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Socio-economic status (SES) disparities exist in the uptake of COVID-19 vaccination; however, most studies were conducted during the initial pandemic wave when vaccination was less discretionary, limiting generalizability. We aimed to determine whether differences in vaccination uptake across SES strata widened after the removal of vaccination-differentiated measures prior to the rollout of the second boosters, in a nationwide cohort of older Singaporeans at higher risk of severe-COVID-19. Retrospective population-based cohort study. Retrospective population-based cohort study of all Singaporeans aged ≥60 years from 22nd February 2021–14th February 2023. Cox regression models controlling for demographics and comorbidities were used to estimate hazard-ratios (HRs) for the uptake of primary vaccination as well as first/second boosters, as recorded in the national vaccination registry, according to SES (housing type). 836,170 individuals were included for completion of a primary vaccine series; 784,938 individuals for completion of the first booster and 734,206 individuals for the completion of the second booster. Differences in vaccination uptake by SES strata were observed (e.g. vaccination uptake in lowest-SES [1–2 room public-housing] versus highest-SES [private housing]: second booster, 47.6% vs. 58.1%; first booster, 93.9% vs. 98.0%). However, relative differences did not markedly widen during second booster rollout when vaccination was more discretionary (e.g. amongst those aged 60–69 years: 0.75 [95% CI = 0.73–0.76] for the first booster; 0.81 [95% CI = 0.79–0.84] for the second booster). While differences in vaccination uptake across SES strata by housing type persisted during the rollout of primary vaccination and subsequent boosters in a nationwide cohort of older Singaporeans, differences did not widen substantially when vaccination was made more discretionary. [ABSTRACT FROM AUTHOR]

The UK implemented a single-dose HPV vaccination policy in September 2023, aiming for sustained protection, better vaccine coverage, and reduced healthcare costs. This research assesses the cost-effectiveness of both one-dose and two-dose schedules from a healthcare perspective. Using an age-structured dynamic model, the study analyzed long-term health and economic outcomes of these two different vaccination approaches. It focused on the effects of vaccinating 12- to 13-year-olds with the 9-valent HPV vaccine in either single-dose or two-dose regimens from 2023 to 2093. The analysis, conducted in 2023–2024, explored different immunity durations (10, 30 years, or lifetime) and efficacy levels for the single-dose strategy. The study indicated that in the UK, vaccinating 12- to 13-year-olds with a two-dose regimen is not considered cost-effective compared to the single-dose option, assumed to be 90% as effective for 10 years. The incremental cost-effectiveness ratios for two doses ranged from £230,903 to £1,082,916 per quality-adjusted life year (QALY), significantly exceeding the UK's £20,000/QALY willingness-to-pay threshold. Over 70 years, a switch from a two-dose to a single-dose vaccination schedule could potentially lead to savings of over £1,073 million in the healthcare system. Furthermore, the single-dose regimen was cost-effective compared to no vaccination, with an incremental cost-effectiveness ratio below £2,040/QALY. The study affirms the cost-effectiveness of the UK's single-dose HPV vaccine, in sync with its September 2023 policy shift. The shift not only provides financial benefits but also simplifies vaccine administration, strategically reducing HPV's epidemiological and economic impacts. [ABSTRACT FROM AUTHOR]

• We report the evaluation of a multicomponent strategy to promote HPV vaccine in schools. • Three interventions were implemented in 32 schools and compared with 32 control schools. • Parents in pilot schools were more likely to vaccinate and less concerned about safety after. • A significant difference in HPV vaccine coverage was observed between pilot and control schools. • Our multicomponent strategy appears effective to enhance HPV acceptability and coverage. Vaccination coverage against human papillomavirus (HPV) in school-based programs in Quebec, Canada, is suboptimal despite more than a decade of introduction. Three interventions to improve HPV vaccine acceptability and coverage in school-based programs were developed, implemented as part of a multicomponent strategy and evaluated. Sixty-four (64) schools were recruited, of which 32 received the interventions (pilot schools), and 32 received usual vaccination activities (control schools). Two approaches were used to assess the impact of the interventions. Pre-post questionnaires were completed by parents in both pilot and control schools. Quantitative analyses of vaccination coverage using the Quebec immunization registry were conducted. Participating parents (n = 989 in the pre-intervention survey and n = 772 in the post-intervention one) were generally aware of HPV and HPV vaccination. Most parents were confident about vaccination, had little or no hesitation and had decided to have their child vaccinated. Parents in the pilot schools were less concerned about vaccine safety than those in the control schools after the interventions. Parents in the pilot schools were also more likely to have decided to have their child vaccinated. A statistically significant difference of 7.4 % in HPV vaccine coverage between pilot and control schools was observed (82.9 % vs 75.5 %, p <0.0001). Although school-based programs offer equitable access to vaccination and minimize access barriers, it remains crucial to identify effective interventions to improve vaccine uptake further and reach the WHO cervical cancer elimination goal. Our multicomponent strategy appears to have positively impacted HPV vaccine acceptability and coverage and could be adapted to other contexts where vaccination is delivered in school-based programs. [ABSTRACT FROM AUTHOR]

The U.S. Virgin Islands (USVI) receives an updated population count once every 10 years and used 2010 decennial census population counts to estimate COVID-19 vaccination coverage during the COVID-19 emergency response. We investigated whether using outdated (2010) or modeled (2020 international database [IDB]) population counts biased vaccination coverage estimates used to inform public health priorities during the 2020–2022 COVID-19 response. We estimated percentage of USVI residents with a completed primary COVID-19 vaccination series during December 16, 2020–September 20, 2022. Vaccination coverage was calculated as number of persons who completed the vaccination series divided by 2010 and 2020 decennial census population counts and 2020 IDB intercensal estimate. COVID-19 vaccination coverage using the 2020 population count was 12 % points higher than coverage using 2010 denominator (2010 denominator: 51 %; 2020 denominator: 63 %). Vaccination coverage estimated using 2020 IDB was approximately equal with the 2010 decennial census estimate (52 %). Using 2010 and modeled population counts underestimated 2020 USVI COVID-19 vaccination coverage given the 18 % population decline during 2010–2020, potentially limiting USVI's ability to assess vaccination progress. Identifying mechanisms for more reliable population enumeration or improved estimate modeling are essential for accurately guiding USVI public health decision-making. [ABSTRACT FROM AUTHOR]

COVID-19 has become widespread in Japanese children. However, the impact of varying immunization coverage on the seroprevalence of SARS-CoV-2 in children is unknown. We examined the SARS-CoV-2 antibody in children aged 0 to 18 who were hospitalized at a university hospital from June 2020 through May 2023. The SARS-CoV-2 anti-nucleoprotein (N) antibody and anti-RBD spike (S) protein antibody was measured. A total of 586 cases were enrolled. The median age was 4 years old (interquartile range 1–9), and 362 (61.8 %) were male. The seroprevalence of anti-S antibodies gradually increased from October 2021 and reached 60 percent by early 2023. The anti-N antibody increased starting in January 2022 and reached 50 percent in May 2023. There was a discrepancy in the seroprevalence of anti-S and N antibodies in children 0 years of age or 12 years and older until the fall of 2022. This discrepancy was minimal for children 1–4 years of age and relatively small in the 5–11-year-old group. The data suggests that approximately half of the children in our cohort had been infected with SARS-CoV-2 by May 2023. The discrepancy in seropositivity between the anti-S and N antibodies corresponded to the reported vaccine uptake of each target age group, which suggested protective effects of immunization. However, this effect appeared to diminish after early 2023. Age dependent discrepancy between SARS-CoV-2 anti-N and anti-S antibody in children reflected differences in vaccine coverage. [ABSTRACT FROM AUTHOR]

To address healthcare disparities among transgender and gender diverse (TGD) adolescents, we examined vaccination coverage in those receiving gender-affirming care. Our study analyzed de-identified data (2013–2022) from a tertiary care clinic. Comparing vaccination rates of 203 TGD adolescent patients to age-matched peers in New York State using CDC National Immunization Survey-Teen data. We found TGD patients had similar vaccination coverage to the general adolescent population. Notably, TGD patients had significantly higher up-to-date human papillomavirus vaccination coverage (76.4%, CI=69.9, 82.0) than the NYS adolescent population (60.5%, CI=53.0, 67.5). This suggests TGD adolescents at gender-affirming clinics maintain or exceed vaccination rates of their cisgender counterparts. Future research should explore vaccination rates for TGD individuals without access to gender-affirming care. [ABSTRACT FROM AUTHOR]

• In Reunion Island, incidence and mortality of cervical cancer are high. • HPV vaccination coverage is low. • HPV genotypes contained in the nonavalent vaccine are more frequent. • Infection with HPV genotypes contained in the vaccine lead to more severe cervical dyplasia. The primary objective of this study was to assess the prevalence and genotypes of human papilloma virus (HPV) in Reunion Island. Study design. In this retrospective study, data were collected from the database of microbiology and anatomopathology laboratories from August 1st 2020 to July 31st 2021. The overall prevalence of human papillomavirus (HPV) in Reunion Island was 14.5 %. The most common HPV genotypes in Reunion Island, were as follows: cluster of HPV 56 + 59 + 66, representing 3.3 % of all samples, cluster of HPV 35 + 39 + 68 (3.2 %), HPV 16 (2.9 %), HPV 33 + 58 (2.3 %) and HPV 52 (2.2 %). HPV types contained in the vaccine accounted for 59.3 % of HPV-positive samples and significantly resulted in more severe cytological lesions compared to HPV types that were not included in the vaccine (p < 0.01). Cervical dysplasia were identified in 57.3 % of HPV-positive cases. Multiple infections were detected in 23.2 % of the cases and were more frequent among younger women (<30 years) and in pathological smears (p < 0.001). In this study, we highlighted that HPV genotypes contained in the vaccine are the most represented in Réunion Island and are the most likely to generate significant cytological abnormalities. Therefore, continuous efforts are necessary to increase HPV vaccination coverage, which is currently in the island among the lowest in developed countries, despite the high mortality rate associated with cervical cancer. Furthermore, considering the inequal offensive capacity of each HPV, identifying patients' HPV infection subtype, could allow customized management and follow-up. [ABSTRACT FROM AUTHOR]

