vaccine for SA Churches

In public health history, vaccinations have been seen as very helpful as they help protect societies from preventable diseases and save many lives around the world. Despite the fact that few religious groups oppose vaccination for a variety of reasons, almost all major religions in the world support vaccination as long as it complies with religious precepts for the preservation, protection, or well-being of livelihoods. However, during the surge of Covid-19 outbreak in South Africa and elsewhere, governments witnessed unprecedented hesitancy and opposition to the Covid-19 vaccination by the general public. Those who opposed the Covid-19 vaccine cited multiple concerns or reasons, ranging from possible side effects, adverse events, vaccine safety, vaccine effectiveness, conspiracy theories, and religious or cultural reasons. Based on a literature search, this paper attempts to discuss various religious views on the subject of vaccination in general and subsequently make use of such perspectives to support calls for a compulsory Covid-19 vaccination, especially for South African churches. This is a timely topic of central concern as it seeks to politely dispel religious misunderstandings and confusion that could arise as a result of debates on mandatory vaccines for Covid-19. Health and religion will be brought together to shape the ongoing discussions about the moral urgency of a mandatory Covid-19 vaccination in South Africa.

Clinical outcomes and cost-effectiveness of COVID-19 vaccination in South Africa

Low- and middle-income countries are implementing COVID-19 vaccination strategies in light of varying vaccine efficacies and costs, supply shortages, and resource constraints. Here, we use a microsimulation model to evaluate clinical outcomes and cost-effectiveness of a COVID-19 vaccination program in South Africa. We varied vaccination coverage, pace, acceptance, effectiveness, and cost as well as epidemic dynamics. Providing vaccines to at least 40% of the population and prioritizing vaccine rollout prevented >9 million infections and >73,000 deaths and reduced costs due to fewer hospitalizations. Model results were most sensitive to assumptions about epidemic growth and prevalence of prior immunity to SARS-CoV-2, though the vaccination program still provided high value and decreased both deaths and health care costs across a wide range of assumptions. Vaccination program implementation factors, including prompt procurement, distribution, and rollout, are likely more influential than characteristics of the vaccine itself in maximizing public health benefits and economic efficiency.

The Magnitude and Determinants of Missed Opportunities for Childhood Vaccination in South Africa.

Missed opportunities for vaccination (MOV) may be among the factors responsible for suboptimal vaccination coverage in South Africa. However, the magnitude and determinants of MOV in the country are not known. Thus, this study seeks to assess the prevalence and determinants of MOV in the country. South Africa is sub-divided into nine administrative provinces. We used nationally representative data from the 2016 South African Demographic and Health Survey. We considered MOV to have occurred if a child aged 12–23 months old had not taken all scheduled basic vaccine doses despite having any of the following contacts with health services: delivery in a health facility; postnatal clinic visit; receipt of vitamin A; and any child-related treatment at a health facility. Multilevel logistic regression was used to determine factors associated with MOV. The national prevalence of MOV among children aged 12–23 months was 40.1%. Children whose mothers attended facility-based antenatal care were considerably less likely to experience MOV than those whose mothers did not attend antenatal care: odds ratio (OR) 0.41, 95% confidence interval (CI) 0.19 to 0.88. Conversely, the independent predictor of an increased MOV among children was residence in either the Gauteng province (OR 2.97, 95% CI 1.29 to 6.81) or Mpumalanga province (OR 2.32, 95%CI 1.04 to 5.18); compared to residence in the Free State province. Our findings suggest a high burden of MOV among children in South Africa and that MOV may be associated with individual and contextual factors. The findings also underscore the need for further exploration of the contextual factors contributing to MOV in South Africa.

Metagenomic Analysis of the Enteric RNA Virome of Infants from the Oukasie Clinic, North West Province, South Africa, Reveals Diverse Eukaryotic Viruses.

