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Timely vaccination adherence for infants can avoid costs for the health care system and support population health. Can public health interventions–such as nurse home visits–encourage timely uptake? We study this question in the context of universal home visits for new parents in Denmark. We exploit merged nurse records and administrative data and use an event study design to compare the outcomes of families, who vary in the exact timing of their nurse visit around the recommended age for infant vaccinations. We find that a nurse visit prior to the recommended vaccination age increases parents' probability of timely vaccination adherence. In the longer run, vaccination coverage rates between treated and control parents converge, and thus our findings suggest that nurses primarily act as human vaccination reminders. However, as our heterogeneity analyses show that a timely nurse visit positively affects vaccination coverage for inexperienced parents, adequately timed nurse visits may have the potential to also increase vaccination coverage. [ABSTRACT FROM AUTHOR]

Background: Growing evidence shows that many parents begin the decision-making process about infant vaccination during pregnancy and these decisions - once established - may be resistant to change. Despite this, many interventions targeting vaccination are focused on communicating with parents after their baby is born. This suggests that the prenatal period may constitute a missed opportunity for communicating with expectant parents about infant vaccination.Methods: Using a longitudinal qualitative design, we conducted two interviews (prepartum and postpartum) with women (n = 19) to explore the optimal timing of vaccination information. The data were analyzed thematically, and examined across all sets of pre- and post-partum interviews as well as within each individual participant to draw out salient themes.Results: Most participants formed their intentions to vaccinate before the baby was born and indicated that they would welcome information about vaccination from their maternity care providers. However, few individuals recalled their maternity care providers initiating vaccination-related conversations with them.Conclusion: The prenatal period is an important time to begin conversations with expectant parents about vaccinating their infants, particularly if these conversations are initiated by trusted maternity care providers. More information is needed on how maternity care providers can be better supported to have these conversations with their patients. [ABSTRACT FROM AUTHOR]

Background: In rural Gambia, rates of malnutrition and infection are higher during the annual rainy/'hungry' season (June-October) in comparison to the dry/'harvest' season (November-May). The effects of this seasonal pattern on an infant's immune development and their capacity to respond to childhood vaccinations remain unclear. The aim of the current analysis was to determine whether antibody responses to diphtheria-tetanus-pertussis (DTP) vaccinations in infants differ between seasons.Methods: Infants received the DTP vaccine at 8, 12 and 16 weeks of age and antibody titres were measured in blood samples collected at 12 (n = 710) and 24 (n = 662) weeks of age. Mean DTP antibody titres, adjusted for maternal and infant confounders, were compared by t-tests and the effect sizes of the mean differences were calculated between seasons at mid-gestation (20 weeks gestation) and first vaccination (8 weeks of infant age).Results: A smaller number of infants received their first vaccination during the rainy/hungry season months compared to the dry/harvest season (n = 224 vs. n = 486). At 12 weeks, infants vaccinated during the rainy/hungry season had lower weight-for-length Z-scores (p = 0.01) and were more likely to be anaemic (p < 0.001). Their mothers, however, were pregnant mostly during the dry/harvest season, had higher weight gain (p < 0.001) and were less likely to be anaemic during pregnancy (p < 0.001). At 12 weeks, infants vaccinated during the rainy/hungry season had significantly higher mean diphtheria, tetanus and pertussis antibody titres; by 62.3, 16.9 and 19.7%, respectively (all, p < 0.001). However, at 24 weeks, they had lower mean anti-diphtheria titres (by 20.6%, p < 0.001) compared with infants vaccinated during the dry/harvest season, and no differences were observed in mean tetanus and pertussis antibody titres by vaccination season.Conclusions: Infant antibody response to the primary dose of the DTP vaccine was influenced by both season of pregnancy and infancy, although effects were diminished following three doses. Environmental exposures, including nutrition, to both the mother and infant are hypothesised as likely drivers of these seasonal effects. [ABSTRACT FROM AUTHOR]

Background: One of the strategies for improving vaccination uptake is to make communities understand the importance of immunization and this is expected to drive the demand for vaccines. Building the capacity of older women who supervise child care in Africa may improve infant vaccination in underserved communities. This study determined the impact of training of older women on their knowledge and support for infant vaccination in selected urban slum communities in Ibadan, Nigeria.Methods: This was a before-and-after study that enrolled women aged ≥35 years. They were trained with a manual and short video using participatory learning methods over an 8 month period. The content of their training includes importance of immunization timeliness and completion, how vaccines work and how to be advocates and supporters of infant vaccination. Their knowledge and support for infant vaccination at baseline were compared with post training values using Student's t test and Chi square test with the level of significance set at 5%.Results: There were 109 women with mean age 55.8 ± 11.6. they had a mean of 5.7 ± 2.1 training sessions. At the end of the training, their knowledge about infant vaccination and the support they give to it increased from 4.8 ± 3.8 to 10.7 ± 0.6, and 3.1 ± 3.5 to 8.1 ± 1.7 respectively. Those with good knowledge about infant vaccination increased significantly from 37(33.9%) to 82(82.8%), while those with good support for the same increased from 31(28.4%) to 85(85.9%). Women who were ≤ 64 years significantly had improved knowledge after the training compared to the older ones. Those with post secondary education had better knowledge and greater support for infant vaccination at baseline. However, there was no difference in the knowledge and support for infant vaccination among the women across the different educational levels after the training.Conclusions: Participatory learning improved the knowledge about, and support for infant vaccination among older women supervising child care in these urban slum communities. Similar training may be extended to comparable settings in order to improve demand for infant vaccination. [ABSTRACT FROM AUTHOR]

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Importance: The standard schedule of national immunization programs for infants may not be sufficient to protect extremely and very preterm infants.Objective: To evaluate the immunogenicity of routine vaccinations administered to preterm infants.Design, Setting, and Participants: A multicenter, prospective, observational cohort study of preterm infants stratified according to gestational age recruited from 8 hospitals across the Netherlands between October 2015 and October 2017, with follow-up until 12 months of age (October 2018). In total, 296 premature infants were enrolled and compared with a control group of 66 healthy term infants from a 2011 study, immunized according to the same schedule with the same vaccines.Exposures: Three primary doses of the diphtheria-tetanus toxoids-acellular pertussis-inactivated poliomyelitis-Haemophilus influenza type b-hepatitis B combination vaccine were given at 2, 3, and 4 months after birth followed by a booster at 11 months and a 10-valent pneumococcal conjugate vaccine at 2, 4, and 11 months after birth.Main Outcomes and Measures: Primary end points were (1) proportion of preterm infants who achieved IgG antibody against vaccine antigens at concentrations above the internationally defined threshold for protection after the primary series and booster dose and (2) serum IgG geometric mean concentrations after the primary series and booster vaccination. Proportions and geometric mean concentrations were compared in preterm infants and the control group of term infants.Results: Of 296 preterm infants (56.1% male; mean gestational age, 30 weeks), complete samples before vaccination, 1 month after the primary series, and 1 month after the booster were obtained from 220 preterm infants (74.3%). After the primary series, the proportion of preterm infants across all gestational age groups who achieved protective IgG antibody levels against pertussis toxin, diphtheria, tetanus and 6 of 10 pneumococcal serotypes varied between 83.0% and 100%, Haemophilus influenzae type b between 34.7% and 46.2% (40.6% among all preterm infants overall), and pneumococcal serotypes 4, 6B, 18C, and 23F between 45.8% and 75.1%. After the booster dose, protective antibody levels were achieved in more than 95% of all preterm groups, except for Haemophilus influenzae type b (88.1%). In general, geometric mean concentrations of all vaccine-induced antibodies were significantly lower in all preterm infants vs term infants, except for pertussis toxin and pneumococcal serotypes 4 and 19F after the primary series and booster vaccination.Conclusions and Relevance: Among preterm infants, administration of routine vaccinations during the first year of life was associated with protective antibody levels against most antigens in the majority of infants after the primary series and booster, except for Haemophilus influenzae type b. However, antibody concentrations were generally lower among preterm infants compared with historical controls. [ABSTRACT FROM AUTHOR]

