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Background: In this article we analyzed the extent of the usage of Theories of Change (TOCs) and causal pathways in the evaluation of immunization programs to identify the challenges to generating evidence on how interventions improve immunization. Methods: We analyzed the use of the TOC in impact evaluations (IEs) of immunization interventions published after 2010, and its associated articles. The review includes studies from Evidence Gap Map and Yale review that were conducted in May and March of 2020, respectively. We synthesized data on six domains using NVIVO — program theory, context, assumptions, usage of TOC, use in evaluation, and description causal pathways. Results: Our review included 47 large-scale and 45 small-to medium-scale interventions. Of the included studies, 19% used a TOC, 56% described a causal pathway or used a conceptual diagram with varying degrees of detail, and 25% of the IEs did not provide any information on how their intervention was expected to affect change. Only 19 of the 92 IEs explicitly outlined any assumptions associated with the implementation of the interventions. Forty studies measured the outputs or intermediate outcomes leading to improved immunization coverage. Conclusion: Future implementers and evaluators need to develop clear TOCs that are based on established theory and have clearly articulated the underlying assumptions. Large-scale health system strengthening initiatives implemented by governments, also need to build TOCs and integrate them into their results frameworks. Additionally, there is a need to combine both impact and process evaluations to understand the how context affects the causal pathways. [ABSTRACT FROM AUTHOR]

Objectives: The federal Section 317 Immunization Program, administered by the Centers for Disease Control and Prevention (CDC), provides funding to support adult immunization efforts; however, current information on program implementation at the jurisdictional level is limited. We assessed the use of Section 317 and other funding sources to support routine adult immunization activities among the 64 immunization programs ("awardees"). Methods: We conducted a survey and key informant interviews with awardees in October to December 2022 to collect quantitative and qualitative data on current adult vaccine purchase and program operation activities funded by Section 317 and other funding sources. We assessed total vaccine cost and data on vaccine purchase projections for each awardee with CDC's Cost and Affordability Tool for 2023. Results: Immunization program managers or their designees from 62 of 64 awardees (97%) completed the survey; 12 awardees participated in key informant interviews. Of 62 awardees, 32 (52%) used a single funding source to support adult vaccine purchases, of which 29 (91%) used only Section 317 funds, 21 (34%) reported not planning to purchase ≥1 age-based recommended vaccine for adults in 2023, and 33 (53%) reported using Section 317 funds only to support adult immunization program operations. Key informant interviews showed varied operational activities among awardees, but 8 awardees stated the need for additional staff to expand adult immunization program services in health care provider education (n = 5), program administration (n = 5), and site visits (n = 6). Conclusions: Additional efforts are needed to understand how to better support routine adult immunization activities implemented at the jurisdictional level. [ABSTRACT FROM AUTHOR]

Copyright of Revista Foco (Interdisciplinary Studies Journal) is the property of Revista Foco and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Despite the introduction of the human papillomavirus (HPV) vaccine in many low- and middle-income countries (LMICs), countries are still struggling to maintain HPV vaccination coverage and manage sustainable delivery strategies. This article explores the challenges and effective strategies for HPV vaccine delivery in LMICs, with a focus on reflecting upon current HPV vaccine delivery strategies in the World Health Organization (WHO) HPV vaccine introduction guidelines to align with practical implementation experiences. The article utilizes presentations and discussions from Coalition to Strengthen the HPV Immunization Community (CHIC) symposia, field experiences of program implementers who participated in the meeting and immunization expert opinions, to inform its findings. Several countries are spotlighted for their delivery strategies. These include routinized campaign mode vaccinations at schools in The Gambia, Zambia, and Ethiopia; routine health facility services in Tanzania, Kenya, and Maldives; and outreach strategies targeting out-of-school girls. By evaluating these diverse strategies, the article suggests a need to delve deeper and build an understanding of the routinized campaign mode of HPV vaccine delivery, and advocates for expanding the scope of delivery strategies and consequently updating the WHO HPV vaccine delivery guidelines in line with the evolving landscape of HPV vaccination delivery to ensure comprehensive, cost-effective, and sustainable programs in LMICs. [ABSTRACT FROM AUTHOR]

Background: Rotavirus is the most common cause of gastroenteritis among children. Currently, four oral live-attenuated vaccines are available to prevent rotavirus infection. The World Health Organization (WHO) has recommended including rotavirus vaccination in national immunization programs; however, it has not been introduced to the Iranian national immunization program. The study aimed to assess the frequency of rotavirus gastroenteritis in the west of Iran and investigate the necessity of rotavirus vaccination. Study Design: A case series study. Methods: In this case series study, 284 cases under six years of age who presented with acute gastroenteritis from March 2021 to 2022 to a referral hospital in the west of Iran were evaluated. Data on baseline characteristics, clinical manifestations, results of stool test, ELISA for rotavirus detection, and polymerase chain reaction (PCR) test for genotyping of rotavirus-positive samples were recorded. Results: Results showed that the prevalence of rotavirus infection was 36.6%. The highest frequency was observed among children aged 6-12 months and during the autumn. According to the PCR results, G1P[8], G9P[8], G9P[4], and G1P [4] were the dominant genotypes, and 33.75% of samples were infected with multiple rotavirus genotypes. Conclusion: The study highlights the considerable prevalence of rotavirus infection among cases of acute gastroenteritis in children under six years of age who were referred to a referral hospital in the west of Iran and the high diversity of rotavirus genotypes in the targeted community. Consequently, physicians and health policymakers should prioritize strategies for the prevention and control of this infection, particularly by considering the rotavirus vaccine as a priority for the Iranian national immunization program. [ABSTRACT FROM AUTHOR]

The aim was to estimate the vaccination timeliness defined as the proportion of children under 6 years of age who received their immunization in the time range established by the Colombian Expanded Immunization Program (EIP). A retrospective cohort study that collected reports of vaccination opportunities between 2014 and 2019 provided by the Ministry of Health. Age, sex, city, ethnicity, health system affiliation regimen, vaccine applied, and timing of vaccination were considered for the time range under study. A total of 3,370,853 immunized children were included from all regions of the country. More than 80% of children had a timeliness to get most vaccines. The exceptions were yellow fever (17%) and seasonal influenza (42%). No differences in timeliness were found according to geographic region or by health system affiliation regime, but the average timeliness for all vaccines of children of the indigenous population (65.8% ±18.4%) was lower than that of the rest of the population (78·6% ± 19·3%) (p = 0·021). The timeliness for vaccination under the EIP of Colombia is high, with proportions of 72–96%, but intergroup differences were identified, mainly lower timeliness among indigenous people. These findings warrant improvement strategies that would guarantee the immunization of the entire child population.

