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The World Health Organization has recently updated their dosing schedule recommendations for the human papillomavirus (HPV) vaccine to include a single-dose schedule. We review the biologic plausibility of a single dose, the evidence from clinical trials, post-licensure observational studies, and mathematical modeling for a single-dose schedule. We also discuss the implications of countries switching to a single-dose program from a two or three-dose schedule. Finally, we review the countries that have currently switched to or introduced the vaccine with a single-dose schedule. [ABSTRACT FROM AUTHOR]

Dear Editor, The Universal Immunisation Programme (UIP) in India was launched in 1978 by the Government of India in collaboration with the World Health Organisation (WHO). The main objective of the programme is to provide free vaccination services to children and pregnant women. Over time, the programme has expanded and evolved to incorporate many vaccines against preventable diseases. Vaccines such as Diphtheria, Pertussis (whooping cough), Tetanus (DPwT), Pentavalent, Inactivated Polio Vaccine (IPV) and Pneumococcal Conjugate Vaccine (PCV) are well known for their post-vaccination fever

Abstract Background While overall COVID-19 vaccine uptake is high in the Netherlands, it lags behind in certain subpopulations. Aim We aimed to explore the characteristics of groups with lower COVID-19 vaccine uptake at neighbourhood level to inform the strategy to improve uptake and guide research into barriers for vaccination. Methods We performed an ecological study using national vaccination register and socio-demographic data at neighbourhood level. Using univariate and multivariable generalized additive models we examined the (potentially non-linear) effect of each determinant on uptake. We focused on those aged 50 years and older, since they are at highest risk of severe disease. Results In those over 50 years of age, a higher proportion of individuals with a non-Western migration background and higher voting proportions for right-wing Christian and conservative political parties were at neighbourhood level univariately associated with lower COVID-19 vaccine uptake. In contrast, higher socioeconomic status and higher voting proportions for right-wing liberal, progressive liberal and Christian middle political parties were associated with higher uptake. Multivariable results differed from univariate results in that a higher voting proportion for progressive left-wing political parties was also associated with higher uptake. In addition, with regard to migration background only a Turkish background remained significant. Conclusion We identified determinants associated with COVID-19 vaccine uptake at neighbourhood level and observed heterogeneity in uptake between different subpopulations. Since the goal of vaccination is not only to reduce suffering and death by improving the average uptake, but also to reduce health inequity, it is important to focus on subpopulations with lower uptake.

Vaccinations for seasonal influenza and pertussis have been recommended for pregnant women in England since 2010 and 2012, respectively. Uptake rates are suboptimal with large regional variations. To improve uptake, from 2016 onwards maternity trusts were commissioned to offer pertussis (and other) vaccinations in addition to these being available in primary care. Since 2021, Covid-19 vaccination has also been recommended for pregnant women. Overall maternal vaccination rates are routinely available, but not the relative provision by maternity trusts. We aimed to describe the national picture of maternity trust provision of maternal vaccinations, including how the maternity trust vaccination programme has progressed. Cross-sectional survey plus comparisons with 2017–18 figures for maternity trust provision of pertussis vaccination, and with UKHSA data for total pertussis vaccination. Twelve NHS commissioners participated (from 13/06/22 to 31/03/23) providing data for 120 (of a total 124) maternity trusts across England. All 120 (100%) trusts were commissioned to deliver influenza, and 107 (89%) to deliver pertussis vaccinations, though not all actually administered the vaccines; 29% offered Covid-19 vaccinations. For 2021–22 we found a mean of 25% (range 0–81.3%) women were vaccinated for pertussis (a large increase compared with previous estimates for 2017–18); and 11% (range 0–74.2%) for influenza, via their maternity trust. Commissioners reported a negative impact of the pandemic on routine vaccination provision. There was indication of efficiency by vaccinating women attending for other appointments. There are diverse mechanisms for reporting pertussis and influenza vaccinations administered at maternity trusts back to primary care, which may be inefficient for maternity staff workload and accuracy of data transfer (especially for pertussis). A high proportion of maternity trusts provide both pertussis and influenza vaccinations, despite a negative impact of the pandemic. Reasons for large between-trust variation in vaccination rates should be explored to improve uptake and equity. [ABSTRACT FROM AUTHOR]

Background: Seasonal influenza is a significant cause of mortality and morbidity worldwide. Despite annual recommendations, influenza vaccination uptake rates are disproportionately lower among nurses compared to other health care professionals, especially when compared to physicians. Nurses have an additional risk of exposure to influenza infection due to the nature of their work. Aim: To determine the effectiveness of interventions in increasing seasonal influenza vaccination uptake among nurses Methods: Evidence on the effectiveness of interventions to improve seasonal influenza vaccination uptake among nurses was systematically reviewed. A comprehensive search of six electronic databases and grey literature was undertaken. A minimum of two reviewers completed study selection, data extraction and risk of bias assessment independently. Results: One hundred and thirty-four studies were identified of which one cluster randomised trial met the inclusion criteria. The results of the included study found the implementation of an intervention with multiple components increased nurses' seasonal influenza vaccination rates during a single influenza season in geriatric healthcare settings in France. As the evidence in this review was very limited, it was not possible to make recommendations regarding which interventions were effective at increasing the seasonal influenza vaccination rate for nurses. Conclusion: This systematic review highlights a lack of high-quality studies that assessed interventions to improve the seasonal influenza vaccination of nurses. In view of the likelihood of influenza and the coronavirus (COVID-19) pandemic occurring together, it is imperative to have evidence on effective interventions for the nursing workforce and for policy decision makers. [ABSTRACT FROM AUTHOR]

