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In 2019 the National Department of Health (NDoH) conducted a national immunisation coverage survey of caregivers of children aged 24-35 months in all 52 districts of South Africa, and reported a national fully immunised under one year-old coverage of 83.9 %, and 76.8 % coverage for all vaccines scheduled up to 18 months of age. This retrospective, descriptive study was a secondary data analysis of 3576 validated Microsoft Excel® records containing the reasons for missed vaccinations collected by field workers during the 2019 national survey. The reason "vaccine out of stock" had been captured by field workers from children's vaccination cards, while other reasons given by caregivers had been captured either as pre-defined codes or free text. Free text reasons were analysed and additional codes created, and all reasons were categorised. In total, 3576 caregivers gave 8116 reasons for 8056 doses that had been missed by their children. Reasons related to health facility obstacles (HFOs) (67.9 %; 2429/3576) and personal obstacles (34.6 %; 1237/3576) constituted the major categories of reasons for missed vaccinations. Of all vaccines missed because of HFO-related reasons, 57.8 % (1403/2429) were missed because of vaccine stock-outs, affecting 39.2 % (1403/3576) of children. Other important HFOs included lack of access to vaccination services (24.5 %; 595/2429); and information about missed vaccinations and the need to return for catch-up not being shared with caregivers (17.1 %; 416/2429). These results were stratified by district and shared with the NDoH, who have initiated several projects in collaboration with other stakeholders, focusing mainly on building capacity for effective vaccine management to prevent vaccine stock-outs, and ensuring that all children are able to access vaccination services. The results of this study can be used as a baseline against which the success of future interventions emanating from these projects can be measured., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Burnett RJ reports financial support was provided by South African National Research Foundation. Burnett RJ reports a relationship with Sanofi Aventis SA that includes: travel reimbursement. Meyer JC (grant holder of unrestricted educational grants) reports a relationship with Vaccine industry (GSK, Sanofi-Aventis SA, MSD Pty Ltd., Pfizer) that includes: funding grants. Meyer JC reports a relationship with South African National Research Foundation that includes: funding grants. Meyer JC reports a relationship with South African Health Products Regulatory Authority that includes: board membership. Meyer JC reports a relationship with Sanofi Aventis SA that includes: consulting or advisory, speaking and lecture fees, and travel reimbursement. Ismail Z reports a relationship with South African Health Products Regulatory Authority that includes: consulting or advisory. Ismail Z reports a relationship with Sanofi Aventis SA that includes: travel reimbursement. Madhi SA reports a relationship with Vaccine industry (Pfizer, Minervax, Novavax, Merck, Providence, Gritstone, ImmunityBio) that includes: funding grants. Madhi SA reports a relationship with Bill & Melinda Gates Foundation that includes: funding grants. Madhi SA reports a relationship with GSK that includes: funding grants and speaking and lecture fees. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.SAVIC receives unrestricted educational grants from the vaccine industry., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Immunization is pivotal for health-related sustainable development, necessitating resilient and sustainable immunization systems. This scoping review explores challenges and strategies for sustained vaccine uptake in the new Decade of Vaccines (2021-2030) within sub-Saharan Africa, encompassing routine and non-routine vaccines., Methods: The review followed the Joanna Briggs Institute's methodology to examine English-language articles published from January 01, 2021, to May 29, 2023. Databases including PubMed, CINAHL, Cochrane Library, Embase, Medline, Scopus, and Web of Science were searched. An extended search and analysis were conducted on PubMed from May 30, 2023, to April 27, 2024, to provide an overview of information not covered within the original search period. Two independent reviewers screened articles by title and abstract, followed by a full-text review. Thematic analysis was applied to extracted data, with results presented in tabular and schematic formats., Results: African immunization systems face numerous challenges, including high hesitancy for new and non-routine vaccines, inadequate program coordination and vaccine infrastructure, persisting social disparities in vaccine access and uptake, under-vaccination with multiple dose, adolescent and adult vaccines, and inadequate resilience against large scale disruptions like the COVID-19 pandemic. Strategies addressing these challenges include education and awareness-based campaigns, mobile phone-based appointment reminders, financial incentives to service providers and vaccinees, as well as supportive supervision and performance monitoring programs for service providers. Geospatial, logistics, and systems models have been used as decision support to inform immunization strategies., Conclusions: The review highlights challenges impeding vaccine access and uptake, casting concerns on the sustainability and resilience of immunization programs in sub-Saharan Africa. While improvement strategies have been employed, very few were based on human-centered design approaches for decision support. Employing systems thinking is recommended to reveal dynamic mechanisms and to design strategies for the long-term viability of immunization efforts., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: David T. Myemba (PhD Student) reports financial support was provided by VLIR-UOS PhD Scholarship. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2025 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: New vaccines for pregnant women have recently been introduced in some high-income countries to protect infants in early life. Implementing maternal immunisation (MI) successfully in low- and middle-income countries will require planning and adaptations to immunisation and maternal health programs. To inform cost of MI delivery studies, we gathered perspectives from key stakeholders in five countries (Bangladesh, Ghana, Kenya, Mozambique, and Nepal) regarding health system requirements, opportunities, and challenges to introducing new maternal vaccines into routine health programs., Methods: We convened national stakeholders for country workshops to deliberate potential delivery strategies, opportunities, and constraints for implementing new MI interventions. Divided into thematic areas, participants discussed health system adaptations needed to establish or strengthen an MI platform., Findings: Stakeholders felt that existing programs that administer vaccines to pregnant women, primarily tetanus-containing vaccines, provide a proven path for the delivery of additional maternal vaccines. Maternal health and immunisation program integration was perceived strongest at the health care provision level and weakest at the national level. Concerted coordination at the national level was identified as critical to the success of introducing new interventions. Stakeholders perceived that most health workforce providing immunisation and antenatal care services undergo similar training and have transferrable skills, however developing operational guidelines with clear roles and responsibilities was deemed critical for ownership and accountability. Human resource constraints were cited as a challenge for some countries. The importance of raising awareness of disease burden and new MI interventions was also highlighted across countries. Sustainable financing was a recurring challenge cited, especially with transitions from Gavi support., Conclusions: The workshops enabled country stakeholders to deliberate needs to support the introduction of new maternal vaccines. While circumstances and needs differed, stakeholders across countries were optimistic about the capability of their health systems to integrate new maternal vaccines., Competing Interests: Declaration of competing interest All authors have no competing interests to declare., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

