Widespread Vaccination Research Articles

Changes in Fractionation Schedules for Breast Cancer Treatment during the COVID-19 Pandemic

Purpose/Objective(s)In 2020, 5-year results of the FAST-Forward trial and 10-year results for both the FAST trial and APBI-IMRT-Florence trials using ultrahypofractionated radiation (UHFR) were all published, each detailing equivalent outcomes for partial and whole breast UHFR schedules compared to more conventional fractionation regimes in early-stage breast cancer. Due to concerns over viral exposure, these treatment regimens were adopted in an effort to minimize patient exposure while achieving equivalent oncologic control. The purpose of this study was to compare the use of UHFR schedules for breast cancer patients before COVID-19, at the height of the pandemic and after widespread vaccination and analyze factors predictive of use.Materials/MethodsBetween October 2019 and February 2022, 733 patients with stage 0 or I breast cancer were offered radiation at our institution following breast conserving surgery. 43 patients were excluded (35 declined radiation and 8 received partial breast re-irradiation). We analyzed target volume (whole vs partial breast) and fractionation schemes (1 week vs 3 or more weeks) for 3 time periods of interest: pre-COVID-19 (October 2019-March 2020), height of COVID-19 (March 2020-March 2021) and post-COVID-19 vaccine (March 2021-February 2022). Fisher's exact test was used to compare frequencies of treatment parameters across groups and time periods. Logistic regression was used to determine factors associated with UHFR use. R (v4.1.2) was used for analysis.ResultsThe use of UHFR increased during the post-vaccine period as compared to pre-Covid-19 and the pre-vaccine time periods (p<0.001), with 4.6%, 9.2% and 23%, receiving UHFR respectively. On univariate analysis in the pre-vaccine time period, patients with grade 2 and 3 cancers were less likely to get UHFR (p = 0.003 and p = 0.005, respectively). Receiving radiation from an academic attending was associated with higher use of UHFR (p = 0.0004). On multivariate (MVA) patients with grade 2 and 3 disease remained less likely to get UHFR (p 0.001 and 0.004). Treatment by an academic attending remained a significant factor for use of UHFR (p=0.0003). In the post-vaccine time period, on univariate analysis, negative ER status and grade 3 tumors were associated with less use of UHFR (p = 0.04 and p = 0.0001, respectively). On MVA, only grade 3 was associated with less UHFR use (p = 0.0002).ConclusionDuring COVID there was a significant increase in the use of UHFR regimens for treatment of early-stage breast cancer patients at our institution that persisted and increased after the introduction of the vaccine despite return to pre-COVID patient volumes. Uptake of these new regimens was initially higher among academic radiation oncologists, however with education of community physicians and implementation of treatment planning scorecards, widespread adoption was seen.

Comparative effectiveness of neutralising monoclonal antibodies in high risk COVID-19 patients: a Bayesian network meta-analysis

The purpose of this work was to review and synthesise the evidence on the comparative effectiveness of neutralising monoclonal antibody (nMAB) therapies in individuals exposed to or infected with SARS-CoV-2 and at high risk of developing severe COVID-19. Outcomes of interest were mortality, healthcare utilisation, and safety. A rapid systematic review was undertaken to identify and synthesise relevant RCT evidence using a Bayesian Network Meta-Analysis. Relative treatment effects for individual nMABs (compared with placebo and one another) were estimated. Pooled effects for the nMAB class compared with placebo were estimated. Relative effects were combined with baseline natural history models to predict the expected risk reductions per 1000 patients treated. Eight articles investigating four nMABs (bamlanivimab, bamlanivimab/etesevimab, casirivimab/imdevimab, sotrovimab) were identified. All four therapies were associated with a statistically significant reduction in hospitalisation (70–80% reduction in relative risk; absolute reduction of 35–40 hospitalisations per 1000 patients). For mortality, ICU admission, and invasive ventilation, the risk was lower for all nMABs compared with placebo with moderate to high uncertainty due to small event numbers. Rates of serious AEs and infusion reactions were comparable between nMABs and placebo. Pairwise comparisons between nMABs were typically uncertain, with broadly comparable efficacy. In conclusion, nMABs are effective at reducing hospitalisation among infected individuals at high-risk of severe COVID-19, and are likely to reduce mortality, ICU admission, and invasive ventilation rates; the effect on these latter outcomes is more uncertain. Widespread vaccination and the emergence of nMAB-resistant variants make the generalisability of these results to current patient populations difficult.