Establishing a diverse gut microbiota after birth is essential for preventing illnesses later in life. However, little knowledge exists about the total viral population (virome) present in the gut of infants during the early developmental stage, with RNA viruses being generally overlooked. Therefore, this small pilot longitudinal study investigated the diversity and changes in the enteric RNA virome in healthy infants from South Africa. Faecal samples (n = 12) were collected from four infants at three time points (on average at 8, 13, and 25 weeks), and then sequenced on an Illumina MiSeq platform. The genomic analysis revealed a diverse population of human enteric viruses from the infants’ stools, and changes in the enteric virome composition were observed over time. The Reoviridae family, more specifically the Rotavirus genus, was the most common and could be linked to viral shedding due to the administration of live-attenuated oral vaccines in South Africa, followed by the Picornaviridae family including parechoviruses, echoviruses, coxsackieviruses, enteroviruses, and polioviruses. Polioviruses were also linked to vaccine-related shedding. Astroviridae (astroviruses) and Caliciviridae (noroviruses) were present at low abundance. It is evident that an infant’s gut is colonized by distinct viral populations irrespective of their health state. Further characterization of the human virome (with a larger participant pool) is imperative to provide more conclusive insights into the viral community structure and diversity that has been shown in the current study, despite the smaller sample size.

COVID-19 Vaccine Acceptability Among Pregnant Women at a Primary Health Care Facility in Durban, South Africa

A vaccine represents the most promising strategy for combatting the COVID-19 pandemic through primary prevention. No study has been reported on the acceptability of the COVID-19 vaccine in South Africa (SA) and in the region. The objective of this study was to determine the acceptance of a COVID-19 vaccine among pregnant women. A cross-sectional, descriptive study was conducted at the Kwadabeka Community Health Center (KCHC), Durban. Logistic regression analysis was performed to determine the factors for vaccine acceptability among pregnant women. About two-thirds of pregnant women (63.3%) may accept COVID-19 vaccination once it becomes available in SA. Participants who were <22 years of age were 72% less likely (OR=0.28, CI: 0.13 -0.62) to accept the vaccine, compared to those who were >39 years old. Women with 0-1 parity were 4.3 times more likely (OR=4.3, CI: 1.98-9.48) to accept the vaccine than those with four or more parity. Single pregnant women were less likely (OR=0.23, CI: 0.10- 0.51) to accept the vaccine than those living with their partners. Employed pregnant women had four times more chances of accepting the vaccine (OR= 4.2, CI: 2.28-7.75) than unemployed pregnant women. It was also found that having a positive attitude towards vaccination increased the chance of accepting the vaccine by four times (OR=4.05, CI: 1.89-8.69). Our study found a 63.3% acceptance of a COVID-19 vaccine, but there were noticeable demographic, knowledge, attitude and practice disparities observed in vaccine acceptance among pregnant women. Before a COVID-19 vaccine is introduced to SA, public health officials and policymakers must prioritize effective COVID-19 vaccine-acceptance messages and mass education for all South Africans, especially for the most vulnerable.

Whole Genome In-Silico Analysis of South African G1P[8] Rotavirus Strains Before and After Vaccine Introduction Over A Period of 14 Years.

Rotavirus G1P[8] strains account for more than half of the group A rotavirus (RVA) infections in children under five years of age, globally. A total of 103 stool samples previously characterized as G1P[8] and collected seven years before and seven years after introducing the Rotarix® vaccine in South Africa were processed for whole-genome sequencing. All the strains analyzed had a Wa-like constellation (G1-P[8]-I1-R1-C1-M1-A1-N1-T1-E1-H1). South African pre- and post-vaccine G1 strains were clustered in G1 lineage-I and II while the majority (84.2%) of the P[8] strains were grouped in P[8] lineage-III. Several amino acid sites across ten gene segments with the exception of VP7 were under positive selective pressure. Except for the N147D substitution in the antigenic site of eight post-vaccine G1 strains when compared to both Rotarix® and pre-vaccine strains, most of the amino acid substitutions in the antigenic regions of post-vaccine G1P[8] strains were already present during the pre-vaccine period. Therefore, Rotarix® did not appear to have an impact on the amino acid differences in the antigenic regions of South African post-vaccine G1P[8] strains. However, continued whole-genome surveillance of RVA strains to decipher genetic changes in the post-vaccine period remains imperative.