Background: Use of same length needle for intramuscularly administered vaccines had been reported to cause under-and over-penetration among infants due to their different body weights and underlying variations in the fat and muscle thickness. Normative data regarding thigh compartment thickness are, however, lacking among neonates and infants aged ≤12 weeks particularly in low- and middle-incoming countries with high burden of low birth weight/growth restricted infants.Methods: Present study investigated skin to muscle and skin to bone (STBD) distances of anterolateral thigh of babies (n = 300) aged ≤12 weeks (1-80 days) with different weight groups (<3 kg, 3-4 kg and >4 kg) by ultrasonography during their intramuscular vaccinations.Results: Overall, mean [standard deviation (SD)] STBD was 17.04 (2.66) mm with range of 10.60-23.30 mm. Stratifying by current body weight, mean (SD) STBD in infants weighing less than 3 kg was 14.39 (1.23) mm. For infants weighing between 3-4 kg and >4 kg, the mean (SD) STBD were 16.69 (1.43) mm and 17.04 (2.66) mm, respectively. Estimated safety (no risk of over-penetration) of 16 mm was observed in 57.33% (172) infants whereas 25 mm needle had 100% over-penetration risk in the study cohort. Current body weight of infants was a significant predictor of safe injection [area under the receiver operating characteristic (ROC) curve 0.95; 95% CI 0.92-0.97].Conclusions: Our study offers objective normative measurements of anterolateral thigh for safe intramuscular vaccination in young infants especially for low birth weight and growth restricted infants in low- and middle-income countries. [ABSTRACT FROM AUTHOR]

Background: Despite policy intention to reach disadvantaged populations, inequalities in health care resource use and health outcomes persist in Nepal. The current study aimed to investigate the trend of full vaccination coverage among infants and its equity gaps between Nepal Demographic and Health Surveys (NDHS) 2001 and 2016.Methods: Using data from NDHS conducted in 2001, 2006, 2011 and 2016, we investigated the trend of coverage of six antigens: Bacille Calmette Guerin (BCG), Diptheria, Pertussis, Tetanus (DPT), Polio, and Measles during their infancy among children aged 12-23 months. We presented trends and correlates of full vaccination coverage by different socio-demographic factors. We measured inequalities in full vaccination coverage by wealth quintile and maternal education using absolute measure (slope index of inequality) and relative measures (Relative index of inequality, concentration index) of inequalities.Results: Full vaccination coverage among infants steadily increased from 65.6% in 2001 to 87.0% in 2011; however, it decreased to 77.8% in 2016. Province 2 had a significantly lower full vaccination coverage compared to Province1.Although decreasing over time, there were significant inequalities by household wealth quintiles and maternal educational status. The slope index of inequality (SII) for wealth quintiles decreased from - 32.3 [- 45.5,-19.1] in 2001 to an SII of-8.4 [- 18.6,-1.7] in 2016. Similarly, the SII for education decreased from - 61.8 [- 73.5,-50.1] in 2001 to an SII of - 30.5 [- 40.7,-20.2] in 2016. Similarly, the relative index of inequality (RII) also showed an improvement over time, indicating the narrowing equity gap. Additionally, concentration index on full vaccination coverage by wealth quintiles dropped from 0.21 (0.12-0.28) in 2001 to 0.054 (- 0.01-0.12) in 2016. Absolute and relative inequalities were persistently larger by maternal educational status compared to household wealth quintiles throughout the study period.Conclusion: Full vaccination coverage in Nepal increased from 2001 until 2011 but saw a significant decrement away from the national target after 2011. However, the equity gap by household wealth quintile and maternal education status has narrowed over time. National Immunization programs need to give higher emphasis to infants born to mothers with less education, those born in the poorer wealth quintile households, and those living in Province 2. [ABSTRACT FROM AUTHOR]

Objective  The objective of this study was to investigate the persistence of maternally derived antibodies to hepatitis A (anti-HAV) and varicella zoster (anti-VZV) viruses to determine the optimal time of vaccination of infants. Materials and Methods  This study was conducted between 2011 and 2012 at the Gazi University Hospital. Blood samples were collected from healthy infants' cord blood and at 12th, 18th, and 24th months of age. Anti-HAV and anti-VZV immunoglobulin M (IgM) and immunoglobulin G (IgG) antibodies were measured by enzyme-linked immunosorbent assay kit in blood samples. Results  A total of 546 infants and children were included in the study; all had blood samples taken at four time points (at birth [cord blood], and at 12, 18, and 24 months). Anti-HAV IgG seropositivity rates in these samples were 77.3, 29.6, 14.8, and 17.7%, respectively (p  < 0.05). Corresponding anti-VZV IgG seropositivity rates were 83.3, 21.5, 29.5, and 33.8%, respectively (p  < 0.05). Conclusion  Anti-HAV and anti-VZV seropositivity rates were lowest at 18 and 12 months, respectively. We suggest that if VZV and hepatitis A vaccines were included in the national vaccination program after the age of 1 year, there should be little interference from passively acquired maternal antibodies. [ABSTRACT FROM AUTHOR]

• Mathematical models can assess potential benefits of vaccination for Lassa virus. • Infant immunisation can reduce incidence by 30–56% if immunity is life-long. • Pulse vaccination of the population is more rapidly effective. Lassa fever is an acute viral illness caused by Lassa virus (LASV), a rodent-borne pathogen. LASV is endemic to much of Sub-Saharan West Africa, where seasonal outbreaks cause significant morbidity and mortality. Increased global awareness of LASV has led to development of improved diagnostic tests, treatments and vaccines. As vaccine candidates are trialled, it is essential to assess the potential outcomes of introducing a LASV vaccination program in endemic regions. This study investigates the potential outcomes of routine and pulse vaccination strategies using a deterministic mathematical model that captures seasonal LASV transmission between rodents and humans. For plausible parameter values, we find that immunization of 40% of infants at 70% vaccine effectiveness achieves a population-level reduction in infectious case numbers of 30%, while coverage of 60% at 90% vaccine effectiveness achieves a 56% reduction. Similar reductions can be achieved more rapidly via population-wide pulse vaccination at 11% coverage (30% reduction at 70% effectiveness) or 23% coverage (56% reduction at 90% effectiveness) repeated every 10 years. Similar pulse vaccine doses delivered at reduced frequency, but increased coverage achieves a greater reduction in infectious cases. Findings around infant vaccination are sensitive to our assumption that immunity is life-long, while pulse-vaccination has only slightly reduced effect if immunity lasts 10–30 years. An effective LASV vaccination program would incorporate pulse vaccination in addition to routine childhood immunization to limit disease. Estimates of feasible vaccine coverage and effectiveness are needed to fully quantify the likely benefits of a vaccination program in LASV endemic regions. [ABSTRACT FROM AUTHOR]

Tetanus, diphtheria, and acellular pertussis (Tdap) vaccination and influenza vaccination are recommended during pregnancy primarily to prevent influenza and pertussis in mothers and their infants. This study examines associations between prenatal Tdap vaccination and influenza vaccination of mothers and hepatitis B vaccination of their infants. A retrospective cohort study was conducted using data from electronic medical records from 15,468 deliveries to 14,925 mothers occurring April 2, 2014-December 3, 2016 at a university hospital in Texas. Hepatitis B vaccine receipt in the first 3 days of life was dichotomized. Margins post-estimation commands in Stata SE 15.1 were used to obtain predicted probabilities and risk differences after estimating odds ratios in logistic regression with robust variance estimates. Adjusted models included maternal age, race/ethnicity, Medicaid use, year of delivery, parity, and gravidity. Infants of mothers who received prenatal influenza vaccination in the 2014-2015 and 2015-2016 influenza seasons were more likely than those of mothers who did not to receive a hepatitis B vaccine in their first 3 days of life (adjusted risk difference (RD) 2.8%, 95% confidence interval (CI) 1.5-4.1% and RD 2.2%, 95% CI 0.9-3.5%, respectively). Hepatitis B vaccination was also higher among infants of Tdap-eligible mothers who received prenatal Tdap vaccination during pregnancy compared to those of mothers who did not (adjusted RD 9.1%, 95% CI 7.6-10.5%). Overall, prenatal vaccination was significantly associated with uptake of infant hepatitis B vaccine. [ABSTRACT FROM AUTHOR]