Exploring Perspectives on Establishing COVID-19 Vaccine Confidence in Black Communities.

To explore factors influencing COVID-19 vaccine decision-making among Black adults at high-risk for COVID-19 infection. Despite effective treatment and vaccination availability, Black Americans continue to be disproportionately impacted by COVID-19. Using community-engaged qualitative methods, we conducted virtual, semi-structured focus groups with Black residents in Los Angeles County before widespread vaccine rollout. Recruitment occurred through local community partners. Themes and subthemes on factors for vaccine confidence and accessibility. As part of a larger study exploring COVID-19 vaccine decision-making factors among multiethnic groups, two-hour virtual focus groups were conducted between December 15, 2020 and January 27, 2021. Transcripts were analyzed using reflexive thematic analysis. Three focus groups were conducted with 17 Black participants, who were primarily female (n=15), residents of high-poverty zip codes (n=11) and employed full-time (n=6). Black-specific considerations for vaccine confidence and accessibility include: 1) reduced confidence in COVID-19 vaccines due to historical government inaction and racism (existing health inequities and disparities are rooted in racism; historical unethical research practices); 2) misunderstanding of Black communities' vaccine concerns ("vaccine hesitancy" as an inaccurate label to describe vaccine skepticism; ignorance to root causes of vaccine skepticism); and 3) recognizing and building on resources (community agency to address COVID-19 vaccine needs adequately). Vaccination campaigns should improve understanding of underlying vaccination concerns to improve vaccine outreach effectiveness and should partner with, provide resources to, and invest in local, trusted Black community entities to improve COVID-19 vaccination disparities.

Exploring Public Discussions Regarding COVID-19 Vaccinations on Microblogs in China: Findings from Machine Learning Algorithms.

Large-scale, widespread COVID-19 vaccination is the most effective means of cutting off the spread of the novel coronavirus and establishing an immune barrier. Due to the large population base in China, it has been a very difficult task to establish such an immune barrier. Therefore, this study aims to explore the public’s discussions related to COVID-19 vaccinations on microblogs and to detect their sentiments toward COVID-19 vaccination so as to improve the vaccination rate in China. This study employed machine learning methods in the field of artificial intelligence to analyze mass data obtained from SinaWeibo. A total of 1,478,875 valid microblog texts were collected between December 2020 and June 2022, the results of which indicated that: (1) overall, negative texts (38.7%) slightly outweighed positive texts (36.1%); “Good” (63%) dominated positive texts, while “disgust” (44.6%) and “fear” (35.8%) dominated negative texts; (2) six overarching themes related to COVID-19 vaccination were identified: public trust in the Chinese government, changes in daily work and study, vaccine economy, international COVID-19 vaccination, the COVID-19 vaccine’s R&D, and COVID-19 vaccination for special groups. These themes and sentiments can clarify the public’s reactions to COVID-19 vaccination and help Chinese officials’ response to vaccine hesitancy. Furthermore, this study seeks to make up for the lack of focus on big data in public health and epidemiology research, and to provide novel insights for future studies.

Identification of Small Molecules with Improved Potency against Orthopoxviruses from Vaccinia to Smallpox.

