Search

• Rotavirus vaccines prevented around 140,000 child deaths in the period 2006-2019. • Relaxing age restrictions prevented up to 17,000 deaths in the period 2013-2019. • Global use of rotavirus vaccines could prevent over one-third of rotavirus deaths. We estimated the global impact of rotavirus vaccines on deaths among children under five years old by year. We used a proportionate outcomes model with a finely disaggregated age structure to estimate rotavirus deaths prevented by vaccination over the period 2006-2019 in 186 countries. We ran deterministic and probabilistic uncertainty analyses and compared our estimates to surveillance-based estimates in 20 countries. We estimate that rotavirus vaccines prevented 139,000 under-five rotavirus deaths (95% uncertainty interval 98,000-201,000) in the period 2006-2019. In 2019 alone, rotavirus vaccines prevented 15% (95% uncertainty interval 11-21%) of under-five rotavirus deaths (0.5% of child mortality). Assuming global use of rotavirus vaccines and coverage equivalent to other co-administered vaccines could prevent 37% of under-five rotavirus deaths (1.2% of child mortality). Our estimates were sensitive to the choice of rotavirus mortality burden data and several vaccine impact modeling assumptions. The World Health Organization's recommendation to remove age restrictions in 2012 could have prevented up to 17,000 rotavirus deaths in the period 2013-2019. Our modeled estimates of rotavirus vaccine impact were broadly consistent with estimates from post-vaccination surveillance sites. Rotavirus vaccines have made a valuable contribution to global public health. Enhanced rotavirus mortality prevention strategies are needed in countries with high mortality in under-5-year-old children. [ABSTRACT FROM AUTHOR]

• Many countries introduced rubella-containing vaccination (RCV) after 2010. • The global Congenital Rubella Syndrome (CRS) incidence fell by 66% during 2010-2019. • By 2019, 32,000 (95% confidence intervals: 13,000-60,000) babies were born annually with CRS globally. • The biggest reductions were in South-East Asia and the Western Pacific region. • Further declines in CRS incidence need continued high coverage and RCV in all nations. Many countries introduced rubella-containing vaccination (RCV) after 2011, following changes in recommended World Health Organization (WHO) vaccination strategies and external support. We evaluated the impact of these introductions. We estimated the country-specific, region-specific, and global Congenital Rubella Syndrome (CRS) incidence during 1996-2019 using mathematical modeling, including routine and campaign vaccination coverage and seroprevalence data. In 2019, WHO African and Eastern Mediterranean regions had the highest estimated CRS incidence (64 [95% confidence intervals (CI): 24-123] and 27 [95% CI: 4-67] per 100,000 live births respectively), where nearly half of births occur in countries that have introduced RCV. Other regions, where >95% of births occurred in countries that had introduced RCV, had a low estimated CRS incidence (<1 [95% CI: <1 to 8] and <1 [95% CI: <1 to 12] per 100,000 live births in South-East Asia [SEAR] and the Western Pacific [WPR] respectively, and similarly in Europe and the Americas). The estimated number of CRS births globally declined by approximately two-thirds during 2010-2019, from 100,000 (95% CI: 54,000-166,000) to 32,000 (95% CI: 13,000-60,000), representing a 73% reduction since 1996, largely following RCV introductions in WPR and SEAR, where the greatest reductions occurred. Further reductions can occur by introducing RCV in remaining countries and maintaining high RCV coverage. [ABSTRACT FROM AUTHOR]

• A large multicenter cohort of pediatric cases with COVID-19 in Shanghai, China. • A total of 36.8% of the cases were asymptomatic, whereas 7.5% had moderate to severe COVID-19. • Children aged <3 years had an increased risk of developing moderate to severe symptoms. • Younger age was associated with an extended duration of viral shedding. • Vaccination protects children from COVID-19 at the household level. To describe the epidemiological, clinical, and household transmission characteristics of pediatric COVID-19 cases in Shanghai, China. Pediatric patients with COVID-19 hospitalized in Shanghai from March-May 2022 were enrolled in this retrospective, multicenter cohort study. The symptoms and the risk factors associated with disease severity were analyzed. In total, 2620 cases (age range, 24 days-17 years) were enrolled in this study. Of these, 1011 (38.6%) were asymptomatic, whereas 1415 (54.0%), 190 (7.3%), and 4 (0.2%) patients developed mild, moderate, and severe illnesses, respectively. Household infection rate was negatively correlated with household vaccination coverage. Children aged 0-3 years, those who are unvaccinated, those with underlying diseases, and overweight/obese children had a higher risk of developing moderate to severe disease than children aged 12-17 years, those who were vaccinated, those without any underlying disease, and those with normal weight, respectively (all P <0.05). A prolonged duration of viral shedding was associated with disease severity, presence of underlying diseases, vaccination status, and younger age (all P <0.05). Children aged younger than 3 years who were not eligible for vaccination had a high risk of developing moderate to severe COVID-19 with a prolonged duration of viral shedding. Vaccination could protect children from COVID-19 at the household level. [ABSTRACT FROM AUTHOR]

• Independent identification of the acute flaccid paralysis case in two European countries. • Poliovirus evolution in a patient who is immunocompetent (Sabin-like poliovirus type 3 to vaccine-derived poliovirus type 3). • Sanger and high-throughput sequencing revealed fast evolution. • Risk assessment of polio spread in Tajikistan and Russia. • There is a need to continue acute flaccid paralysis surveillance and high vaccination coverage. The detection of a vaccine-derived poliovirus (VDPV) requires an epidemiological assessment and response. Using repeated stool sampling from a child who is immunocompetent and was vaccinated against poliomyelitis with acute flaccid paralysis, a case of an extremely rapid evolution of Sabin-like poliovirus (PV) type 3 was traced in the child's body. The case was independently identified in two countries—Tajikistan and Russia. Stool samples for the study were also independently collected in two countries on different days from the onset of paralysis. Virological, serological, and molecular methods; full genome Sanger; and high-throughput sequencing were performed to characterize isolates. PV isolates from samples collected on days 2, 3, and 14 contained eight, seven, and seven mutations in the VP1-coding region, respectively, and were classified as Sabin-like PV type 3. The isolates from samples collected on days 15 and 18 had 11 mutations and were classified as vaccine-derived PVs, which required an epidemiological response in the two countries. The results indicate the need to continue acute flaccid paralysis surveillance, maintain high vaccination coverage, and develop and introduce new effective, genetically stable PV vaccines. [ABSTRACT FROM AUTHOR]