Among people receiving opioid-agonist treatment (OAT), the risk of COVID-19 infection and disease may be higher owing to underlying health problems and vulnerable social circumstances. We aimed to determine whether recent OAT, when compared with past exposure, affected the risk of (i) testing for SARS-CoV-2, (ii) testing positive for SARS-CoV-2, and (iii) being hospitalized or dying with COVID-19 disease. We included individuals prescribed OAT in Scotland from 2015 to 2020. We performed record linkage to SARS-CoV-2 PCR testing, vaccination, hospitalization, and mortality data, and followed up from March 2020 to December 2021. We used proportional hazards analysis and multivariate logistic regression to estimate associations between recent OAT prescription (in the previous 2 months), compared with past exposure (off treatment for over a year), and COVID-19 outcomes. Models were adjusted for confounders. Among 36 093 individuals prescribed OAT, 19 071 (52.9%) were tested for SARS-CoV-2; 2896 (8.3%) tested positive; and 552 (1.5%) were hospitalized or died with COVID-19. Recent OAT, compared with past exposure, was associated with lower odds of testing positive among those tested (aOR, 0.63; 95% CI, 0.57–0.69). However, among those testing positive, recent OAT was associated with two-fold higher odds of hospitalization or death (aOR, 2.04; 95% CI, 1.60–2.59). We found that recent OAT was associated with lower odds of SARS-CoV-2 infection, but with higher odds of disease once diagnosed. Clinical studies are needed to unravel the role of OAT in these associations. An enhanced effort is warranted to increase vaccine coverage among OAT patients to mitigate the severe consequences of COVID-19. [Display omitted] [ABSTRACT FROM AUTHOR]

Vaccine prevention strategies play a crucial role in the management of people living with HIV (PLWH). The aim of this study was to assess vaccination coverage and identify barriers to vaccine uptake in PLWH in the Paris region. A cross-sectional survey was conducted in PLWH in 16 hospitals in the Paris region. The vaccination status, characteristics, opinions, and behaviors of participants were collected using a face-to-face questionnaire and from medical records. A total of 338 PLWH were included (response rate 99.7 %). The median age of participants was 51 years (IQR: 41–58). Vaccination coverage was 77.3 % for hepatitis B (95 % CI: 72.3–81.8 %), 62.7 % for hepatitis A (57.3–67.9 %), 61.2 % for pneumococcal vaccines (55.8–66.5 %), 56.5 % for diphtheria/tetanus/poliomyelitis (DTP) (51.0–61.9 %), 44.7 % for seasonal influenza (39.3–50.1 %), 31.4 % for measles/mumps/rubella (26.4–36.6 %) and 38.5 % for meningococcal vaccine (13.9–68.4 %). The main reason for vaccine reluctance was related to the lack of vaccination proposals/reminders. The overall willingness to get vaccinated was 71.0 % (65.9–75.8 %). In the multivariable analysis, several factors were associated with a higher vaccine uptake; for DTP vaccine: higher education level, having vaccination records, being registered with a general practitioner; for seasonal influenza vaccine: age > 60 years, higher education level, being employed. The overall vaccination coverage was suboptimal. Development of strategies reducing missed opportunity to offer vaccines is needed. [ABSTRACT FROM AUTHOR]

Measles remains a critical public health concern causing significant morbidity and mortality globally. Despite the success of measles vaccination programs, challenges persist, particularly in India. This study investigates dose-wise measles vaccination coverage and explores gaps in immunization focusing on zero-dose, one-dose, and two-dose coverage among children aged 24–35 months. The National Family Health Survey 2019–21 (NFHS-5) served as the data source and the study analyzed information from 43,864 children aged 24–35 months. Sociodemographic variables such as birth order, wealth quintile, gender, social group, religion, residence, mother education, delivery-related factors, and media exposure were considered. Statistical analysis involved weighted estimates, chi-square tests, and multivariate multinomial logistic regression. The study revealed that challenges persist in achieving optimal measles vaccination coverage. Analysis by sociodemographic factors highlighted disparities in coverage, with variations in zero dose prevalence across states and districts. The percentage of zero-dose children was significantly higher, with 11.5% of children in India remaining to receive any measles vaccination. Factors influencing vaccine coverage include birth order, age, wealth quintile, social group, religion, residence, maternal education, place of delivery, media exposure, and mode of delivery. The findings from the spatial analysis show the clustering of zero-dose children is high in the northeastern states of India. Measles zero-dose children pose a significant obstacle to achieving elimination goals. Spatial analysis identifies clusters of unvaccinated populations guiding targeted interventions. The study aligns with global initiatives such as the Immunization Agenda 2030 emphasizing equitable vaccine access and discusses how India can tailor its strategies to achieve the goal. Lessons from polio eradication efforts inform strategies for measles elimination, stressing the importance of high-quality data and surveillance. The study underscores the urgency of addressing last-mile measles vaccination gaps in India. Spatially targeted interventions informed by sociodemographic factors can enhance immunization coverage. Achieving measles elimination requires sustained efforts and leveraging lessons from successful vaccination campaigns. The study findings have the potential to contribute to informed decision-making, supporting India's roadmap for the measles and rubella elimination goal. [ABSTRACT FROM AUTHOR]

This article aims to analyse the evolution of 40 Sustainable Development Goals' (SDGs) health-related indicators in Brazil and Ecuador from 1990 to 2019. Epidemiological study of long-term trends in 40 SDGs' health-related indicators for Brazil and Ecuador from 1990 to 2019, using estimates from the Global Burden of Disease Study. Forty SDGs' health-related indicators and an index from 1990 to 2017 for Brazil and Ecuador, and their projections up to 2030 were extracted from the Institute for Health Metrics and Evaluation's Global Burden of Disease website and analysed. The percent annual change (PC) between 1990 and 2019 was calculated for both countries. Both countries have made progress on child stunting (Brazil: PC = −38%; Ecuador: PC = −43%) and child wasting prevalences (Brazil: PC = −42%; Ecuador: PC = −41%), percent of vaccine coverage (Brazil: PC = +215%; Ecuador: PC = +175%), under-5 (Brazil: PC = −75%; Ecuador: PC = −60%) and neonatal mortality rates (Brazil: PC = −69%; Ecuador: PC = −51%), health worker density per 1000 population (Brazil: PC = +153%; Ecuador: PC = +175%), reduction of neglected diseases prevalences (Brazil: PC = −40%; Ecuador: PC = −58%), tuberculosis (Brazil: PC = −27%; Ecuador: PC = −55%) and malaria incidences (Brazil: PC = −97%; Ecuador: PC = −100%), water, sanitation and hygiene mortality rates (Brazil and Ecuador: PC = −89%). However, both countries did not show sufficient improvement in maternal mortality ratio to meet SDGs targets (Brazil: PC = −37%; Ecuador: PC = −40%). Worsening of indicators were found for violence, such as non-intimate partner violence for both countries (Brazil: PC = +26%; Ecuador: PC = +18%) and suicide mortality rate for Ecuador (PC = +66%), child overweight indicator for Brazil (PC = −67%), disaster mortality rates (Brazil: PC = +100%; Ecuador: PC = +325%) and alcohol consumption (Brazil: PC = +46%; Ecuador: PC = +35%). Significant improvements are necessary in both countries requiring the strengthening of health and other policies, particularly concerning the prevention and management of violence and alcohol consumption, and preparedness for dealing with environmental disasters. [ABSTRACT FROM AUTHOR]

Currently, there is no comprehensive picture of the global surveillance landscape. This survey examines the current state of surveillance systems, levels of integration, barriers and opportunities for the integration of surveillance systems at the country level, and the role of national public health institutes (NPHIs). This was a cross-sectional survey of NPHIs. A web-based survey questionnaire was disseminated to 110 NPHIs in 95 countries between July and August 2022. Data were descriptively analysed, stratified by World Health Organization region, World Bank Income Group, and self-reported Integrated Disease Surveillance (IDS) maturity status. Sixty-five NPHIs responded. Systems exist to monitor notifiable diseases and vaccination coverage, but less so for private, pharmaceutical, and food safety sectors. While Ministries of Health usually lead surveillance, in many countries, NPHIs are also involved. Most countries report having partially developed IDS. Surveillance data are frequently inaccessible to the lead public health agency and seldomly integrated into a national public health surveillance system. Common challenges to establishing IDS include information technology system issues, financial constraints, data sharing and ownership limitations, workforce capacity gaps, and data availability. Public health surveillance systems across the globe, although built on similar principles, are at different levels of maturity but face similar developmental challenges. Leadership, ownership and governance, supporting legal mandates and regulations, as well as adherence to mandates, and enforcement of regulations are critical components of effective surveillance. In many countries, NPHIs play a significant role in integrated disease surveillance. Article in a tweet : Our multicountry survey found disease surveillance systems globally are at different levels of maturity but face similar challenges, for example, in leadership, governance, legal mandates, and resourcing. In many countries, NPHIs play a key role in supporting integrated disease surveillance. [ABSTRACT FROM AUTHOR]

A global shift to bivalent mRNA vaccines is ongoing to counterbalance the diminishing effectiveness of the original monovalent vaccines due to the evolution of SARS-CoV-2 variants, yet substantial variation in the bivalent vaccine effectiveness (VE) exists across studies and a complete picture is lacking. We searched papers evaluating absolute or relative effectiveness of SARS-CoV-2 BA.1 type or BA.4/5 type bivalent mRNA vaccines on eight publication databases published from September 1st, 2022, to November 8th, 2023. Pooled VE against Omicron-associated infection and severe events (hospitalization and/or death) was estimated in reference to unvaccinated, ≥2 original monovalent doses, and ≥ 3 original monovalent doses. From 630 citations identified, 28 studies were included, involving 55,393,303 individuals. Bivalent boosters demonstrated higher effectiveness against symptomatic or any infection for all ages combined, with an absolute VE of 53.5 % (95 % CI: –22.2–82.3 %) when compared to unvaccinated and relative VE of 30.8 % (95 % CI: 22.5–38.2 %) and 28.4 % (95 % CI: 10.2–42.9 %) when compared to ≥ 2 and ≥ 3 original monovalent doses, respectively. The corresponding VE estimates for adults ≥ 60 years old were 22.5 % (95 % CI: 16.8–39.8 %), 31.4 % (95 % CI: 27.7–35.0 %), and 30.6 % (95 % CI: −13.2–57.5 %). Pooled bivalent VE estimates against severe events were higher, 72.9 % (95 % CI: 60.5–82.4 %), 57.6 % (95 % CI: 42.4–68.8 %), and 62.1 % (95 % CI: 54.6–68.3 %) for all ages, and 72.0 % (95 % CI: 51.4–83.9 %), 63.4 % (95 % CI: 41.0–77.3 %), and 60.7 % (95 % CI: 52.4–67.6 %) for adults ≥ 60 years old, compared to unvaccinated, ≥2 original monovalent doses, and ≥ 3 original monovalent doses, respectively. The bivalent boosters demonstrated superior protection against severe outcomes than the original monovalent boosters across age groups, highlighting the critical need for improving vaccine coverage, especially among the vulnerable older subpopulation. [ABSTRACT FROM AUTHOR]