At its October 2024 meeting, the Advisory Committee on Immunization Practices* (ACIP) approved the Recommended Immunization Schedule for Child and Adolescent Ages 18 Years or Younger, United States, 2025. The schedule supports health care providers, as well as public health and other professionals, by providing a consolidated summary of current ACIP recommendations for vaccinating children and adolescents. The 2025 schedule includes several updates to the cover page, tables, notes, and appendix. † The addendum remains part of the schedule and will be used to summarize new or updated ACIP recommendations that occur before the next annual schedule update. Health care providers are strongly encouraged to use all parts of the schedule (the cover page, tables, notes, appendix, and addendum) together when making recommendations for individual patients. The 2025 child and adolescent immunization schedule can be found on the CDC website (https://www.cdc.gov/vaccines/hcp/imz-schedules/index.html)., Competing Interests: All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. Charlotte A. Moser reports receipt of advanced book payments from Columbia University Press. Sybil Cineas reports membership in Medical Advisory Committee, Rhode Island Free Clinic. No other potential conflicts of interest were disclosed.

At its October 2024 meeting, the Advisory Committee on Immunization Practices* (ACIP) approved the Recommended Immunization Schedule for Adults Ages 19 Years or Older, United States, 2025. The schedule supports health care providers, as well as public health and other professionals, by providing a consolidated summary of current ACIP recommendations for adult vaccination. The 2025 schedule includes several updates to the cover page, tables, notes, and appendix. † The addendum remains part of the schedule and will be used to summarize new or updated ACIP recommendations that occur before the next annual schedule update. Health care providers are strongly encouraged to use all parts of the schedule (the cover page, tables, notes, appendix, and addendum) together when making recommendations for individual patients. The 2025 adult immunization schedule can be found on the CDC website (https://www.cdc.gov/vaccines/hcp/imz-schedules/index.html)., Competing Interests: All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. Charlotte A. Moser reports advanced book payments from Columbia University Press. Sybil Cineas reports membership in Medical Advisory Committee, Rhode Island Free Clinic. No other potential conflicts of interest were disclosed.