Abstract Background The Lao People’s Democratic Republic (Lao PDR), a lower-middle-income country, lags behind other Southeast Asian countries in immunization coverage for children under two years of age. The organization of health services is a key determinant of the functionality of immunization programs. However, this aspect, and in particular its decentralization component of the healthcare system, has never been studied. Methods A case study in the Lao National Immunization Program was performed using a neo-institutional theory-based conceptual framework, highlighting the structure (rules, laws, resources, etc.) and interpretative schemes (dominant beliefs and ideas) that underlie the state of decentralization of the healthcare system that support the conduct of the immunization program. Twenty-two semi-structured interviews were conducted with representative actors from various government levels, external donors, and civil society, in four provinces. Data were complemented with information retrieved from relevant documents. Results The Lao healthcare system has a deconcentrated form of decentralization. It has a largely centralized structure, albeit with certain measures promoting the decentralization of its immunization programs. The structure underlying the state of centralization of immunization services provided is coherent with a shared dominant interpretive scheme. However, the rapid economic, technical, and educational changes affecting the country suggest that the coherence between structure and interpretative schemes is bound to change. Conclusion Unprecedented opportunities to access quality higher education and the use of social networks are factors in Lao PDR that could affect the distribution of responsibilities of the different levels of government for public health programs such as the National Immunization Program.

Objective To systematically understand the cognitive status of immunization professionals in Jinan on the relevant vaccination guidance in the "National Immunization Program Vaccine Child Immunization Program and Instructions (2021 Edition)'; in order to provide more targeted technical guidance and better improve the immunization program and guidance principles for children. Methods In September 2022, a questionnaire survey was conducted on 15 immunization technical backbones in the district and county CDCs of Jinan, as well as 423 vaccination units (including maternity vaccination rooms) engaged in pre -check and vaccination. The survey data was descriptively analyzed, and %2 tests and multivariate logistic regression analysis were conducted using Excel 2010 and SPSS 18.0 software. The awareness rate of the corresponding knowledge of the survey subjects was calculated based on the accuracy of the answers given by the 15 CDC personnel to the overall knowledge of the immunization program, the knowledge of immunization of children with special health conditions, and the knowledge of simultaneous vaccination. Results The awareness rates of the survey subjects for the overall knowledge of the immunization program, the knowledge of immunization of children with special health conditions, and the knowledge of simultaneous vaccination were 29.91%, 23.29%, and 48.63%, respectively. The results of the multiple -factor logistic regression analysis showed that educational level & 95%CI: 1.13-3.12), years of preventive vaccination work (OR= 1,49, 95%CI: 1.01-2.22), and professional qualification category (Oi=0.25, 95%CI: 0.068-0.88) were influencing factors of the awareness rate of the immunization program for the survey subjects. Educational level (OR=3.01, 95%CI: 1.63-5.57) and profession (OR =0.24, 95%CI: 0.075-0.78) were influencing factors of the awareness rate of immunization for children with special health conditions. Only gender (OR =037, 95%CI: 0.16-0.86) was an influencing factor of the awareness rate of simultaneous vaccination for the survey subjects. Conclusion The cognitive level of immunization clinic staff in Jinan regarding the immunization program, including the vaccination of children with special health conditions and simultaneous vaccination, still needs to be further improved. It is recommended to reasonably increase professional technical training focused on relevant knowledge of immunization. It is also recommended to further improve and refine the guidelines or instructive documents related to the immunization of children with special health conditions and simultaneous vaccination. [ABSTRACT FROM AUTHOR]

Background: The Lao People's Democratic Republic (Lao PDR), a lower-middle-income country, lags behind other Southeast Asian countries in immunization coverage for children under two years of age. The organization of health services is a key determinant of the functionality of immunization programs. However, this aspect, and in particular its decentralization component of the healthcare system, has never been studied. Methods: A case study in the Lao National Immunization Program was performed using a neo-institutional theory-based conceptual framework, highlighting the structure (rules, laws, resources, etc.) and interpretative schemes (dominant beliefs and ideas) that underlie the state of decentralization of the healthcare system that support the conduct of the immunization program. Twenty-two semi-structured interviews were conducted with representative actors from various government levels, external donors, and civil society, in four provinces. Data were complemented with information retrieved from relevant documents. Results: The Lao healthcare system has a deconcentrated form of decentralization. It has a largely centralized structure, albeit with certain measures promoting the decentralization of its immunization programs. The structure underlying the state of centralization of immunization services provided is coherent with a shared dominant interpretive scheme. However, the rapid economic, technical, and educational changes affecting the country suggest that the coherence between structure and interpretative schemes is bound to change. Conclusion: Unprecedented opportunities to access quality higher education and the use of social networks are factors in Lao PDR that could affect the distribution of responsibilities of the different levels of government for public health programs such as the National Immunization Program. [ABSTRACT FROM AUTHOR]

Immunization programs globally have played a pivotal role in reducing mortality rates. However, the effectiveness of these programs often falls short of the intended coverage targets, primarily due to challenges within the supply chain, storage facilities, and distribution processes. Notably, a substantial percentage of vaccine wastage has been observed in numerous countries, thereby imposing a significant financial burden on immunization initiatives, and presenting a formidable challenge to policymakers. This paper undertakes a comprehensive study of the financial dynamics inherent in an immunization program within the context of India. Employing a systems perspective, we scrutinize the intricate interactions among various cost factors. Through a five-year system dynamics simulation, we derive insights into the amplified financial constraints resulting from vaccine wastage and the inefficiencies associated with shared personnel. Furthermore, our analysis extends to evaluate the impact of an additional investment aimed at enhancing the quality of the cold chain infrastructure and health worker proficiency on the overall funds of the immunization program. This research contributes to a nuanced understanding of the financial intricacies of immunization programs, offering valuable insights for policymakers and stakeholders seeking to optimize program efficiency and resource allocation. [ABSTRACT FROM AUTHOR]