The persistence of varicella outbreaks in Brazil has underscored the high concern with the low vaccine coverage in the last 4 years. Using publicly available data from the Brazilian Health System (SUS), this study analyzed varicella vaccine coverage and incidence trends from 2019 to 2022 in Brazilian States. Vaccine coverage decreased nationally in 2020, possibly influenced by the COVID-19 pandemic's initial phase. In Bahia State, we have the persistence of varicella with an incidence rate of 3.0 cases per 100,000 inhabitants (higher incidence compared to other States) in 2023. Under 15 months children and young children (4–6 Years old) faced the highest risk, urging the importance of vaccination. Despite a monovalent varicella vaccine being available through Brazil's National Immunization Program (NIP), Bahia fell short of achieving the ≥95 % disease control target for coverage. The study highlight the importance of vaccines to prevent some infectious diseases, as varicella, in poor tropical regions. Addressing vaccine hesitancy and misinformation, and augmenting awareness campaigns, are important to achieve and sustain high vaccine coverage over 80% as WHO guidelines to obtain a safe rate of protection for Brazilian population (Brazil's national immunization program has a target of 95% coverage). [ABSTRACT FROM AUTHOR]

• Despite a very high COVID-19 population-level vaccine effectiveness in 2022, its reduction in the order of 6–8 % in the subsequent year was likely caused by a very low (<10 %) vaccine uptake, leading to a significant upturn in COVID-19 hospitalizations and mortality in the first half of 2023. • Almost 600 lives could have been saved and over 800 hospitalizations avoided had the 2022 vaccination level continued in the first half of 2023. • COVID-19 burden could have also been considerably lower had the vaccination started three months earlier, thus avoiding over 92,000 lives and 277,000 hospitalizations between the start of the epidemic and June 2023. To estimate the number of avoidable COVID-19 deaths and hospitalizations in Brazil. Secondary data on COVID-19 deaths and hospitalizations were related to two measures of cumulative vaccine coverage (in the last six months and before this period) by negative binomial regression to estimate population-level protective effectiveness (PLPE) against severe disease. The latter includes the overall protective effect of all COVID-19-preventive measures, such as direct and indirect vaccine effectiveness, social distancing, and lockdown, but only the vaccine coverage data were available for the regression analysis. COVID-19 mortality rates per 100,000 inhabitants were 10.26, 16.45, 0.14, and 0.94, for the years 2020, 2021, 2022, and the first half of 2023. In the same order and scale, COVID-19 hospitalization rates were 28.96, 47.04, 0.40, and 3.74. Both hospitalizations and deaths peaked early in 2021, then sharply reduced by the end of the year as the first-dose vaccine coverage reached 90 %, and rose with the vaccine coverage within the last six months falling below 10 % in 2023. PLPE for preventing COVID-19 deaths was 19.9 %, 98.9 %, and 93.1 % for the years 2021, 2022, and the first half of 2023. Had Brazil vaccinated the same number of people against COVID-19 in the last quarter of 2020 as it did in the first quarter of 2021, over 117,000 deaths and 277,000 hospitalizations could have been avoided over the period analyzed. PLPE reduction in 2023 was likely caused by low vaccine uptake. The disease burden could have been much lower had the vaccination started earlier and had the vaccine uptake not dropped so sharply in 2023. [ABSTRACT FROM AUTHOR]

• Vaccine Pass policy was associated with reduced COVID-19 vaccine hesitancy and associated with increased vaccine uptake. • Various significant psychosocial factors were identified to influence COVID-19 vaccine uptake. • Vaccine uptake in older adults was increased by a greater extent after introduction of the Vaccine Pass policy. Recognising the importance of attaining high vaccine coverage to mitigate the COVID-19 impact, a Vaccine Pass scheme was implemented during and after the first large Omicron wave with high mortality in older ages in Hong Kong in early 2022 requiring three doses by June 2022. We did not identify any studies evaluating the policy impact of vaccination mandates with vaccine uptake over whole policy period of time in a Chinese population. We aim to evaluate the impact of the Vaccine Pass policy on COVID-19 vaccine uptake in adults in a Chinese population in Hong Kong. We analysed patterns in vaccine uptake and hesitancy using local data from population vaccine registry and 32 cross-sectional telephone surveys conducted from October 2021 to December 2022. The association of Vaccine Pass phases with vaccine uptake was examined using logistic regression analyses, taking into account covariates including self-risk perception, perceived self-efficacy in preventing COVID-19 and trust in government in pandemic control as well as physical distancing measures and demographics. The uptake of primary series and third doses was positively significantly associated with the successive stages of Vaccine Pass implementation (adjusted odds ratios ranged from 2.41 to 7.81). Other statistically significant drivers of uptake included age group, chronic condition, higher perceived personal susceptibility to COVID-19, higher trust in government, and higher educational attainment. Vaccine uptake in older adults was observed to have increased by a greater extent after the policy annoucement and implementation, under the contextual changes during and after a large Omicron wave with high mortality in Hong Kong in early 2022. Since the policy withdrawal the uptake of further booster doses has been very low in all ages. We suggest that improving voluntary booster uptake in older adults should be prioritized. [ABSTRACT FROM AUTHOR]

• Religion significantly related to COVID-19 vaccine uptake. • Church of England affiliation linked to higher rates of vaccination. • Lower uptake among Pentecostals, Muslims and Roman Catholics. • Religion needs to be considered in public health strategy. • Approaches need to be tailored for diverse religious groups. While many countries have successfully deployed COVID-19 vaccination programmes, there are disparities in their uptake. One factor influencing vaccine coverage is religion. Existing research has found a link between religious beliefs and vaccine hesitancy. This study looks at religion in England to examine its relationship with public health. This analysis used data from a survey of over 12,000 respondents in England, conducted through the YouGov Online Panel. Respondents were asked whether they identified with a religion, and if so which, and the number of COVID-19 vaccinations they had received. We employed logistic regressions to analyse the data, accounting for age, gender, education, generalised trust, trust in government, and political ideology. We find that respondents who identify as part of the Church of England have had significantly more COVID-19 vaccinations. Conversely, adherents to the Pentecostal Evangelical and Islamic faiths have had significantly fewer COVID-19 vaccinations. These relationships hold even when adjusting for age, education, level of trust, and political affiliation. This research indicates a potential influence of religious affiliation on vaccine uptake, highlighting the need for more carefully-tailored public health programmes. Recognizing the diverse associations of different religious affiliations on health behaviour is important for shaping future vaccination campaigns and policy interventions. Engaging with religious communities and leaders may be one method through which to deal with vaccine hesitancy and improve public health. [ABSTRACT FROM AUTHOR]

In October 2023, the Tel Aviv District was notified of ten cases of measles. The outbreak initiated in a preschool with high vaccination coverage with one dose of MMR vaccine. Serological testing was available for eight patients (six children and two adults). Among the six children vaccinated with one dose of MMR vaccine, primary vaccine failure was demonstrated. Among the adults, secondary vaccine failure was confirmed. The outbreak was successfully contained due to a combination of factors, notably its occurrence within a population characterized by high vaccination coverage in Tel Aviv, during a period of restricted public interactions due to the prevailing state of war in the country. Despite challenging wartime conditions, effective prophylactic measures were promptly executed, encompassing a 2-dose MMR vaccination schedule for close contacts and the broader community of children in the TA district, successfully curbing the outbreak and preventing widespread infections. [ABSTRACT FROM AUTHOR]

• In the United States (US), COVID-19 vaccination rates among non-US-born individuals are variable, but understanding them is critical to identifying disparities. • Among over 1.5 million patients eligible for COVID-19 vaccination at 4 health systems across the US, completion of the primary vaccination series was lower in patients with a language preference other than English (62.7 %) compared with English preferring patients (63.6 %). • Though completion of the primary series was higher for non-US-born persons compared with US born persons, completion of a booster dose was lower for non-US-born persons, refugees, and patients with language preference other than English compared with their counterparts. • Requirements for COVID-19 primary vaccination for entry into the US may have played a role in the higher completion of primary COVID-19 series vaccines among refugee, immigrant and migrant populations. • The lower rate of booster uptake among newcomer populations is worthy of further attention. In the United States (US), COVID-19 vaccination rates among non-US-born individuals (i.e., refugees, immigrants, and migrants [RIM]) are variable. Understanding baseline COVID-19 vaccine coverage among these populations and determining if disparities exist is essential for quality improvement initiatives and public health interventions. Baseline COVID-19 vaccination rates for both primary series and booster doses were calculated at four health systems located in Minnesota, Colorado, and Pennsylvania participating in the Minnesota Department of Health's Center of Excellence in Newcomer Health. Patients aged ≥5 years as of 1/1/22, seen for ≥1 primary care visit during 7/1/2019–6/30/22 were included. Descriptive statistics were calculated for three measures of COVID-19 vaccine coverage during 12/14/2020–6/30/2022: 1) initiation of primary series; 2) completion of primary series; 3) completion of first booster. We calculated vaccine coverage rates for the entire population and stratified by subgroup including country of origin, refugee status, and primary language preference. We included 1,624,573 patients eligible for COVID-19 primary series vaccine and 907,749 eligible for COVID-19 booster vaccination. The percent of eligible patients who completed a COVID-19 primary series (63.4 %) and booster dose (66.2 %) were similar. Completion of the primary series was higher for non-US-born persons (72.7 %) compared with US born persons (65.4 %), similar among refugees (63.5 %) and non-refugees (63.4 %), and lower in patients with language preference other than English (62.7 %) compared with English preferring patients (63.6 %). Booster completion was lower for non-US-born persons (61.8 %), refugees (46.7 %), and patients with language preference other than English (55.3 %) compared with US-born (70 %), non-refugees (66.3 %), and English preferring patients (67.3 %) respectively. This evaluation identified disparities in COVID-19 vaccination rates among non-US-born persons and persons with a language preference other than English living in the US. Targeted outreach efforts may be beneficial in reaching these populations. [ABSTRACT FROM AUTHOR]