The genus Orthopoxvirus contains several human pathogens, including vaccinia, monkeypox, cowpox, and variola virus, the causative agent of smallpox. Although there are a few effective vaccines, widespread prophylactic vaccination has ceased and is unlikely to resume, making therapeutics increasingly important to treat poxvirus disease. Here, we described efforts to improve the potency of the anti-poxvirus small molecule CMLDBU6128. This class of small molecules, referred to as pyridopyrimidinones (PDPMs), showed a wide range of biological activities. Through the synthesis and testing of several exploratory chemical libraries based on this molecule, we identified several compounds that had increased potency from the micromolar into the nanomolar range. Two compounds, designated (12) and (16), showed inhibitory concentrations of 326 nM and 101 nM, respectively, which was more than a 10-fold increase in potency to CMLDBU6128 with an inhibitory concentration of around 6 μM. We also expanded our investigation of the breadth of action of these molecules and showed that they can inhibit the replication of variola virus, a related orthopoxvirus. Together, these findings highlighted the promise of this new class of antipoxviral agents as broad-spectrum small molecules with significant potential to be developed as antiviral therapy. This would add a small molecule option for therapy of spreading diseases, including monkeypox and cowpox viruses, that would also be expected to have efficacy against smallpox.

Endemic, not over: looking ahead to a new COVID era.

After large waves of SARS-CoV-2 this summer, experts predict a relatively “quiet” fall. Hybrid immunity from widespread infections and vaccination has transformed SARS-CoV-2 into a “manageable endemic respiratory virus,” said Mel Kradjen of the B.C. Centre for Disease Control’s public

COVID-19 vaccine perceptions and hesitancy amongst parents of school-aged children during the pediatric vaccine rollout

BackgroundThe United States has the highest number of total cases and deaths due to coronavirus disease 2019 (COVID-19) worldwide (Johns Hopkins COVID Dashboard, 2021). Despite COVID-19 vaccine availability, uptake in the United States has been slow and vaccine hesitancy has been a significant barrier to achieving widespread vaccine uptake. Understanding determinants of vaccine acceptance is essential to implement successful population health interventions to increase COVID-19 vaccination. MethodsWe developed an anonymous cross-sectional parent survey to assess factors associated with parent and child COVID-19 vaccine acceptance and hesitancy during the initial pediatric vaccine rollout amongst adolescents 16 years +. The survey was sent via email to 25,308 parents registered to the Alachua County Public School System in May 2021 and remained active until July 2021. FindingsThere were a total of 2,620 survey responses. Overall, 31.5 % of parents with children ages 16 years + reported their child had received the COVID-19 vaccine, 65.2 % reported their (eligible) child had not received the vaccine, and 3.3 % reported their child was scheduled for the vaccine. A majority of parents (60.9 %) reported they planned to vaccinate all of their children once the COVID-19 vaccine was available for their children’s age. COVID-19 vaccine uptake in adolescents ages 16 + reported by Hispanic and White parents was two times higher than that reported by Black parents. Parent COVID-19 and influenza vaccine uptake were associated with increased child COVID-19 vaccination. The most commonly reported reasons why parents chose not to have their child vaccinated against COVID-19 were concerns about long–term negative side effects (75.7 %) and a negative reaction (56.5 %). Medical providers were reported as the most trusted source of information. ConclusionOur study provides insight into determinants of vaccine acceptance, vaccine hesitancy, and trusted sources of information that may be helpful to develop targeted interventions to increase youth COVID-19 vaccination.

Assessment of Attitudes and Intentions towards COVID-19 Vaccines and Associated Factors among General Populations of Pakistan: A Cross-Sectional Study.

Objective: The goal of public health in combatting COVID-19 is to increase herd immunity. However, vaccine reluctance makes attaining herd immunity a worldwide challenge. This investigation aimed to identify negative and positive attitudes and intentions about COVID-19 vaccinations. Methods: A cross-sectional online survey was conducted once free COVID-19 vaccines became available in Pakistan in 2021. 4392 Pakistanis aged 18 and older were surveyed from seven administrative units between 1 July and 30 August 2021. Online structured questionnaires were utilized to collect data using a simple sampling procedure. The questionnaires were divided into three major sections: sociodemographic, health factors, and attitudes toward COVID-19. Results: The survey link was shared with approximately 4500 participants. 97.6%(4392) completed the survey once begun. Frequency, percentage and Chi-square tests were used to analyze statistical data. Most of the participants in the research were men (2703 (61.54%)), 3277 (74.61%) were aged 18–29 years, and 1824 (41.53%) were residents of the Khyber Pakhtunkhwa province. (18.69%) Respondents expressed COVID-19 vaccine hesitancy, whereas 36.66% of participants liked getting the Sinopharm and Sinovac vaccines and (35.84%) of participants preferred the Pfizer vaccine. A significant number of participants (38.05%) were concerned about the vaccine’s unexpected side effects Thus, it is essential to realize that many participants were concerned about the vaccine’s unexpected side effects. Conclusions: The overall high level of concern about the unforeseen side effects of COVID-19 vaccines, as well as widespread vaccine hesitancy among Pakistani populations and its predictors, should be taken into account if public health intervention campaigns in Pakistan are changing negative attitudes and improving compliance with regard to COVID-19 vaccines.