Copyright of Chinese Journal of Preventive Veterinary Medicine / Zhongguo Yufang Shouyi Xuebao is the property of Chinese Journal of Preventive Veterinary Medicine Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Routine vaccinations help prevent the outbreak and spread of infectious diseases; however, it can take up to ten years from vaccine approval to introduction into routine vaccination schedules in Japan. Here, we investigate the information required to introduce an approved vaccine into routine vaccination schedules and the reasons why it takes so long. Based on the published data of the Immunization and Vaccine Committee of the Health Science Council, we set out to explore ways to facilitate discussion on this topic. The following issues were identified as discussion points: disease burden, efficacy and safety, and cost-effectiveness. Until now, epidemiological information has been used to evaluate the efficacy of vaccines, and also to evaluate the safety in the presence of notable adverse reactions. However, in some cases, it took a long time to obtain epidemiological information regarding the frequency of rare but serious adverse reactions and the need for a booster dose. Given the risk of spreading infectious diseases due to delays in decision-making, vaccines may have to be introduced into routine vaccination schedules based on the results of clinical trials that can be obtained in a relatively short period. In contrast, epidemiological information is necessary to evaluate the disease burden, frequency of adverse reactions, and the necessity of booster doses. Therefore, developing an epidemiological information collection system is urgently required. [ABSTRACT FROM AUTHOR]

Background: peripheral neuroblastic tumors (pNT) have high incidence and mortality, and infants are prone to various infectious diseases. The purpose of this study is to understand the immunization status of children with pNT in the real-world and the incidence of adverse reactions after vaccination, and to evaluate the feasibility of vaccination and the influencing factors of vaccination. Methods: Children with pNT treated in the Children's Hospital Affiliated to Zhejiang University from January 1, 2011 to December 1, 2021 were included. By referring to medical records, the vaccination history of the national immunization program (NIP) vaccines and the occurrence of adverse events following immunization(AEFI), current status and safety of immunization in children with pNT in the real-world were analyzed. Results: Among 784 children with pNT, 394 were able to obtain the history of vaccination. The overall vaccination rate of NIP vaccines was 71.49% before chemotherapy and 37.67% after chemotherapy, and the recovery time of vaccination after treatment was 16.00 (6.00,24.00) months. Age, time of tumor diagnosis and disease classification were significantly correlated with vaccination. AEFI reported an incidence of 0.23‰. Conclusion: The vaccination rate of children with pNT is generally low, especially the vaccination rate after chemotherapy. The vaccination safety is good, children should be encouraged to immunize. [ABSTRACT FROM AUTHOR]

In posyandu, the role of cadres is to be able to show their figure and be active in one of the health programs, namely immunization. Posyandu Sudirejo I village is under the coordination of puskesmas Simpang Limun with 11 (42.31%) active posyandu. This study aims to determine the factors associated with the activeness of posyandu cadres in the immunization program in Sudirejo I village, Medan City. The method in the study used quantitative methods with a cross sectional research design. A total of 55 cadres were used as samples using univariate and bivariate analysis using the chi-square test (pα 0.05) and incentives (p 0.324>α 0.05) in the posyandu immunization program. The conclusion is that, knowledge, motivation and infrastructure are related to the activeness of posyandu cadres while interpersonal relationships and incentives are not related to the activeness of posyandu cadres in the immunization program in Sudirejo I village, Medan City.

Abstract China's immunization programs conducted a unified, tightly coordinated COVID-19 vaccination campaign during the dynamic COVID Zero period that reached well over 90% of the population with vaccines having > 90% effectiveness against serious-to-fatal COVID-19. The campaign was eight times the size of the annual routine national immunization program, administering 3.4 billion doses of vaccines while monitoring vaccine coverage, acceptability, safety, and effectiveness. Every asset of the routine immunization program had to be strengthened and expanded to attain high coverage and reach hundreds of millions of adults who had not been vaccinated since childhood. Program strengthening and expansion were in directions aligned with the World Health Organization's Immunization Agenda 2030, which has a vision that "everyone, everywhere, at every age fully benefits from vaccines for good health and well-being" and requires reaching all children, adolescents, and adults with lifesaving vaccines. Momentum from this campaign should not be lost but should be invested into achieving what is possible with a properly resourced national immunization program that is now proven to be capable of reaching everyone in the world’s largest country throughout the life course, and to do so with all vaccines recommended by the World Health Organization. Graphical Abstract

ObjectiveTo construct an evaluation framework for prioritizing the inclusion of non-program vaccines into planned immunization of Shenzhen city. MethodsAfter developing a preliminary evaluation framework with literature studies, we conducted two rounds of Delphi consultation among 15 experts for screening relevant indicators and modifying the framework during March – July 2022. The weight of each indicator in the framework was calculated using analytic hierarchy process. ResultsThe active coefficients for the two rounds of expert consultation were 100% and 86.67% and the expert authority index was 0.84 for the two rounds of consultation. The concordance coefficients for the experts′ comprehensive evaluation scores of all indicators ranged between 0.199 – 0.465 (P < 0.05) and 0.253 – 0.442 (P < 0.05) in the first and second consultation. Totally 4 primary, 13 secondary and 34 tertiary indicators were included in the finally established evaluation framework for assessing the priority of a non-program vaccine to be included into planned immunization on 4 dimensions: disease impact (disease burden, economic burden, prevention urgency), vaccine effect (safety, efficacy, related attributes), vaccination feasibility (policy making, fund, vaccine supply, human resource, surveillance), and cost-effectiveness (economic and social benefit). The combined weights were between 0.003 and 0.279 for all the indicators. ConclusionThe established evaluation framework is innovative and reliable and could provide a reference tool in selecting a vaccine to be included into Shenzhen municipal immunization program.

ObjectiveTo analyze the epidemiological characteristics of varicella in Minhang District， Shanghai from 2013 to 2022， and to evaluate the impact of adjusting the varicella vaccination program to a two-dose regimen and its inclusion in the Shanghai immunization program on the incidence of varicella.MethodsData on reported varicella cases from 2013 to 2022 in Minhang District were collected. Interrupted time series analysis and segmented regression models were used to analyze the changes in varicella incidence before and after the adjustment of varicella immunization strategies.ResultsFrom 2013 to 2022， the average annual incidence of varicella was 76.58/100 000， with the highest incidence in 2017 （119.21/100 000） and the lowest in 2022 （27.02/100 000）. The varicella incidence exhibited seasonal patterns with peaks occurring from March to June and October to January of the following year. Prior to the adjustment of varicella immunization strategies （2013‒2017）， the varicella incidence showed an upward trend （z=2.20， P=0.03）， while after the adjustment （2018‒2022）， a adownward trend was observed （2018‒2022） （z=-2.25， P=0.02）. Interrupted time series analysis showed that following the adjustment of varicella immunization strategies， an immediate change of -33.91/100 000 （t=-4.35， P