• Coverage of measles and pertussis childhood vaccines in Norway vary by parental immigrant background. • East-European background was often associated with relatively low and recently declining coverage of both vaccines. • Somali background was associated with relatively low coverage of measles vaccine, but not of pertussis vaccine. • Mother's length of residency was positively associated with coverage among children of East-European or Vietnamese background. The Norwegian Childhood Immunization Program maintains a high national coverage of 95–97% in the most recent years. Whether there are subgroups with lower uptake is less studied. This study examines pertussis and measles vaccination coverage among six immigrant groups in Norway. These vaccines are normally administered as part of different combination vaccines and their coverage rate indicate the national vaccination coverage against a range of additional infections. Data from the Norwegian National Population Register were linked at individual level with vaccination data from the Norwegian Immunisation Registry. The final sample consisted of 53,052 children born during 2000–2018 in Norway to parents who were born in Iraq, Lithuania, Pakistan, Poland, Somalia, or Vietnam. Vaccination coverage was measured at 2-years of age. Multivariate linear regression was utilized to estimate the relationship between vaccinations status, year of birth, gender, mother's length of residency in Norway, and area of residence. At two years of age, the majority of the children were vaccinated. Coverage among the groups varied at, above, and below the national average for the two vaccines. For most of the years examined, children born by parents from Lithuania, Poland, and Somalia had lower coverage for the measles vaccine (range 81–84% in 2020) than the national level (97% in 2020). Children born by parents from the Eastern-European countries also had lower coverage than the national level for the pertussis vaccine (range 87–89% in 2020). This study illustrates how subgroups with lower vaccination coverage may exists within a well-established vaccination program with high national coverages. Differences in coverage were found for both vaccines, but the differences were more pronounced for the measles vaccine. The high vaccination coverage in Norway provides indirect protection through herd immunity for unvaccinated individuals, however, the lower vaccination coverage in some immigrant groups is a concern. [ABSTRACT FROM AUTHOR]

Healthcare workers are more likely to contract measles than the general population. Our study aimed to assess measles vaccination and immunization levels among nurses, examine the influencing factors and implement an intervention program to increase immunization coverage. Our study was conducted in a university hospital in Türkiye. The study included 1012 nurses. It was an intervention study, continued between 01/11/2021 and 30/10/2023. Measles IgG and vaccination status of the participants were evaluated. Participants with negative measles IgG results who had not been vaccinated against measles or received a single dose of the vaccine were invited to the outpatient clinic to receive two doses. Participants who had received two doses of the measles vaccine and had negative measles IgG results were invited to the outpatient clinic for one dose of the measles vaccine. Nine hundred seventy-eight people participated in our study. The access frequency was 96.6%. Among the participants aged 21–30, 68.4 % were Measles IgG (+). Measles IgG (+) prevalence was higher in women than men (85.3 % vs. 61.0 %). The department with the lowest measles IgG positivity was intensive care (75.8 %). Measles IgG (+) prevalence became higher as the duration of employment increased. The measles seropositivity in total population rose from 83.1 % before the intervention to 94.3 % after, to 91.8 % in the 21–30 age group, and to 90.2 % in male. Sixteen people had never received measles vaccination. Of the 37 participants who had previously received two doses of measles vaccine, 22 received a single dose and after the intervention 16 (72.7 %) were positive. Only 1 person was found to have vaccine refusal during the intervention. Expanding the immunization scope in hospitals by screening for measles antibodies among healthcare personnel and vaccinating those who are seronegative can be considered an effective public health strategy. [ABSTRACT FROM AUTHOR]

The vaccine coverage against human papillomavirus (HPV) vaccination remains low in France. The objective of this study was to study adolescent perceptions by comparing boys and girls, in order to build effective school-based interventions. This paper presents a cross-sectional study in French middle school pupils. They completed online questionnaires on their knowledge and attitudes toward the HPV vaccine, HPV vaccination status, their intention, reasons to vaccinate or not to vaccinate, and psychological antecedents of vaccination. A structural equation modeling (SEM) analysis was used to test the hypothesized model. The participants are 818 pupils aged from 12 to 16 years (M age = 13.78). Most pupils were in the pre-contemplative stage (62.7 % of boys and 40.8 % of girls). SEM analysis indicated that the relationship between the level of HPV knowledge, the representations of vaccines in general, and vaccine intention was mediated by attitudes towards the HPV vaccine among both boys and girls. These findings reveal a high percentage of boys who do not feel concerned by the HPV vaccine and highlight the need to consider the psychological antecedents of vaccination in general in addition to the specific attitudes to the HPV vaccine. [ABSTRACT FROM AUTHOR]

There has been increasing recognition of vaccine access challenges in middle-income countries and the need for increased action, particularly in countries that are not eligible for or have transitioned out of Gavi, the Vaccine Alliance support. These countries' immunization systems are more vulnerable than ever as the COVID-19 pandemic exacerbates existing programme challenges, increasing the risk of delayed vaccine introductions, backsliding immunization coverage rates, and increased coverage inequity. The potential health and equity impact of improving immunization outcomes in middle-income countries is substantial. Modelling suggests that the introduction of pneumococcal conjugate vaccine and vaccines for rotavirus and human papillomavirus in this set of Gavi-transitioned and non-Gavieligible middle-income countries in 2020 could have saved an estimated 70,000 lives if 90 % coverage had been reached. Further, increasing coverage for already-introduced vaccines to 90 % could have saved an additional estimated 16,000 lives. Over the past decade, stakeholders have made considerable efforts to identify immunization challenges in middle-income countries as documented in the 2015 SAGE-endorsed Shared Partner Middle-Income Country Strategy. In the coming decade, new global platforms like Gavi 5.0 and the Immunization Agenda 2030 provide opportunities to align on MIC strategies and provide coordinated global support to middle-income countries. The international COVID-19 pandemic response has the potential to lay the foundation for long term support beyond the scope of COVID-19 to non-Gavi eligible middle-income countries. Meanwhile regional mechanisms to address immunization barriers in middle-income countries have grown in number and strength, offering sustainable platforms for cross-country collaboration and the provision of tailored technical support. To ensure that these opportunities are successfully acted upon and that middle-income countries achieve the Immunization Agenda 2030 goals, comprehensive, multi-stakeholder consultations were conducted to identify areas of action with the greatest potential to accelerate immunization progress. Stakeholders should work together to put these findings, highlighted in this paper, into action, adapting their approaches to specific country contexts and learning from and building on existing efforts. [ABSTRACT FROM AUTHOR]

The Immunization Agenda 2030 (IA2030) Impact Goal 1.1. aims to reduce the number of future deaths averted through immunization in the next decade. To estimate the potential impact of the aspirational coverage targets for IA2030, we developed an analytical framework and estimated the number of deaths averted due to an ambitious vaccination coverage scenario from 2021 to 2030 in 194 countries. A demographic model was used to determine annual age-specific mortality estimates associated with vaccine coverage rates. For ten pathogens (Hepatitis B virus, Haemophilus influenzae type B, human papillomavirus, Japanese encephalitis, measles, Neisseria meningitidis serogroup A, Streptococcus pneumoniae, rotavirus, rubella, yellow fever), we derived single measures of country-, age-, and pathogen-specific relative risk of deaths conditional upon coverage rates, leveraging the data from 18 modeling groups as part of the Vaccine Impact Model Consortium (VIMC) for 110 countries. We used a logistic regression model to extrapolate the relative risk estimates to countries that were not modeled by VIMC. For four pathogens (diphtheria, tetanus, pertussis and tuberculosis), we used estimates from the Global Burden of Disease 2019 study and existing literature on vaccine efficacy. A future scenario defining years of vaccine introduction and scale-up needed to reach aspirational targets was developed as an input to estimate the long-term impact of vaccination taking place from 2021 to 2030. Overall, an estimated 51.5 million (95 % CI: 44.0–63.2) deaths are expected to be averted due to vaccinations administered between the years 2021 and 2030. With immunization coverage projected to increase over 2021–2030 an average of 5.2 million per year (4.4–6.3) deaths will be averted annually, with 4.4 million (3.9–5.1) deaths be averted for the year 2021, gradually rising to 5.8 million (4.9–7.5) deaths averted in 2030. The largest proportion of deaths is attributed to Measles and Hepatitis B accounting for 18.8 million (17.8–20.0) and 14.0 million (11.5–16.9) of total deaths averted respectively. The results from this global analysis demonstrate the substantial potential mortality reductions achievable if the IA2030 targets are met by 2030. Deaths caused by vaccine preventable diseases disproportionately affect LMICs in the African region. [ABSTRACT FROM AUTHOR]

Attention to gender-related issues in immunization programmes goes beyond focusing on coverage discrepancies between girls and boys. There are multiple ways in which gender roles, norms and relations influence resource allocation, decision making, access, and health outcomes, including for immunization programmes. Gender impacts immunization both on the demand side through people's health seeking behaviours, and the supply side through provision of health services. To increase immunization coverage, and in particular to reach zero-dose children, it is necessary to understand and address the many ways in which gender interacts with additional socio-economic, geographic and cultural factors -- such as age, race/ethnicity, religion, marital status, education, wealth, sexual orientation and gender identity, HIV status, disability and migration status -- to influence access to and delivery of vaccines. The Immunization Agenda 2030 (IA2030) commits to addressing gender-related barriers to immunization and advancing gender equality and gender is an important cross-cutting consideration for all seven IA2030 strategic priorities. Gender-responsive strategies are particularly highlighted as an IA2030 key area of focus for Strategic Priority 3: Coverage & Equity. Gender-related barriers and gender inequality can prevent people, both male and female and those of diverse gender identities, from getting vaccinated. These operate at multiple levels from the individual and family/household to community and within institutions/systems and national policies/frameworks and are underpinned by power relations leading to different opportunities, limitations, challenges, needs and vulnerabilities, especially for women and girls. By applying knowledge about gender and taking action to design gender-responsive interventions, it is possible to implement more effective immunization programmes and increase coverage for all. [ABSTRACT FROM AUTHOR]