Background: While overall COVID-19 vaccine uptake is high in the Netherlands, it lags behind in certain subpopulations. Aim: We aimed to explore the characteristics of groups with lower COVID-19 vaccine uptake at neighbourhood level to inform the strategy to improve uptake and guide research into barriers for vaccination. Methods: We performed an ecological study using national vaccination register and socio-demographic data at neighbourhood level. Using univariate and multivariable generalized additive models we examined the (potentially non-linear) effect of each determinant on uptake. We focused on those aged 50 years and older, since they are at highest risk of severe disease. Results: In those over 50 years of age, a higher proportion of individuals with a non-Western migration background and higher voting proportions for right-wing Christian and conservative political parties were at neighbourhood level univariately associated with lower COVID-19 vaccine uptake. In contrast, higher socioeconomic status and higher voting proportions for right-wing liberal, progressive liberal and Christian middle political parties were associated with higher uptake. Multivariable results differed from univariate results in that a higher voting proportion for progressive left-wing political parties was also associated with higher uptake. In addition, with regard to migration background only a Turkish background remained significant. Conclusion: We identified determinants associated with COVID-19 vaccine uptake at neighbourhood level and observed heterogeneity in uptake between different subpopulations. Since the goal of vaccination is not only to reduce suffering and death by improving the average uptake, but also to reduce health inequity, it is important to focus on subpopulations with lower uptake. [ABSTRACT FROM AUTHOR]

By September 2022, the uptake of at least one dose of COVID-19 vaccine in the Dutch adult population was 84%. Ecological studies have indicated a lower uptake in certain population groups. We aimed to investigate determinants of COVID-19 vaccine uptake in the Netherlands at individual level to evaluate and optimize implementation of the vaccination program and generate hypotheses for research on drivers of, and barriers to, vaccination. A retrospective database study was performed including the entire Dutch population ≥ 18. Vaccination data (5 January 2021–18 November 2021) were at individual levels linked to sociodemographic data. Random forest analyses ranked sociodemographic determinants of COVID-19 vaccine uptake. The most important determinant was age; uptake increased until the age of 80 (67% in 18–35 years, 92% in 67–79 years, and 88% in those > 80). Personal income and socioeconomic position ranked second and third, followed by migration status. Uptake was lower among individuals in the lowest income group (69%), those receiving social benefits (56%), and individuals with two parents born abroad (59%). Our finding that age is the most important determinant for uptake likely reflects the prioritisation of elderly in the programme and the general understanding of their increased vulnerability. However, our findings also reveal important other disparities in vaccine uptake. How to best address this inequity in future vaccination campaigns requires further research. [ABSTRACT FROM AUTHOR]

Objective: Despite the Global Vaccine Action Plan's goal of at least 90% vaccine coverage for all children, Uganda has made limited progress in vaccination over the past decade. The objective of this study was to examine the subnational trends in the prevalence and inequalities in under-immunisation and zero-dose among children aged 12-23 months in Uganda., Study Design: A retrospective national cross-sectional study., Setting: Uganda PARTICIPANTS: Uganda Demographic and Health Survey secondary data of only children aged 12-23 months. The samples selected for analyses were 1507 in 2006, 1409 in 2011 and 2650 children in 2016., Outcome Measure: The primary outcomes were under-immunisation and zero-dose vaccination.Absolute and relative inequality measures were used in the analysis., Results: From 2006 to 2016, the under-vaccination rate decreased by 21%, but remained high at 40.8%. The zero-dose vaccination rate dropped by 82%, affecting 1.2% of children in 2016. Subnational inequalities in under-vaccination increased over time with widening gaps between regions. While inequalities across wealth quintiles, maternal education levels and places of residence narrowed, children of mothers with lower education levels continued to have the highest under-vaccination rates. The rural-urban gap for zero-dose vaccination remained unchanged, with rural children disproportionately impacted., Conclusion: While some progress was made in reducing under-vaccination rates in Uganda within the study period, no region achieved an under-vaccination rate below 20%. This indicates significant challenges in reaching the Sustainable Development Goal target of at least 80% immunisation coverage. Targeted interventions are necessary to improve healthcare access, enhance public health communication and strengthen the health system, particularly in underserved communities and among vulnerable populations., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY. Published by BMJ Group.)

Background: A digital supportive supervision (DiSS) tool was developed and implemented in Rajasthan, India, to enhance the coverage and quality of maternal health, child health and nutrition (MCHN) services. This study aims to assess the impact and cost-effectiveness of DiSS compared to traditional paper-based supportive supervision., Methods and Analysis: A quasi-experimental research design incorporating interrupted time series regression analysis will be employed to evaluate the impact of DiSS. Two districts from the high DiSS intensity group, defined as having at least 25% of the MCHN sessions supervised digitally, will be randomly selected as intervention districts. Two comparator districts will be selected from the low DiSS intensity group (less than 25% of MCHN sessions supervised digitally) after matching with intervention districts based on three indicators-female literacy, proportion of population belonging to scheduled caste or tribe and coverage of four antenatal care visits. District-level monthly data on the number of beneficiaries using MCHN services will be obtained from the state's routine health management information system. Key informants involved in supervising MCHN sessions will also be interviewed to complement the quantitative findings. A mixed micro-costing methodology, incorporating top-down and bottom-up approaches, for assessing the cost of implementing supervision in either scenario. A decision model will estimate long-term health outcomes, in the form of quality-adjusted life years (QALY), in both the intervention and comparator groups. Cost-effectiveness of DiSS will be assessed by computing the incremental cost per QALY gained in the intervention versus comparator group., Ethics and Dissemination: The study has been approved by the Institute Ethics Committee of the PGIMER, Chandigarh, India (IEC No. IEC-03/2023-2671). The study results will be disseminated at research conferences and published in peer-reviewed journals., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Background We determined the risk factors associated with unvaccinated children in rural Gambia. Methods We conducted prospective demographic surveillance and recorded immunisations in real time in the Upper River Region, The Gambia. Analysis included residents born from 1 January 2012 to 31 December 2016. Data included age, sex, household members and relationships, migrations, births, deaths, ethnicity, residential location and birth type. Children were defined as unvaccinated at 10, 15 and 24 mo of age if they missed all primary series doses (pentavalent, oral polio and pneumococcal conjugate vaccines), secondary series (first dose measles and yellow fever vaccines) or both vaccination series, respectively. Logistic regressions measured the association between risk factors and being unvaccinated. Results In total, 5% (1567/30 832) of infants born during the study period and who were residents at the age of 10 mo were unvaccinated. Being unvaccinated at 10 mo of age was associated with children; who did not reside with either parent (adjusted OR 2.26, 95% CI 1.60 to 3.19), whose parents were not the head of household (1.29, 1.09 to 1.52), who had experienced immigration (2.78, 1.52 to 5.08) or who were not of Mandinka ethnicity (between 1.57 and 1.85 for other ethnicities). Conclusions Family characteristics are associated with unimmunised children in rural Gambia. Our findings may inform strategies to increase vaccine coverage. [ABSTRACT FROM AUTHOR]