Objective To analyze the epidemiological characteristics of varicella in Guiyang city and to provide scientific basis for formulating appropriate prevention and control measures and immunization strategies for varicella. Methods The data of varicella incidence, resident population, and vaccination in Guiyang were collected through China Disease Prevention and Control Information Management system and Guizhou Immunization Planning Information Management system. Descriptive epidemiological methods were used to analyze the epidemiological characteristics and vaccination of varicella vaccine in Guiyang City from 2010 to 2022. Results A total of 32 405 varicella cases were reported in Guiyang city from 2010 to 2022, with an average annual incidence of 54.39/100 000. The incidence of varicella in people under 15 years old was 75.46%. The incidence of varicella was relatively stable from 2011 to 2016 and then increased in 2017 and 2021, while the proportion of female cases in the total population showed an upward trend (S=56.000, τ=0.718, P < 0.001). The incidence of 0 to < 3 years old showed a downward trend, increased continuously in 3 to < 5 years old, reached a peak in 5 to < 6 years old, and then decreased gradually. The incidence percentage of the whole population aged 10 to < 15 and 15 to < 20 years old showed an increasing trend. The two peak incidence rates were from November to January and from May to July, respectively, and the incidence rates in Guanshan Lake district and Baiyun district were higher than those in other districts (cities and counties). The incidence of varicella in Guiyang city over the years was negatively correlated with the number of two doses of varicella vaccine in the same year (r=-0.610, P=0.027). Conclusion The incidence of varicella in Guiyang city shows a downward trend, with obvious seasonal, regional, and population characteristics, and the incidence is mainly among students under 15 years old. The better the second dose of varicella vaccine is, the lower the incidence is, so it is necessary to strengthen the inspection of varicella vaccination in enrollment. On the other hand, considering the increasing incidence of people aged 10 to < 15 and 15 to < 20 years old in Guiyang, it is necessary to strengthen the publicity and varicella vaccination for students of all ages. [ABSTRACT FROM AUTHOR]

China's immunization programs conducted a unified, tightly coordinated COVID-19 vaccination campaign during the dynamic COVID Zero period that reached well over 90% of the population with vaccines having > 90% effectiveness against serious-to-fatal COVID-19. The campaign was eight times the size of the annual routine national immunization program, administering 3.4 billion doses of vaccines while monitoring vaccine coverage, acceptability, safety, and effectiveness. Every asset of the routine immunization program had to be strengthened and expanded to attain high coverage and reach hundreds of millions of adults who had not been vaccinated since childhood. Program strengthening and expansion were in directions aligned with the World Health Organization's Immunization Agenda 2030, which has a vision that "everyone, everywhere, at every age fully benefits from vaccines for good health and well-being" and requires reaching all children, adolescents, and adults with lifesaving vaccines. Momentum from this campaign should not be lost but should be invested into achieving what is possible with a properly resourced national immunization program that is now proven to be capable of reaching everyone in the world's largest country throughout the life course, and to do so with all vaccines recommended by the World Health Organization. [ABSTRACT FROM AUTHOR]

Persistent infection of human papillomavirus (HPV) can cause a variety of diseases including cervical cancer, which affects human health and leads to a huge socio-economic burden. Although it has shown that HPV vaccines could effectively prevent HPV infection and reduce cervical cancer incidence, China hasn′t introduced HPV vaccination into the national immunization program. The multiple streams framework proposed by Kindon is an essential theoretical tool for analyzing public policy agendas and is suitable for analyzing decision-making processes of immunization programs. In this study, we adopted multiple streams framework to assess main influencing factors of introducing HPV vaccination into the immunization programs by examining the problem stream, policy stream, politics stream, the policy spillover effect of pilot cities, and the role of policy entrepreneurs. And we also give some suggestions to promote the inclusion of HPV vaccines in the immunization programs at regional and national levels, and finally achieve the purpose of ‘eliminating cervical cancer′.

ObjectiveTo analyze the epidemiological characteristics and the vaccination status of the cases in Jing’an District from 2017 to 2019， so as to provide reference basis for the strategy of prevention and control of varicella epidemic.MethodsDescriptive epidemiological methods were used to analyze the epidemiological characteristics of varicella in Jing’an District. The differences between the vaccinated group and the unvaccinated group were compared by statistical methods.ResultsA total of 2 508 cases of varicella were reported with an average annual incidence of 78.7/105 from 2017 to 2019. There was no significant difference in the incidence among the three years（χ2=5.535，P=0.063）. There were 1 308 males and 1 200 females， and sex ratio was 1.1∶1. The highest incidence occurred in the age group from 5 to 9 years old （562 cases， 479.3/105）. Two annual peaks occured in May and November. The incidence in the aged 18 and below decreased year by year. There was significant difference in the proportion among the three years（χ2=78.129， P

Human papillomavirus (HPV) is a viral infection that, if does not go away, can cause health problems like genitalwarts and cancer. The national immunization schedules for individuals before sexual debut, significantly decreased HPV-associated mortality and it will be affordable. However, immunization programs remain vulnerable to macroeconomic factors such as inflation, fiscal policy, employment levels, and national income. This review aims to investigate the association between national income in lower-middle-income countries to explore recent advances and potential issues, as well as how to deal with challenges. [ABSTRACT FROM AUTHOR]

Despite the availability of vaccines, the World Health Organization (WHO), in the year 2019, declared the population's reluctance to vaccinate, threatening to reverse the progress made in the fight against preventable diseases by immunization, causing the return of already eradicated diseases. This study aimed to analyze, according to the literature, the factors related to vaccine hesitancy and refusal in Brazil. The results show that uncertainty about the reactogenicity and safety of vaccines, fear of adverse events, and lack of information/guidance were the main causes of vaccine refusal. The spread of fake news, low perception of disease risk, and distrust in science happen due to lack of information and knowledge about the importance of the vaccine. Nursing has an essential role in promoting knowledge about vaccination. It is necessary to incorporate educational actions in order to reestablish high vaccination coverage, avoiding the recrudescence of already eradicated diseases or the increase of controlled diseases. [ABSTRACT FROM AUTHOR]