Gains in immunization coverage and delivery of primary health care service have stagnated in recent years. Remaining gaps in service coverage reflect multiple underlying reasons that may be amenable to improved health system design. Immunization systems and other primary health care services can be mutually supportive, for improved service delivery and for strengthening of Universal Health Coverage. Improvements require that dynamic and multi-faceted barriers and risks be addressed. These include workforce availability, quality data systems and use, leadership and management that is innovative, flexible, data driven and responsive to local needs. Concurrently, improvements in procurement, supply chain, logistics and delivery systems, and integrated monitoring of vaccine coverage and epidemiological disease surveillance with laboratory systems, and vaccine safety will be needed to support community engagement and drive prioritized actions and communication. Finally, political will and sustained resource commitment with transparent accountability mechanisms are required. The experience of the impact of COVID-19 pandemic on essential PHC services and the challenges of vaccine roll-out affords an opportunity to apply lessons learned in order to enhance vaccine services integrated with strong primary health care services and universal health coverage across the life course. [ABSTRACT FROM AUTHOR]

• Lack of expertise, integrating policy recommendations, and visibility were challenges. • Collaboration, linkages to policymakers, and effective communication were opportunities. • Optimizing the Regional NITAG Network is one of the most promising ways forward. Following the COVID-19 pandemic, the Americas faced a significant decline in vaccination coverage as well as increased vaccine hesitancy. The objective of this paper is to summarize the challenges and opportunities outlined by the National Immunization Technical Advisory Groups (NITAGs) in Latin America and the Caribbean (LAC) and prioritize targeted interventions. The exploratory survey included open-ended questions on two primary components: challenges, and opportunities. Free-text comments presented by each NITAG were collated and classified using indicators and sub-indicators of the NITAG Maturity Assessment Tool (NMAT). Opportunities were classified thematically, and priority actions were generated from the responses. All 21 NITAGs in LAC, representing 40 countries, 76 % of which have been active for over a decade, responded to the survey. The most common challenges were establishment and composition (62 %), integration into policymaking (62 %), resources and secretariat (52 %), and stakeholder recognition (48 %). The distribution of responses was seen across the whole sample and did not suggest a more pronounced need in relation to year of establishment. Opportunities included maximizing the Regional NITAG Network of the Americas (RNA) to facilitate collaboration, information sharing, visibility, and communication; existing global, regional, and systemic analyses; the World Health Organization/Pan American Health Organization (WHO/PAHO) templates for standard operating procedures; twinning programs with mature NITAGs; and NITAGs in governance structures. Action plans were outlined to formalize the establishment of NITAGs and broaden their composition; strengthen decision-making and access to data resources; and enhance the credibility of evidence-based recommendations and their uptake by policymakers and the public. NITAG challenges are not unique to LAC. NITAGs have outlined a short-term prioritized action plan which is critical to enhancing NITAG value and importance in countries. [ABSTRACT FROM AUTHOR]

• Estimates incidence of COVID-19 infection, hospitalization, & deaths in Japan. • Examines potential impact of Fall 2023 COVID-19 vaccine on clinical outcomes. • Target population for COVID-19 vaccination is adults ≥18 years in Japan. • Fall 2023 vaccine may reduce COVID-19 infections, hospitalizations, & deaths. The study objective was to estimate the incidence of COVID-19 infection, hospitalization, and deaths in Japan from September 2023 to August 2024 and potential impact of a monovalent XBB.1.5 variant–adapted Fall 2023 COVID-19 vaccine (modified version: XBB monovalent) for adults aged ≥18 years on these outcomes. A previously developed Susceptible-Exposed-Infected-Recovered model for the United States (US) was adapted to Japan. The numbers of symptomatic infections, COVID-19–related hospitalizations, and deaths were calculated. Given differences in vaccination coverage, masking practices and social mixing patterns between the US and Japan, all inputs were updated to reflect the Japanese context. Vaccine effectiveness (VE) values are hypothetical, but predicted based on existing VE values of bivalent BA.4/BA.5 boosters against BA.4/BA.5 in Japan, from the VERSUS test-negative case-control study. Sensitivity analyses were performed. The base case model predicts overall that there will be approximately 35.2 million symptomatic COVID-19 infections, 690,000 hospitalizations, and 62,000 deaths in Japan between September 2023 and August 2024. If an updated COVID-19 vaccine is offered to all adults aged 18 years and older in Fall 2023, the model predicts that 7.3 million infections, 275,000 hospitalizations and 26,000 deaths will be prevented. If vaccines are only given to those aged 65 years and older, only 2.9 million infections, 180,000 hospitalizations and 19,000 deaths will be prevented. Sensitivity analysis results suggest that hospitalizations and deaths prevented are most sensitive to initial VE against infection and hospitalizations, and the waning rate associated with VE against infection. Symptomatic infections prevented was most sensitive to initial VE against infection and VE waning. Results suggest that a Fall 2023 COVID-19 vaccine would reduce total numbers of COVID-19–related infections, hospitalizations, and deaths. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic changed the setting of education for many children in the U.S. Understanding COVID-19 vaccination coverage by educational setting is important for developing targeted messages, increasing parents' confidence in COVID-19 vaccines, and protecting all children from severe effects of COVID-19 infection. Using data from the Household Pulse Survey (n = 25,173) collected from December 9–19, 2022, January 4–16, 2023, and February 1–13, 2023, this study assessed factors associated with COVID-19 vaccination and reasons for non-vaccination among school-aged children 5–11 and adolescents 12–17 by educational setting. Among children 5–11 years, COVID-19 vaccination coverage was higher among those who received in-person instruction (53.7%) compared to those who were homeschooled (32.5%). Furthermore, among adolescents 12–17 years, COVID-19 vaccination coverage was higher among those who received in-person instruction (73.5%) or virtual/online instruction (70.1%) compared to those who were homeschooled (51.0%). Children and adolescents were more likely to be vaccinated if the parental respondent had been vaccinated compared to those who had not. Among children and adolescents who were homeschooled, main reasons for non-vaccination were concern about side effects (45.4–51.6%), lack of trust in COVID-19 vaccines (45.0–50.9%), and lack of trust in the government (32.7–39.2%). Children and adolescents who were home-schooled during the pandemic had lower vaccination coverage than those who attended school in person, and adolescents who were home-schooled had lower vaccination coverage than those who received virtual instruction. Based on the reasons for non-vaccination identified in this study, increasing parental confidence in vaccines, and reducing barriers to access are important for supporting COVID-19 vaccination for school-age children. [ABSTRACT FROM AUTHOR]

Refugees and migrants (R&Ms) exhibited higher risk of COVID-19 infection, and higher mortality rates during the pandemic. Acknowledging these risks, R&Ms early in the pandemic were identified by WHO as a priority vaccination group in need of protection. The aim of this study was to assess the vaccination roll-out and uptake among R&Ms residing in Reception Identification Centers (RICs) and Reception Sites (RSs) in Greece, relative to the general population. Nationwide observational study. Retrospective analysis of national vaccination routine data and population census data, collected and triangulated from multiple official/governmental sources. Weekly vaccine roll-out and uptake were calculated for the general Greek population and the R&M population, through the first year of the vaccination programme in Greece (December 2020–December 2021). Vaccine roll-out among migrants in RICs/RSs started with a 22-week delay, compared to the general population. By the end of the first year of the vaccination programme in Greece in December 2021, the national vaccination uptake among registered R&Ms residing in official reception facilities was 27.3 % for 1st dose and 4.7 % for booster dose; considerably lower compared to the general population (69.5 % uptake for 1st dose, 64.7 % for 2nd dose, and 32.0 % for 3rd dose). Delayed vaccine roll-out and low vaccine uptake among R&Ms in Greece are signs of low prioritisation and implementation failures in the R&M vaccination strategy. In face of future public health threats, lessons should be learned, and vaccine equity should be insured for all socially vulnerable and high-risk population groups. [ABSTRACT FROM AUTHOR]

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• Gaps in knowledge about the role of HPV in head and neck cancers and anal cancers, • Most of health students would recommend the HPV vaccine to friends and relatives. • Positive attitudes were more frequent in medical/pharmacy versus nursing students. • After adjustment, educational health program didn't remain associated with attitudes. Despite documented effectiveness in preventing several cancers, genital warts and safety of Human Papillomavirus (HPV) vaccine, immunization coverage among French adolescents remains far from the 80 % target. University health students (HS) in France may promote HPV vaccine through a national service (Service Sanitaire des Etudiants en Santé). We aimed to evaluate intentions to recommend the HPV vaccine to friends and relatives, to receive HPV vaccine, and to identify factors associated with these attitudes. We conducted a cross-sectional survey in five French Universities from October 2019 to February 2020, using a self-administered online questionnaire. We used bivariable and multivariable logistic regression models to identify determinants of behavior around HPV vaccine: (i) individual intention for vaccination, and (ii) vaccine recommendation to friends and relatives. Among the 732 respondents (180 men, 552 women), 305 (41.7%) reported previous HPV vaccination (54.5 % among women), 504 (68.9%) would recommend the HPV vaccine to friends and relatives, 532 (72.7%) respondents would be vaccinated today if it was recommended for them. Intentions to recommend or to receive the HPV vaccine were less frequent in nursing students compared to medical and pharmacy students. After adjustment for demographical factors, HPV vaccine knowledge was associated with intention [aOR 1.30 (95%-confidence interval, 1.15–1.47)] and recommendation [1.26 (1.10–1.45)], respectively. Additionally, adjusting for knowledge about HPV infections, and confidence in vaccines in general was associated with vaccine intention [1.55, (1.30–1.84)] and recommendation [1.52 (1.24–1.86)]. HPV-vaccinated HS were more prone to recommend the HPV vaccine to friends and relatives [10.9 (6.6–17.9)]. A majority of HS would accept and/or recommend HPV vaccines. HS with greater knowledge about the HPV vaccine were more prone to recommend it. Strengthening knowledge about HPV and its vaccination is probably necessary before their Involvement in a HPV immunization program. [ABSTRACT FROM AUTHOR]