Country-Level Assessment of Missed Opportunities for Vaccination in South Africa: Protocol for Multilevel Analysis.

BackgroundVaccination is one of the greatest public health interventions of all time. Vaccination coverage in South Africa has shown a steady improvement in reaching the national target. However, while there is progress nationally, there are districts within the country that are below the set target for vaccination coverage. One of the main drivers of suboptimal vaccination coverage is thought to be missed opportunities for vaccination.ObjectiveThis study aims to understand the magnitude and determinants of missed opportunities for vaccination in South Africa.MethodsThe 2016 South African Demographic and Health Survey will be used to conduct multilevel regression analyses to determine individual and contextual factors associated with missed opportunities for vaccination in South Africa. The perspectives of parents attending health care facilities in South Africa will be explored through exit interviews and focus group discussions. Similarly, perspectives of the health care providers will be sought to understand enablers and barriers to vaccination coverage at the facility level. Insights to such factors will aid in designing tailor-made interventions to improve vaccination coverage in South Africa.ResultsEthical review submission is planned for October 2020. Data collection is expected to be underway in January 2021.ConclusionsThe extent of missed opportunities in South Africa coupled with the associated factors presents an opportunity for efforts to increase uptake in districts where vaccination coverage is below the national target. Population-level data such as those from the 2016 South African Demographic Health Survey will provide an idea of the magnitude of missed opportunities for vaccination in South Africa at the national and subnational levels. The findings of the study will inform national and subnational policy implementation on vaccinations and help to find context-specific interventions to improve vaccination coverage.International Registered Report Identifier (IRRID)PRR1-10.2196/16672

Vaccines from the Spanish Influenza as a firm foundation for new developments

ABSTRACT In 1914, the concept of a prophylactic vaccine, administered to a person before the disease had been contracted, was still controversial. Nevertheless, Almroth Wright tested new pneumococcus vaccines in South Africa, where the incidence of bacterial pneumonia was high amongst workers in the gold mines. He established the use of clinical trials, using around ten thousand workers, both in vaccinated and unvaccinated groups. The two groups were not matched to modern standards. Also, of course, those workers in the control unvaccinated group could not be protected: but some considered a prophylactic vaccine would exacerbate the disease. The vaccines were manufactured to contain a range of pneumococci from different clinical samples, in a serious attempt to match the microbes in the vaccine to the field bacteria. Deaths were averted by the vaccine; and side effects were noted to be minimal. Reexamination of pathology samples from the Spanish Influenza Pandemic showed quite clearly the contribution of pneumococci and streptococci to the mortality of over fifty million people in 1918–1919. The microbe causing this Pandemic was isolated in 1933, and was shown to be a true virus; this finding initiated a huge expanse and interest in influenza virus vaccines, both killed and live. A chance discovery allowed the purification of Influenza M and NP proteins then permitted the production of experimental vaccines. These vaccines were formulated to induce and B and/or T cell responses to the internal proteins. Several of these Universal Influenza Vaccines have been tested in quarantine, and have now reached Phase III trials in the community.