The current COVID‐19 vaccination program requires frequent booster vaccination to maintain sufficient neutralization levels against immune evasive SARS‐CoV‐2 variants. However, prior studies found more potent and durable immune response in convalescing individuals, raising the possibility of less frequent booster vaccination for them. Here, we conducted a longitudinal immunological study based on two prospective cohorts of booster vaccinated convalescing COVID‐19 patients or healthcare workers (HCW) without COVID‐19 history in Xiangyang, China. Comparing to 1‐month post‐boosting, pseudovirus neutralization titers (pVNT50) of ancestral Wuhan‐Hu‐1 and circulating omicron sub‐variants BA.5, BF.7, BA.4.6, BA.2.75, and BA.2.75.2 spikes were stable or even increased in convalescing samples at 6‐month post‐boosting, when HCW samples showed substantial drop of neutralization titers across the spectrum. Variant‐to‐Wuhan‐Hu‐1 pVNT50 ratios showed no significant variation during the 17 months from pre‐vaccination to 6‐month post‐boosting in convalescing individuals, indicating that the high durability of hybrid immunity was likely sustained by continuously improving neutralization potency that compensated immune decay. Our data provide mechanistic insight into prior epidemiological findings that vaccine‐elicited humoral immune response was more durable in convalescing individuals than those without SARS‐CoV‐2 infection, and suggest further research into potential extension of boosting intervals for convalescing individuals. [ABSTRACT FROM AUTHOR]

This study determined the coverage and timeliness of immunization in children

Two RV vaccines have been licensed in Zhejiang province, China, including the pentavalent RotaTeq (RV5) and the monovalent RV vaccine (RV1). This study aimed to evaluate the cost-effectiveness of RV1 and RV5 to inform the prioritization of provincial immunization program. A decision tree-Markov model was applied to assess the cost-effectiveness of RV1 or RV5 vaccination, compared to no RV vaccination in a 5-year period. The incremental health cost per disability-adjusted life year (DALY) is averted when each kind of RV vaccine included in the immunization program was estimated. It was also compared to the willingness-to-pay (WTP) threshold of 1 time of the Gross Domestic Product (GDP) per capita of Zhejiang province in 2021 (16865.70US$). The uncertainties of these results were assessed through the one-way sensitivity analysis and probabilistic sensitivity analysis. In the base-case scenario, RV5 was the least costly RV vaccine with a cost-effectiveness ratio of 510 US$ per DALY averted. The other RV1 vaccines provided equivalent benefits but at higher costs, with a cost-effectiveness ratio of 4600 US$ per DALY averted. Compared to no vaccination, the probabilities of being cost-effective were 72.3% for RV1 and 88.4% for RV5, at a WTP threshold of 1 time of the GDP per capita. An RV vaccination program using any of the two China-licensed RV vaccines compared to no vaccination would avert 30–70% of outpatient visits, hospitalizations, and deaths from RVGE. RV5 was currently estimated to be the most cost-effective.

Human papillomavirus (HPV) is a viral infection that, if does not go away, can cause health problems like genital warts and cancer. The national immunization schedules for individuals before sexual debut, significantly decreased HPV-associated mortality and it will be affordable. However, immunization programs remain vulnerable to macroeconomic factors such as inflation, fiscal policy, employment levels, and national income. This review aims to investigate the association between national income in lower-middle-income countries to explore recent advances and potential issues, as well as how to deal with challenges.

In 2023, the world will be at "halftime" with respect to the sustainable development goals (SDGs). This midline acts as an important milestone to review the progress of the SDGs and develop policies based on the most effective interventions. To estimate the remaining resources needed to achieve SDG targets for vaccines from 2023 to 2030 as well the resulting economic benefits, in this analysis, the incremental economic benefit-cost ratio (BCR) for immunization programs in 80 low- and middle-income countries targeted by the Global Vaccine Action Plan from 2023 to 2030 is calculated. Of these 80 countries, 27 are classified as low-income countries and 53 are classified as lower-middle-income countries (LMICs). The economic evaluation covers 9 vaccines employed against 10 antigens and delivered through both routine immunization programs and supplemental immunization activities. The vaccines covered in the analysis include pentavalent vaccine, human papillomavirus vaccine, Japanese encephalitis vaccine, measles vaccine, measles-rubella vaccine, meningococcal conjugate A vaccine, pneumococcal conjugate vaccine, rotavirus vaccine, and yellow fever vaccine, and correspond to the vaccines covered in the return-on-investment estimates presented in Sim et al. , which covered 94 LMICs from 2011 to 2030. For these countries, we estimate program costs from the health system perspective, including vaccine costs such as costs to procure vaccines, which incorporate injection supplies and freight; and immunization delivery costs, which include nonvaccine commodity costs to deliver immunizations to target populations and incorporate labor, cold chain and storage, transportation, facilities, training, surveillance, and wastage. Economic benefits are calculated using a value of statistical life year (VSLY) approach applied to modeled cases, and deaths averted are converted into averted years of life lost using life expectancy data. BCRs are presented as the final output that compares incremental costs and benefits from the baseline of 2022 levels, assuming diminishing returns to scale. Overall, for this period, we estimate total costs of US$ 7,581,837,329.08 with VSLY benefits of US$ 762,172,371,553.54, resulting in a BCR of 100.53. [ABSTRACT FROM AUTHOR]

Background: Human papillomavirus (HPV) vaccines effectively prevent, and can even eliminate, HPV-related cancers. Currently, vaccination rates are suboptimal in the national Swedish school-based vaccination program. School nurses play a key role in all aspects of the vaccination process. Therefore, this study aims to explore school nurses' perceived HPV vaccination challenges. Methods: Seven focus group interviews were conducted with school nurses (n = 35) working in nine socio-demographically diverse municipalities in mid-Sweden. Data were analyzed using qualitative content analysis. Results: Participants described difficulties in encountering and handling the diversity of reasons for vaccine hesitancy. Parents known to be skeptical of vaccines in general were seen as most difficult to reach. Uncertainty was expressed concerning the extent of professional responsibility for vaccine promotion. The informants expressed a lack of guidelines for vaccine promotion and described challenges in supporting the child's own wishes. Creating a safe space for the individual child was seen as crucial. Other problems described were the challenges of overcoming children's fear of needles, supporting unvaccinated children, and being confronted with the remaining gender inequities of the pan-gender vaccination program. Conclusions: Our results suggest that school nurses, especially those new to their profession, may benefit from training and guidance22 material on how to address vaccine hesitancy. [ABSTRACT FROM AUTHOR]