COVID-19 seriously impacted routine immunization (RI) in Iraq. Coverage declined to a 6-year low in 2021, and COVID-19 vaccination uptake was slow. In response, government implemented intensification of integrated immunization services (3IS), a nationwide approach comprising regular outreach sessions of COVID-19 vaccination and RI for children who had either missed doses or never commenced scheduled vaccination (zero-dose children). We describe the 3IS and its impact on vaccination coverage in Iraq. 3IS comprised new outreach sessions for urban and rural communities where administrative data suggested there were gaps in coverage. Groups of six personnel from each of 1,321 primary healthcare centres implemented six outreach sessions per month during February-November 2022. Community engagement was an integral component. We compared RI administrative data (2019–2022) and data reported during 3IS activities to assess its impact. In total 4,189,859 vaccine doses were administered during 72,495 3IS outreach sessions, over one-fifth of 19,106,849 vaccine doses administered in Iraq over these 10 months. Among them, 957,874 (22.9 %) were COVID-19 vaccines, adding slightly to national coverage, and 3,231,985 (77.1 %) were RI vaccines, dramatically reducing zero-dose children, adding 18 %, 25 %, 21 %, and 31 % to 2022 penta1, penta3, measles first-dose and MMR1 vaccine coverage, and contributing to national coverage of 102.2 %, 94.5 %, 91.8 % and 96.3 % for these vaccines during February-November, respectively. Moreover, 3IS sessions delivered 133,528 doses of tetanus toxoid, 16,353 doses of adult HepB vaccine, and 315,032 vitamin A doses to eligible individuals. In the context of global encouragement to integrate vaccination services, Iraq's 3IS approach enabled dramatic improvements in RI coverage, virtual elimination of zero-dose status among children born during the pandemic, and small improvements in COVID-19 and adult vaccination. Our findings provide lessons for future integrated primary care towards universal health coverage in Iraq, and for other countries yet to undertake integration. [ABSTRACT FROM AUTHOR]

Ghana witnessed an outbreak of measles in 2022 following the COVID-19 pandemic, and Savannah Region was among the regions severely impacted. The objective of this study was to conduct trend analysis of measles case incidence and measles-rubella (MR) vaccination coverage in the Savannah Region to identify gaps and propose remedial actions to mitigate future outbreaks of vaccine preventable diseases (VPDs). Analysis of measles surveillance and measles-rubella vaccination data for 2018–2022 was conducted to assess relationship between immunization coverage and measles case incidence. Data were extracted from the District Health Information Management System (DHIMS) platform and loaded into Microsoft Excel 16.0 spreadsheet for analysis. Coverages for first (MR1) and second (MR2) doses of measles-rubella vaccination, dropout rates, and measles incidence (per 100,000) were calculated. The coverage trend for both vaccine doses followed similar trajectories, increasing from 2018 to a peak in 2019, and declining sequentially thereafter to the lowest (for the study period) in 2022. Generally, MR1/MR2 dropout rate was high across all districts during the entire study period. The regional incidence of confirmed measles rose sharply from less than 1/1,000,000 in 2018–2021 to 94 in 2022. Wide variations in vaccination coverage and dropout rates were observed among the districts. There was moderate to fairly strong negative correlation between MR vaccination coverage and measles case incidence. The MR vaccination coverage in the Savannah Region declined probably due to pre-existing weaknesses in the immunization programme accentuated by impact of the COVID-19 pandemic. The lowered population immunity likely contributed to occurrence of the measles outbreak in 2022. Pragmatic actions are needed to catch-up on missed children, restore coverage to pre-pandemic levels, and strengthen the immunization programme as part of global efforts towards achieving the Immunization Agenda 2030 (IA2030) trajectory. [ABSTRACT FROM AUTHOR]

• In 2022, a case of paralytic polio in an unvaccinated adult resident of Rockland County was confirmed. • In the US, detection of a single case of polio represents a public health emergency. • We assessed the cost of provider outreach and immunization record assessments of licensed childcare and Head Start facilities aimed at preventing future outbreaks of VPDs. • Total public health labor cost incurred of activities was approximately $139,000. In 1994, the World Health Organization Region of the Americas was declared polio-free. In July 2022, a confirmed case of paralytic polio in an unvaccinated adult resident of Rockland County, New York was reported by the New York State Department of Health (NYSDOH) and Rockland County Department of Health (RCDOH). While only one case was identified, a single case of paralytic polio represents a public health emergency in the United States. The patient's county of residence was identified to have low vaccination coverage indicating that the community was at risk for additional cases. Disease outbreaks are resource-intensive and incur high costs to the patient, local health departments, and to society. These costs are potentially avoidable for vaccine-preventable diseases and thus, highlight the urgency to not only interrupt transmission but to prevent future vaccine-preventable disease outbreaks by improving vaccination coverage. Following case confirmation, an investigation and response was initiated by NYSDOH, along with local health departments and the Centers for Disease Control and Prevention (CDC). After the initial investigation and response, collaborative efforts to mitigate risk and strengthen routine immunization continued, which included provider outreach and immunization record assessments of Head Start and licensed childcare facilities (primarily those with missing or incomplete required vaccination coverage reports from the previous year) in Rockland County. We estimated the costs of (1) provider outreach and (2) childcare and pre-kindergarten immunization record assessments of select licensed childcare and Head Start facilities in Rockland County. The total labor cost incurred for these activities was $138,514 with a total of 2,555 h incurred. Often there are unique opportunities in the midst of an outbreak for public health to implement activities to proactively address low vaccination and strengthen vaccination coverage and possibly prevent future outbreaks. Understanding the cost of these activities might help inform future outbreak planning. [ABSTRACT FROM AUTHOR]

Influenza vaccination is recommended and provided free-of-charge to Danish citizens aged ≥65 years and to individuals with acquired immunodeficiency. We aimed to estimate influenza vaccination coverage and investigate predictors of influenza non-vaccination in Danish cancer patients. A nationwide cohort study of all Danish citizens aged ≥18 years with an incident cancer diagnosis between 2002 and 2017. Using national registries, we assessed information on influenza vaccination and potential predictors of influenza non-vaccination. We estimated adjusted prevalence ratios (aPR) of influenza non-vaccination for patients aged <65 years and ≥65 years. We observed 269,863 patients during 840,876 influenza vaccination seasons. The influenza vaccination coverage was 14 % for cancer patients <65 years and 51 % for those ≥65 years. No influenza vaccination in the previous season was associated with non-vaccination in the current season (<65 years: aPR = 2.75, 95 %CI = 2.71–2.80; ≥65 years: aPR = 5.15, 95 %CI = 5.10–5.21). Haematological cancer patients receiving chemotherapy had lower vaccination prevalence compared with those not receiving chemotherapy. The influenza vaccination coverage was low among cancer patients. Influenza non-vaccination in the previous season was the strongest predictor of not receiving influenza vaccination in the current season. Haematological cancer patients on current chemotherapy had lower vaccination prevalence than those not currently receiving chemotherapy. [ABSTRACT FROM AUTHOR]

Vaccination against measles is one of the most effective public health interventions which has saved millions of lives and interrupted circulation of the natural virus in the population. However, it is widely accepted that the immunity after vaccination can wane, especially in those who have had no contact with the virus. This study aimed to classify the particular birth cohorts of adults with regard to their exposure to the wild measles virus in the population with a long history of mandatory vaccination. We introduced two methods. In the first, we estimated the probability of exposure to the wild virus through an analysis of antibody levels from the Immunologic Survey performed in the Slovak Republic in 2018, while the second was based on historical epidemiological data. Both methods resulted in similar estimations. Cohorts born in Slovakia before 1964 can be considered to be cohorts in which most people were exposed to the wild measles virus. Cohorts born after 1977 can be designated as cohorts that most likely did not come into the contact with the wild virus. Cohorts born between 1965 and 1976 are composed of a mixture, with a decreasing proportion of people exposed to the wild virus with increasing year of birth. The proposed methods can help identify potential immunity gaps in the adult population. They can be applied in other countries with high measles vaccination coverage to estimate the probability of exposure to the wild measles virus in particular birth cohorts. [ABSTRACT FROM AUTHOR]

• Issues on Dengvaxia resulted in decline in children's vaccination. • Mostly women, those in rural areas, and those with low income held negative perceptions. • Majority of the information on Dengvaxia came from media sources, particularly television. • Information from health professionals protect against negative vaccine perception. • Inadequate functional health literacy is a risk for negative vaccination perception. Issues that arose from the Dengvaxia vaccination program in the Philippines in 2017 were followed by a remarkable decline in immunization coverage in the country. This study intended to describe the Filipinos' perceptions about vaccination after hearing about the Dengvaxia vaccine and the vaccination program and determine its potential relationship with selected demographic factors and other variables such as: health literacy, sources of information on Dengvaxia, information heard about the vaccine, healthcare visits, and perceived health status. The study utilized secondary data derived from a national health literacy survey in the Philippines. A total of 1992 respondents were included in the analysis. Majority were females, had reached college, residing in urban areas, and were unemployed. Most obtained information about Dengvaxia from media, particularly the television and heard that it caused death and prevents dengue. Seventy-one per cent had negative vaccination perception upon obtaining information about Dengvaxia. Sex, residence type, and income were found to be associated with vaccination perception. Females and those living in rural areas were more likely to have a negative vaccination perception while those with the highest income were less likely to have negative vaccination perception. Respondents who heard that Dengvaxia prevents dengue, those who obtained Dengvaxia information from health professionals, and those who visited both public and private health facilities in the last 12 months were less likely to have negative vaccination perception. On the other hand, those with inadequate functional health literacy were more likely to have negative vaccination perception. The study presents the implications of information heard about Dengvaxia on Filipinos' perception on vaccination through selected variables and other factors. The findings are important in designing strategies in communicating health information, building public trust, and in reinforcing policies to improve vaccination uptake. [ABSTRACT FROM AUTHOR]

• Adherence to the recommended schedule increased from 2011 to 2021 (56.4% to 70.6%) • Adherence to the alternative schedule decreased from 2011 to 2021 (28.2% to 15.1%). • Not being up-to-date decreased from 2011 to 2021 (40.3% to 33.3%). • Adherence decreased among children 19–23 months in 2021 compared to 2020. • Disparities persist by age group, race/ethnicity, and poverty status. Being up-to-date with all recommended vaccines is needed to protect children from vaccine preventable diseases. Understanding vaccination patterns is needed to develop messaging and strategies to increase vaccination uptake and confidence. Data from the 2011 to 2021 National Immunization Surveys was used to assess trends and disparities in vaccination patterns, zero vaccination status, and up-to-date status of U.S. children by 19–35 months. From 2011 to 2021, adherence to the recommended schedule using the stringent definition increased from 35.7 % to 52.2 % (p < 0.01), adherence to the alternate schedule decreased from 28.2 % to 15.1 % (p < 0.01), and proportion of children who were not up-to-date decreased from 49.0 % to 33.3 % (p < 0.01). However, the proportion of children who had zero vaccinations did not change from 2011 (0.9 %) to 2021 (0.9 %; p = 0.08). In 2021, children 19–23 months were less likely to follow the recommended schedule than children 24–29 months (49.2 % compared to 56.4 %, p < 0.01). Adherence to the recommended schedule among children 19–23 months decreased in 2021 compared to 2020 overall and for some subpopulations (e.g. those with non-Hispanic (NH) Black parents (33.2 % compared to 44.9 %, p < 0.01). Furthermore, it was lowest among children of NH Black parents living at or below the federal poverty level (31.2 %) compared to their respective NH White counterparts (43.6 %, p < 0.01). While there were overall increases in adherence to the recommended schedule from 2011 to 2021, a sustained catch-up program is needed to prevent missed vaccinations and achieve equitable vaccination coverage for all children. [ABSTRACT FROM AUTHOR]