Incomplete vaccination and associated factors among children aged 12–23 months in South Africa: an analysis of the South African demographic and health survey 2016

ABSTRACT Background Socioeconomic and health inequalities remain a huge problem in post-apartheid South Africa. Despite substantial efforts at ensuring universal access to vaccines, many children remain under-vaccinated in the country. This study aimed to assess the prevalence and factors associated with incomplete vaccination in the first year of life, among children aged 12–23 months in South Africa. Methods The study is a secondary analysis of the 2016 South African Demographic and Health Survey. A multivariable logistic regression model was applied to the data on 708 children aged 12–23 months. The study outcome, vaccination completeness, was assessed using a composite assessment of nine doses of four vaccines; Bacillus Calmette–Guérin (BCG) (one dose), Polio (four doses), diphtheria-tetanus-pertussis containing vaccines (DTP) (three doses) and measles-containing vaccines (MCV) (one dose). Children who received all the nine doses were categorized as completely vaccinated. Independent variables included child, maternal, and demographic characteristics. Variables were included in the model based on literature findings. Bivariate analyses were used to examine the crude association between each independent variable and incomplete vaccination, while the multivariable logistic regression model was used to examine the adjusted association after controlling for other variables. Measures of association were presented as odds ratios (OR) with their 95% confidence intervals (CI). Results About two-fifths (40.8%) of the children were incompletely vaccinated. The prevalence of incomplete vaccination was significantly high among children whose mothers did not receive antenatal care (ANC) during pregnancy (57.5%), and children living in Gauteng Province (52.2%). From the bivariate analyses, the odds of being incompletely vaccinated were three times higher in children whose mothers did not attend ANC compared with children whose mothers attended ANC (crude OR = 2.93; 95% CI 1.42–6.03). The odds were about three times higher in children living in Mpumalanga province (OR = 2.58; 95% CI 1.27–5.25) and in those living in Gauteng province (OR = 2.76; 95% CI 1.30–5.91), compared with those living in Free State province. Conversely, the odds were 32% lower in children from rich households, compared with those from poor households (OR = 0.68; 95% CI 0.47–0.98). In the adjusted model, the higher odds of incomplete vaccination in children whose mothers did not attend ANC were maintained in both magnitude and direction (adjusted OR [aOR] = 2.87; 95% CI 1.31–6.25). Similarly, compared with children living in Free State province, the higher odds of a child being incompletely vaccinated in Mpumalanga (aOR = 2.30; 95% CI 1.03–5.14) and in Gauteng (aOR = 3.10; 95% CI 1.35–7.15) provinces were maintained in both magnitude and direction. Conclusions There is a substantial burden of incomplete childhood vaccination in South Africa. Maternal ANC attendance during pregnancy and area of residence significantly influences this burden. Interventions that promote broader health service utilization, such as ANC attendance, can help improve the awareness and uptake of routine childhood vaccination. It is also imperative to take into consideration the provincial disparities in childhood vaccination completeness, in planning and implementing interventions to improve vaccination coverage in the country.

Impact of HIV status and vaccination schedule on bacterial nasopharyngeal carriage following infant immunisation with the pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine in South Africa

BackgroundNasopharyngeal carriage (NPC) of Streptococcus pneumoniae is a precondition for pneumococcal disease and a source of transmission. This trial evaluated NPC of S. pneumoniae and other pathogens post-vaccination with the pneumococcal non-typeable Haemophilus influenzae (NTHi) protein D conjugate vaccine (PHiD-CV) in human immunodeficiency virus (HIV)-infected (HIV+), HIV-exposed-uninfected (HEU), and HIV-unexposed-uninfected (HUU) South African children. MethodsIn this phase III, open, single‐centre, controlled study (ClinicalTrials.gov: NCT00829010), 484 children were stratified by HIV status: 83 HIV+, 101 HEU, and 300 HUU. HIV+ and HEU children received a 3 + 1 PHiD-CV vaccination schedule: primary vaccination, age 6/10/14 weeks, and booster dose, age 9–10 months. HUU infants were randomised (1:1:1) to 3-dose priming and booster (HUU/3+1); 3-dose priming without booster (HUU/3+0); or 2-dose priming and booster (HUU/2+1). Bacterial NPC was assessed 8 times up to 24–27 months of age. ResultsOverall pneumococcal carriage rates were similar across 3+1 groups irrespective of HIV status; trends towards higher carriage rates in the HIV+ than HEU and HUU/3+1 groups were observed at 24–27 months of age. In HUU children, carriage of any pneumococcal serotype was similar for the three different dosing schedules at all timepoints; carriage of vaccine-type pneumococci tended to be lower at 16–19 months and 24–27 months of age in children who had received a booster dose (HUU/2+1 and HUU/3+1 groups) than in the HUU/3+0 group. Carriage rates of NTHi, Staphylococcus aureus and Moraxella catarrhalis were comparable between all groups. ConclusionsHIV infection or exposure did not seem to alter the effect of PHiD-CV on pneumococcal NPC in children during their first 2 years of life. NPC prevalence of vaccine-type pneumococci following vaccination series tended to be lower in children who had received a booster dose in comparison to those who had not.