Background: GPs are integral to the COVID-19 vaccination rollout, providing education and administering vaccines. We sought to describe how counselling relating to COVID-19 vaccination was impacting Australian general practice consultations. Methods: We conducted an online, mixed-methods, cross-sectional survey of Australian community-based primary care from 7 to 15 July 2021. This survey, number 15 in a series of recurrent cross-sectional surveys conducted over a 14-month period, explored how counselling relating to COVID-19 vaccination was impacting general practice consultations, through multiple selection and open text responses; it also included questions on respondent and practice characteristics, and pandemic-related stress and strain. We calculated descriptive statistics for quantitative variables, and analysed free-text responses using an inductive content analysis approach. Results: We received 73 responses (72 GPs) across all states/territories. Discussions with patients about COVID-19 vaccines and vaccination were common, increasing the duration of routine consultations by 6 min on average (s.d. 2.9). Respondents described the impact of the resulting time pressures, and the stress and challenges of participating in COVID-19 vaccine communication and administration. Although our results are illuminating, they are limited by the small sample, with some different characteristics from national estimates, an uncertain response rate and the inability to pilot the survey prior to distribution. Conclusions: The significant impact on general practice consultation from COVID-19 vaccine counselling is on a background of ongoing pandemic-related stress and strain. With a strong track record of population vaccination, GPs are well-placed to deliver COVID-19 immunisations to the Australian population. However, they must be represented in planning and coordination, to reduce the overall burden on primary care. The COVID-19 vaccination program is a crucial element of the Australian pandemic management plan and goal to return to 'normal' life, and primary care is a vital player in vaccine provision. Integrating new population-wide vaccinations into existing general practice has had a significant, but not well-documented, impact on primary care. Our study describes the experiences of general practice in Australia nearly 5 months into the vaccine rollout. [ABSTRACT FROM AUTHOR]

By September 2022, the uptake of at least one dose of COVID-19 vaccine in the Dutch adult population was 84%. Ecological studies have indicated a lower uptake in certain population groups. We aimed to investigate determinants of COVID-19 vaccine uptake in the Netherlands at individual level to evaluate and optimize implementation of the vaccination program and generate hypotheses for research on drivers of, and barriers to, vaccination. A retrospective database study was performed including the entire Dutch population ≥ 18. Vaccination data (5 January 2021–18 November 2021) were at individual levels linked to sociodemographic data. Random forest analyses ranked sociodemographic determinants of COVID-19 vaccine uptake. The most important determinant was age; uptake increased until the age of 80 (67% in 18–35 years, 92% in 67–79 years, and 88% in those > 80). Personal income and socioeconomic position ranked second and third, followed by migration status. Uptake was lower among individuals in the lowest income group (69%), those receiving social benefits (56%), and individuals with two parents born abroad (59%). Our finding that age is the most important determinant for uptake likely reflects the prioritisation of elderly in the programme and the general understanding of their increased vulnerability. However, our findings also reveal important other disparities in vaccine uptake. How to best address this inequity in future vaccination campaigns requires further research.

Objectives: To conduct the first pre‐Haemophilus influenzae (Hi) type b (Hib) immunisation programme‐based epidemiological study using national health data. Methods: We analysed National Health Security Office data, which cover 72% of the Thai population. The study population included children aged <18 years admitted for Hi disease from 2015 to 2019. Hi disease diagnosis and death were based on the International Statistical Classification of Diseases and Related Health Problems (10th revision) hospital discharge summary codes. We estimated the hospital cost per admission using diagnosis‐related grouping with a global budget. Results: A total of 1125 children aged <18 years were admitted for Hi disease. During the 5‐year‐study, the annual incidence of Hi disease varied from 1.5 to 1.9 per 100,000 children, with an overall case fatality rate (CFR) of 2%. Pneumonia was the most common clinical form, followed by meningitis and sepsis. The incidence, clinical forms and severity of Hi disease were age specific. Infant CFR was higher than that of other age groups. The incidence of Hi disease in children aged <5 years was 4.9 per 100,000 (CFR = 2.0%). Sepsis was the primary cause of infant death, whereas pneumonia was the cause of death in children aged >5 years. The hospital cost ranged from 25,000 to 30,000 THB per admission. Conclusions: This analysis provided epidemiological data of Hi in Thai children before the Hib routine immunisation programme. The incidence of Hi disease was lower than that previously speculated. Our results could facilitate an assessment of the impact of Hib immunisation programme in Thailand. [ABSTRACT FROM AUTHOR]

The influenza immunisation season of 2020/21 was very challenging for practice nurses involved in delivering the programme. The main challenge was delivering the programme while coping with the difficulties of ensuring venues and practices were operating safely with the aim of reducing the risk of transmission of the SARS-CoV-2 virus. There has been comprehensive guidance from the Department of Health and Social Care (DHSC), Public Health England (PHE) and the Royal Colleges to support vaccination providers this year. Additionally, the vaccination programme was expanded to include more patients who are at risk of severe disease from influenza and SARS-CoV-2. This expanded programme is likely to continue in 2021/22 and guidance and directives on influenza vaccines for use in the programme are expected soon. [ABSTRACT FROM AUTHOR]