Tegal district is facing obstacles in achieving immunization targets during the Covid-19 pandemic as the declining number of children who have been immunized. The role and support of village stakeholders considerably play a very significant role in overcoming these obstacles. This current study aimed to analyze the dimensions of village stakeholders’ roles in achieving basic immunization targets during the pandemic era. This study was conducted using a quantitative survey with a cross-sectional approach. The participants were all village stakeholders related to the immunization program. There were 300 people from 30 selected villages as samples chosen through a purposive technique sampling. The roles of stakeholders were found to be the dimensions of perceptions, powers, and respectively interests. The results were most of the stakeholders showed such positive dimensions of perception related to their roles in immunization as well as interest dimensions. All respondents, in addition, considered that their institutions have no power in implementing immunization programs in villages. The immunization success was the responsibility of PHC and health workers instead. There was a relationship between perceptions with strengths and interests, as well as a relationship between strengths with interests of village stakeholders in the immunization program (p

Switching a vaccine for another on a pediatric national immunization program is often done for the betterment of society. However, if poorly implemented, switching vaccines could result in suboptimal transitions with negative effects. A systematic review was conducted to evaluate the existing knowledge from identifiable documents on implementation challenges of pediatric vaccine switches and the real-world impact of those challenges. Thirty-three studies met the inclusion criteria. We synthesized three themes: vaccine availability, vaccination program deployment, and vaccine acceptability. Switching pediatric vaccines can pose unforeseen challenges to health-care systems worldwide and additional resources are often required to overcome those challenges. Yet, the magnitude of the impact, especially economic and societal, was frequently under-researched with variability in reporting. Therefore, an efficient vaccine switch requires a thorough consideration of the added benefits of replacing the existing vaccine, preparation, planning, additional resource allocation, implementation timing, public–private partnerships, outreach campaigns, and surveillance for program evaluation.

The COVID-19 pandemic represents a threat that has posed a challenge to public health response and threatens immunization programs globally. Despite recommendations to continue routine immunization services, disruptions have been observed to these and mass vaccination campaigns. This may result in setbacks to immunization initiative successes and a rise in cases of vaccine-preventable diseases. We conducted a systematic literature review to identify studies globally that described how indicators of health system resilience, defined using the Resilient Health System Framework, enabled routine immunizations to continue during the COVID-19 pandemic. A systematic search was conducted in Embase, Web of Science, PsychInfo, medRxiv, bioRxiv, and the gray literature between 1 January 2020, and 12 November 2021. Information was extracted from the studies identified describing how the specific elements of resiliency (being aware, diverse, self-regulating, integrated, and adaptive) were applied to their routine immunization programs. Our study demonstrates the use of tools that contributed to immunization program resilience during the COVID-19 pandemic in all geographic regions and for countries with different income levels. These tools may help inform preparations for other immunization programs to catch up from the COVID-19 pandemic or mitigate the impact of future threats. [ABSTRACT FROM AUTHOR]

The aim was to estimate the vaccination timeliness defined as the proportion of children under 6 years of age who received their immunization in the time range established by the Colombian Expanded Immunization Program (EIP). A retrospective cohort study that collected reports of vaccination opportunities between 2014 and 2019 provided by the Ministry of Health. Age, sex, city, ethnicity, health system affiliation regimen, vaccine applied, and timing of vaccination were considered for the time range under study. A total of 3,370,853 immunized children were included from all regions of the country. More than 80% of children had a timeliness to get most vaccines. The exceptions were yellow fever (17%) and seasonal influenza (42%). No differences in timeliness were found according to geographic region or by health system affiliation regime, but the average timeliness for all vaccines of children of the indigenous population (65.8% ±18.4%) was lower than that of the rest of the population (78·6% ± 19·3%) ( p  = 0·021). The timeliness for vaccination under the EIP of Colombia is high, with proportions of 72-96%, but intergroup differences were identified, mainly lower timeliness among indigenous people. These findings warrant improvement strategies that would guarantee the immunization of the entire child population.

Despite the benefits of immunization, differences in attitudes persist toward vaccines. We captured individuals' perceptions of vaccines and vaccination across the United States (US) to inform vaccine-related policy development. A survey was completed by 5000 respondents from 10 states. Respondents were screened for inclusion, which included individuals ≥ 18 years of age that had received a vaccine or were unvaccinated but indicated a favorable or neutral attitude towards vaccinations. Participants were excluded if they indicated they did not support the idea of vaccinations. Questions explored perceptions of vaccines for all age groups. Among unvaccinated individuals, the most common concerns were about safety (38%). Most respondents (95%) highlighted the importance of state immunization programs for disease prevention. Access to health and immunization records and immunization information systems were important to 96% and 88% of respondents, respectively, for future health planning. Doctors and healthcare professionals (HCPs) were considered trusted sources for vaccine information (95%). Overall, respondents recognized the importance of vaccination, but documented concerns among the unvaccinated indicated a need for greater promotion regarding vaccine safety. Doctors and HCPs, as trusted information sources, should continue to and increasingly advocate for the importance of immunization to increase vaccine uptake. [ABSTRACT FROM AUTHOR]

A national immunization program using two doses of live attenuated varicella vaccine was introduced for children aged one to two years in Japan in October 2014. Varicella cases declined after 2014, and immunological status against varicella among vaccinated children changed in post-vaccination era. A retrospective observational study of anti-varicella antibody seroprevalence, varicella vaccination status, and history of varicella among 528 students in the first grade of elementary school was conducted. The percentage of students who received at least a single dose of varicella vaccination increased from 67% (187 of 279 students) in 2007–2008 to 91% (226 of 249 students) in 2017. Students with a history of varicella decreased from 114 of 279 (41%) in 2007–2008 to 48 of 249 (19%, P

• Innovation was needed to optimize the pediatric COVID-19 vaccination program. • Practices addressed vaccine access, confidence, and motivation. This report highlights state and local practices for optimizing the pediatric COVID-19 vaccination program for children ages 6 months through 11 years. State and local practices designed to optimize pediatric COVID-19 vaccine uptake were identified from a range of sources, including immunization program, CDC, and partner staff; and media stories or program descriptions identified via online searches. A range of practices were identified across different categories: provider-focused practices, school-based practices, jurisdiction or health department-based activities, community-focused practices involving partners, use of vaccination incentives, and Medicaid-related practices. Immunization programs and stakeholders implemented a variety of practices to meet the challenge of the pediatric COVID-19 vaccination program. The key findings may serve to inform not only the current pediatric COVID-19 vaccination program, but also future outbreak response work and routine immunization activities. [ABSTRACT FROM AUTHOR]