Determining optimal use of an HIV vaccine in South Africa

Determining optimal use of an HIV vaccine in South Africa

Reassortment of bluetongue virus vaccine serotypes in cattle.

Bluetongue is primarily a disease of sheep in South Africa, while cattle and goats are mostly subclinically infected. The viraemia of bluetongue virus in cattle lasts much longer than in sheep and the role of cattle in the epidemiology of bluetongue in South Africa is poorly understood. Bluetongue virus has a segmented double-stranded ribonucleic acid genome and reassortment of genomes is a common feature. The aim of the study was to investigate whether reassortment occurs between vaccine and field strains when simultaneously administered to cattle. Six cattle between the ages of 6 and 12 months were infected with five strains of modified live vaccine bluetongue virus and a virulent field isolate of bluetongue virus 4. Blood samples were subsequently collected daily from these animals from day 1 to day 39 post-inoculation. Viruses were directly isolated during viraemia from the buffy coat on Vero cells using the plaque forming unit method. Analysis of plaques indicated that no reassortants between virulent field and vaccine strains occurred and the virulent bluetongue virus 4 was identified as the predominant virus strain. However, a reassortant virus between two bluetongue virus vaccine strains was isolated from the buffy coat. Whole genome sequences from the vaccine viruses were compared to the suspected reassortant and it was found that segment 8 exchanged between the bluetongue virus 8 and bluetongue virus 9 vaccine strains. The use of the live-attenuated bluetongue virus multivalent vaccine in South Africa causes circulation of different vaccine serotypes in Culicoides spp. and susceptible hosts and cattle might provide the ideal host for reassortment to occur.

Reassortment of bluetongue virus vaccine serotypes in cattle

Bluetongue is primarily a disease of sheep in South Africa, while cattle and goats are mostly subclinically infected. The viraemia of bluetongue virus in cattle lasts much longer than in sheep and the role of cattle in the epidemiology of bluetongue in South Africa is poorly understood. Bluetongue virus has a segmented double-stranded ribonucleic acid genome and reassortment of genomes is a common feature. The aim of the study was to investigate whether reassortment occurs between vaccine and field strains when simultaneously administered to cattle. Six cattle between the ages of 6 and 12 months were infected with five strains of modified live vaccine bluetongue virus and a virulent field isolate of bluetongue virus 4. Blood samples were subsequently collected daily from these animals from day 1 to day 39 post-inoculation. Viruses were directly isolated during viraemia from the buffy coat on Vero cells using the plaque forming unit method. Analysis of plaques indicated that no reassortants between virulent field and vaccine strains occurred and the virulent bluetongue virus 4 was identified as the predominant virus strain. However, a reassortant virus between two bluetongue virus vaccine strains was isolated from the buffy coat. Whole genome sequences from the vaccine viruses were compared to the suspected reassortant and it was found that segment 8 exchanged between the bluetongue virus 8 and bluetongue virus 9 vaccine strains. The use of the live-attenuated bluetongue virus multivalent vaccine in South Africa causes circulation of different vaccine serotypes in Culicoides spp. and susceptible hosts and cattle might provide the ideal host for reassortment to occur.