In the majority of cases, influenza causes a mild illness that is typically self-limiting. For some groups, infection can cause more severe symptoms and complications. People who are in at-risk groups, as well as children who are likely to spread the virus, are eligible for free NHS vaccination. Practice nurses are actively involved in delivering the vaccination programme each year, and it can be very difficult to persuade reluctant patients. A better understanding of the complications of influenza will help nurses to educate their at-risk patients. [ABSTRACT FROM AUTHOR]

Recent trends of 'vaccine hesitancy' have resulted in calls for public health campaigns to improve immunisation uptake to World Health Organisation (WHO) targets. One potential strategy to improve uptake is to offer opportunistic vaccination to those hospital in-patients who have missed them. We aimed to evaluate parental and staff attitudes about introducing such a service for hospitalised children. Cross sectional questionnaire-based design. We developed and distributed a questionnaire for parents/guardians of paediatric inpatients aged 5 years and under, and a questionnaire for frontline paediatric staff (including medical, nursing and allied health professionals). Vaccination rates were assessed through discussion with parents and by reviewing the personal child health record. One-hundred families and 100 paediatric staff participated. Local vaccination rates were significantly below the WHO target (P < 0.001), particularly for the Bacille Calmette-Guerine (BCG) vaccination (P = 0.001). Both parents (89/100, 89%) and staff (87/100, 87%) regarded inpatient opportunistic vaccination acceptable. Parents of children with chronic disease reported a potentially higher rate of missed vaccinations, stating reasons of frequent illness and inpatient stays. The majority of staff (81/95, 85.3%) would be willing to support inpatient vaccination if appropriately trained. A significant minority had reservations. Opportunistic vaccination is a strategy deemed acceptable by the majority of parents and staff. Children with chronic disease would especially benefit from opportunistic inpatient immunisation. In order to facilitate this, improved digital access to primary care vaccination records and investment in staff training, education and support would be required. • Inpatient opportunistic vaccination is acceptable to parents (89%) and staff (87%). • Staff expectations of parental resistance were not reflected in parent surveys. • Most staff (85%) would help vaccinate inpatients if appropriately trained. [ABSTRACT FROM AUTHOR]

Digitalisation offers great potential to improve vaccine uptake, supporting the need for effective life-course immunisation services. We conducted semi-structured in-depth interviews with public health experts from 10 Western European countries (Germany, Greece, Italy, Luxembourg, Malta, the Netherlands, Norway, Poland, Portugal, and the United Kingdom) to assess the current level of digitalisation in immunisation programmes and retrieve data on interventions and best practices. Interviews were performed using an ad hoc questionnaire, piloted on a sample of national experts. We report a mixed level of digital technologies deployment within vaccination services across Europe: Some countries are currently developing eHealth strategies, while others have already put in place robust programmes. Institutional websites, educational videos, and electronic immunisation records are the most frequently adopted digital tools. Webinars and dashboards represent valuable resources to train and support healthcare professionals in immunisation services organisation. Text messages, email-based communication, and smartphone apps use is scattered across Europe. The main reported barrier to the implementation of digital-based programmes is the lack of resources and shared standards. Our study offers a comprehensive picture of the European context and shows the need for robust collaboration between states and international institutions to share best practices and inform the planning of digital intervention models with the aim of countering vaccine hesitancy and increasing vaccine uptake.

Seasonal influenza epidemics are a major public health concern, each year causing tens of millions of respiratory illnesses and many deaths worldwide. The young, the elderly and those with pre-existing medical conditions are particularly susceptible to influenza virus complications. In addition to the risk to health, the economic costs of influenza is substantial and the burden posed by the virus to the NHS is great. The currently available influenza virus vaccines are safe and effective in preventing influenza. Along with vaccination, adherence to universal precautions and infection control measures can help prevent the spread of influenza. This article will explore some the most up-to-date influenza literature and research. It will discuss how nurses and other health professionals can use this evidence in order to help them mitigate the consequences of influenza. [ABSTRACT FROM AUTHOR]

Aim: To identify and describe potentially vaccine-preventable child deaths in New South Wales (NSW).Methods: Child deaths in NSW from 2005 to 2014 potentially preventable by vaccination were identified from the NSW Child Death Register (maintained by the NSW Ombudsman) and the Notifiable Conditions Information Management System (NSW Health). Medical and post-mortem records were reviewed. Cases were classified as vaccine-preventable based on the strength of evidence for the relevant infection causing death and likelihood that death was preventable through vaccination. A two-source capture-recapture method was used to estimate the true number of deaths. Age-specific mortality rate and number of deaths by disease, area of residence and comorbidity were analysed. Deaths were classified as preventable based on vaccine availability, eligibility under the National Immunisation Program, age and presence of any contraindications.Results: Fifty-four deaths were identified as definitely or probably due to diseases for which a vaccine was available, with a total average annual mortality rate of 0.33 per 100 000 children and 2.1 per 100 000 infants. Two thirds of deaths occurred in children with no identified comorbidities. Twenty-three deaths were classified as preventable or potentially preventable by vaccination, with influenza (12 deaths) and meningococcal disease (five deaths) most common. An additional 15 deaths would be potentially preventable as of August 2016 due to immunisation recommendation changes including maternal vaccination.Conclusion: Maternal vaccination along with increased uptake of childhood influenza vaccination could reduce child deaths, particularly from influenza. [ABSTRACT FROM AUTHOR]

London's vaccination rates are consistently lower than England's averages. General practices are inspected by England's Care Quality Commission, but to date no best practice guidance for vaccination services has been published. This study explores what learning could be extrapolated from general practices that are rated as 'outstanding' by England's Care Quality Commission in relation to their vaccination services. The intention is to share this learning to help other practices improve their vaccination services. A qualitative methodology was utilised, consisting of 12 unstructured interviews with staff at seven of London's nice 'outstanding' practices in February 2016. Thematic analysis revealed that good immunisation practice was influenced by having patient- and family-centred care, trained 'up-to-date' staff, planning ahead, an ethos of working together, and allowing time for discussion about vaccinations with patients/parents. Further research is needed to test if the implementation of learning from 'outstanding' practices will increase immunisation rates. [ABSTRACT FROM AUTHOR]