Several vaccine events causing public concern have occurred in China that were investigated and responded to by the central government. We describe causes, influences, and policy or practice changes associated with vaccine events that occurred between 2005 and 2021. We make recommendations to foster resilience in China's Expanded Program of Immunization (EPI) system and vaccination enterprises and to sustain vaccine and program confidence. Our study included all vaccine events since 2005 that were investigated and responded to by the central government of China. We verified mainstream and social media visibility of the events through Internet search. We extracted event times, causes, investigation processes, results, actions, and policy or practice regulation changes from official reports of government meetings and from official websites with media briefings. Seven vaccine events were identified, each of which caused more than 100,000 mainstream or social media reports nationally or nationally and internationally. The events ranged in magnitude from 145 children receiving out-of-date oral poliovirus vaccine to a measles supplementary immunization activity involving 103 million children. Few, if any, children were directly harmed by vaccines in the events. Government responded to each event with program or policy changes, and in one case, with legislation. Responses affected the conduct of campaigns and supplementary immunization activities, use of schools as vaccination venues, financial incentives for vaccinating with non-program vaccines, vaccine procurement and distribution, and program policy making. The most fundamental response was enacting the country's first vaccine law, the 2019 Vaccine Administration Law, which guides virtually all aspects of vaccination work, from vaccine development through regulation, program implementation, and safety and impact monitoring. All seven events generated substantial national and international mainstream and social media criticism and discussion, most commonly expressed through concerns of vaccine safety or vaccine effectiveness. Most had temporally associated temporary declines in vaccine confidence and coverage, jeopardizing decades of vaccination effort. The central government responded to each event by attempting to address root causes. Faithful implementation of the Vaccine Administration Law is fundamental to program strengthening and sustaining confidence of families, stakeholders, and government in vaccines and immunization in China. [ABSTRACT FROM AUTHOR]

Boosting Bacillus Calmette-Guérin (BCG) with subunit vaccine is expected to induce long-term protection against tuberculosis (TB). However, it is urgently needed to optimize the boosting schedule of subunit vaccines, which consists of antigens from or not from BCG, to induce long-term immune memory. To address it two subunit vaccines, Mtb10.4-HspX (MH) consisting of BCG antigens and ESAT6-CFP10 (EC) consisting of antigens from the region of difference (RD) of Mycobacterium tuberculosis (M. tuberculosis), were applied to immunize BCG-primed C57BL/6 mice twice or thrice with different intervals, respectively. The long-term antigen-specific immune responses and protective efficacy against M. tuberculosis H37Ra were determined. The results showed that following BCG priming, MH boosting twice at 12-24 weeks or EC immunizations thrice at 12-16-24 weeks enhanced the number and function of long-lived memory T cells with improved protection against H37Ra, while MH boosting thrice at 12-16-24 weeks or twice at 8-14 weeks and EC immunizations twice at 12-24 weeks or thrice at 8-10-14 weeks didn't induce long-term immunity. It suggests that following BCG priming, both BCG antigens MH boosting twice and "non-BCG" antigens EC immunizations thrice at suitable intervals induce long-lived memory T cell-mediated immunity. [ABSTRACT FROM AUTHOR]

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Boosting Bacillus Calmette-Guérin (BCG) with subunit vaccine is expected to induce long-term protection against tuberculosis (TB). However, it is urgently needed to optimize the boosting schedule of subunit vaccines, which consists of antigens from or not from BCG, to induce long-term immune memory. To address it two subunit vaccines, Mtb10.4-HspX (MH) consisting of BCG antigens and ESAT6-CFP10 (EC) consisting of antigens from the region of difference (RD) of Mycobacterium tuberculosis (M. tuberculosis), were applied to immunize BCG-primed C57BL/6 mice twice or thrice with different intervals, respectively. The long-term antigen-specific immune responses and protective efficacy against M. tuberculosis H37Ra were determined. The results showed that following BCG priming, MH boosting twice at 12-24 weeks or EC immunizations thrice at 12-16-24 weeks enhanced the number and function of long-lived memory T cells with improved protection against H37Ra, while MH boosting thrice at 12-16-24 weeks or twice at 8-14 weeks and EC immunizations twice at 12-24 weeks or thrice at 8-10-14 weeks didn’t induce long-term immunity. It suggests that following BCG priming, both BCG antigens MH boosting twice and “non-BCG” antigens EC immunizations thrice at suitable intervals induce long-lived memory T cell-mediated immunity.

Abstract Background There has been significant recent prioritization and investment in the immunization program in Ethiopia. However, coverage rates have stagnated and remained low for many years, suggesting the presence of systemic barriers to implementation. Hence, there is a need to consolidate the existing knowledge, in order to address them and consequently improve program effectiveness. Methods A thorough literature review and Delphi method were used. In this review, we searched Pubmed/Medline, WHO library, Science direct, Cochrane library, Google scholar and Google using different combinations of search strategies. Studies that applied any study design, data collection and analysis methods related to immunization program were included. In the Delphi method, a panel of 28 national and international experts were participated to identify current evidence gaps and set research priorities under the immunization program. Results In this review, a total of 55 studies and national documents were included. The review showed that the vaccination coverage ranged from 20.6% in Afar to 91.7% in Amhara region with large inequities related to socio-economic, health service access and knowledge about vaccination across different settings. Only one study reported evidence on timeliness of immunization as 60%. The review revealed that 80% of health facilities provide immunization service nationally while service availability was only 2% in private health facilities. This review indicated that poor vaccine storage, vaccine shortage, service interruptions, poor defaulter tracing, low community engagement and poor documentation were the main barriers for the Expanded Program on Immunization with variations across different regions. Through expert panel of discussion using Delphi method, 10 priority research areas were identified across different domains of the immunization program at national level. Conclusion We found out that there is substantial knowledge on vaccination coverage, however, there is little evidence on timeliness of vaccination. The existing barriers that affect full immunization coverage also varied from context to context which indicates there is a need to design and implement evidence based locally tailored interventions. This review also indicated evidence gaps with more focus on health system related implementation barriers at lower level and identified further research priorities in the immunization program of Ethiopia.