PMU16 - DISPENSING PATTERNS OF VACCINES IN A PRIVATE HEALTHCARE SETTING IN SOUTH AFRICA

Vaccination is an effective medical intervention to reduce death and morbidity caused by infectious diseases. The aim of the study was to analyse the dispensing patterns of vaccines in South Africa from a medical insurance scheme perspective. A retrospective drug utilisation study was conducted on a South African medical insurance administrator database for 2017. The database contained 3 898 535 records for medicine, medical devices and procedures. All products in ATC subgroup J07 (vaccines) were extracted and analysed. A total of 7 254 vaccines at a cost of R1 982 238.86 were dispensed in 2017 to 4 596 patients. The average age of patients was 32.57 (SD=21.67) years, with 65.62% male patients. Bacterial vaccines (J07B) accounted for 47.13% of the total number of vaccines dispensed (28.24% of cost), viral vaccines for 36.89% (44.02% of cost), and combined bacterial and viral vaccines for 15.98% (27.73% of cost). The Influenza vaccine (J07BB01) accounted for most of the vaccines dispensed (26.70%), followed by tetanus toxoid (J07AM01, 23.85%) and the diphtheria-pertussis-poliomyelitis-tetanus-hepatitis B vaccine (J07CA12, 15.00%). Three-quarters of the influenza vaccine prescriptions were dispensed during March and April 2017. The trade name vaccine that was the most commonly dispensed was TetavaxR (tetanus toxoid) single dose syringe 0.5 ml. Sixty percent of these vaccines were dispensed to patients between 30 and 49 years (mostly to male patients). The average cost claimed per vaccine was R273.26, with pneumococcus, purified polysaccharide antigen (J07AL01) on average the most expensive (R794.49). Most vaccines were dispensed by private hospitals (27.29%) and registered nurses (34.86%), with only 11.18% dispensed by pharmacies. The influenza vaccine was the most commonly dispensed, followed by tetanus toxoid. This is possibly due to medical scheme members being mostly the economically active sector of the population where workplace vaccination campaigns are often offered.

Quadrivalent influenza vaccines in low and middle income countries: Cost-effectiveness, affordability and availability

In high-income countries, there is an increased tendency to replace inactivated seasonal trivalent influenza (TIV) vaccines with quadrivalent (QIV) vaccines as these are considered to give a greater public health benefit. In addition, several recent studies from the USA and Europe indicate that replacement with QIV might also be cost-effective; however, the situation in low- and middle-income countries (LMIC) is less clear as few studies have investigated this aspect.The paper by de Boer et al. (2018) describes a dynamic modelling study commissioned by WHO that suggests that in LMICs, under certain conditions, QIV might also be more cost-effective than TIV. In this commentary, we discuss some important aspects that policymakers in LMICs might wish to take into account when considering replacing TIV by QIV.Indeed, from the data presented in the paper by de Boer et al. it can be inferred that replacing QIV for TIV would mean a 25–29% budget increase for seasonal influenza vaccination in South Africa and Vietnam, resulting in an incremental influenza-related health impact reduction of only 7–8% when a 10% symptomatic attack rate is assumed. We argue that national health budget considerations in LMIC might lead decision-makers to choose other investments with higher health impact for a budget equivalent to roughly a quarter of the yearly TIV immunization costs.In addition to an increased annual cost that would be associated with a decision to replace TIV with QIV, there would be an increased pressure on manufacturers to produce QIV in time for the influenza season requiring manufacturers to produce some components of the seasonal vaccine at risk prior to the WHO recommendations for influenza vaccines.Unless the current uncertainties, impracticalities and increased costs associated with QIVs are resolved, TIVs are likely to remain the more attractive option for many LMICs. Each country should establish its context-specific process for decision-making based on national data on disease burden and costs in order to determine whether the health gains out-weigh the additional cost of moving to QIV. For example, immunizing more people in the population, especially those in higher risk groups, with TIV might not only provide better value for money but also deliver better health outcomes in LMICs.Countries with local influenza vaccine manufacturing capacity should include in their seasonal influenza vaccine procurement process an analysis of the pros- and cons- of TIV versus QIV, to ensure both feasibility and sustainability of local manufacturing.