Vaccination is a principal and highly cost-effective means of controlling infectious diseases, providing direct protection against pathogens by conferring long-lasting immunological memory and inducing population-level herd immunity. Despite rapid ongoing progress in vaccinology, there remain many obstacles to the development and deployment of novel or improved vaccines; these include the underlying science of how to induce and sustain appropriate protective immune responses as well as bureaucratic, logistic and socio-political hurdles. The failure to distribute and administer existing vaccines to at-risk communities continues to account for a large proportion of infant mortality worldwide: almost 20 million children do not have access to basic vaccines and several million still die each year as a result. While emerging epidemic or pandemic diseases pose a significant threat to global health and prosperity, there are many infectious diseases which provide a continuous or cyclical burden on healthcare systems which also need to be addressed. Gaps in knowledge of the human immune system stand in the way of developing technologies to overcome individual and pathogenic variation. The challenges in tackling infectious disease and directions that the field of preventive medicine may take to improve the current picture of global health are the focus of this review. [ABSTRACT FROM AUTHOR]

Pneumococcal disease can be divided into invasive disease, i.e. when bacteria are detected in normally sterile body fluids, and noninvasive disease. Pneumococcal disease occurs more frequently in younger children and older adults. It is estimated that, in 2050, 30.3% of the European population will be ≥65 yrs old, compared with 15.7% in 2000. Preventive medicine, including vaccination, is essential for the promotion of healthy ageing. Uptake rates for influenza vaccination in the elderly are generally low, despite recommendations in many countries. In addition, it has been reported that influenza infections can make people more susceptible to pneumococcal infections. Despite pneumococcal vaccination, case fatality rates for patients hospitalised with invasive pneumococcal disease have remained at around 12% since the 1950s. Even when effective antibiotic therapy is administered, mortality can be high amongst immunocompetent patients in intensive care. Timely and accurate diagnosis of pneumococcal disease and identification of patients at high risk of poor outcome is essential to ensure that adequate treatment, including hospitalisation when necessary, is implemented as early as possible. Improved diagnostic techniques and more efficacious treatments may help to reduce the burden of pneumococcal disease, but preventive measures, such as influenza and pneumococcal vaccination, should be promoted in order to avoid preventable disease, particularly in the elderly.

Increasing uptake of flu vaccination aims to reduce the number of people seeing their GP, being hospitalised, or in worst case scenarios, dying from flu and its complications. According to data from Public Health England, vaccine uptake increased in all of the eligible groups in the 2017/18 winter season compared to the previous year. Vaccine uptake goals for 2018/19 remain similar. Recently, the National Institute for Health and Care Excellence published guidelines on increasing uptake of flu vaccination in those who are eligible for the vaccine on the NHS. This article highlights the relevant recommendations for those working in primary care. [ABSTRACT FROM AUTHOR]

Objective: Having failed to achieve adequate influenza vaccination rates among employees through voluntary programmes, healthcare organisations have adopted mandatory ones. Some programmes permit religious exemptions, but little is known about who requests religious objections or why.Methods: Content analysis of applications for religious exemptions from influenza vaccination at a free-standing children's hospital in Cincinnati, Ohio, USA during the 2014-2015 influenza season.Results: Twelve of 15 260 (0.08%) employees submitted applications requesting religious exemptions. Requestors included both clinical and non-clinical employees. All requestors voluntarily identified their religious affiliation, and most were Christian (n=9). Content analysis identified six categories of reasons used to justify an exemption: risks/benefits, ethical/political, lack of direct patient contact, providence, purity and sanctity of life. Individuals articulated reasons in 1-5 (mean 2.6) categories. The most frequently cited category (n=9) was purity; the vaccine and/or its mode of administration were impure, or receiving the vaccine would make the individual impure. Two individuals asserted that the vaccine contained cells derived from aborted human fetuses. Individuals (n=6) also volunteered information supporting the sincerity of their beliefs including distress over previous vaccination and examples of behaviour consistent with their specific objection or their general religious commitment. All requests were approved.Conclusions: Less than 0.1% of employees requested religious exemptions. Partnering with religious leaders and carefully correcting erroneous information may help address requestors' concerns. [ABSTRACT FROM AUTHOR]

Background Health policy makers often have to face decisions on whether and how to incorporate new vaccines into immunisation plans. This study aims to review and catalogue the relevant current frameworks and taxonomies on vaccines and connect these to the DECIDE Evidence to Decision framework (EtD), a general framework based on evidence-based criteria to guide decision-making on intervention adoption. Methods We systematically searched MEDLINE, EMBASE, Cochrane Library and funding agency websites from 1990 to 2013. We included systematic reviews and primary studies presenting decision-making tools for community vaccine adoption. We qualitatively summarised the reports by purpose, targeted country, principal results, and decisional models. We then extracted and compared the dimensions adopted by vaccine frameworks across studies. Results Fourteen studies (five systematic reviews and nine primary studies) were included. Several factors frequently influenced decision-makers’ views on vaccines: the most frequent political-context factors considered were Importance of illness or problem, Vaccine characteristics, Resource use , and Feasibility . Others such as Values and preferences and Acceptability were less consistently reported. We did not find evidence on the reasons why a framework for vaccine adoption differs from that for decisions on the adoption of an intervention in general, such as the EtD. There are limited data on how dimensions are explained in practical factors and directly linked to coverage decisions. Conclusions This review summarises conceptual models and taxonomy of a heterogeneous and evolving area in health policy decisions. A shared and comprehensive framework on vaccine coverage remains to be achieved with its single dimensions (epidemiologic, effectiveness, economic, and social) valued differently across studies. A generic tool such as the EtD conceptualises all relevant dimensions, and might reduce inconsistencies. [ABSTRACT FROM AUTHOR]