A prospective, observational, survey of pediatricians and general practitioners (GPs) was conducted to assess pediatric vaccination knowledge and practices. The survey was distributed by email to 1069 pediatricians and 1700 GPs and completed by 151 pediatricians (14.1%) and 201 GPs (11.8%). Knowledge of the vaccination calendar was very good (99% overall). Of the respondents, 98% were confident in vaccine efficacy. Eight-one percent of pediatricians and 62% of GPs agreed that recommended vaccinations should become obligatory; all prescribed hexavalent vaccines often or always. More pediatricians (88%) than GPs (75%) used anti-pyretics; the use of anesthetic cream/patches was similar in each group (79% and 75%, respectively). The ambience at vaccination was considered to be important by both groups, and was disturbed in 37% of cases. Seventy percent of pediatricians and 57% of GPs agreed that vaccine reconstitution (e.g., Hib pellet) is a complicating factor: overall, 28% reported occasionally omitting to reconstitute a pentavalent or hexavalent vaccine in error, and 60% reported having not fully reconstituted the vaccine. Almost all (93%) considered non-reconstitution as an important error.Conclusion: Overall, adherence to good vaccination practices was good, although errors in reconstitution were reported by physicians. These problems would be minimized by wider use of fully liquid vaccines. What is Known: • Pediatric vaccination schedules are crowded. • Good vaccination practices and the use of multivalent vaccines are essential to maintain good compliance to pediatric vaccination recommendations. What is New: • Overall good compliance to good vaccination practices by both pediatricians and GPs in France. • Omission of pentavalent or hexavalent vaccine reconstitution of Hib pellet and incomplete reconstitution reported by pediatricians/GPs. Awareness of pediatricians/GPs that omission and incomplete reconstitution are important errors. [ABSTRACT FROM AUTHOR]

Pain is an unpleasant sensation that can range from mild, localized discomfort to agony. It is too difficult to face pain of vaccinations in children.Helfer skin tapping technique is resulting to minimize the level of pain during intramuscular injections among children. Objective- Primary objective behind this literature review is to find out effectiveness of helfer skin tap technique in reduction of level of pain among children. Method- A systematic literature review was conducted. The literature includes last 8years’ data. The literature reviewed was obtained through different database includes CINHAL (Cumulative index TO Nursing & Allied Health Literature), MEDLINE (Medical Literature Analysis & Retrieval System Online), PubMed, Science Direct, SpringerLink, ProQuest & Google scholar. Result—Pain level of experimental group is less than control group. Helfer skin tap technique is effective to reducing the level of pain among infants who are undergone with pentavalent vaccination. Conclusion—Helfer skin tap technique is helpful in minimizing the level of pain during vaccination among infants. All the nurses can perform Helfer skin tap technique in routine practices for reducing pain intensity. [ABSTRACT FROM AUTHOR]

Background: We characterize the risk factors for delayed polio dose 1, diphtheria-tetanus-pertussis (DTP) dose 1, pentavalent dose 1, and measles dose 1 in Ethiopian infants. We also examine the interaction between institutional delivery and demographic factors on the birth doses of the BCG and polio vaccines to better understand factors influencing vaccination. Methods: Using the 2011 Ethiopia Demographic and Health Survey, we calculated the distribution of the study population across different demographic and vaccination characteristics. We computed acceleration factors using a multivariable accelerated failure time model with a Weibull distribution to account for left and right censoring. For the birth doses, we further specified an interaction term between institutional delivery and every other a priori specified independent variable to test whether institutional delivery modifies sociodemographic disparities in vaccination timeliness. Results: Low wealth status, home delivery, and ethnicity are risk factors for delayed vaccination of polio 1, DPT 1, pentavalent 1, and measles 1. Religion is a risk factor for measles 1 vaccination delay and rural residence are risk factors for delayed DPT1 and polio 1 doses. For birth doses of polio and BCG, institutional delivery attenuated many sociodemographic disparities in vaccination delay, except for urbanicity, which showed rural dwellers with more delay than urban dwellers with an institutional vs home birth. Conclusions: Less delayed vaccination among children with institutional deliveries highlights the importance of perinatal care and the potential for promoting healthy behaviors to parents. Persistent disparities between urban and rural residents, even among those with institutional births, can be targeted for future interventions. Timely vaccination is key to prevention of unnecessary childhood mortality. [ABSTRACT FROM AUTHOR]

Highlights • In France the vaccination of all infants born on or after January 1, 2018 against 11 diseases has changed from a recommended to a mandatory status. • Vaccinoscopie is an annual French web-based survey targeting mothers, monitoring vaccine coverage rates (VCRs) in children as well as mothers' opinion regarding vaccination. • This study reports the positive impact of mandatory vaccination extension on VCRs and on the opinion of mothers of infants. • Among infants born after the extension of mandatory vaccination, VCRs for at least one dose at six months of age greatly increased for vaccines that previously did not meet Public Health objectives (MenC and HepB). Abstract Objective In France infant vaccines protecting against 11 diseases have changed from a recommended to a mandatory status for all children born on or after January 1, 2018. Using the Vaccinoscopie survey, we measured the impact of this new vaccination policy on vaccine coverage rates (VCRs) and on mothers' perception of vaccination. Methods Online survey with 1000 mothers of 0- to 11-month-old infants. Results VCRs for at least one dose at the age of 6 months strongly progressed for diseases that previously did not meet Public Health objectives (+8 points for Hepatitis B and +31 points for meningococcal C vaccines). Mothers were more favorable to mandatory vaccination and better informed in 2018 than in 2017. Conclusion These first results showed a positive impact of the extension of mandatory vaccination on mothers' opinion regarding vaccination and on infant VCRs. [ABSTRACT FROM AUTHOR]

Summary: Background: Data on tenofovir disoproxil fumarate (TDF) therapy for preventing vertical transmission of hepatitis B virus (HBV) in the real‐world setting are limited. Aim: To investigate TDF for preventing vertical transmission of HBV in real‐world practice. Methods: Hepatitis B e‐antigen (HBeAg)‐positive mothers with HBV‐DNA >6 log10 IU/mL to receive TDF between gestational weeks 24‐33 and delivery were prospectively enrolled and followed until post‐partum week 28. All infants received immunoprophylaxis. Primary endpoints were safety of TDF use and mother‐to‐child transmission rates. Secondary outcomes were maternal HBV‐DNA level suppression (<200 000 IU/mL) at delivery and HBeAg and hepatitis B surface antigen (HBsAg) serologic changes during the study. Results: Among 147 mothers enrolled, 143 started TDF and 143/144 infants completed the study. At delivery, 93.7% (134/143) of the mothers achieved HBV‐DNA<200 000 IU/L. On‐treatment, alanine aminotransferase (ALT) flares were observed in 8.4% (12/143) of mothers. After TDF cessation, ALT increased in 7.7% (11/143) of the mothers and 2.8% (4/143) achieved HBeAg negativity, but none had HBsAg loss. At birth, HBsAg was detected in 13.9% (20/144) of newborns and none at post‐partum week 28. Vertical transmission rates among infants were 0.7% (1/144, intention‐to‐treat) and 0% (per‐protocol). No infants had birth defects. No serious adverse effects were reported in either mothers or infants. Breastfeeding did not increase the HBV infection rate among infants although mothers had viral rebound after TDF cessation. Conclusions: TDF for highly viraemic mothers was well tolerated and reduced vertical transmission of HBV in a real‐world setting. There were no safety concerns during the postpartum 28‐week follow‐up. Registry number: Chinese Clinical Trial Registration No. ChiCTR‐OIC‐17010869 [ABSTRACT FROM AUTHOR]