• Lazio region mpox prevention strategies included social and public health measures. • The vaccination campaign was an opportunity to inform those at risk of mpox adequately. • Mpox slowdown could result from mitigation strategies and vaccine effectiveness. • Vaccination campaign plays a role in the decline of mpox cases. • Integrating vaccination campaigns with information and sensitization is crucial. A pre-exposure vaccination campaign to prevent the spread of the mpox virus was initiated in Italy in August 2022. We explore the possible factors affecting the trend of mpox cases in an Italian region (Lazio) with a rapid roll-out of the vaccination campaign. We estimated the impact of the communication and vaccination campaign by fitting a Poisson segmented regression model. Results By September 30, 2692, high-risk men who have sex with men had received at least one dose of vaccine, with a vaccination coverage of 37%. The analysis of surveillance data showed a significant decreasing trend in the number of mpox cases starting from the second week after vaccination (incidence rate ratio 0.452 [0.331-0.618]). The reported trend in mpox cases is likely to result from a combination of multiple social and public health factors combined with a vaccination campaign. [ABSTRACT FROM AUTHOR]

• The magnitude of the measles outbreak was illustrated by a two-peak temporal shape. • Measles cases were linked to heterogeneity in vaccination coverage across provinces. • Cross-province transmission of measles was predominantly observed. Southern Vietnam experienced a large measles outbreak of over 26,000 cases during 2018-2020. We aimed to understand and quantify the measles spread in space-time dependence and the transmissibility during the outbreak. Measles surveillance reported cases between January 2018 and June 2020, vaccination coverage, and population data at provinicial level were used. To illustrate the spatio-temporal pattern of disease spread, we employed the endemic-epidemic multivariate time series model decomposing measles risk additively into autoregressive, spatio-temporal, and endemic components. Likelihood-based estimation procedures were performed to determine the time-varying reproductive number R e of measles. Our analysis showed that the incidence of measles was associated with vaccination coverage heterogeneity and spatial interaction between provincial units. The risk of infections was dominated by between-province transmission (36.1% to 78.8%), followed by local endogenous transmission (4.1% to 61.5%). In contrast, the endemic behavior had a relatively small contribution (2.4% to 33.4%) across provinces. In the exponential phase of the epidemic, R e was above the threshold with a maximum value of 2.34 (95% CI: 2.20-2.46). Local vaccination coverage and human mobility are important factors contributing to the measles dynamics in Southern Vietnam, and the high risk of inter-provincial transmission is of most concern. Strengthening the disease surveillance is recommended, and further research is essential to understand the relative contribution of population immunity and control measures in measles epidemics. [ABSTRACT FROM AUTHOR]

• Multi-centric hospital-based study was conducted across 11 cities in India. • Both Covishield and Covaxin confer high protection against severe COVID-19. • Both vaccines provide high protection against severe disease by the Delta strain. • Expansion of the two-dose vaccination coverage is key to reducing hospitalizations. India introduced BBV152/Covaxin and AZD1222/Covishield vaccines in January 2021. We estimated the effectiveness of these vaccines against severe COVID-19 among individuals aged ≥45 years. We did a multi-centric, hospital-based, case-control study between May and July 2021. Cases were severe COVID-19 patients, and controls were COVID-19 negative individuals from 11 hospitals. Vaccine effectiveness (VE) was estimated for complete (2 doses ≥ 14 days) and partial (1 dose ≥ 21 days) vaccination; interval between two vaccine doses and vaccination against the Delta variant. We used the random effects logistic regression model to calculate the adjusted odds ratios (aOR) with a 95% confidence interval (CI) after adjusting for relevant known confounders. We enrolled 1143 cases and 2541 control patients. The VE of complete vaccination was 85% (95% CI: 79-89%) with AZD1222/Covishield and 71% (95% CI: 57-81%) with BBV152/Covaxin. The VE was highest for 6-8 weeks between two doses of AZD1222/Covishield (94%, 95% CI: 86-97%) and BBV152/Covaxin (93%, 95% CI: 34-99%). The VE estimates were similar against the Delta strain and sub-lineages. BBV152/Covaxin and AZD1222/Covishield were effective against severe COVID-19 among the Indian population during the period of dominance of the highly transmissible Delta variant in the second wave of the pandemic. An escalation of two-dose coverage with COVID-19 vaccines is critical to reduce severe COVID-19 and further mitigate the pandemic in the country. [ABSTRACT FROM AUTHOR]