Objectives Worldwide, rotavirus infections cause approximately 453 000 child deaths annually. Two licensed vaccines could be life- and cost-saving in low-income countries where the disease burden is highest. The aim of our study was to estimate the total cost of implementing the rotavirus vaccine in the national immunisation programme of a low-income country. Furthermore, the aim was to examine the relative contribution of different components to the total cost. Methods Following the World Health Organization guidelines, we estimated the resource use and costs associated with rotavirus vaccine implementation, using Malawi as a case. The cost analysis was undertaken from a governmental perspective. All costs were calculated for a 5-years period (2012-2016) and discounted at 5%. The value of key input parameters was varied in a sensitivity analysis. Results The total cost of rotavirus vaccine implementation in Malawi amounted to US$ 18.5 million over a 5-years period. This translated into US$ 5.8 per child in the birth cohort. With GAVI Alliance financial support, the total cost was reduced to US$ 1.4 per child in the birth cohort. Approximately 83% of the total cost was attributed to vaccine purchase, while 17% was attributed to system costs, with personnel, transportation and cold chain as the main cost components. Conclusion The total cost of rotavirus vaccine implementation in Malawi is high compared with the governmental health budget of US$ 26 per capita per year. This highlights the need for new financing opportunities for low-income countries to facilitate vaccine implementation and ensure sustainable financing. [ABSTRACT FROM AUTHOR]

Background Over the past four decades, extraordinary progress has been made in establishing and improving childhood immunization programmes around Africa. In order to ensure effective and sustainable positive growth of these childhood immunisation programmes, the development, adaptation and implementation of all interventions (programme activities, new vaccines, new strategies and policies) should be informed by the best available local evidence. Methods An assessment of the peer-reviewed literature on childhood immunization research published in English from 1970 to 2010 was conducted in PubMed and Africa-Wide databases. All study types were eligible for inclusion. A standard form was used to extract information from all studies identified as relevant and entered into a Microsoft Access database for analysis. Results Our initial search yielded 5436 articles from the two databases, from which 848 full text articles were identified as relevant. Among studies classified as clinical research (417), 40% were clinical trials, 24% were burden of disease/epidemiology and 36% were other clinical studies. Among studies classified as operational research (431), 77% related to programme management, 18% were policy related and 5% were related to vaccine financing. Studies were conducted in 48 African countries with six countries (South Africa, The Gambia, Nigeria, Senegal, Guinea-Bissau and Kenya) accounting for 56% of the total research output. Studies were published in 152 different journals with impact factors ranging from 0.192 to 53.29; with a median impact factor of 3.572. Conclusion A similar proportion of clinical versus operational research output was found. However, an uneven distribution across Africa was observed with only six countries accounting for over half of the research output. The research conducted was of moderate to high quality, with 62% being published in journals with 2010 impact factors greater than two. Urgent attention should be given to the development of research capacity in low performing countries around Africa, with increased focus on the process of turning immunisation programme research evidence into policy and practice, as well as increased focus on issues relating to vaccine financing and sustainability in Africa. [ABSTRACT FROM AUTHOR]

Objective The objective of this study was to determine the prevalence of antibodies against varicella-zoster virus (VZV) in pregnant women in Catalonia (Spain). Setting The prevalence of antibodies against VZV was assessed in a representative sample ( n= 1522) of pregnant women of Catalonia obtained in 2003. Method The sample was obtained including all women attended for childbirth, during 2 months of 2003, in 27 randomly selected hospitals with maternity clinics. Main outcome measures Varicella-zoster antibodies were determined using the enzyme-linked immunosorbent assay test. Results The total number of women included in the study was 1522, corresponding to a participation rate of 83%. The prevalence of varicella-zoster antibodies in pregnant women was 96.1% (95% CI 95.1–97.1). The prevalence of antibodies was 94% in pregnant women aged 15–24 years, 95% in those aged 25–29 years and >95% in those aged 30–49 years. The prevalence of antibodies was not associated to the place of birth, place of residence (urban or rural), educational level and social class. The study showed that 6% of pregnant women aged 15–24 years and 5% of those aged 25–29 years were susceptible to varicella-zoster infections in Catalonia (Spain). Conclusion The study showed that a varicella-zoster vaccination programme aimed at women of childbearing age could be necessary in Catalonia to prevent all varicella-zoster infections during pregnancy. [ABSTRACT FROM AUTHOR]

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Risk factors for invasive pneumococcal disease (IPD) include young and old age, comorbidities (such as splenic dysfunction, immunodeficiencies, chronic renal disease, chronic heart or lung disease or cerebral spinal fluid leak), crowded environments or poor socioeconomic conditions. Universal use of the 7-valent pneumococcal conjugate (7vPncCRM) vaccine for infants and young children has led to significant decreases in IPD in the vaccinated population (direct protection), and there has also been a decrease in the incidence of IPD among the nonvaccinated population (indirect immunity; herd protection). While 7vPncCRM vaccine is administered universally to children in USA, many countries of the European Union have chosen to target children with comorbidities. This review aims to highlight individual risk factors for IPD, describe studies that evaluated pneumococcal conjugate vaccines in at-risk groups and estimate the proportion of at-risk children who may have been vaccinated in the European Union since the 7vPncCRM vaccine was introduced, using UK as an example. Although immunisation targeting only children with comorbidities may achieve satisfactory results for a few, many otherwise healthy children at risk simply because of their age will be neglected, and herd protection might not be established. [ABSTRACT FROM AUTHOR]

No child should be denied immunisation without serious consideration given to the consequences. In the past, many contraindications to vaccination were based on theoretical concerns. These concerns often assumed an immunoallergic mechanism for adverse reactions, whereas many such events are often due to other causes. Other contraindications were based on evidence of excess risk, but this risk was not always balanced against the higher risk of disease. Therefore, contraindications often varied between countries and over time. In recent years, the widespread availability of less reactogenic vaccines and the common use of combined preparations have prompted a review of contraindications in many countries. Accumulated experience worldwide has allowed the list of conditions that contraindicate vaccination to be reduced. The international consensus now is that there are very few situations in which a child should not be immunised and the only true contraindication applicable to all vaccines is a history of anaphylaxis to a vaccine component or following a previous dose of the vaccine. Health professionals should feel confident in accepting national recommendations and, if in doubt, should refer children for an expert opinion, rather than deny a child protection against a serious infection. [ABSTRACT FROM AUTHOR]