Introduction: Exposure to noxious stimuli can cause pain in infants. This study was conducted to evaluate the effects of the lavender oil inhalation on the pain resulting from the pentavalent vaccination. Methods: This clinical trial consisted of two groups: the lavender oil group with 42 infants and the placebo group with 57 infants. The healthy infants without congenital abnormalities in need of pentavalent vaccine also participated in our study. The infants started the lavender oil or placebo aromatherapy one minute before injection. The pain was assessed three times, using the Neonatal Infant pain Scale (NIPS): before vaccination, 15 s, and 5 min after vaccination. Also, the duration of crying was measured in both groups. Results: At baseline, the two groups were similar in relation to the NIPS scores. While, after 5 minutes, the NIPS score was significantly lower in the lavender group. Based on the repeated measures analysis, the NIPS score changed over time totally. However, the two groups were significantly different in relation to the NIPS score over time. The duration of crying was 75.47 (60.675) second in the lavender group and 105.22 (75.739) s in the control group. The statistical test showed a significant difference between the two groups. Conclusion: A low concentration of the lavender oil inhalation can reduce the pain and improve soothing in the infants with the pentavalent vaccine injection. [ABSTRACT FROM AUTHOR]

The problem of infant mortality arose in the discussion on risks connected with new-borns' vaccination. When we compare infant mortality about ninety years ago and nowadays, then it is easy to see that children's mortality has decreased enormously. But this process has not been uniform during the whole 90-year period: we can see the sub-periods of rapid progress and also sub-periods of stagnation. Obviously, some social and political factors have an impact here, but the mechanism of this influence is not clear. [ABSTRACT FROM AUTHOR]

Objective: To determine the normal reference ranges and values for red cell distribution width (RDW) amongst various age groups of infants. Study Design: Descriptive Cross Sectional Study. Place and Duration: At Haematology Department of Armed Forces Institute of Pathology (AFIP), Rawalpindi, from 25th March 2010 to 24th March 2011. Methodology: Two thousand healthy infants visiting the vaccination centers were enrolled and the venous blood samples were taken to assess the values for red cell distribution width (RDW) by haematology analyzer. Percentages for reference ranges along with mean ± SD values for RDW were identified. Results: The reference range for RDW value for less 27 days neonates was 65.1 - 80 fl (i.e66.05 ± 7.32 fl). In more than 27 days to less than 03 months aged infants, reference range was 35.1-50 fl (42.47 ± 5.61 fl).In more than 03 months to less than 06 months aged infants, reference range was 50.1-65fl (40.76 ± 4.59 fl).In more than 06months to less than 09 months aged infants, reference range was 50.1 - 65 fl(41.48 ± 4.29 fl). In more than 09 months to less than 01 year aged infants, reference range was 35.1 -50 fl (43.39 ± 7.54 fl). Conclusion: Normal RDW reference values vary with age of growing infant. [ABSTRACT FROM AUTHOR]

Noroviruses are a leading cause of diarrhea in children aged <5 years worldwide. We genotyped 88 viruses collected by active surveillance in a birth cohort of children <2 years of age in Dhaka, Bangladesh, during 2010-2013. Twenty-five of 31 (81%) established GI and GII genotypes were detected, with GII.4 as the predominant genotype (20%). Our results show that children in Bangladesh are infected with a great diversity of norovirus strains. Reinfections are common, but not with closely related genotypes. Birth cohort studies are critical to understand cross-protective immunity and advance the development of pediatric norovirus vaccines. [ABSTRACT FROM AUTHOR]

This article describes our experience using art and theatre to engage rural communities in western Cambodia to understand malaria and support malaria control and elimination. The project was a pilot science-arts initiative to supplement existing engagement activities conducted by local authorities. In 2016, the project was conducted in 20 villages, involved 300 community members and was attended by more than 8000 people. Key health messages were to use insecticide-treated bed-nets and repellents, febrile people should attend village malaria workers, and to raise awareness about the risk of forest-acquired malaria. Building on the experience and lessons learnt in the year prior, the 2017 project which was conducted in 15 villages involved 600 community members and attracted more than 12,000 people. In addition to the malaria theme, upon discussion with local health authorities, secondary theme (infant vaccination) was added to the 2017 project. We learnt the following lessons from our experience in Cambodia: involving local people including children from the beginning of the project and throughout the process is important; messages should be kept simple; it is necessary to take into consideration practical issues such as location and timing of the activities; and that the project should offer something unique to communities. [ABSTRACT FROM AUTHOR]

Abstract Background Pediatric use of pneumococcal conjugate vaccines (PCV) has been associated with significant decrease in disease burden. However, disease caused by non-vaccine serotypes has increased. Safety and immunogenicity of 15-valent PCV (PCV15) containing serotypes included in 13-valent PCV (PCV13) plus serotypes 22F and 33F were evaluated in infants (NCT01215188). Methods Infants received adjuvanted PCV15, nonadjuvanted PCV15, or PCV13 at 2, 4, 6, and 12–15 months of age. Safety was monitored for 14 days after each dose. Serotype-specific IgG geometric mean concentrations (GMCs) and opsonophagocytic activity (OPA) geometric mean titers (GMTs) were measured at postdose-3, predose-4, and postdose-4. Results Safety profiles were comparable across vaccination groups. At postdose-3, both PCV15 formulations were non-inferior to PCV13 for 10 of 13 shared serotypes but failed non-inferiority for 3 serotypes (6A, 6B, and 19A) based on proportion of subjects achieving IgG GMC ≥0.35 µg/mL. Adjuvanted PCV15 and nonadjuvanted PCV15 were non-inferior to PCV13 for 11 and 8 shared serotypes, respectively, based on postdose 3 comparisons of GMC ratios. PCV15 induced higher antibodies to serotypes 3, 22F, and 33F than PCV13. Conclusions PCV15 displayed acceptable safety profile and induced IgG and OPA to all 15 vaccine serotypes at levels comparable to PCV13 for 10 of 13 shared serotypes. Study identification: V114-003. CLINICALTRIALS.GOV identifier: NCT01215188. [ABSTRACT FROM AUTHOR]

Background: Parents have reported that they want to learn how to reduce pain in infants during vaccinations. Our objective was to compare different levels of intensity of postnatal education about pain mitigation on parental self-reported use of interventions at future infant vaccinations.Methods: We conducted a longitudinal, 3-group parallel, add-on, randomized controlled trial on the postnatal ward of a hospital. New mothers, unaware of the hypothesis, were randomly assigned to 1 of 3 intervention groups and 3 follow-up groups (i.e., 9 groups, 3 × 3). The 3 intervention groups were control (general immunization information), pain pamphlet (pain mitigation information), and pain pamphlet and pain video (pain mitigation information). Both pain mitigation education groups also received general immunization information. The 3 follow-up groups were 2-, 4- and 6-month infant vaccinations. Mothers reported use of breastfeeding, sucrose and topical anesthetics during infant vaccinations in a telephone survey.Results: Of 3420 participants, follow-up was available for 2549 (75%): 36.1%, 34.2% and 29.7% reported on pain mitigation practices at 2-, 4- and 6-month vaccinations, respectively (p = 0.9). Maternal characteristics did not differ (p > 0.05): mean age, 33.6 years; 58% were primipara. Utilization of any intervention (breastfeeding, sucrose or topical anesthetics) was 53.2%, 61.4% and 63.0% for control, pain pamphlet, and pain pamphlet and pain video groups, respectively (p < 0.001); both pain education groups had higher utilization than the control group, but did not differ from one another. Uptake differed among intervention groups at 2 and 4 months but not at 6 months.Interpretation: Hospital-based postnatal education increased parental use of pain interventions at infant vaccinations and can be added to existing education.Trial Registration: ClinicalTrials.gov, no. NCT01937143. [ABSTRACT FROM AUTHOR]