• A first COVID-19 model for Northwest Syria using a participatory approach. • A second COVID-19 wave is likely if only 20% of the population is vaccinated. • A more transmissible and lethal variant could increase the death toll by a factor of 6. • Vaccinating 60% of the population could reduce hospital occupancy below the threshold. • Decision-makers should urgently increase COVID-19 vaccination coverage. Ten years of conflict has displaced more than half of Northwest Syria's (NWS) population and decimated the health system, water and sanitation, and public health infrastructure vital for infectious disease control. The first NWS COVID-19 case was declared on July 9, 2020, but impact estimations in this region are minimal. With the rollout of vaccination and emergence of the B.1.617.2 (Delta) variant, we aimed to estimate the COVID-19 trajectory in NWS and the potential effects of vaccine coverage and hospital occupancy. We conducted a mixed-method study, primarily including modeling projections of COVID-19 transmission scenarios with vaccination strategies using an age-structured, compartmental susceptible-exposed-infectious-recovered (SEIR) model, supported by data from 20 semi-structured interviews with frontline health workers to help contextualize interpretation of modeling results. Modeling suggested that existing low stringency non-pharmaceutical interventions (NPIs) minimally affected COVID-19 transmission. Maintaining existing NPIs after the Delta variant introduction is predicted to result in a second COVID-19 wave, overwhelming hospital capacity and resulting in a fourfold increased death toll. Simulations with up to 60% vaccination coverage by June 2022 predict that a second wave is not preventable with current NPIs. However, 60% vaccination coverage by June 2022 combined with 50% coverage of mask-wearing and handwashing should reduce the number of hospital beds and ventilators needed below current capacity levels. In the worst-case scenario of a more transmissible and lethal variant emerging by January 2022, the third wave is predicted. Total COVID-19 attributable deaths are expected to remain relatively low owing largely to a young population. Given the negative socioeconomic consequences of restrictive NPIs, such as border or school closures for an already deeply challenged population and their relative ineffectiveness in this context, policymakers and international partners should instead focus on increasing COVID-19 vaccination coverage as rapidly as possible and encouraging mask-wearing. [ABSTRACT FROM AUTHOR]

Objectives: To describe the characteristics of a large hepatitis A virus (HAV) outbreak among men who have sex with men (MSM) in Berlin and to assess the impact of measures implemented. Methods: Cases of laboratory-confirmed, symptomatic HAV infection notified in Berlin, Germany between August 2016 and February 2018 were analysed using routine and enhanced surveillance data including genotyping results. Several studies involving different groups of participants were conducted to further investigate the outbreak, including surveys on knowledge and practices of HAV vaccination among physicians and vaccination coverage and determinants of vaccination status among MSM. The measures implemented were categorized by target group in a Gantt chart. To assess their impact, health insurance data on HAV vaccination uptake were analysed, comparing Berlin and other federal states. Results: During the outbreak period, a total of 222 cases were reported (of which 91 were sequence-confirmed), with a peak in case numbers in January 2017. Physicians were aware of the existing vaccination recommendations, but vaccination coverage among 756 MSM was low, with 32.7% being completely vaccinated and 17.3% being incompletely vaccinated before 2017. HAV vaccination before 2017 was associated with being born in Germany (odds ratio 2.36) and HIV-positive (odds ratio 1.80). HAV monovalent vaccination uptake increased by 164% from 2016 to 2017 among males in Berlin, compared to 7% in other federal states. Conclusions: Multiple measures targeting the MSM community, physicians, and public health to increase HAV vaccination uptake were successfully implemented. To prevent future HAV outbreaks, we recommend monitoring vaccination coverage among MSM, promoting awareness of existing recommendations among physicians, and ensuring access for foreign-born and young MSM.

• The CFRs of COVID-19 varied across the epidemic periods of different VOCs. • The CFRs of COVID-19 disparities existed among continents. • VOCs, HDI value, age and coverage of vaccination were factors influencing the CFR. To calculate the case fatality rates (CFR) of COVID‐19 during epidemic periods of different variants of concern (VOC) by continents. We systematically searched five authoritative databases (Web of Science, PubMed, Embase, Cochrane Library, and MedRxiv) for epidemiological studies on the CFR of COVID-19 published between January 1, 2020, and March 31, 2023. After identifying the epidemic trends of variants, we used a random-effects model to calculate the pooled CFRs during periods of different VOCs. This meta-analysis was conducted following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and registered with PROSPERO (CRD42023431572). There were variations in the CFRs among different variants of COVID-19 (Alpha: 2.62%, Beta: 4.19%, Gamma: 3.60%, Delta: 2.01%, Omicron: 0.70%), and disparities in CFRs also existed among continents. On the whole, the CFRs of COVID-19 in Europe and Oceania were slightly lower than in other continents. There was a statistically significant association between the variant, HDI value, age distribution, coverage of full vaccination of cases, and the CFR. The CFRs of COVID-19 varied across the epidemic periods of different VOCs, and disparities existed among continents. The CFR value reflected combined effects of various factors within a certain context. Caution should be exercised when comparing CFRs due to disparities in testing capabilities and age distribution among countries, etc. [ABSTRACT FROM AUTHOR]

• Social distancing and face mask use could reduce the effective reproduction number (R e) to 1 in wildtype epidemics. • Containing wildtype epidemics required interventions to begin before the number of daily reported cases was >6. • Containing Alpha epidemics required more stringent interventions that commenced earlier. • Containing Delta epidemics required 70% vaccination combined with other interventions. • Increasing vaccination coverage will allow less strict interventions and increase the tolerance for the timing of intervention commencement. The exact characteristics of a coronavirus disease 2019 (COVID-19) outbreak that trigger public health interventions are poorly defined. The aim of this study was to assess the critical timing and extent of public health interventions to contain COVID-19 outbreaks in Australia. A practical model was developed using existing epidemic data in Australia. The effective combinations of public health interventions and the critical number of daily cases for intervention commencement under various scenarios of changes in transmissibility of new variants and vaccination coverage were quantified. In the past COVID-19 outbreaks in four Australian states, the number of reported cases on the day that interventions commenced strongly predicted the size and duration of the outbreaks. In the early phase of an outbreak, containing a wildtype-dominant epidemic to a low level (≤10 cases/day) would require effective combinations of social distancing and face mask use interventions to be commenced before the number of daily reported cases reaches six. Containing an Alpha-dominant epidemic would require more stringent interventions that commence earlier. For the Delta variant, public health interventions alone would not contain the epidemic unless the vaccination coverage was ≥70%. This study highlights the importance of early and decisive action in the initial phase of an outbreak. Vaccination is essential for containing variants. [ABSTRACT FROM AUTHOR]