Les bactéries encapsulées (comme Haemophilus influenzae type b [Hib], Neisseria meningitidis ou Streptococcus pneumoniae) visent les nourrissons et les jeunes enfants qui, d’une part, n’ont plus d’antigènes (Ag) maternels et, d’autre part, ont un système immunitaire inefficace contre les Ag thymo-indépendants comme les polyosides capsulaires. Les vaccins polysaccharidiques conjugués transforment le polyoside en lui faisant adopter le comportement immunologique d’un Ag thymo-dépendant, ce qui permet la mise en place d’une réponse immunitaire protectrice chez le nourrisson. Là où les vaccins conjugués furent introduits dans les programmes de vaccination du nourrisson, l’incidence des infections dûes à Hib, au méningocoque du sérogroupe C, ou au pneumocoque ont chuté d’au moins 80 % : un large succès de santé publique. De plus, le suivi épidémiologique a démontré que les vaccins conjugués induisent une immunité de groupe, liée à leur effet bénéfique sur la colonisation rhinopharyngée du nourrisson. Les applications potentielles de la technologie de conjugaison à l’élargissement du nombre des sérogroupes capsulaires visés par les vaccins méningococciques ou pneumococciques sont prometteuses. Mots clés : vaccins polysaccharidiques conjugués, efficacité, protection de groupe, programme de vaccination, réponse immunitaire Encapsulated bacterial pathogens (e.g. Haemophilus influenzae type b [Hib], Neisseria meningitidis, or Streptococcus pneumoniae) target infants and young children who have lost any protective anti-capsular antibodies supplied maternally and whose immune systems are ineffective against T-independent antigens such as the polysaccharides of the capsule. The polysaccharide-protein conjugate vaccines overcome this limitation by converting the polysaccharide to a T-dependent antigen, which allows a vaccinated infant to mount a protective immune response. Where conjugated vaccines have been introduced into paediatric vaccination schedules, the incidence of invasive diseases caused by Hib, the group C meningococcus, or the pneumococcus has plummeted by at least 80%, a major public health success. Furthermore, surveillance has demonstrated that the conjugate vaccines provide ‘herd protection’ through their beneficial impact on nasopharyngeal colonisation among vaccinated children. Promising future approaches include enhancement of the number of capsular serogroups targeted by the meningococcal or pneumococcal conjugate vaccines. Keywords: conjugated polysaccharide vaccine, effectiveness, herd protection, immunisation programmes, immune response [ABSTRACT FROM AUTHOR]

The availability of accelerated schedules of vaccination, as well as the development of combination vaccines, has enhanced the methods of protection against infectious disease, in particular that of hepatitis A and B viruses. The benefits of using accelerated schedules include: (i) enhanced adherence to and subsequent completion of vaccine courses; (ii) convenience for the recipient of the vaccine; (iii) reduced administration costs of providing the vaccine; and, most importantly, (iv) the ability to provide protection against these serious infections to those who will be imminently exposed to the risk and so require protection as quickly as possible. Active immunisation against both hepatitis A and B viruses has only been recognised within the last 20 years. During this time clinical studies have demonstrated the safety and efficacy of administering the monovalent hepatitis B vaccine by way of accelerated schedules. There are now several accelerated schedules of administration of hepatitis B vaccine which can be tailored to the needs of the individual at risk of exposure to infection. One such schedule allows the primary course to be administered within a period of 1 month. This schedule of day 0, 7 and 21, with a booster at 12 months, is licensed for use with the recombinant hepatitis B vaccine Engerix B™ and results in a seroprotection rate of 65% at day 28 which increases to 99% at month 13. In more recent years, the development of a multivalent or combination vaccine against hepatitis A and B (Twinrix™) has been a welcome advance in the protection against viral hepatitis, and has been of particular benefit to those who are at risk of infection with both viruses. The advantages of accelerated schedules have also been recognised with this combination vaccine. The primary course may be administered within a period of 1 month so providing protection for those at risk and, in particular, the last minute traveller. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the most efficient approach to managing an outbreak of serogroup C meningococcal disease. An early planned mass immunisation programme (MIP) was compared with a delayed programme implemented at the peak of a meningococcal outbreak.Design and Setting: A cost-benefit model was constructed of meningococcal cases reported in Quebec, Canada, from 1990-1993, before and after the MIP, during the winter of 1992-1993, when 84% of residents aged 6 months to 20 years were vaccinated. Epidemiological data from 1990-1993 were transposed to 2002-2003 under the assumption that Quebec is on the brink of an identical outbreak cycle. All Quebec residents aged 2 months to 20 years were assumed to be vaccinated, which required a total of 1.7 million doses of conjugated vaccine. Clinical and economic outcomes of both vaccination scenarios were compared. All costs were transformed to 2001 Canadian dollars ($Can), at an annual inflation rate of 3%. Future earnings due to premature death were discounted at 5% per year with a 3% increase in wages per year and a 9% unemployment rate.Perspective: Ministry of Health and society.Main Outcome Measures: The number of new cases avoided and the prevention of hospital and societal costs due to meningococcal disease-attributed premature mortality and morbidity, and direct costs associated with implementation of a MIP.Results: When compared with a delayed MIP over a 14-month period, an early planned MIP would have prevented 112 new cases of meningococcal disease (16 deaths, 21 major complications) while saving $ Can 37.1 million in total direct costs to the Ministry of Health and an additional $ Can 17.4 million in societal costs in the province of Quebec.Conclusion: An early planned MIP implemented in Quebec in September 2001, should be cost beneficial compared with delaying mass immunisation until a meningococcal outbreak is underway. Although this conclusion is limited by the assumption that epidemiological trends in 2001 in absence of a MIP would have been similar to that observed in the early 1990s prior to the MIP, the analysis still indicates that an early MIP in the 1990s would have been cost beneficial compared with a delayed MIP. [ABSTRACT FROM AUTHOR]