Botswana had a resurgent diarrhea outbreak in 2018, mainly affecting children under five years old. Botswana introduced rotavirus vaccine (RotarixTM) into the national immunization programme in July 2012. Official rotavirus vaccine coverage estimates averaged 77.2% over the five years following introduction. The outbreak was investigated using multiple data sources, including stool laboratory testing, immunization data review, water assessment, and vaccine storage assessment. We reviewed official reports of the routine immunization data from 2013 to 2017 and compared district-level rotavirus vaccine coverage with district-level attack rates during the outbreak. During the outbreak, a total of 228 stool samples were tested at the national health laboratory and 152 (67%) of the specimens were positive for rotavirus. A portion of adequate samples (80) were selected for referral to the Regional Reference Lab. The laboratory testing of 80 samples at the Regional Reference Laboratory in South Africa showed that 91% of the stool samples were positive for rotavirus, and the dominant strain 47/80 (58.7%) was G3P[8]. The immunization data showed that rotavirus vaccine coverage varied widely among districts, and there was no correlation between districts with high attack rates and those with low immunization coverage. Water assessment showed that some water sources were contaminated with E Coli. There was no problem with vaccine storage. The outbreak was caused by rotavirus G3P[8], a strain that was not common in the country prior to the outbreak. Despite the significant pressure and anxiety that outbreaks cause, the number of diarrhea cases and deaths were less compared to pre-vaccine era due to the impact of vaccination. This highlights the need for continuous implementation of high impact child survival interventions. [ABSTRACT FROM AUTHOR]

Aotearoa New Zealand implemented a Covid-19 elimination strategy in 2020 and 2021, which enabled a large majority of the population to be vaccinated before being exposed to the virus. This strategy delivered one of the lowest pandemic mortality rates in the world. However, quantitative estimates of the population-level health benefits of vaccination are lacking. Here, we use a validated mathematical model of Covid-19 in New Zealand to investigate counterfactual scenarios with differing levels of vaccine coverage in different age and ethnicity groups. The model builds on earlier research by adding age- and time-dependent case ascertainment, the effect of antiviral medications, improved hospitalisation rate estimates, and the impact of relaxing control measures. The model was used for scenario analysis and policy advice for the New Zealand Government in 2022 and 2023. We compare the number of Covid-19 hospitalisations, deaths, and years of life lost in each counterfactual scenario to a baseline scenario that is fitted to epidemiological data between January 2022 and June 2023. Our results estimate that vaccines saved 6650 (95% credible interval [4424, 10180]) lives, and prevented 74500 [51000, 115400] years of life lost and 45100 [34400, 55600] hospitalisations during this 18-month period. Making the same comparison before the benefit of antiviral medications is accounted for, the estimated number of lives saved by vaccines increases to 7604 [5080, 11942]. Due to inequities in the vaccine rollout, vaccination rates among Māori were lower than in people of European ethnicity. Our results show that, if vaccination rates had been equitable, an estimated 11%–26% of the 292 Māori Covid-19 deaths that were recorded in this time period could have been prevented. We conclude that Covid-19 vaccination greatly reduced health burden in New Zealand and that equity needs to be a key focus of future vaccination programmes. [ABSTRACT FROM AUTHOR]

• Vaccine microarray patches have the potential for broad utility across various health and non-health settings, may extend the cadre of individuals capable of administering vaccines, and could enable new vaccine delivery channels. • Use cases help define priority target populations that can be reached with a new vaccine presentation most effectively and highlight the most relevant delivery strategies and their implications on health systems. • The potential for broad use of vaccine microarray patches suggests a sizeable market for these new products. • The use cases for vaccine microarray patches highlight critical product attributes that enable the novel vaccine presentation to provide public health value, which can help optimize clinical development and inform target product profiles. • Broad adoption of vaccine microarray patches will require supportive vaccine policy changes to enable the administration of vaccines by new cadres of health-workers and to improve access to vaccines in hard-to-reach communities. As an innovative vaccine delivery technology, vaccine microarray patches could have a meaningful impact on routine immunization coverage in low- and middle-income countries, and vaccine deployment during epidemics and pandemics. This review of the potential use cases for a subset of vaccine microarray patches in various stages of clinical development, including measles-rubella, measles-mumps-rubella, and typhoid conjugate, highlights the breadth of their applicability to support immunization service delivery and their potential scope of utilization within national immunization programs. Definition and assessment of the use cases for this novel vaccine presentation provide important insights for vaccine developers and policymakers into the strengths of the public health and commercial value propositions, and the preparatory requirements for public health systems for the future rollout of vaccine microarray patches. An in-depth understanding of use cases for vaccine microarray patches serves as a foundational input to overcoming the remaining technical, regulatory, and financial challenges. Additional efforts will help to realize the potential of vaccine microarray patches as part of the global effort to improve the coverage and equity of national immunization programs. [ABSTRACT FROM AUTHOR]

• Health on Wheels (HoW) increased access to COVID-19 vaccination in rural Guatemala. • 1st, 2nd, and 3rd dose administration was over 2 times higher in intervened communities. • 1st, 2nd, and 3rd dose administration increased by 20 % post intervention. • The increase in 1st and 2nd dose administration was higher in communities with vaccine hesitancy. In April 2022, after a year of COVID-19 vaccination, there were large differences in coverage between urban and rural areas in Guatemala. To address barriers in rural communities, the "Health on Wheels" (HoW) strategy was implemented. The strategy deployed mobile brigades with a dedicated team of health workers and a culturally sensitive health promotion plan in selected communities in 15 districts in Alta Verapaz, a health area with low COVID-19 vaccination uptake and a high-level of COVID-19 vaccine hesitancy. This study evaluates the impact of the HoW strategy. We measured the relative increase in COVID-19 doses administered prior and during the HoW implementation period in the 190 intervened communities and compared to 188 communities without the intervention. Communities were grouped by health district and the impact analyses were stratified by number of COVID-19 vaccine dose (1st, 2nd, and 3rd doses) and history of vaccine hesitancy. The increase in 1st, 2nd, and 3rd dose-COVID-19 vaccination coverage between before and during HoW implementation was 2.4, 2.2 and 2.6 times higher in intervened communities (20 %, 21 % and 37 % increase in 1st, 2nd and 3rd dose, respectively) than in non-intervened communities (8 %, 10 % and 14 % increase in 1st, 2nd and 3rd dose respectively). For the 1st dose, increase in dose administration was 2.9 times higher in intervened communities (n = 24) with hesitancy (24 % increase) compared to non-intervened communities (n = 188) without hesitancy (8 % increase). The deployment of mobile brigades with a dedicated team of vaccinators and culturally sensitive health promotion through the HoW strategy successfully accelerated the increase in COVID-19 vaccination coverage in rural communities in Guatemala. [ABSTRACT FROM AUTHOR]

Pneumococcal Diseases (PDs) remains a serious public health problem around the world and in China. Pneumococcal vaccination is the most cost-effective measure to prevent PDs. In 2021, the government of Weifang City, Shandong Province, China introduced a free dose of domestic 13-valent Pneumococcal Conjugate Vaccine (PCV 13) to vaccinate registered children aged 6 months–2 years. This study aimed to evaluate the vaccination rate of PCV13 in children aged under 5 years before and after the vaccination program to provide evidences for further improving the prevention and control strategy for PDs. We collected data from the children's vaccination information management system in Weifang City and analyzed the PCV13 vaccination coverage and characteristics in all vaccination clinics of Weifang City for children aged under 5 years. We compared the differences in vaccination rates by gender, birth year, manufacturer, and county before and after innovative immunization strategy. Among the included 593,784 children aged under 5 years, the PCV13 vaccination rate in Weifang was generally low before the innovative immunization strategy. Urban children had a higher PCV13 coverage than rural children (P < 0.001), and parents tended to vaccinate their children with imported PCV13.The full vaccination rate for domestic and imported PCV13 was 0.67 % and 1.70 %, respectively. After the vaccination program, the PCV13 coverage of children increased significantly in all counties within Weifang City (P < 0.001), especially for children above 12 months of age. Most parents preferred to vaccinate their children with domestic PCV13, and the full vaccination rate of domestic and imported PCV13 was 6.59 % and 0.16 %, respectively. The vaccination rate of PCV13 in children is still much lower than the global average, posting a severe health challenge that needs to be addressed thoroughly. To improve the prevention and control strategy for PDs, it is recommended to continue to explore other relevant incentives based on the innovative immunization strategy. Furthermore, it is also recommended that China should incorporate PCV13 into the National Immunization Programs (NIP) as soon as possible. [ABSTRACT FROM AUTHOR]

• Boot Camp Translation was studied for promoting rural adolescent vaccination. • Rural counties were randomized in a study conducted during the COVID pandemic. • 11–12-year-old vaccination decreased slightly; 13–17-year old coverage increased. • Vaccination outcomes did not differ between intervention and control counties. • Effect of BCT on vaccination is difficult to know due to influence of the pandemic. Routine vaccination coverage for adolescents living in the rural US is lower than adolescents living in urban areas. We sought to measure the effect of Boot Camp Translation (BCT), a community-based participatory intervention, on rural adolescent vaccination coverage. A cluster randomized controlled trial was performed September 2018-November 2021 involving 16 rural Colorado counties. Intervention county community members engaged in BCT to develop interventions to improve adolescent vaccination locally. Adolescent vaccination coverage was measured using the Colorado Immunization Information System. For 11–12-year-olds, HPV initiation, HPV up-to-date, MenACWY, and Tdap vaccination coverage was lower post- versus pre-intervention in the control and intervention groups. For 11–12-year-olds in the intervention group, there was no significant difference post- versus pre-intervention in the odds of HPV vaccine initiation (adjusted ratio of odds ratios [aROR] = 0.93, 95 %: 0.85–1.02, p = 0.10) or up-to-date HPV vaccination (aROR: 1.10, 95 % CI: 0.98–1.23, p = 0.11) compared with the control group. Among 11–12-year-olds, the decrease in the proportion vaccinated with MenACWY and Tdap in the intervention group was significantly greater than the control group. Among 13–17-year-olds, there were significant increases in HPV initiation, HPV up-to-date, MenACWY, and Tdap vaccination coverage from pre- to post-intervention for both groups, with no significant differences between groups. 11–12-year-old vaccination coverage decreased slightly from pre- to post-intervention while 13–17-year-old vaccination coverage increased. We saw no effect from the BCT intervention. Our findings about the effectiveness of BCT for improving vaccine uptake may not be generalizable because the study coincided with the COVID-19 pandemic. Clinical Trial Registry: This study was registered with ClinicalTrials.gov , NCT03955757. [ABSTRACT FROM AUTHOR]