In Madura, a lot of infants have incomplete immunization status in which one of the areas with low immunization coverage is Burneh sub-district. The coverage of complete basic immunization in Burneh only 64% in 2015. The aim of this study was to analyze factors related to vaccination in Madurese, using cross sectional design. The sample were 97 mothers with babies 0-1 years old in Burneh sub-district. Data were collected using questionnaires, then analyzed using Chi square test. The results showed the correlation between knowledge (p = 0.027), confidence (p = 0.000), attitude (p = 0.003), culture (p = 0.000), access to health care (p = 0.013), family support (p = 0.034), and support of health professionals (p = 0.021) with the basic immunization status. Meanwhile, the support of community leaders (p = 0.054) had no correlation with the basic immunization status. [ABSTRACT FROM AUTHOR]

Objectives We conducted the first nationwide survey in Slovenia to measure and characterise vaccine confidence among mothers of young children. This survey measured confidence in routine vaccines for children <2 years of age and in the information sources about these vaccinations to provide baseline data for public health actions to maintain and improve vaccination coverage. Methods We randomly selected women giving birth in 2014–15 from the national perinatal information system (N = 39,497). Participants were asked to rate statements measuring vaccine confidence, including confidence in their child’s paediatrician, the Slovenian healthcare system, and different paediatric vaccination information sources. We estimated vaccine confidence with 95% confidence intervals (CI), for seven socio-demographic characteristics for mothers with young children. Spearman’s rank correlation coefficient was used to assess correlations between vaccine confidence and the confidence in the health system or child's paediatrician. Results We sent out 3854 questionnaires, the response rate was 44.4%. While 46.8% (95% CI: 44.4–49.2%) mothers were confident in vaccines, 34.2% (95% CI: 32.0–36.6%) were undecided. We found a correlation (Spearman's rho = 0.457) between vaccine confidence and confidence in the child’s paediatrician. Mothers that were confident in paediatrician were more likely to be confident in vaccines (odds ratio: 7.7; 95% CI: 5.3–11.3). Overall, the most frequently trusted information source were physicians (84.6%). In contrast, among mothers not at all confident in vaccines, 51.9% reported friends as the trusted information source. Conclusion More than half of mothers had low vaccine confidence or were undecided regarding their confidence. While vaccination coverage in Slovenia is high, these levels warrant public health intervention, particularly with the undecided mothers. Communication strategies should focus first on undecided parents and involve physicians, who for many are the most trusted vaccine information source. Different approaches will likely be required for those who are not at all confident in vaccines. [ABSTRACT FROM AUTHOR]

Abstract Introduction and aims Human breast milk is a natural pain reliever that contains endorphins. The aim of this study was to compare the effects of breast milk and powdered milk on pain severity after a muscular injection in 1-day-old neonates. Materials and methods One hundred neonates admitted to a teaching hospital in Ilam city, Iran, participated in a randomized clinical trial in 2016. One-day-old neonates were divided into four equal groups including: the control group (no feeding); the breastfed group; the bottle-fed mother's milk group and the powdered formula group. All infants received the hepatitis B vaccine by muscle injection in the same position of the thigh. The severity and duration of pain were compared among all groups during and after injection using the DAN scoring method (evaluation behavioral scale of acute pain in newborn infant). Results One hundred neonates (57% boys) participated in this study. The mean ± SD age and weight for participants were 39.15 ± 0.05 weeks and 3016 ± 28 g, respectively. Crying duration either during or after the injection in breastfed infants was significantly shorter compared to the control and powdered formula groups (9.2 ± 3.9 and 16 ± 4.6 s vs. 38.2 ± 8.9 and 30.0 ± 4.4 s, respectively, during injection, P < 0.003); (11.8 ± 3.4 and 20.6 ± 5.1 s vs. 56.2 ± 6.5 and 49.8 ± 9.6 s, respectively, after injection, P < 0.006). There was also a significant relationship between behavioral variations and pain during injection (P < 0.0001). Conclusions The results of this study showed that breastfeeding decreases pain severity during painful experiences in neonates, which is in accordance with other reports. Based on this finding, neonates are advised to be breastfed if a painful intervention such as vaccination is needed. The pain-relieving effect of breast milk could also be added to its other suitable effects. [ABSTRACT FROM AUTHOR]

Objective: Vaccine hesitancy and refusal and the resulting outbreaks of vaccine-preventable diseases continue to be an issue today. Most of contemporary research on these issues has focused on underlying characteristics of non-vaccinators and ambivalent parents; however, few studies have looked into how or when vaccine preferences develop. In this study, we sought to explore when parental preferences for vaccines develop in relation to a pregnancy. We also examined self-reported influences on vaccine decision making. Methods: We recruited and administered a short survey to parents at the North Carolina Women's Hospital in Chapel Hill, NC, following the birth of their child from February to April 2015. Results: A total of 166 parents (55%) completed the entire survey. Seventy-two percent of surveyed parents reported deciding on their vaccine preferences for their newborn before conception. Parents who were older, Caucasian, married, and had attained higher levels of education were significantlymore likely to develop preconception vaccine preferences. The presence of partner conversations in the past and the desire for more information on vaccines were also significant predictors of preconception vaccine preference development. After logistic regression adjustment, only education level and past vaccine conversations remained significant. Themost common influences for vaccine decision making were family, friends, and medical staff and organizations. Conclusion: Our study documents that a majority of parents establish vaccine decision making and preferences before conception. Notable influences from friends, family, and medical sources are part of the process. These findings suggest that vaccine information and interventions currently are given too late in the vaccine preference decision-making process. [ABSTRACT FROM AUTHOR]

Background Bacille Calmette-Guérin (BCG) vaccination at birth may cause mild and benign local adverse effects (AE). More serious AE are rarely reported. Objective To describe clinical features and outcomes of BCG (Tokyo-172 strain)-induce diseases (BCG-ID) that required medical attention at a tertiary care center in Bangkok, Thailand. Method We retrospectively reviewed medical records from January 2007 to December 2016 that were selected by ICD-10 codes. The inclusion criteria were the patients under 3 years of age who developed lymphadenitis, osteitis, or disseminated infections of which BCG was a possible pathogen. Cases were classified into suspected (clinically compatible without laboratory confirmation), probable (suspected cases with M. tuberculosis complex identified), and confirmed BCG-ID (probable cases with molecular confirmation of M. bovis BCG strain). Results 95 children were identified; 57 (60.0%) were male, and the median age at presenting symptom was 3.5 (range: 0.6–28.7) months. Of these, 25 (26.3%) were suspected, 49 (51.6%) were probable, and 21 (22.1%) were confirmed BCG-ID. Overall, 87 (92%) children had regional lymphadenitis corresponding to the BCG site, 5 (5%) had osteitis, and 3 (3%) had disseminated BCG. Of those with lymphadenitis, average size was 2.2 (range 0.7–5) cm. in diameter and 53% (46/87) had pulmonary involvement. Five children with immunodeficiency; three had disseminated BCG and two had lymphadenitis. Eight (9.2%) patients with lymphadenitis underwent needle aspiration; 57 (65.5%) had surgical excision. All children with BCG osteitis underwent surgical intervention in combination with anti-tuberculosis treatment. One patient with osteitis experienced long-term leg length discrepancy. Conclusion Regional lymphadenitis was the most common feature of BCG-ID requiring medical attention. That none of the BCG osteitis were immunocompromised hosts suggested the potential virulence of BCG in neonates. A systematic national surveillance and reporting system is needed to develop accurate estimates of population incidence and support development of effective vaccine policy. [ABSTRACT FROM AUTHOR]