Despite significant public health attention and investment, hundreds of thousands of individuals have suffered fatal opioid overdose since the onset of the opioid crisis. Risk of opioid overdose has been exacerbated by the influx of fentanyl, a powerful synthetic opioid, into the drug supply. The National Institutes of Health Helping End Addiction Long-term (HEAL) Initiative is supporting the development of vaccines targeting fentanyl to protect against overdose. If successful, a vaccine would induce anti-fentanyl antibodies to sequester fentanyl (but not other opioids) in the blood, preventing fentanyl from crossing into the brain and reaching the central nervous system where it can cause overdose. Introduction of an overdose preventing strategy that relies on a vaccine to confer passive protection may be impactful. However, vaccines are poorly understood by the public and politicized. Moreover, the overdose ecosystem is complex and extends across numerous social, economic, medical, and cultural systems. As such, optimal use of a vaccine strategy to address overdose may benefit from multidisciplinary consideration of the social, ethical, and systemic factors that influence substance use and overdose that may also impact the acceptability of a fentanyl vaccine and related implementation strategies. In March 2022, Dr. Elissa Weitzman convened a two-day conference at the Harvard Radcliffe Institute for Advanced Study on the Social Complexity of a Fentanyl Vaccine to Prevent Opioid Overdose. In all, 19 professionals from diverse disciplines (medicine, psychology, history, ethics, immunology, vaccinology, communications, policy) attended the conference and led discussions that centered on population health and epidemiology, history of medicine and frameworks for understanding substance use, ethics, decision-making and attitudes, and operational issues to the question of a novel immunotherapy targeting fentanyl overdose. Participants also debated the risks and benefits of vaccine administration in response to fictional clinical case vignettes. A summary of the conference presentations and discussions follows., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Dr. Elissa Weitzman reports that administrative support for the conference was provided by Harvard University Radcliffe Institute for Advanced Study. Dr. Elissa Weitzman is an advisor to Ovax, Inc. Conference participants and contributors have the following disclosures: AC has conducted unpaid webinars for Jansen Pharmaceuticals, has a paid contract with Web MD/Medscape to provide op-eds about medical ethics, has done legal work with Parker Waichman LLP, Nelson Mullins Riley & Scarborough, and NY State AG opioid litigation, and consulted for Angamo, Sanofi, Novartis (unpaid), Abeona, paid), Cabaletta (paid), and Penn Orphan Disease Center’s Advisory Board (unpaid). DJD has served as a consultant for Merck Research Laboratories/Merck Sharp & Dohme Corp. (a Merck & Co., Inc. subsidiary), and is on EdJen BioTech's scientific advisory board. DJD is a co-founder of Ovax, Inc. DJD is a named inventor on patents held by Boston Children’s Hospital relating to vaccines, adjuvants and human in vitro systems. OL is a named inventor on patents held by Boston Children's Hospital relating to vaccine adjuvants and human in vitro systems that model vaccine action. He is a consultant to GSK and Hillevax and co-founder of Ovax. SL is a named inventor on a patent held by Boston Children's Hospital relating to adjuvanted opioid vaccines and serves as a consultant to Ovax, which was co-founded by her husband, OL. All other conference participants have no relevant conflicts of interest to report., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective: To evaluate opportunity for vaccination in children born alive in Londrina, up to 6 months old and the relationship between socioeconomic stratum and vaccination regularity., Method: Population survey study based on a retrospective cohort of children born in 2017 and 2018 that identified vaccines not administered in a given session. Vaccination regularity was compared between socioeconomic strata using Pearson's chi-square test., Results: Out of 456 vaccination cards, the proportion of vaccination opportunities not recovered for doses to be administered at birth and at two, four and six months was 5.0% (95%CI 3.1;7.5), 4. 5% (95%CI 2.8;6.9), 7.2% (95%CI 5.0;10.2) and 2.1% (95%CI 1.0;4.0), respectively. There was no statistical difference in vaccination regularity between the strata., Conclusion: Missed opportunities for vaccination were found at all ages. Socioeconomic stratum did not influence vaccination regularity.