• We surveyed 2,712 people in Canada following COVID-19 vaccine mandates in 2021. • Perceiving COVID-19 as less serious predicted reporting a mostly unvaccinated social circle. • Risk perception was a more powerful predictor than sociodemographic variables. • Risk perception may be a key indicator of social networks with lower intervention uptake. • Identifying high risk social circles has utility for outreach design and health system readiness. Social networks have an important impact on our health behaviours, including vaccination. People's vaccination beliefs tend to mirror those of their social network. As social networks are homogenous in many ways, we sought to determine in the context of COVID-19 which factors were most predictive of belonging to a mostly vaccinated or unvaccinated social group. We conducted a cross-sectional survey among Canadian residents in November and December 2021. Participants were asked about the vaccination status of their social networks their beliefs relating to COVID-19, and various sociodemographic factors. Respondents were split into three groups based on social network vaccination: low-, medium-, and high-risk. Chi-squared tests tested associations between factors and risk groups, and an ordinal logistic model was created to determine their direction and strength. Most respondents (81.1 %) were classified as low risk (i.e., a mostly vaccinated social network) and few respondents (3.7 %) were classified as high-risk (i.e., an unvaccinated social group). Both the chi-square test (29.2 % difference between the low- and high- risk groups [1.8 % vs. 31.0 %], p < 0.001) and the ordinal logistic model (odds ratio between the low- and high-risk groups: 14.45, p < 0.01) found that respondents' perceptions of COVID-19 as a "not at all serious" risk to Canadians was the most powerful predictor of belonging to a predominantly unvaccinated social circle. The model also found that those in mostly unvaccinated social circles also more often reported severe COVID-19 symptoms (odds ratio between the low- and high-risk groups: 2.26, p < 0.05). Perception of COVID-19 as a threat to others may signal communities with lower vaccination coverage and higher risk of severe outcomes. This may have implications for strategies to improve public outreach, messaging, and planning for downstream consequences of low intervention uptake. [ABSTRACT FROM AUTHOR]

Delays in achieving polio eradication have led to ongoing risks of poliovirus importations that may cause outbreaks in polio-free countries. Because of the low, but non-zero risk of paralysis with oral poliovirus vaccines (OPVs), countries that achieve and maintain high national routine immunization coverage have increasingly shifted to exclusive use of inactivated poliovirus vaccine (IPV) for all preventive immunizations. However, immunization coverage within countries varies, with under-vaccinated subpopulations potentially able to sustain transmission of imported polioviruses and experience local outbreaks. Due to its cost, ease-of-use, and ability to induce mucosal immunity, using OPV as an outbreak control measure offers a more cost-effective option in countries in which OPV remains in use. However, recent polio outbreaks in IPV-only countries raise questions about whether and when IPV use for outbreak response may fail to stop poliovirus transmission and what consequences may follow from using OPV for outbreak response in these countries. We systematically reviewed the literature to identify modeling studies that explored the use of IPV for outbreak response in IPV-only countries. In addition, applying a model of the 2022 type 2 poliovirus outbreak in New York, we characterized the implications of using different OPV formulations for outbreak response instead of IPV. We also explored the hypothetical scenario of the same outbreak except for type 1 poliovirus instead of type 2. We find that using IPV for outbreak response will likely only stop outbreaks for polioviruses of relatively low transmission potential in countries with very high overall immunization coverage, seasonal transmission dynamics, and only if IPV immunization interventions reach some unvaccinated individuals. Using OPV for outbreak response in IPV-only countries poses substantial risks and challenges that require careful consideration, but may represent an option to consider for some outbreaks in some populations depending on the properties of the available vaccines and coverage attainable. [ABSTRACT FROM AUTHOR]

Pakistan still has ongoing transmission of wild type polio virus. This study aims to determine changes in full vaccination with recommended Expanded Program on Immunization vaccines, including polio, by several socio-economic and demographic factors. We used three waves of Pakistan's Demographic and Health Survey, a population-based cross-sectional study from 2006–07 (N = 1471), 2012–13 (N = 1706), and 2017–18 (N = 1549), analyzed by residence, wealth, and sociodemographic factors. Analysis was limited to children aged 12–23 months in Punjab, Sindh, Northwest Frontier Province/Khyber Pakhtunkhwa and Balochistan. Full vaccination was measured as receipt of one Bacillus Calmette–Guérin dose, one measles dose, 3 polio doses, and 3 Diphtheria-Tetanus-Pertussis doses. Odds ratios (ORs) and 95 % confidence intervals (CIs) from logistic regression were used to determine associations between undervaccination and demographic variables. Full vaccination coverage was 50.6 % in 2006–07, 54.7 % in 2012–13, and 68.3 % in 2017–18. In 2006–07, the odds of undervaccination were significantly higher in Sindh (OR: 1.74, 95 % CI: 1.30, 2.31) than Punjab, and disparities across province changed over time (P < 0.0001); notably, undervaccination was significantly higher in Sindh, KPK, and Balochistan than Punjab in 2017. Compared to the middle wealth quintile, the poorest had significantly higher odds of undervaccination in 2006–07 (OR: 2.58, 95 % CI: 1.76, 3.78), and this did not significantly change over time (P = 0.2168). The proportion of those with a polio birth dose increased across waves from 56.3 % in 2006–07 to 83.7 % in 2017–18; receiving three or more polio vaccine doses remained unchanged. This study showed that the proportion of fully vaccinated children in Pakistan increased across three waves. Full vaccination and administration of polio vaccine birth doses have increased recently in Pakistan. The association between undervaccination with province differed significantly across the waves, with vaccination disparities between provinces increasing. Those in the poorest wealth quintile had the greatest odds of undervaccination. [ABSTRACT FROM AUTHOR]

Socioeconomic inequalities have played a significant role in the unequal coverage of the COVID-19 vaccine. The objectives of this study were to (1) assess the socioeconomic inequalities in COVID-19 vaccination coverage in Catalonia, Spain; (2) analyse the spatial variation over time of these inequalities; and (3) assess variations in time and space in the effect of vaccination on inequalities in COVID-19 outcomes. A mixed longitudinal ecological study design was used. Catalonia is divided in to 373 Basic Health Areas. Weekly data from these Basic Health Areas were obtained from the last week of December 2020 until the first week of March of 2022. A joint spatio-temporal model was used with the dependent variables of vaccination and COVID-19 outcomes, which were estimated using a Bayesian approach. The study controlled for observed confounders, unobserved heterogeneity, and spatial and temporal dependencies. The study allowed the effect of the explanatory variables on the dependent variables to vary in space and in time. Areas with lower socioeconomic level were those with the lowest vaccination rates and the highest risk of COVID-19 outcomes. In general, individuals in areas that were located in the upper two quartiles of average net income per person and in the lower two quartiles of unemployment rate (i.e., the least economically disadvantaged) had a higher propensity to be vaccinated than those in the most economically disadvantaged areas. In the same sense, the greater the percentage of the population aged ≥65 years, the higher the propensity to be vaccinated, while areas located in the two upper quartiles of population density and areas with a high percentage of poor housing had a lower propensity to be vaccinated. Higher vaccination rates reduced the risk of COVID-19 outcomes, while COVID-19 outcomes did not influence the propensity to be vaccinated. The effects of the explanatory variables were not the same in all areas or between the different waves of the pandemic, and clusters of excess risk of low vaccination in the most disadvantaged areas were detected. COVID-19 vaccination inequalities in the most disadvantaged areas could be a result of structural barriers, such as the lack of access to information about the vaccination process, and/or logistical challenges, such as the lack of transportation, limited Internet access or difficulty in scheduling appointments. Public health strategies should be developed to mitigate these barriers and reduce vaccination inequalities. [ABSTRACT FROM AUTHOR]

Nursing home residents have been disproportionately affected by the COVID-19 pandemic. Despite recognition as a priority group for receipt of the COVID-19 vaccine, vaccine uptake and COVID-19 cases, hospitalizations, and deaths in nursing home facilities were variable across nursing homes. This study has 2 objectives: (1) to describe nursing facility characteristics associated with higher vs lower vaccination rates and (2) to estimate facility characteristics associated with COVID-19 cases, hospitalizations, and deaths, stratified by vaccination rate. Cross-sectional study. Facility-level data from 12,811 US nursing home facilities. Using the CMS's Nursing Home COVID-19 Public File, we analyzed nursing home COVID-19 vaccination rates and outcomes from June 13, 2021, to September 19, 2021. We performed multivariable logistic regressions and identified facility characteristics associated with increased vaccination uptake and COVID-19 outcomes. Nursing homes with average vaccination rates ≤80% experienced higher total average COVID-19 cases, hospitalizations, and deaths compared to facilities with >80% average vaccination rates during the Delta surge. Moreover, facility factors, such as higher average age of residents, proportion of non-white residents, nurse staffing hours, and occupancy rates, were variably associated with increased risk of COVID-19 outcomes. Facilities with higher resident vaccination rates experienced lower average COVID-19 cases, hospitalizations, and deaths in US nursing homes. Access to vaccines may play a role in mitigating harm associated with infectious diseases. Additionally, facility factors associated with increased adverse outcomes were variably associated with increased odds of COVID-19 outcomes, often, irrespective of vaccination level. As the COVID-19 pandemic continues to evolve and as the possibility of other infectious disease variants emerge, this research provides insight into facility factors, including vaccine uptake, that may mitigate adverse outcomes. [ABSTRACT FROM AUTHOR]