Background Invasive meningococcal disease has a high burden in young children, particularly during infancy. We investigated the immunogenicity and safety of a quadrivalent meningococcal conjugated vaccine (MenACWY-TT) co-administered with routine vaccines in healthy infants. Methods In this phase IIIb study ( NCT01340898 ) conducted in 2 centers in Lebanon and Mexico, 750 infants were randomized (2:1:1) to receive MenACWY-TT according to 3 schedules: 3+1 (at ages 2, 4, 6 and 15–18 months; group ACWY3+1); 1+1 (at 6 and 15–18 months; group ACWY1+1) or single-dose at 15–18 months (group ACWY1). All infants received PHiD-CV and DTPa-IPV/Hib at ages 2, 4, 6, 15–18 months. Immune responses to MenACWY-TT were assessed by rSBA and hSBA at 7 months (groups ACWY3+1, ACWY1+1) and pre- and post-vaccination at 15–18 months of age (all groups). Immune responses to co-administered vaccines, reactogenicity and safety were also evaluated. Results Immunogenicity of MenACWY-TT at 1 month post-primary vaccination was demonstrated in group ACWY3+1: the lower limit of the 95% confidence interval for the percentage of infants with rSBA titers ≥8 was >80% for each serogroup. At 7 months of age, ≥93.9% of MenACWY-TT-primed infants had rSBA titers ≥8. Post-MenACWY-TT vaccination at age 15–18 months, ≥96.3% of participants in all groups had rSBA titers ≥8, regardless of the number of doses received previously. The percentage of infants with hSBA titers ≥4 were ≥87.2% and ≥89.7% at post-primary and booster/single-dose vaccination, respectively. Immune responses to PHiD-CV and DTPa-IPV/Hib did not seem impacted by co-administration with MenACWY-TT in infancy. The incidence of all adverse events was similar among groups. Serious adverse events were reported for 63/750 children in all groups; none were considered vaccine-related by investigators. Conclusion Primary vaccination with 3 or 1 dose(s) of MenACWY-TT when co-administered with routine pediatric vaccines in infants is immunogenic and well-tolerated. [ABSTRACT FROM AUTHOR]

Reported infant vaccination coverage at age 12 months in Australia is >90%. On-time coverage of the 2–4–6 month schedule and coverage in specific populations is rarely reported. We conducted a population-based cohort study of 1.9 million Australian births, 1996–2012, combining individual birth and perinatal records with immunisation records through probabilistic linkage. We assessed on-time coverage across 13 demographic and perinatal characteristics of diphtheria-tetanus-pertussis vaccines (DTP) defined as vaccination 14 days prior to the scheduled due date, to 30 days afterwards. On-time DTP vaccination coverage in non-Aboriginal infants was 88.1% for the 2-month dose, 82.0% for 4-month dose, and 76.7% for 6-month dose; 3-dose coverage was 91.3% when assessed at 12 months. On-time DTP coverage for Aboriginal infants was 77.0%, 66.5%, and 61.0% for the 2–4–6 month dose; 3-dose coverage at 12 months was 79.3%. Appreciable differences in on-time coverage were observed across population subgroups. On-time coverage in non-Aboriginal infants born to mothers with ≥3 previous pregnancies was 62.5% for the 6-month dose (47.9% for Aboriginal infants); up to 23.5 percentage points lower than for first-borns. Infants born to mothers who smoked during pregnancy had coverage 8.7–10.3 percentage points lower than infants born to non-smoking mothers for the 4- and 6-month dose. A linear relationship was apparent between increasing socio-economic disadvantage and decreasing on-time coverage. On-time coverage of the 2–4–6 month schedule is only 50–60% across specific population subgroups representing a significant avoidable public health risk. Aboriginal infants, multiparous mothers, and those who are socio-economically disadvantaged are key groups most likely to benefit from targeted programs addressing vaccine timeliness. [ABSTRACT FROM AUTHOR]

Streptococcus pneumoniae colonization is a serious problem since dissemination to other organs in the body can cause serious infections. This study investigates the impact of the pneumococcal conjugate vaccine (PCV7) on pneumococcal carriage and resistance in healthy infants in the rural areas of Ajlun, Jordan. 415 infants younger than two years of age were selected for this study. The vaccination was given at ages 2, 4 and 10 months between April 2009 and July 2010 (Scheme 2+1). Nasopharyngeal (NP) swabs were taken at the first vaccination (phase one), the third vaccination (phase two), and also three months after the last vaccination (phase three). Pneumococcal isolates were identified according to morphology, bile solubility, and optochin sensitivity. Antimicrobial susceptibility was tested via the micro-broth dilution method and serotyping by the (Neufeld) Quellung reaction. At the first vaccination, carriage in two-month old infants was 26.3%. At the third vaccination, carriage in ten-month-old infants was 29.9%, and at three months after their last vaccinations it was 29.4%. Twenty cases were found positive for all the three nasopharyngeal swabs (5.1%). At the end of the study 241/415 cases (58.1%) were carriers. Resistance rates were as follows: (intermediate and resistant): penicillin (84.0%), cefotaxime (5.6%), clarithromycin (47.2%), clindamycin (25.6%), trimethoprim-sulfamethoxazole (59%), and tetracycline (39%). Multidrug resistance rate was 39.5% for phase one, 48.4% for phase two, and 46.7% for phase three. Frequent serotypes at the time of the first vaccination were: 6A (14.7%), 19F (12.8%), 6B, 23F, and 15B at 6.4% each, and 11A (5.5%). Frequent serotypes after the last vaccination were: 11A (12.3%), 19A (10.7%), 6A (9.0%), and 19F (8.2%). The prevalence of vaccine serotypes (4, 6B, 9V, 14, 19F and 23F) at phase one (0.9%, 6.4%, 1.8%, 3.7%, 12.8%, 6.4%, respectively) was reduced at phase three (0.0%, 2.5%, 0.0%, 3.3%, 8.2%, 0.8%, respectively). Serotype 18C was not identified. An increase of 19A in phase one from 2.8% to 10.7% at phase three was observed. The impact of vaccination was an observed reduction in the resistance to penicillin, cefotaxime, clarithromycin, and clindamycin by 5.9%, 2.4%, 11.4%, and 18.3%, respectively. Coverage of the PCV7 and PCV13 three months after receiving the third injection was 27.8% and 49.4% respectively. High carriage and resistance rates were observed among the infants. Vaccine administration reduced pneumococcal carriage and antimicrobial resistance among the infants. [ABSTRACT FROM AUTHOR]

Background Delivering vaccination services during the second year of life (2YL) 1 Abbreviations: 2YL, denotes Second Year of Life or 2nd Year of Life. 1 provides countries with an opportunity to achieve greater coverage, to provide booster doses and vaccines missed during the first year of life, as well as contribute towards disease control and elimination goals. Methods Using data from demographic health surveys (DHSs) conducted during 2010 to 2016, this paper explores the proportion of missed opportunities for vaccinations generally provided during routine immunization among children in their 2YL. Results DHS data in 46 countries surveyed 478,737 children, from which 169,259 children were 12–23 months old and had vaccination/health cards viewed by surveyors. From this group, 69,489 children aged 12–23 months had contact with health services in their 2YL. Three scenarios for a missed opportunity for vaccinations were analysed: (1) a child received one vaccine in the immunization schedule and was eligible for another vaccine, but did not receive any further vaccination, (2) a child received a vitamin A supplementation (VAS) and was due for a vaccine, but did not receive vaccines that were due, and (3) a child was taken to a health facility for a sick visit and was due (and eligible) for a vaccine, but did not receive the vaccine. A total of 16,409 (24%) children had one or more missed opportunities for vaccinations. Conclusion This analysis highlights the magnitude of the problem of missed opportunities in the 2YL. The global community needs to provide better streamlined guidance, policies and strategies to promote vaccination screenings at well-child and sick child visits in the 2YL. Where they do not exist, well-child visits in the 2YL should be established and strengthened. [ABSTRACT FROM AUTHOR]