RESUMEN: El Programa Nacional de Inmunizaciones (PNI) nace el año 1978 en Chile, considerando dentro de sus objetivos la prevención de la morbilidad, discapacidad y muertes secundarias a enfermedades inmunoprevenibles a lo largo de todo el ciclo vital. Dentro de los eventos asociados al proceso de inmunización y que el PNI contempla desde sus inicios, se encuentran los “Errores Programáticos en vacunación” (EPRO), definidos como eventos relacionados con los aspectos operativos de la vacunación, evitables, que no cumplen con las normas establecidas y que no causaron daño en el paciente. La gestión y prevención de los EPRO son vitales para asegurar la calidad y seguridad en la atención de pacientes durante todo su ciclo vital, debido a que a partir de estos se efectúan medidas correctivas y se puede realizar una evaluación de las razones de su ocurrencia pudiendo así evitar su futura aparición, a través de la elaboración de lineamientos para su prevención. Esta tarea ha sido liderada por los equipos de enfermería desde los inicios del proceso de inmunización en nuestro país y la cual se ha demostrado mediante estrategias como la estandarización de procesos, implementación de pautas de seguridad durante todo el proceso de vacunación, realización de reportes de errores con información detallada y veraz, programas de mejoras continua, evaluación de pautas de calidad de procesos, sistemas de gestión de control de stock, trabajo en equipo y metodologías de comunicación efectivas. SUMMARY: The Expanded Program on Immunization (EPI) in Chile, was born in 1978, considering within its objectives the prevention of morbidity, disability and deaths secondary to immunoprevenible diseases throughout the entire life cycle. Among the risks associated with the immunization process and that the EPI contemplates since its inception, there are the “Programmatic Errors in Vaccination” (EPRO), defined as attitudes or procedures that do not comply with the established norms of vaccination and that alone or in together they can generate serious and fatal adverse events. The management and prevention of events such as EPROs are vital for the assurance of quality and safety in patient care throughout their life cycle, a task that the Nursing team has been responsible for leading since the beginning of the immunization process in our country and which has been demonstrated through strategies such as process standardization, implementation of safety guidelines throughout the vaccination process, reporting of errors with detailed and truthful information, continuous improvement programs, evaluation of quality guidelines of processes, stock control management systems, teamwork and effective communication methodologies.

Influenza contributes to morbidity and mortality worldwide. Children are at a higher risk of influenza-related complications and vaccination promotes direct protection and limits transmission. This study aimed to explore influenza vaccination coverage among children in Australian general practice from 2015 to 2018, and patterns in coverage before and after the implementation of state-funded immunization programs. Data from 196,520 ‘active’ patients (3+ consultations in two consecutive years) aged

Background: Infantile pertussis is a major concern and causes a significant health burden worldwide. Maternal adult tetanus, diphtheria, and acellular pertussis (Tdap) vaccination is very effective way of preventing infantile pertussis. However, Tdap has not been approved by the Japanese government or been included in Japan’s national immunization program (NIP). We carried out a questionnaire survey to investigate whether Japanese women would accept the Tdap vaccination if they were provided with appropriate information. Methods: The questionnaire survey was administered to pregnant women who visited the Obstetrics and Gynecology Department and mothers who visited the Pediatrics Department of Nara Medical University, Kashihara City, Japan, between October 2018 and May 2019. The questionnaire included information about pertussis infection and maternal vaccination, followed by seven questions. Results: A total of 943 participants answered the questionnaire (481 pregnant women and 462 mothers). Before reading the information, just 4.6% of participants knew that infantile pertussis can be prevented by maternal vaccination. After reading the information, 93.0% and 92.6% of participants thought that the maternal Tdap vaccine should be approved by the Japanese government and be included in the NIP, respectively. Although only 67.6% of participants wished to have the maternal Tdap vaccine without government financial support after reading the information, 92.5% said they would have the vaccine with government support (P

The discovery and development of vaccines remain one of the major successes of global health with millions of lives saved every year through routine vaccination. Although vaccines provide a safe and cost-effective solution to vaccine-preventable diseases (VPDs), VPDs are still a serious public health problem in most parts of the world, especially in sub-Saharan Africa (SSA) and Asia. In this review, we discuss the burden of VPDs and vaccine coverage several decades after the introduction of the Expanded Program on Immunization (EPI) in Cameroon. We also discuss how different factors affect the implementation of the EPI, highlighting context-specific factors such as the ongoing civil conflict in Cameroon, and the presence of other infectious diseases like COVID-19.

Background: Since development of the first COVID-19 vaccine, the landscape of public confidence in these vaccines is uncertain. Building confidence is crucial for better preparedness of future pandemics. Following the mandatory COVID-19 vaccination policy in the country, the aim of this study was to examine whether the Saudi public feels relieved post-vaccination and to identify the factors predicting such relief.Methods: An online cross-sectional survey was conducted in July 2021 among COVID-19 vaccine recipients in Saudi Arabia. A multivariable logistic regression analysis was employed to examine and identify the variables associated with feeling relieved post-vaccination.Results: Most of the respondents (66%) stated feeling more relieved post-vaccination. Male gender [adjusted odds ratio (AOR): 1.380; 95% confidence interval (CI): 0.981–1.943], being a student (AOR: 3.902; 95% CI: 1.674–9.096), and received two doses of the vaccine (AOR: 2.278; 95% CI: 1.630–3.182) were associated with feeling more relieved after getting vaccinated. Respondents who were anxious about the vaccine before receiving it (AOR: 0.220; 95% CI: 0.160–0.302), and experienced a severe reaction after vaccination (AOR: 0.288; 95% CI: 0.165–0.504) had lower odds of feeling relieved post-vaccination. Respondents who relied on social media as the main source of vaccine-related information and those having no information about the vaccine were also less likely to feel relieved post-vaccination.Conclusions: Individuals' attitudes toward COVID-19 vaccines may not necessarily alter post-vaccination. Although mandatory vaccination policies can significantly contribute to achieving herd immunity, public confidence toward vaccines might be eroded, which could in turn impose significant challenges in future pandemics efforts.

Background: Despite the introduction of rubella-containing vaccine into routine immunization in 1977, rubella has not been eliminated in Japan. This study aimed to validate the immunization strategy and to highlight the crucial elements of elimination program., Methods: We scrutinized cases of rubella and congenital rubella syndrome (CRS). Additionally, we analyzed the national vaccination coverage, seroprevalence, and number of maternal rubella-related spontaneous or artificial fetal deaths., Results: The shift from selective to universal immunization significantly reduced rubella cases coupled with increased seroprevalence in children. However, rubella resurged in 2012-2013 and 2018-2019, which was virologically and serologically confirmed to be associated with imported rubella virus (RuV) and susceptible males. Although the disease burden of CRS may have been suppressed in the past by the large number of spontaneous or artificial fetal deaths, the incidence rate of CRS was comparable to that of the 1960s to 1980s. Cases of breakthrough infection and CRS were identified in females who were considered to have a history of single-dose vaccination., Conclusions: Even with universal immunization, future epidemics and severe outcomes cannot be prevented unless immunization gaps are closed. Furthermore, CRS and breakthrough infection are not completely prevented by single-dose vaccination, indicating the need for second-dose vaccination., (© The Author(s) 2024. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)