Strategies for Addressing Vaccine Hesitancy Within California State Prisons in 2021 and Beyond.

Although widespread vaccination in correctional facilities is crucial for preventing COVID-19 morbidity and mortality in these institutions and their surrounding communities, there are little data on how to effectively perform vaccine outreach to people experiencing incarceration who remain unvaccinated. In this article, we describe lessons learned from a successful vaccine education initiative in California state prisons and describe opportunities for application to other correctional settings. (Am J Public Health. 2022;112(11):1543-1545. https://doi.org/10.2105/AJPH.2022.307042).

Split dosing of coronavirus disease 2019 vaccines provides noninferior antibody responsiveness to conventional vaccine dosing

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) caused an acute respiratory disease pandemic, termed coronavirus disease 2019 (COVID-19), that has resulted in considerable mortality and morbidity in the United States since early 2020.1 Several vaccines, including the use of messenger RNA (mRNA) vaccines, have proven to be effective against the multiple variant strains of COVID-19,2-5 and therefore, widespread vaccination of the public remains imperative. For patients with a history of allergic reaction to a previous COVID-19 vaccine, a graded administration protocol represents an option, with limited studies showing the safety or efficacy of this approach.

Examining the Prevailing Negative Sentiments Related to COVID-19 Vaccination: Unsupervised Deep Learning of Twitter Posts over a 16 Month Period.

Despite the demonstrated efficacy, safety, and availability of COVID-19 vaccines, efforts in global mass vaccination have been met with widespread scepticism and vaccine hesitancy or refusal. Understanding the reasons for the public’s negative opinions towards COVID-19 vaccination using Twitter may help make new headways in improving vaccine uptake. This study, therefore, examined the prevailing negative sentiments towards COVID-19 vaccination via the analysis of public twitter posts over a 16 month period. Original tweets (in English) from 1 April 2021 to 1 August 2022 were extracted. A bidirectional encoder representations from transformers (BERT)-based model was applied, and only negative sentiments tweets were selected. Topic modelling was used, followed by manual thematic analysis performed iteratively by the study investigators, with independent reviews of the topic labels and themes. A total of 4,448,314 tweets were analysed. The analysis generated six topics and three themes related to the prevailing negative sentiments towards COVID-19 vaccination. The themes could be broadly understood as either emotional reactions to perceived invidious policies or safety and effectiveness concerns related to the COVID-19 vaccines. The themes uncovered in the present infodemiology study fit well into the increasing vaccination model, and they highlight important public conversations to be had and potential avenues for future policy intervention and campaign efforts.

Frequent detection but lack of infectivity of SARS-CoV-2 RNA in presymptomatic, infected blood donor plasma.