Introduction: Cystic echinococcosis (CE), a chronic disabling parasitic zoonosis, poses a great threat to public health and livestock production and causes huge economic losses globally. The commercial Quil-A-adjuvanted Eg95 vaccine was empirically effective for CE control; however, it is expensive and has side effects and insufficient immunity., Purpose: This study aimed to employ a novel adjuvant consisting of a delivery system and an immune potentiator and assess its adjuvanticity to Eg95 antigen, thereby developing a safe and cost-effective novel vaccine against the disease., Methods: A ferritin-based Eg95 nanoparticle antigen was prepared and then mixed with a plasmid containing the TLR9 agonist CpG to formulate a novel nanovaccine. The safety and efficacy of the vaccine were evaluated in vitro and in vivo., Results: The nanovaccine induced potent and enduring Eg95-specific humoral and cellular immune responses, as well as protective immunity-associated Th1 polarization supported by the higher ratios of IgG2a/IgG1 and IFN-γ/IL-4. Meanwhile, this nanovaccines exhibited favorable safety and economic profiles., Conclusion: Our data demonstrated that the ferritin-CpG hybrid is a promising combination adjuvant to upgrade the traditional Quil-A and this combination adjuvant-based nanovaccine presents good potential as an alternative to the commercial one for practical CE control., Competing Interests: The authors declare no conflicts of interest in this work., (© 2025 Gao et al.)

We investigate the impact of differential vaccine effectiveness, waning immunity, and natural cross-immunity on the capacity for vaccine-induced strain replacement in two-strain models of infectious disease spread. We focus specifically on the case where the first strain is more transmissible but the second strain is more immune-resistant. We consider two cases on vaccine-induced immunity: (1) a monovalent model where the second strain has immune escape with respect to vaccination; and (2) a bivalent model where the vaccine remains equally effective against both strains. Our analysis reaffirms the capacity for vaccine-induced strain replacement under a variety of circumstances; surprisingly, however, we find that which strain is preferred depends sensitively on the degree of differential vaccine effectiveness. In general, the monovalent model favors the more immune-resistant strain at high vaccination levels while the bivalent model favors the more transmissible strain at high vaccination levels. To further investigate this phenomenon, we parametrize the bifurcation space between the monovalent and bivalent model., (© 2024. The Author(s), under exclusive licence to the Society for Mathematical Biology.)

Vaccination has been shown to be the most effective means of preventing infectious diseases, although older people commonly have a suboptimal immune response to vaccines and thus impaired protection against subsequent adverse outcomes. This Review provides an overview of the existing mechanistic insights into compromised vaccine response for respiratory infectious diseases in older people, defined as aged 65 years and older, including immunosenescence, epigenetic regulation, trained immunity, and gut microbiota. We further summarise the latest proven or potential strategies to strengthen weakened immunogenicity. Insights from these analyses will be conducive to the development of the next generation of vaccines., Competing Interests: Declaration of interests We declare no competing interests., (Copyright © 2024 Elsevier Ltd. All rights reserved, including those for text and data mining, AI training, and similar technologies.)

Nanovaccines have significantly contributed in the prevention and treatment of diseases. However, most of these technologies rely on chemical or hybrid semibiological synthesis methods, which limit the manufacturing performance advantages and improved inoculation outcomes compared with traditional vaccines. Herein, a universal and purely biological nanovaccine system is reported. This system integrates three modules: (1) self-assembling nanoparticles, (2) self-catalyzed synthesis of small-molecule stimulator of interferon gene (STING) agonists, and (3) delivery vectors that target the cytosolic surveillance system. Various nanoparticles are efficiently self-assembled using this system. After confirming the excellent immunostimulatory and lymph node targeting of this system, its broad-spectrum antiviral efficacy is further demonstrated. By leveraging the comprehensive biosynthetic capabilities of bacterial cells, this system can efficiently combine various adjuvant-active modular components and antigenic cargo, thereby providing a highly diversified and potent vaccine platform., (© 2024 The Author(s). Advanced Science published by Wiley‐VCH GmbH.)