Recommendations for the use of meningococcal vaccines in South Africa

Background: Although meningococcal disease (MD) incidence in South Africa is low, Neisseria meningitidis (NM) causes severe disease that is often life-threatening and can cause long-term disabilities. A quadrivalent protein-conjugated meningococcal vaccine (MCV4) is available, and provides protection against 75% of disease causing serogroups in South Africa. Recommendations: We advise vaccination of persons at high risk of meningococcal disease including those with complement deficiency and asplenia; laboratory personnel from reference laboratories who work with NM; and travellers to Saudi Arabia. The need for routine vaccine against meningococcal disease in South Africa is controversial given the current burden of disease. However, due to the high morbidity/mortality of MD we recommend that clinicians consider vaccination of healthy infants and children; HIV-infected persons with a CD4 count 25%; students attending college /university /military academies; and miners.Conclusion: Protein-conjugated meningococcal vaccine is preferable to the polysaccharide vaccine given the ability of the protein-conjugated meningococcal vaccine to induce immune memory, allow for booster responses and eliminate carriage of the organism in the person vaccinated.

Conservation in gene encoding Mycobacterium tuberculosis antigen Rv2660 and a high predicted population coverage of H56 multistage vaccine in South Africa

H56/AERAS-456+IC31 (H56), composed of two early secretion proteins, Ag85B and ESAT-6, and a latency associated protein, Rv2660, and the IC31 Intercell adjuvant, is a new fusion subunit vaccine candidate designed to induce immunity against both new infection and reactivation of latent tuberculosis infection. Efficacy of subunit vaccines may be affected by the diversity of vaccine antigens among clinical strains and the extent of recognition by the diverse HLA molecules in the recipient population. Although a previous study showed the conservative nature of Ag85B- and ESAT-6-encoding genes, genetic diversity of Rv2660c that encodes RV2660 is largely unknown. The population coverage of H56 as a whole yet remains to be assessed. The present study was conducted to address these important knowledge gaps. DNA sequence analysis of Rv2660c found no variation among 83 of the 84 investigated clinical strains belonging to four genetic lineages. H56 was predicted to have as high as 99.6% population coverage in the South Africa population using the Immune Epitope Database (IEDB) Population Coverage Tool. Further comparison of H56 population coverage between South African Blacks and Caucasians based on the phenotypic frequencies of binding MHC Class I and Class II supertype alleles found that all of the nine MHC-I and six of eight MHC-II human leukocyte antigen (HLA) supertype alleles analyzed were significantly differentially expressed between the two subpopulations. This finding suggests the presence of race-specific functional binding motifs of MHC-I and MHC-II HLA alleles, which, in turn, highlights the importance of including diverse populations in vaccine clinical evaluation. In conclusion, H56 vaccine is predicted to have a promising population coverage in South Africa; this study demonstrates the utility of integrating comparative genomics and bioinformatics in bridging animal and clinical studies of novel TB vaccines.

Recommendations for the use of meningococcal vaccines in South Africa

Background: Although meningococcal disease (MD) incidence in South Africa is low, Neisseria meningitidis (NM) causes severe disease that is often life-threatening and can cause long-term disabilities. A quadrivalent protein-conjugated meningococcal vaccine (MCV4) is available, and provides protection against 75% of disease causing serogroups in South Africa.Recommendations: We advise vaccination of persons at high risk of meningococcal disease including those with complement deficiency and asplenia; laboratory personnel from reference laboratories who work with NM; and travellers to Saudi Arabia.The need for routine vaccine against meningococcal disease in South Africa is controversial given the current burden of disease. However, due to the high morbidity/mortality of MD we recommend that clinicians consider vaccination of healthy infants and children; HIV-infected persons with a CD4 count > 25%; students attending college /university /military academies; and miners.Conclusion: Protein-conjugated meningo...