Respiratory viruses such as influenza do not typically cause viremia; however, SARS-CoV-2 has been detected in the blood of COVID-19 patients with mild and severe symptoms. Detection of SARS-CoV-2 in blood raises questions about its role in pathogenesis as well as transfusion safety concerns. Blood donor reports of symptoms or a diagnosis of COVID-19 after donation (post-donation information, PDI) preceded or coincided with increased general population COVID-19 mortality. Plasma samples from 2,250 blood donors who reported possible COVID-19–related PDI were tested for the presence of SARS-CoV-2 RNA. Detection of RNAemia peaked at 9%–15% of PDI donors in late 2020 to early 2021 and fell to approximately 4% after implementation of widespread vaccination in the population. RNAemic donors were 1.2- to 1.4-fold more likely to report cough or shortness of breath and 1.8-fold more likely to report change in taste or smell compared with infected donors without detectable RNAemia. No infectious virus was detected in plasma from RNAemic donors; inoculation of permissive cell lines produced less than 0.7–7 plaque-forming units (PFU)/mL and in susceptible mice less than 100 PFU/mL in RNA-positive plasma based on limits of detection in these models. These findings suggest that blood transfusions are highly unlikely to transmit SARS-CoV-2 infection.

249.4: COVID-19 Outcomes After Widespread Vaccine Availability in Kidney Transplant Recipients

249.4: COVID-19 Outcomes After Widespread Vaccine Availability in Kidney Transplant Recipients

Quality of Life in Post-COVID-19 Patients after Hospitalization.

The COVID-19 pandemic has had a strong impact on people’s quality of life (QoL), which is affected by social and economic changes as well as by mental and physical health. The aim of this study was to determine QoL in post-COVID-19 patients who had required hospitalization, and to identify relevant sociodemographic data. We used questionnaires which considered demographic and socioeconomic data, health and vaccination status, the pandemic situation, and EQ-5D scoring. The interactions of all data and the scores of EQ-5D were analyzed. Multivariate logistic regression analysis was applied to the five dimensions of EQ-5D. In this single-hospital-cohort study, the average times elapsed since initial diagnosis and hospital admission were 2.5 (76.3 ± 18.1 days) and 5 months (155.4 ± 33.9 days), respectively. Post-COVID-19 females were 3–5 times more likely to be affected in terms of anxiety/depression, and in negative impact upon their usual activities, at 5 months after diagnosis. At the same time, reductions in mobility were 3–4 times more likely in elderly post-COVID-19 patients, whose levels of pain and discomfort increased. Single patients, those with low incomes, and those with severe clinical outcomes were 2–4 times more likely to experience a reduction in their usual activities, while the presence of co-morbidities and lower levels of education were associated with increased pain and discomfort. Aging-induced pain/discomfort and anxiety/depression were significantly exacerbated in elderly patients with widespread vaccination. Our study revealed effects of demographic and socioeconomic factors upon lower QoL in post-COVID-19 patients in four dimensions of EQ-5D: mobility, usual activity, pain/discomfort, and anxiety/depression, 5 months after first diagnosis and hospitalization.

COVID-19 mortality and excess mortality among working-age residents in California, USA, by occupational sector: a longitudinal cohort analysis of mortality surveillance data