• Carriage rates of S. pneumoniae are high in low- and lower-middle-income countries. • Pneumococcal Conjugate Vaccine coverage is moderate in L-MICs compared to HICs. • Vaccine-type carriage has decreased in most countries with introduction of the PCV. • Non-vaccine-type pneumococcal carriage has increased due to serotype replacement. Streptococcus pneumoniae is one of the most important causes of diseases leading to child mortality, especially in low- and lower-middle-income countries. This review aims to describe the prevalence of carriage of S. pneumoniae and the impact of vaccination among children aged under five years in low- and lower-middle-income countries since 2012. The study is a systematic review of the literature. Relevant publications were searched in PubMed and screened systematically for information on the prevalence of carriage of S. pneumoniae among children aged under five years. 149 publications were identified, and 20 were included in the review. The prevalence of S. pneumoniae ranged between 26.7% - 90.7%. The prevalence of vaccine-type carriage ranged between 4.4% - 57.6% but generally decreased in countries after the introduction of PCV, with a reduction of 15.6% - 65.7%. Half of the post- pneumococcal conjugate vaccine (PCV) studies reported a vaccine-type carriage rate below 15%. Vaccine-type-carriage has decreased in most countries with the introduction of PCV. Still, coverage is only moderate, and carriage rates of S. pneumoniae vary significantly between countries. Continuous monitoring of carriage is needed to evaluate the effect of the further introduction of PCV10 and PCV13. [ABSTRACT FROM AUTHOR]

• The outbreak in Germany's gay hotspot Berlin included 222 cases, most self-identifying as MSM. • Hepatitis A vaccination is recommended and free of charge for MSM in Germany. • The vaccination coverage was low among MSM, in particular among young and foreign-born. • Various measures were implemented targeting the MSM community, physicians, and the public. • Increased vaccination uptake shows the success of the interventions. To describe the characteristics of a large hepatitis A virus (HAV) outbreak among men who have sex with men (MSM) in Berlin and to assess the impact of measures implemented. Cases of laboratory-confirmed, symptomatic HAV infection notified in Berlin, Germany between August 2016 and February 2018 were analysed using routine and enhanced surveillance data including genotyping results. Several studies involving different groups of participants were conducted to further investigate the outbreak, including surveys on knowledge and practices of HAV vaccination among physicians and vaccination coverage and determinants of vaccination status among MSM. The measures implemented were categorized by target group in a Gantt chart. To assess their impact, health insurance data on HAV vaccination uptake were analysed, comparing Berlin and other federal states. During the outbreak period, a total of 222 cases were reported (of which 91 were sequence-confirmed), with a peak in case numbers in January 2017. Physicians were aware of the existing vaccination recommendations, but vaccination coverage among 756 MSM was low, with 32.7% being completely vaccinated and 17.3% being incompletely vaccinated before 2017. HAV vaccination before 2017 was associated with being born in Germany (odds ratio 2.36) and HIV-positive (odds ratio 1.80). HAV monovalent vaccination uptake increased by 164% from 2016 to 2017 among males in Berlin, compared to 7% in other federal states. Multiple measures targeting the MSM community, physicians, and public health to increase HAV vaccination uptake were successfully implemented. To prevent future HAV outbreaks, we recommend monitoring vaccination coverage among MSM, promoting awareness of existing recommendations among physicians, and ensuring access for foreign-born and young MSM. [ABSTRACT FROM AUTHOR]

Through mass vaccination, rapid attainment of population immunity can be achieved to create community defence against impending outbreaks. This study characterised the timing of COVID-19 vaccination coverage at population level and evaluated its association with age in Hong Kong. In an ongoing population-based cohort, participant's demographics, histories of COVID-19 vaccination and diagnosis were collected as of June 2022. For both the second and third/booster dose, the average time to achieve 50% coverage in the cohort was estimated using Kaplan-Meier method. Multivariable cox regression model was applied to determine the age effects on vaccination timing. Among 4668 participants (42% male, median age: 46 years [IQR 34-57]), 93% and 68% have received the second and third/booster dose against COVID-19, respectively. The second-dose 50% coverage was achieved at 164 days after vaccination roll-out. Uptake decelerated when 75% participants were vaccinated, after which it took an additional 163 days to augment the coverage to 90%. Second-dose uptake did not differ significantly by age over time, but a notable gap was observed between those aged 65+ (34%) and 18-29 years (15%) in the first 100 days. Between November 2021 and March 2022 when the 180-day dose-interval was effective, half of the participants received their third/booster dose in less than 54 days after they became eligible. Stratified by age, 50% subjects aged 18-29, 30-39, 40-49, 50-64 and 65+ years received the vaccine within 82, 73, 67, 45 to 26 days, respectively. A consistently higher uptake of third/booster dose was identified in those aged 40-49 (adjusted hazard ratio[aHR] 1.21), 50-64 (aHR 1.19) and 65+ (aHR 1.19) compared to 18-29 years adjusted for demographics. This study highlighted the need of tracking the age pattern of immunity against SARS-CoV-2 and tailoring strategies to expedite vaccination in younger adults. The heterogeneous pattern of vaccination timing also informed future vaccination campaigns. [ABSTRACT FROM AUTHOR]