Introduction Severe and fatal pertussis infections are concentrated among infants who are too young to be protected through routine vaccinations. Maternal Tdap (mTdap), which is now the standard of care in the US and UK, is considered to be the most effective way to address this gap in preventative care. Little is known about how pregnant women in low-resource settings might view mTdap. To inform strategies for mTdap implementation in these contexts, public health researchers sought to understand knowledge, attitudes, and beliefs toward pertussis and maternal vaccines and assess the barriers to vaccine acceptance. Methods We conducted focus group discussions (FGDs) among mothers who participated in a longitudinal birth cohort study at the Chawama primary health center in Lusaka, Zambia. Since SAMIPS was not a clinical trial, but instead an observational cohort study, registration on clinicaltrials.gov was not required. Trained interviewers conducted the FGDs in January 2016 using a semi-structured interview guide, exploring participants’ knowledge, attitudes and beliefs toward pertussis and vaccines. We analyzed the transcripts using Nvivo v.11 software. Results Fifty mothers participated across 7 FGDs. Mothers had limited knowledge of pertussis and vaccines, yet expressed generally positive views of vaccinating themselves and their children. Participants conveyed very little vaccine hesitancy around maternal vaccinations, and discussed how they could protect their children’s health. Mothers also highlighted barriers and facilitators to vaccine uptake, which included partner involvement, feelings of maternal authority over healthcare decision-making, and community rumors about Western medicine. Conclusion Mothers viewed vaccinations as an important method to keep their children healthy, despite cultural myths and misconceptions about pertussis and vaccines. FGD results suggest that vaccine acceptability is high in Zambia, which is a critical factor to vaccine uptake. A strategy addressing myths and misconceptions should be prioritized if and when mTdap is introduced across low-resource settings. [ABSTRACT FROM AUTHOR]

Aims Clinical guidelines for management of infants with fever but no evident focus of infection recommend that those aged 1–3 months with a white cell count >15 × 10 9 /l have a full septic screen and be admitted for parenteral antibiotics. However, there is limited information about leucocyte changes following routine immunization, a common cause of fever. We investigated white cell counts shortly after routine immunization in Ugandan infants under 3 months of age. Methods White cell counts were measured in 212 healthy infants following routine immunizations (DTwP-HepB-Hib, oral polio and pneumococcal conjugate 7 vaccines) received prior to 3 months of age. Results Mean leucocyte counts increased from 9.03 × 10 9 /l (95% confidence interval 8.59–9.47 × 10 9 /l) pre-immunizations to 16.46 × 10 9 /l (15.4–17.52 × 10 9 /l) at one-day post-immunizations at 6 weeks of age, and 15.21 × 10 9 /l (14.07–16.36 × 10 9 /l) at one-day post-immunizations at 10 weeks of age. The leucocytosis was primarily a neutrophilia, with neutrophil percentages one-day post-immunization of 49% at 6 weeks of age and 46% at 10 weeks of age. White cell parameters returned to baseline by two-days post-immunization. No participant received antibiotics when presenting with isolated fever post-immunization and all remained well at follow-up. Conclusions In our study almost half the children <3 months old presenting with fever but no evident focus of infection at one-day post-immunization met commonly used criteria for full septic screen and admission for parenteral antibiotics, despite having no serious bacterial infection. These findings add to the growing body of literature that questions the utility of white blood cell measurement in identification of young infants at risk of serious bacterial infections, particularly in the context of recent immunizations, and suggest that further exploration of the effect of different immunization regimes on white cell counts is needed. This observational work was nested within a clinical trial, registration number ISRCTN59683017. [ABSTRACT FROM AUTHOR]

Introduction Vaccination in pregnancy is an effective method to protect against disease for the pregnant woman, foetus and new born infant. In England, it is recommended that pregnant women are vaccinated against pertussis and influenza. Improvement in the uptake of both pertussis and influenza vaccination among pregnant women is needed to prevent morbidity and mortality for both the pregnant women and unborn child. Aim To identify effective strategies in increasing the uptake of vaccination in pregnancy in high-income countries and to make recommendations for England. Methods A systematic review of peer reviewed literature was conducted using a keyword search strategy applied across six databases (Medline, Embase, PsychInfo, PubMed, CINAHL and Web of Science). Articles were screened against an inclusion and exclusion criteria and papers included within the review were quality assessed. Results and conclusions Twenty-two articles were included in the review. The majority of the papers included were conducted in the USA and looked at strategies to increase influenza vaccination in pregnancy. There is limited high quality evidence for strategies in high-income countries to increase coverage of pertussis and influenza vaccination in pregnancy. A number of strategies have been found to be effective; reminders about vaccination on antenatal healthcare records, midwives providing vaccination, and education and information provision for healthcare staff and patients. Future interventions to increase vaccination in pregnancy should be evaluated to ensure efficacy and to contribute to the evidence base. [ABSTRACT FROM AUTHOR]

Background We compared PCV7 serological response and protection against carriage in infants receiving 3 doses (2, 4, 6 months; 3+0 schedule) to those receiving a booster (12 months; 3+1). Methods A prospective, randomized controlled study, conducted between 2005 and 2008, before PCVs were implemented in Israel. Healthy infants were randomized 1:1:1 to receive 3+1, 3+0 and 0+2 (control group; 12, 18 months doses). Nasopharyngeal/oropharyngeal swabs were obtained at all visits. Serum serotype-specific IgG concentrations and opsonic activities (OPA) were measured at 2, 7, 13 and 19 months. This study was registered with Current Controlled Trials, Ltd. ISRCTN28445844. Results Overall, 544 infants were enrolled: 3+1 (n = 178), 3+0 (n = 178) and 0+2 (n = 188). Post-priming (7 months), antibody concentrations were similar in both groups, except for serotype 18C (higher in 3+0). Post-booster (13, 19 months), ELISA and OPA levels were significantly higher in 3+1 than in 3+0 group. Nasopharyngeal/oropharyngeal cultures were positive for Streptococcus pneumoniae in 2673 (54.3%) visits. Acquisition rates (vaccine and non-vaccine serotypes) were similar for 3+1 and 3+0 groups at 7–30 months and for 0+2 group at 19–30 months. Conclusions PCV7 booster after 3 priming doses increased substantially IgG concentrations but did not further reduced vaccine-serotype nasopharyngeal acquisition, suggesting that protection from pneumococcal carriage does not depend primarily on serum IgG. [ABSTRACT FROM AUTHOR]

Background Hepatitis B virus (HBV) vaccination has decreased the prevalence of chronic HBV infections and their sequelae. However, whether vaccination at birth provides lifelong protection is unclear. Objective To assess long-term immunity following neonatal HBV immunization in a large population-based cohort. Methods Using the database of a 2 million member sick fund in Israel, we identified all subjects born after introduction of universal HBV vaccination in Israel (January 1992 through December 2014), that were tested for hepatitis B surface antibody (anti-HBs Ab's). Years since vaccination were categorized into 5-year groups and linear trends in the seroprevalence of HBV immunity were calculated. Anamnestic response and presence of Hepatitis B surface antigen (HBs Ag) were assessed. Results Included were 20,634 tested individuals. Mean (±SD) age at testing was 14.8 (±5.4) years. Mean anti-HBs Ab levels declined with time to 16.39 mIU/ml in the 15–20 year group (P < 0.001). The proportion of negative results increased gradually (P < 0.001) to 66.7% after 15 years. Anamnestic response assessment showed that 604 of 644 seronegative subjects (93.8%, 95% CI: 91.6–95.5%) became seropositive after a booster dose. HBs Ag was identified in 91 of the 20,634 (4.4 per 1000 study participants). Conclusions Following vaccination, anti-HB's Ab's progressively decline, with only a third of the population retaining protective levels after 15 years. In adolescence, anamnestic response shows that nearly all revaccinated adolescents exhibit immunity. A low rate of Hepatitis B infection was demonstrated despite vaccination of nearly all newborns. [ABSTRACT FROM AUTHOR]