The immunity to vaccine-preventable diseases included in the Dutch immunisation programme in the general population and among orthodox reformed individuals who refuse vaccination was assessed. The programme induces good protection. However, a large proportion of adults lacks diphtheria and tetanus immunity. Measles, mumps and rubella seroprevalence was somewhat lower among vaccinated compared to unvaccinated cohorts. The prevalence of HibPS antibodies declined during 2.5 years after the fourth vaccination. However, protection occurs also by memory immunity. Herd immunity is sufficient among the general population, but not among orthodox reformed individuals. Immunosurveillance is an efficient way to evaluate the effects of immunisation programmes and identify risk groups for infection. [Copyright &y& Elsevier]

Chickenpox infections are generally mild but due to their very high incidence among healthy children they give rise to considerable morbidity and occasional mortality. With the development of a varicella vaccine in the early 1970s and its progressive licensing in many countries, interest in the efficiency of varicella immunisation programmes grew. The objective of this review was to discuss the methodological aspects and results of published economic evaluations of varicella vaccination. From this, we attempted to make recommendations. A computerised search was carried out; 17 full economic evaluations of varicella vaccination were retrieved. The review identified the methodological divergences and similarities between the articles in four areas: study design, epidemiological data, economic data and model characteristics. We assessed to what extent the applied methods conform to general guidelines for the economic evaluation of healthcare interventions and compared the studies’ results. The desirability of a universal vaccination programme depends on whose perspective is taken. Despite variability in data and model assumptions, the studies suggest that universal vaccination of infants is attractive to society because large savings occur from averted unproductive days for parents. For the healthcare payer, universal vaccination of infants does not generate savings. Vaccination of susceptible adolescents has been proposed by some authors as a viable alternative; the attractiveness of this is highly dependent on the negative predictive value of anamnestic screening. Targeted vaccination of healthcare workers and immunocompromised individuals appears relatively cost effective. Findings for other target groups are either contradictory or provide insufficient evidence for any unequivocal recommendations to be made. High sensitivity to vaccine price was reported in most studies. This review highlights that some aspects of these studies need to be further improved before final recommendations can be made. First, more transparency, completeness and compliance to general methodological guidelines are required. Second, because of the increasing severity of varicella with age, it is preferable and in some cases essential to use dynamic models for the assessment of universal vaccination strategies. Third, most studies focused on the strategy of vaccinating children only while their results depended heavily on disputable assumptions (regarding vaccine effectiveness and impact on herpes zoster). Since violation of these assumptions could have important adverse public health effects, we suggest pre-adolescent vaccination as a more secure alternative. This option deserves more attention in future analyses. [ABSTRACT FROM AUTHOR]

The methods that have been used to estimate the clinical and economic impact of vaccination programmes are not always uniform, which makes it difficult to compare results between economic analyses. Furthermore, the relative efficiency of vaccination programmes can be sensitive to some of the more controversial aspects covered by general guidelines for the economic evaluation of healthcare programmes, such as discounting of health gains and the treatment of future unrelated costs. In view of this, we interpret some aspects of these guidelines with respect to vaccination and offer recommendations for future analyses. These recommendations include more transparency and validation, more careful choice of models (tailored to the infection and the target groups), more extensive sensitivity analyses, and for all economic evaluations (also nonvaccine related) to be in better accordance with general guidelines. We use these recommendations to interpret the evidence provided by economic evaluation applied to viral hepatitis vaccination. We conclude that universal hepatitis B vaccination (of neonates, infants or adolescents) seems to be the most optimal strategy worldwide, except in the few areas of very low endemicity, where the evidence to enable a choice between selective and universal vaccination remains inconclusive. While targeted hepatitis A vaccination seems economically unattractive, universal hepatitis A vaccination strategies have not yet been sufficiently investigated to draw general conclusions. [ABSTRACT FROM AUTHOR]

In 1999, the World Health Organization (WHO) Department of Vaccines and Biologicals launched the Immunisation Safety Priority Project to boost its activities in this area, with the aim of establishing a comprehensive system to ensure the safety of all immunisations given in national immunisation programmes. Countries are the primary focus of this project. The WHO has a role to play not only because of its technical and normative role but also because of its privileged relationship with country authorities and other partners, its global vision and mandate, and because it is perceived as free from conflicts of interest. There are four areas of focus in the project: quality control and assessment tools to ensure vaccine safety from clinical trials up to and including the point of use;research and development of safer and simpler delivery systems; access to safer and more efficient systems for vaccine delivery and sharps waste management; and mechanisms to respond promptly and effectively to vaccine safety concerns. The project emphasises the importance of advocating safety and developing necessary infrastructure and human resource to properly deal with immunisation related safety issues at a national level. [ABSTRACT FROM AUTHOR]

Digitalisation offers great potential to improve vaccine uptake, supporting the need for effective life-course immunisation services. We conducted semi-structured in-depth interviews with public health experts from 10 Western European countries (Germany, Greece, Italy, Luxembourg, Malta, the Netherlands, Norway, Poland, Portugal, and the United Kingdom) to assess the current level of digitalisation in immunisation programmes and retrieve data on interventions and best practices. Interviews were performed using an ad hoc questionnaire, piloted on a sample of national experts. We report a mixed level of digital technologies deployment within vaccination services across Europe: Some countries are currently developing eHealth strategies, while others have already put in place robust programmes. Institutional websites, educational videos, and electronic immunisation records are the most frequently adopted digital tools. Webinars and dashboards represent valuable resources to train and support healthcare professionals in immunisation services organisation. Text messages, email-based communication, and smartphone apps use is scattered across Europe. The main reported barrier to the implementation of digital-based programmes is the lack of resources and shared standards. Our study offers a comprehensive picture of the European context and shows the need for robust collaboration between states and international institutions to share best practices and inform the planning of digital intervention models with the aim of countering vaccine hesitancy and increasing vaccine uptake. [ABSTRACT FROM AUTHOR]