• Significant increase of presumably vaccinated students after vaccine introduction. • Increased vaccination rates translated into lower prevalence of past HBV infection. • Older students from Bolikhamxay were less likely vaccinated. • Students from Bolikhamxay and older students were more likely exposed to HBV. • High number of unprotected students warrants introduction of HBV booster dose. Hepatitis B is endemic in Lao PDR with 8–10% of the adult population being chronically infected. We investigated the impact of hepatitis B vaccination on infection in adolescents born shortly before and after the introduction of the vaccine in 2001. 779 students from Vientiane Capital and Bolikhamxay province were tested for HBV markers by ELISA. Socio-demographic information was collected with a standardized questionnaire. Predictors/risk factors for seroprotection or exposure to hepatitis B infection were assessed by bivariate and multivariable analyses. The prevalence of a serological vaccination profile increased significantly after the introduction of the vaccine (13.2%–21.9%, p < 0.05, in Vientiane; 3.0%–19.7%, p < 0.001, in Bolikhamxay), which translated into at least a 2-times lower prevalence of past infection. In logistic regression, older students in Bolikhamxay were less likely to be vaccinated and more likely to have been infected by HBV in the past. Even though this study documented a sizable and lasting reduction in past hepatitis B infections in adolescents born after the introduction of infant hepatitis B vaccination, the overall levels of protective anti-HBs were low and warrant at least the introduction of a booster for adolescents. Furthermore, we suggest improving the coverage of the hepatitis B birth dose. [ABSTRACT FROM AUTHOR]

Two rotavirus vaccines are licensed in China (RotaTeq and Lanzhou Lamb Rotavirus [LLR] vaccine), but their use is not widespread. We sought to understand the public health impact of widespread rotavirus vaccination with these two vaccines on public health outcomes, in China, among children ages 0- 7 years old. We developed a Markov Model to simulate a birth cohort from 0 to 7 years of age under three scenarios- i) vaccination with RotaTeq; ii) vaccination with LLR; iii) no-vaccination; and calculated each scenario's expected number of health outcomes. The model was parameterized using published information on rotavirus epidemiology, RotaTeq and LLR effectiveness in China, as abstracted from national estimates and peer-reviewed literature. We assumed individuals could have up to five rotavirus infections, the first two being the ones that could lead to hospitalization. We considered high (90%) and low (50%) vaccination coverage scenarios (since rotavirus vaccines are not reimbursed) and fitted the model by changing the percent of immunity conferred by previous infection and the asymptomatic to symptomatic ratio. For a cohort of 100,000 children over the first 7 years of life, and in the absence of a rotavirus vaccine in China, 899 hospitalizations, 11,708 outpatient visits, and 64,746 symptomatic rotavirus cases are expected. Using RotaTeq, 67% (39%) of hospitalizations, and 61% (35%) of outpatient visits and rotavirus cases can be averted under the high (low) vaccination coverage scenario. Given lower vaccine effectiveness estimates for LLR, its use would avert 24% (14%) hospitalizations, 24% (14%) outpatient visits, and 24% (14%) rotavirus symptomatic cases compared to no vaccination, in the high (low) vaccination coverage scenario. Widespread use of rotavirus vaccination can avert a significant number of rotavirus gastroenteritis outcomes, with a three to two times higher potential public health impact for RotaTeq compared to LLR. [ABSTRACT FROM AUTHOR]

In most European countries the booster vaccine doses against Tick-Borne Encephalitis (TBE) are indicated every 3 or 5 years depending on the number of previous doses and the age of the person. That means more frequent boosters than with any other vaccine. There is evidence that this results in low compliance with recommendations. Concerned about a low TBE vaccination coverage in Swiss endemic regions, the Swiss Federal Office of Public Health (SFOPH) in 2006 decided to recommend booster doses only every 10 years for all age groups after completion of the primary immunization. This amendment combined with intensified recommendations resulted in a sharp increase of the proportion of the immunized population. To ascertain that the amended recommendations would not result in increased risk of breakthroughs the SFOPH started to annually monitor TBE vaccine failures with particular attention to older age groups. Additionally, a matched case-control study evaluated TBE vaccine effectiveness by booster interval. Surveillance data of the SFOPH demonstrates that in the initial 3 years after the last vaccine dose the annual breakthrough incidence was 7.7 (95% CI 5.0-11.7), while in the years 4 to 10 it was 5.4 (3.9-7.5) per year. The case-control study demonstrated a vaccine effectiveness of 91.6 (95% CI 88.4-94.0)% when the most recent dose was received <5 years, of 95.2 (92.4-97.0)% among those with the last booster dose 5 to 10 years, and of 98.5 (96.8-99.2)% when the most recent dose was received >10 years prior to infection. Both studies indicate that there is not even a trend indicating an increase in vaccine failures with longer booster intervals. Obviously, cell mediated immunity assures protection in above 95% despite of declining antibodies over time. Thus, the cumbersome TBE vaccine schedules should be reconsidered. Longer intervals will result in increased acceptability, lower costs and thus in a public health success. [ABSTRACT FROM AUTHOR]

Oral rabies vaccines (ORVs) have been used successfully to control rabies in carnivore reservoir populations across the globe. Fox rabies was eliminated from Europe through strategic distribution of ORVs across Western Europe from 1978. The vaccine strains have been modified repeatedly to improve safety and immunogenicity through modern technologies such as monoclonal selection, recombination, and reverse genetics. The 3rd generation ORVs developed for canids used reverse genetics to enable site-especific modifications at G protein encoding regions. These vaccines have been demonstrated to be safe and robust for the use in free roaming dogs in close proximity to human populations. Over 99% of human rabies deaths in endemic regions are the result of transmission from dogs. Although effective delivery of post exposure prophylaxis can prevent 100% of dog mediated human rabies, the source of transmission will continue to be a threat, indefinitely burdening the health sector. Mass dog vaccination is a proven approach to eliminate dog mediated human rabies, however accessing a sufficiently high proportion of the dog population by parenteral approaches remains a significant technical barrier to district-level campaigns across much of South Asia. The introduction of ORVs as an additional tool to parenteral vaccination methods can increase vaccination coverage in roaming dog populations, may reduce the operational cost and management of mass dog vaccination, therefore improving the feasibility of control efforts. ORVs are proven to be an effective tool in controlling canine rabies through feasibility studies, simulations and field trails demonstrating the ease of distribution and improved coverage. Structuring mass dog vaccination techniques to be more feasible would also encourage local authorities to attempt control canine and dog mediated human rabies. [ABSTRACT FROM AUTHOR]