Background More than 10 years after the authorisation of two rotavirus vaccines of demonstrated efficacy and with a strongly positive benefit-risk profile, uptake in Europe remains low. Only 13 countries in Europe provide a fully-funded rotavirus universal mass vaccination (UMV) programme, three provide a partially-funded programme, and one provides full funding for a reduced programme targeting at-risk infants. Around 40% of countries in Europe currently have no existing recommendations for rotavirus vaccine use in children from the national government. Methods We provide an overview of the status of rotavirus vaccine recommendations across Europe and the factors impeding uptake. We consider the evidence for the benefits and risks of vaccination, and argue that cost-effectiveness and cost-saving benefits justify greater access to rotavirus vaccines for infants living in Europe. Results Lack of awareness of the direct and indirect burden caused by rotavirus disease, potential cost-saving from rotavirus vaccination including considerable benefits to children, families and society, and government/insurer cost constraints all contribute to complacency at different levels of health policy in individual countries. Conclusions More than 10 years after their introduction, available data confirm the benefits and acceptable safety profile of infant rotavirus UMV programmes. Europe serves to gain considerably from rotavirus UMV in terms of reductions in healthcare resource utilization and related costs in both vaccinated subjects and their unvaccinated siblings through herd protection. [ABSTRACT FROM AUTHOR]

Immunogenicity and safety of a newly developed liquid DTwP-Hib/HepB-IPV hexavalent vaccine (EasySix™) was evaluated and compared with administration of commercially licensed Pentavac SD® (DTwP-HepB/Hib) and Imovax Polio® vaccine in an open-label, randomized multi-centric trial. 284 participants, aged 6–10 weeks, randomized in a 1:1 allocation, received three doses of test or comparator vaccines, administered 4 weeks apart. Immunogenicity of the vaccines was determined by measuring the baseline and post-vaccination antibody responses and comparing the proportions of subjects achieving seroprotection against the vaccine antigens; safety was evaluated in terms of solicited (local and systemic) and unsolicited incidences in the follow up phase. Post-vaccination, seroprotection was achieved against all six vaccine antigens in both vaccine groups. The seroresponse rate as well as geometric mean titers of antibody for all vaccine components were comparable between EasySix™ and Pentavac SD®-Imovax Polio® group. Both vaccines had similar reactogenicity profiles and were well tolerated; all adverse events resolved completely without any sequelae. Only one serious adverse event was reported that completely resolved; it was regarded unconnected to the vaccine administered. This study demonstrated that immunogenicity and safety profiles of EasySix™ vaccine, manufactured by Panacea Biotec Ltd, are non-inferior to the commercially available vaccines. Clinical trial registration: CTRI/2015/02/005578 . [ABSTRACT FROM AUTHOR]

In many settings, serotype changes as a result of infant 13-valent pneumococcal conjugate vaccine (PCV13) programs are likely to continue after the introduction of adult PCV13 programs. We applied a multi-cohort model to explore how potential serotype changes may impact on the cost-effectiveness of PCV13 use in Australian adults aged over 65 years. We found assumptions around continued herd protection from infant PCV13 programs to be critical when assessing the cost-effectiveness of adult PCV13 vaccination in Australia. Future cost-effectiveness analyses of adult PCV13 programs need to carefully consider how to predict these future changes in serotypes, with Australian data suggesting that the changes post-PCV13 use in infants may be different than post-PCV7. [ABSTRACT FROM AUTHOR]

Background Non-specific effects (NSEs) of vaccines have increasingly gained attention in recent years. Recent studies suggest that live vaccines, such as measles vaccine (MV), have beneficial effects on health, while inactivated vaccines, such as the diphtheria-tetanus-pertussis (DTP) vaccine, may have harmful effects. If this is the case, it should improve child health to move MV closer to the last vaccination with DTP. The objective of this study was to investigate the NSEs of an additional early dose of MV on hospitalization or mortality. Methods Children were randomized to receive either the standard MV at 9 months (control) or an additional early dose of MV 4 weeks after the third dose of DTP-containing Pentavalent vaccine and the standard MV at 9 months (intervention). In this analysis of a secondary outcome in the trial, we investigated the effect of the intervention on a composite endpoint of over-night hospitalization with or without recovery, or death without previous hospitalization, in children between 4.5 and 36 months of age in the Nouna HDSS in Burkina Faso. We used Cox proportional hazards regression with repeated events and time since study enrolment as underlying time-scale. Results Among 2258 children in the intervention and 2238 children in the control group we observed a total of 464 episodes of hospitalization or mortality. There was no difference between intervention and control group (HR = 1.00, 95% Confidence Interval (CI) 0.83–1.20). Results from the per-protocol and intention-to-treat analysis were similar. Although no significant, results suggest a possible beneficial effect of early MV in children that had not been exposed to an OPV campaign after enrolment (HR = 0.83, 95% CI 0.55–1.29). Conclusions We did not detect any effect of early MV on subsequent hospitalization or mortality. However, possible effects of early MV could have been obscured by NSEs of the frequent OPV campaigns. Registration: The trial was registered at ClinicalTrials.gov , NCT01644721 [ABSTRACT FROM AUTHOR]

Background During a pertussis epidemic in 2009, the Department of Health, Victoria, Australia, implemented a cocoon program offering parents of new babies a funded-dose of pertussis-containing vaccine. We assessed vaccine effectiveness (VE) of the program in reducing pertussis infection in infants. Methods Using a matched case-control design, infants aged <12 months that were notified with pertussis between 1 January 2010 and 31 December 2011, and born during the time that the cocoon program was in place, were identified. Controls were matched by area of residence and date of birth. Telephone interviews we conducted to ascertain parents’ vaccination status, and if vaccinated, timing of vaccination receipt relative to the birth of their baby. Odds ratios (ORs) were calculated for the association between vaccination and pertussis infection, with VE calculated as (1 – OR) × 100%. Results The study recruited 215 cases and 240 controls (response rates 67% and 25% of eligible participants, respectively). Vaccination of both parents after delivery of the infant and ≥28 days prior to illness onset reduced pertussis infection by 77% (Vaccine Effectiveness [VE] = 77% (confidence interval [95% CI], 18–93%). After adjusting for maternal education, presence of a sibling within the household, and the infants’ primary course vaccination status, the adjusted VE was 64% (95% CI, −58–92%). Conclusions Although not reaching statistical significance, our results demonstrated that cocoon immunisation – where both parents are vaccinated in the post-partum period – may offer some protection again infant pertussis infection. Cocoon immunisation could be considered in circumstances where antenatal vaccination of the mother has not occurred. [ABSTRACT FROM AUTHOR]

Background Infants are at the highest risk of severe complications – including death – as a result of pertussis infection. Controlling pertussis in this group has been challenging, particularly in those too young to be vaccinated. Following revised national recommendations in March 2015, the state of New South Wales, Australia, introduced a funded maternal vaccination campaign at 28 – 32 weeks of gestation using a 3-component tetanus-diphtheria-acellular pertussis vaccine (dTpa; Boostrix, GSK). This study aimed to assess the effectiveness of maternal vaccination and add to the growing body of evidence for this strategy. Methods A 1:1 matched case-control study was conducted between 16 August 2015 and 17 August 2016. Cases were laboratory or doctor notified, laboratory confirmed (nucleic acid testing or culture) and aged <6 months at onset. Each control infant was randomly selected from public hospital births in the same geographical area in the period up to 3 days before and after the case’s birthdate. Odds ratios (OR) were calculated using conditional logistic regression. Vaccine effectiveness (VE) was calculated as 1 – OR. Findings In total, 117 cases and 117 controls were recruited. The overall VE estimate was non-significantly protective for infants <6 months old (VE 39%, 95% CI −12 to 66%). Higher VE was observed for infants <3 months old (VE 69%, 95% CI 13–89%) and against hospitalisation (VE 94%, 95% CI 59–99%). Interpretation Maternal pertussis vaccination with a 3-component acellular vaccine was found to be highly effective at preventing severe disease in infants, but was less effective at preventing disease which did not require hospitalisation. The overall VE reported in this study was lower than in prior studies and suggests that maternal vaccination, while an effective strategy at preventing severe pertussis, is less effective at protecting against infection or mild disease. [ABSTRACT FROM AUTHOR]