BackgroundDuring the first year of the COVID-19 pandemic, workers in essential sectors had higher rates of SARS-CoV-2 infection and COVID-19 mortality than those in non-essential sectors. It is unknown whether disparities in pandemic-related mortality across occupational sectors have continued to occur during the periods of SARS-CoV-2 variants and vaccine availability.MethodsIn this longitudinal cohort study, we obtained data from the California Department of Public Health on all deaths occurring in the state of California, USA, from Jan 1, 2016, to Dec 31, 2021. We restricted our analysis to residents of California who were aged 18–65 years at time of death and died of natural causes. We classified the occupational sector into nine essential sectors; non-essential; or unemployed or without an occupation provided on the death certificate. We calculated the number of COVID-19 deaths in total and per capita that occurred in each occupational sector. Separately, using autoregressive integrated moving average models, we estimated total, per-capita, and relative excess natural-cause mortality by week between March 1, 2020, and Nov 30, 2021, stratifying by occupational sector. We additionally stratified analyses of occupational risk into counties with high versus low vaccine uptake, categorising high-uptake regions as counties where at least 50% of the population were fully vaccinated according to US guidelines by Aug 1, 2021.FindingsFrom March 1, 2020, to Nov 30, 2021, 24 799 COVID-19 deaths were reported in residents of California aged 18–65 years and an estimated 28 751 (95% prediction interval 27 853–29 653) excess deaths. People working in essential sectors were associated with higher COVID-19 deaths and excess deaths than were those working in non-essential sectors, with the highest per-capita COVID-19 mortality in the agriculture (131·8 per 100 000 people), transportation or logistics (107·1 per 100 000), manufacturing (103·3 per 100 000), facilities (101·1 per 100 000), and emergency (87·8 per 100 000) sectors. Disparities were wider during periods of increased infections, including during the Nov 29, 2020, to Feb 27, 2021, surge in infections, which was driven by the delta variant (B.1.617.2) and occurred during vaccine uptake. During the June 27 to Nov 27, 2021 surge, emergency workers had higher COVID-19 mortality (113·7 per 100 000) than workers from any other sector. Workers in essential sectors had the highest COVID-19 mortality in counties with low vaccination uptake, a difference that was more pronounced during the period of the delta infection surge during Nov 29, 2020, to Feb 27, 2021.InterpretationWorkers in essential sectors have continued to bear the brunt of high COVID-19 and excess mortality throughout the pandemic, particularly in the agriculture, emergency, manufacturing, facilities, and transportation or logistics sectors. This high death toll has continued during periods of vaccine availability and the delta surge. In an ongoing pandemic without widespread vaccine coverage and with anticipated threats of new variants, the USA must actively adopt policies to more adequately protect workers in essential sectors.FundingUS National Institute on Aging, Swiss National Science Foundation, and US National Institute on Drug Abuse.

A qualitative study of COVID-19 vaccine decision making among urban Native Americans

BackgroundSignificant disparities in COVID-19 morbidity and mortality exist for Native American (NA) people, the majority of whom live in urban areas. COVID-19 vaccination is a key strategy for mitigating these disparities; however, vaccination disparities affect NA communities. The current study investigated COVID-19 vaccine decision-making before widespread vaccine rollout occurred, among urban NA communities. We aimed to understand vaccine decision-making factors to develop recommendations about COVID-19 vaccine outreach. MethodsWe conducted three in-depth virtual focus groups with 17 NA adults living in an urban community (Los Angeles County) between December 2020 and January 2021. Participants were recruited through NA community-based organizations and community stakeholders. Reflexive thematic analysis was conducted using Atlas.ti. FindingsParticipants in this study identified two overarching themes with implications for health vaccination campaigns. First, participants described a need for tailored information and outreach, including NA vaccine outreach that addresses misconceptions about vaccine development to calm fears of experimentation and support communication of vaccine evidence specific to NA people. Second, participants suggested strategies to improve public health resources in the urban NA community, such as the need for unified, proactive communication across trusted NA entities, navigation support to improve vaccine accessibility, and adequately resourcing health partnerships with and among trusted NA community agencies for improved reach. ConclusionIn this qualitative study, we found that urban NA participants reported several factors that affected their vaccine decision-making, including a lack of tailored information for their communities. Our findings also underscore the need to work with tribes, tribal leadership, and urban NA serving organizations to coordinate vaccine communication and distribution to urban communities where the majority of NAs now reside. Further, these findings have implications for COVID-19 vaccine outreach among urban NA communities and demonstrate the need for clear and tailored engagement about the COVID-19 vaccine.

Trends in Parents' Confidence in Childhood Vaccines During the COVID-19 Pandemic.

The coronavirus disease 2019 (COVID-19) pandemic substantially disrupted well-child visits and vaccinations in the United States.1,2 Parent hesitancy for pediatric COVID-19 vaccines3 and widespread vaccine misinformation during the pandemic may have affected parent confidence in routine childhood vaccines. Little is known beyond two studies: one involved a convenience sample from a single medical center;4 the other evaluated adolescent vaccines only.5 Using longitudinal data from a nationally representative sample, we assessed how parents' confidence in childhood vaccines changed during the pandemic.

Factors Influencing COVID-19 Vaccine Acceptance in the Workplace: Results From a Rapid Survey at 2 Corporations in Los Angeles County, California, 2021.