In 2010, PCV10 was introduced in the Colombian National Immunization Program (NIP) for children, with good vaccination coverage >82% since 2012. However, the NIP does not include routine pneumococcal vaccination for older adults. We assessed trends in mortality rate (MR) due to potential pneumococcal pneumonia (PPP) from 2006-2019. This ecological time-series study used Colombian nationwide administrative databases. We analyzed the pre-PCV10 (2006-2009) and post-PCV10 (2012-2019) periods, excluding the years 2010 and 2011 (transition period). ICD-10 codes included J13-J18. MRs were calculated per 100,000 people and stratified by age groups (<1, 1-4, 5-17, 18-49, 50-59, 60-64 and ≥65 years). The percent of change was calculated by the difference between the average rate in the pre-PCV and post-PCV periods for each age group. Joinpoint regression analysis was performed to assess changes in MRs. Annual percent changes (APCs) for each line segment and average APC (AAPC) over 2006-2019 were estimated. During 2006-2019, there were 102,082 deaths due to PPP. The highest MRs were seen for the age groups <1 and ≥65 years. Mean MRs decreased in age groups <18 years in the post-PCV10 period. A decreasing trend was seen primarily in those <1 year (AAPC -6.8; 95%CI: -8.6;-5.1) and 1-4 years (AAPC -5.0; 95%CI: -7.2;-2.8%) from 2006-2019. In contrast, for the age groups 50-59 years and 60-64 years, there was a significant increasing trend (AAPC 1.6%;95%CI 1.7%-5.1% and AAPC 3.4; 95%CI: 1.7;5.1, respectively) from 2006-2019. In ≥65 years, there was a significant increasing trend from 2011-2016 (APC 6.6; 95% CI: 0.5;13.1), followed by a non-significative decrease trend from 2016-2019 (APC -2.8; 95%CI-10.4;5.5). This study provided additional evidence for the benefits of childhood PCV programs. For older adults, MR has been consistently higher in post-vaccination period compared to pre-vaccination. These findings can inform decision-makers about the needs for pneumococcal vaccination among older adults in Colombia. [ABSTRACT FROM AUTHOR]

India began the world's largest vaccination programme for Covid-19 on 16 Jan 2021. Two vaccines used for this drive were Oxford-AstraZeneca's Covishield and Bharat Biotech's Covaxin. Our institute an upcoming state of art cancer centre in eastern Uttar Pradesh and acted as a centre for vaccination. The health ministry targeted to vaccinate four priority groups in its first phase: healthcare workers, frontline workers, people> 60 yrs and < 60 yrs with comorbidities. A prospective observational survey was done to find out vaccine coverage (COVISHIELD) for the HCW and staff (n= 335) at Super speciality cancer institute, Lucknow. It was conducted over a period of 3 months i.e, from Jan 2021 to march 2021. Data that were collected included age, gender, occupation, post vaccination symptoms, number of 1st dose and 2nd dose beneficiaries, post vaccination covid 19 infection after 2nd dose A total of 336 HCW in this institute were eligible for vaccination including faculty, residents, nursing staff, attendant, other supporting staff. Majority belonged to age group 15 to 30 years (n=175) followed by 31 to 45 years (n=121), 46-65 years(n=39). Vaccine hesitancy were seen among 68 HCW. While 31 skipped vaccination due to pregnancy, lactation, out of station, accidents and technical error. Most of the HCW had post vaccination symptoms: Tiredness 45%, myalgia 49 %, Fever 34%, headache 32%, local pain at injection site 30%, joint pain 10%, nausea 6%, diarrhoea 3%. Among those who reported symptoms 79 % notices within first 12 hrs with no serious events reported. These symptoms were consistent with an immune response commonly associated with vaccine. Post vaccination mild COVID 19 infection after 2nd dose were seen in 22 HCW and required no hospitalisation. Vaccination of HCW in oncology setting is critical in managing an immunocompromised host population. Vaccination coverage was 87.4% for 1st dose and 70.4% 2nd dose, showing its successful implementation. [ABSTRACT FROM AUTHOR]

Background Globally, influenza is a major cause of morbidity, hospitalization and mortality. Influenza vaccination has shown substantial protective effectiveness in the United States. Methods We investigated state-level patterns of coverage rates of seasonal and pandemic influenza vaccination, among the overall population (six months or older) in the U.S. and specifically among children (aged between 6 months and 17 years) and the elderly (aged 65 years or older), from 2009/10 to 2014/15, and associations with ecological factors. We obtained state-level influenza vaccination rates from national surveys, and state-level socio-demographic and health data from a variety of sources. We employed a retrospective ecological study design, and used both linear models and linear mixed-effect models to determine the levels of ecological association of the state-level vaccinations rates with these factors, both with and without region as a factor for the three populations. Results and Conclusions Health-care access has a robust, positive association with state-level vaccination rates across all populations and models. This highlights a potential population-level advantage of expanding health-care access. We also found that prevalence of asthma in adults is negatively associated with mean influenza vaccination rates in the elderly populations. [ABSTRACT FROM AUTHOR]

Between 2020 and 2021, the school-based human papillomavirus (HPV) vaccination program was temporarily interrupted in Peru due to the COVID-19 pandemic. While immunization services resumed in March 2022, the efforts and time required for immunization services to catch-up girls who missed doses of HPV vaccine are unclear. We aimed to estimate the impact of the pandemic on the number of HPV doses administered and time needed to reverse to pre- pandemic coverage levels. A previously published model (Saxena et al 2021) was adapted to the Peruvian context to quantify the deficit in HPV doses administered to Peruvian girls aged 9-13 years between 2020 and 2021. The model included the following periods: pre-pandemic, COVID-19 pandemic, transition period (linear increase until reach an assumed rate) and catch-up (rates higher than 2019). The monthly HPV vaccine doses were compared with 2019 levels. The model estimated the cumulative deficit in doses administered and the projected time and catch-up rates/number of doses required to close the 2020/2021 HPV immunization gap relative to 2019. Based on administrative data, we estimated that a total of 430,000, 358,207, and 301,650 doses of HPV vaccine were administered to 9-13 years girls in Peru in 2019, 2020, and 2021, respectively. Annual doses decreased by 16.7% and 29.8% in 2020 and 2021 compared to 2019. Starting on October 2022 with a monthly catch-up rate of 5% (1,792 additional doses/month) and 10% (3,588 additional doses/month), the projected dose deficit was expected to be cleared in August 2025 and March 2024, respectively. A marked disruption to HPV routine immunization occurred in 2020 and 2021 in Peru, with HPV vaccine coverage estimated to have fallen between 16.7-29.8%. The recovery to pre-pandemic coverage and catch-up of missed doses require a sustained increase in vaccination over multiple years to prevent HPV infection/disease in near and long term. [ABSTRACT FROM AUTHOR]

A weekly-based service was hypothesized as feasible and usable for surveillance, to monitoring cases in Long-Term Care Facilities (LTCFs) in the SARS-CoV-2 emergency in Italy. A web-based platform was set-up at the Italian National Institute of Health (ISS) at mid-2020. Protocols were validated and people trained to guarantee the delivery of a reliable weekly report to the Reference person of each participating Region, including the most relevant SARS-CoV-2 data and criticalities, i.e. new infections and outbreaks, deaths, hospitalization, isolations, vaccination coverage (VC), personal protective equipment and swabs. The service has been working at regimen since October 2020, available 24/7, the ISS database being fed by 7 Regions. In the period January 2021 – June 2022, 852 LCTFs (with over 22.000 residents) contributed to the service, with high adherence rate (92% on average in January 2021, 82% in March 2022 - end of emergency in Italy - and 77% in June 2022). Reports are delivered on Thursdays to inform Regional Contacts. So far, weekly data inconsistencies ranged between 6% and 10%; they were all solved by variables cross-check, comparisons with previous information, and direct interviews with the LCTFs' operators. Regularly, data are processed to monitor trends, with focus on waves of infections. In particular, prevalence of infections reached 1.4% and SARS-CoV-2 positive deaths 0.4% in January 2021 (vaccination campaign just started), 5.5% and 0.2% respectively in January 2022 (VC ≈ 97%), 4.0% and <0.1% respectively in March 2022 (VC ≈ 97.5%). Collected data allowed to monitoring impact of the measures taken to combat the pandemic, and resilience of LCTFs with respect to the most critical waves of infection. The weekly-based service was proved feasible with one ISS fulltime person required and usable for surveillance of SARS-CoV-2 cases and criticalities in LTCFs even after the declared end of the national emergency. [ABSTRACT FROM AUTHOR]

COVID-19 vaccines are safe and effective at reducing risk of severe COVID-19 among pregnant women, a group at higher risk of severe disease. However, vaccine uptake has been slow among people in Zambia. We sought to describe vaccine uptake among pregnant women in Zambia. We conducted serial cross-sectional surveys among pregnant women attending first antenatal care visits in one rural and two urban districts of Zambia from December 2021 through June 2022. Ten health facilities per district were randomly selected and a convenience sample of 20 women per facility per month were recruited. Consenting participants were administered an electronic questionnaire asking about offers and receipt of COVID-19 vaccines. In total, 3,652 women were recruited from December 2021 to June 2022, and 82.4% had not received a COVID-19 vaccine. Vaccine coverage among participants rose from 10.5% in December 2021 to 28.7% in June 2022 (p<0.01). During the same period, the proportion of women who reported being offered a vaccine rose significantly from 22.4% to 52.5% (p<0.01), with a non-significant increase in the proportion of women who were unvaccinated but willing to accept a vaccine (58.0% to 65.8%, p=0.59). Among 785 women who were unvaccinated and not willing to accept a vaccine, 42.3% were concerned about the safety of vaccination during pregnancy. Vaccine coverage among pregnant women in Zambia remains low and safety concerns during pregnancy are high. Door-to-door vaccination campaigns and individual vaccination consultations at all healthcare encounters may increase the number of women being offered a vaccine. Focused safety messaging for pregnant women may help to alleviate fears and increase COVID-19 vaccine uptake. [ABSTRACT FROM AUTHOR]

Due to the ongoing COVID-19 pandemic, routine childhood immunization coverage globally decreased from 86% in 2019 to 81% in 2021. In India, the impact of the pandemic and associated lockdowns on routine childhood immunization has not been adequately reported. Here, we survey the effect of the pandemic on routine childhood immunization coverage and examine delays in previously censused rural communities in Tamil Nadu, southern India. In this community-based cross-sectional study conducted in September 2021, we approached all households with children born between March 2019 and February 2021 located in two rural blocks - Jawadhu hills, a primarily tribal population, and Timiri. A structured questionnaire was administered to the parents or primary caregivers using a mobile phone-based data collection application. From the available immunization card, dates for each vaccine administered to the child were recorded and cross-verified, and caregivers were asked for reasons for delayed or missed doses of specific vaccines. Overall, 1254 and 1962 households with children in Jawadhu hills and Timiri blocks consented to participate. Coverage for all vaccines was significantly lower in the Jawadhu hills block compared to Timiri before and during the pandemic (except for OPV-0 during the pandemic). During the pandemic, vaccine coverage remained unchanged or improved for all vaccines except for measles in the Timiri site (p<0.001). During the pandemic, an increased number of delays for all vaccines was seen in Jawadhu hills, but in Timiri, only the OPV-3, pentavalent-3, and Rotavirus-3 vaccines were delayed. Perceived reasons for delays in vaccination provided by caregivers did not change during the pandemic. Routine childhood immunization coverage during the pandemic for most vaccines was comparable to the pre-pandemic period in both rural sites, but significant delays in vaccination were noted. The effect of the pandemic was primarily seen in vaccines given after three months of age. [ABSTRACT FROM AUTHOR]