Achieving widespread vaccine acceptance across various employment sectors is key to a successful public health response to COVID-19, but little is known about factors influencing vaccine acceptance among essential non-health care workers. We examined factors influencing vaccine acceptance among a sample of essential non-health care workers in California. We conducted a survey in early spring 2021 at 2 corporations in Los Angeles County, California, to identify and describe factors influencing vaccine acceptance and the ability of incentives to increase this acceptance. We used modified Poisson regression analysis to estimate adjusted prevalence ratios and a best-subset selection algorithm to identify the strongest factors influencing vaccine acceptance. Of 678 workers who completed the survey, 450 were unvaccinated. Among unvaccinated participants, having trust in information about the vaccine from public health experts, having ≥1 chronic health condition related to COVID-19 severity, being Asian, and perceiving risk for COVID-19 were factors that most influenced vaccine acceptance. Most (271 of 296, 91.6%) participants who had trust in information from public health experts and 30.6% (30 of 98) of participants who did not have trust in information from public health experts said that they would accept the vaccine. Seventeen of 24 (70.8%) vaccine-hesitant workers who had trust in information from public health experts and 12 of 72 (16.7%) vaccine-hesitant workers who did not have trust in this information said that they would be more likely to accept the vaccine if an incentive were offered. Efforts to increase vaccine coverage at workplaces should focus on improving trust in the vaccine and increasing public awareness that the vaccine is free.

Organisational and Structural Drivers of Childhood Immunisation in the European Region: A Systematic Review.

Despite the implementation of widespread vaccination programs, the European Health Systems continue to experience care challenges attributable to organizational and structural issues. This study aimed to review the available data on aspects within the organizational and structural domains that might impact vaccination coverage. We searched a comprehensive range of databases from 1 January 2007 to 6 July 2021 for studies that reported quantitative or qualitative research on interventions to raise childhood vaccine coverage. Outcome assessments comprised organizational and structural factors that contribute to vaccine concern among pediatric parents, as well as data reported influencing the willingness to vaccinate. To analyze the risk of bias, the Ottawa, JBI’s (Joanna Briggs Institute) critical appraisal tool, and Amstar quality assessment were used accordingly. The inclusion criteria were met by 205 studies across 21 articles. The majority of the studies were conducted in the United Kingdom (6), the European Union (3), and Italy (3). A range of interventions studied in primary healthcare settings has been revealed to improve vaccination coverage rates including parental engagement and personalization, mandatory vaccination policies, program redesign, supply chain design, administering multiple/combination vaccines, improved vaccination timing and intervals, parental education and reminders, surveillance tools and Supplemental Immunisation Activity (SIA), and information model.

An Extensive Review on the Development of Plant-Based Vaccines against SARS-Cov-2 and Respiratory Disorders Using Plant Biotechnology Platform

The COVID-19 pandemic is the most recent of numerous pathogenic viral pandemics that have posed risks to global health. Its exponentially expanding global transmission is placing pressure on the global health system. There are currently a large number of COVID-19 candidate vaccines on the market, and there is fierce worldwide competition to obtain the most vaccinations for each nation. The main objective among several nations during the exceptional COVID-19 epidemic has been to build herd immunity through the planning of large-scale vaccination efforts. However, the availability of vaccines has been a challenge for developing countries. However, there are strains in the world's vaccine manufacturing as a result of the high demand. This international effort aims to develop plant-based heterologous expression systems, virus-like particles (VLPs)-vaccines, antiviral drugs, a rapid supply of antigen-antibodies for detecting kits, and plant-origin bioactive compounds that boost immunity and provide tolerance to fight against virus infection, also includes the use of a plant biotechnology-based expression system for vaccine production. Due to possible benefits including low cost, high manufacturing volume, and physicochemical characteristics, the idea of a plant-based vaccination has gained more and more momentum in recent years. By utilising local commodities, we suggest plant-based vaccines as an appealing alternative to widespread and inexpensive vaccination methods against COVID-19 in this review. Additionally, we discussed the processes of action, necessary standards, and prospects for applying unique biotechnology tools in near future.