In 2018-19, even before the pandemic, the world experienced major outbreaks of measles with 140,000 reported deaths mostly in low income countries where children suffer from malnutrition and overcrowding. In areas recovering from natural disasters and conflict areas and most children remain unvaccinated, outbreaks occur. The Philippines suffered similarly, with a devastating outcome and deaths of more than 800 children, even adults, in more than 40,000 hospitalized cases reported in 2019 over a 2 month period. A massive loss of vaccine confidence in 2018, brought about by the controversial introduction of a dengue vaccine reduced childhood vaccination coverage at an all-time low of 40-50%. Previous rates were in the 80-90% and measles was almost on the verge of elimination with no deaths and no cases between 2005-2009. The basic elements of complacency, convenience and confidence plus frequent occurrence of natural disasters over the years contributed much to these measles outbreaks. As a strategy, the government went into a massive supplementary immunization program with measles campaign including home visits to prevent another outbreak in the next 2 years after the pandemic begun. It has been implemented but targets are still wanting. The lessons learned from Measles resurgence are echoing all throughout the world and as the global response to the COVID19 continues, the measles as well as polio and other vaccine- preventable diseases need to be addressed with strategies that each country would find appropriate for them. Without sustained attention, the gains that have been achieved previously could easily get lost. [ABSTRACT FROM AUTHOR]

To minimize the impact of the COVID-19 pandemic, local public health authorities are often required to make prompt and informed decisions on anticipated case-loads, resource allocation for surveillance and testing, and public health intervention appropriateness. The objective of this research was to develop a near-term forecasting model to predict COVID-19 cases using real-time human mobility information in Ontario, Canada to assist public health authorities with outbreak response. We utilized a deep neural network model to generate a short-term forecast of new COVID-19 cases by two weeks from May to August 2021. Variable selection was informed by a recent literature review and our ongoing research associating COVID-19 cases with human mobility, demographic and socio-economic factors. A real-time human mobility statistics consisting of a weekly summary of short and long-distance movement, demographic characteristics, weather, vaccination coverage, geo-location, and reported COVID-19 cases two weeks prior were included as predictors. We considered weeks as temporal and health regions as geographic units to account for population-level variabilities. We used a holdout method for model validation of over 300 iterations. Average mean squared error (MSE) and 95% confidence interval (CI) along with overlaying forecasted COVID-19 cases over the reported were used to evaluate the overall model fit. The model predictions were summarized as means and 95% CIs. Our best forecasting model had a mean MSE of 0.53 (95% CI: 0.49 – 0.56). Since May 2021, the overall trend of the reported COVID-19 cases in Ontario closely followed the forecasted cases, about 89% of the reported cases were within 1.5 times the interquartile range (IQR) and all were within the entire range of the distribution of the predictions. Forecasting accuracy also varied by health region characteristics, such a population size and density, remoteness, and reported COVID-19 case volume during the most recent weeks. A near-term prediction of new COVID-19 cases with real-time population-level data could help public health authorities anticipate, plan and monitor disease burden in a population. Such predictions also allow the assessment of population-level health interventions to minimize new COVID-19 cases on a real-time basis and inform prompt decision making. [ABSTRACT FROM AUTHOR]

Summary: Objective: To evaluate the impact of the universal infant hepatitis B vaccination program on hepatitis B virus (HBV) infection in Guangdong Province, China. Methods: In 2006, a serosurvey was conducted in Guangdong Province among children aged <15 years, 14 years after the introduction of universal infant hepatitis B vaccination. The participants were selected by stratified, multi-stage random sampling. Demographic characteristics and hepatitis B vaccination history were collected by a questionnaire and a review of the vaccination records, and serum specimens were tested for hepatitis B surface antigen (HBsAg), antibody to hepatitis B core antigen (anti-HBc), and antibody to hepatitis B surface antigen (anti-HBs) by ELISA. The prevalence rate of HBV serological markers and the rate of immunization coverage in this survey were compared with those of the 1992 and 2002 surveys. Results: A total of 1967 children aged <15 years participated in 2006. The prevalence rate of HBsAg decreased from 19.86% in the 1992 survey to 4.91% in the 2006 survey. The rates of three-dose and timely birth dose coverage of hepatitis B vaccine were 92.40% and 70.84%, respectively, among children born during the period 2002–2005. The prevalence of HBsAg was significantly lower among fully immunized children (1.99%) than among unvaccinated children (5.56%). Conclusions: Guangdong Province has successfully integrated the hepatitis B vaccine into routine immunization programs and this has had a very significant impact on decreasing the HBsAg carrier rate among children. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To evaluate the effect of the universal infant hepatitis B vaccination program on hepatitis B infection in China. Methods: In 2006, a survey was conducted in Shandong Province, China, among children aged 1–14 years, 15 years after the introduction of universal infant hepatitis B vaccination. The subjects were selected by stratified, multi-stage sampling. Vaccination history was obtained by immunization certificate (when available) or parent recall. Hepatitis B surface antigen (HBsAg) and antibodies to HBsAg (anti-HBs) and core antigen (anti-HBc) were detected by ELISA. Hepatitis B infection was defined as the presence of HBsAg and/or anti-HBc. The prevalence rates of HBsAg, anti-HBs and hepatitis B infection obtained in this survey were compared with the results of a survey conducted in 1992 (prior to universal vaccination). Results: A total of 3738 children aged 1–14 years were included in the final analysis. A vaccination coverage rate of 93% was achieved in 2006. The prevalence rates of HBsAg and hepatitis B infection decreased from 8% and 46% in the 1992 survey to 1% and 4%, respectively, in the 2006 survey. Conclusions: Universal hepatitis B vaccination in infants can result in a 90.47% reduction in hepatitis B infection in children aged 1–14 years. [Copyright &y& Elsevier]