Background: Low-income and Middle-income Countries (LMIC) are continually working to ensure everyone can access life-saving vaccines. Recognising the considerable impact of Information and Communication Technology (ICT) in healthcare, we performed a systematic review and meta-analysis to summarise ICT effectiveness in improving vaccine delivery in LMICs., Methods: A systematic search from January 2010 to August 2023 in MEDLINE, EMBASE, Cochrane Library, BMJ Health & Care Informatics, and grey literature was performed. This search focused on randomised controlled trials (RCTs), non-RCTs, observational, and mixed-methods studies in English, examining ICT's effects on childhood immunisation in LMICs. Risk of bias in RCTs and non-RCTs was assessed using the Joanna Briggs Institute tool, and mixed-methods studies were evaluated with the Mixed Methods Appraisal Tool. A meta-analysis summarised ICT's impact on third pentavalent dose coverage and full immunisation by age one. The study is registered with PROSPERO (CRD42023446062)., Findings: Of 6535 screened studies, 27 involving 354,979 children were included. All apart from one study demonstrated a positive impact on immunisation coverage and timeliness, completeness and accuracy of records, number of adverse events reporting, vaccine stockouts, and cold chain expansion. The meta-analysis demonstrated that reminders effectively improved coverage rate of the third dose of the pentavalent vaccine (OR 2.32, 95% CI 1.34-4.03) and the full immunisation at one year of age (OR 2.61, 95% CI 1.2-5.67) with significant degrees of heterogeneity, respectively I 2 82% and I 2 89%. Main concerns for bias in RCTs included unblinded outcome assessors and intervention providers. Interpreting quasi-experimental studies was more challenging due to the higher risk of baseline differences between study arms, statistical methods, and dropouts. Mixed-methods studies often lacked clarity in integrating qualitative and quantitative data., Interpretation: This systematic review confirms the benefits of ICT in immunisation programmes by enhancing various stages of vaccine delivery. Specifically, reminders have been shown to enhance childhood immunisation coverage rates., Funding: Deutsche Gesellschaft für Internationale Zusammenarbeit (German Corporation for International Cooperation, GIZ) as part of the Digital Innovation in Pandemic Control (DIPC) Initiative, financed by the Bundesministerium für Wirtschaftliche Zusammenarbeit (Federal Ministry for Economic Cooperation and Development, BMZ)., Competing Interests: Declaration of interests The authors declare that there are no conflicts of interest regarding the publication of this manuscript. TL is employed by Deutsche Gesellschaft für Internationale Zusammenarbeit and this article reflects her personal opinion. All other authors have disclosed any financial or personal relationships with individuals or organisations that could potentially influence the work presented in this paper., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Background: Low vaccination coverage among travelers poses a critical challenge to global health security. Indeed, public concerns regarding vaccines can lead to vaccine reluctance and refusal, but evidence about the impacts of concerns regarding vaccines on the uptake of travel vaccinations remains sparse. We examined the associations between concerns about vaccines and vaccination behavior among travelers., Methods: Japanese travelers aged 18 years or older, who stayed at a guesthouse in New Delhi, India, were targeted (n = 153). We conducted cross-sectional surveys from August 23 to September 2, 2019, and from February 19 to March 5, 2020. We examined the associations of three concerns regarding vaccines (5-point scale)-serious side effects from vaccines, vaccine safety, and vaccine effectiveness-with the uptake of travel vaccinations., Results: In total, 60 participants (39.2 %) had been vaccinated for this or a past trip. After adjusting for all potential confounding variables, concerns about serious side effects from vaccines and vaccine safety were negatively associated with the uptake of travel vaccinations. The ORs (95 % CIs) for 1-point increases in concerns about serious side effects from vaccines and vaccine safety were 0.72 (0.52, 0.99) and 0.71 (0.52, 0.96), respectively. Sensitivity analyses did not change the results substantially., Conclusions: Concerns about vaccine safety issues were negatively associated with the uptake of travel vaccinations among the participants, with no corresponding association observed for vaccine effectiveness. Addressing concerns about vaccine safety issues, rather than vaccine effectiveness may contribute to an increased uptake of travel vaccinations., (Copyright © 2024 Japanese Society of Chemotherapy, Japanese Association for Infectious Diseases, and Japanese Society for Infection Prevention and Control. Published by Elsevier Ltd. All rights reserved.)

The Immunization and Vaccines-related Implementation Research Advisory Committee (IVIR-AC) is the primary advisory body of the World Health Organization conducting independent reviews of immunization-related implementation research, with a primary focus on transmission and economic modeling analyses that estimate the value and impact of vaccines. From 10 to 13th September 2024, IVIR-AC convened virtually for its second of two semi-annual meetings to provide feedback and recommendations across six sessions including: pneumococcal vaccination strategies that rely on indirect protection; vaccine impact modeling for chikungunya; The Lancet Commission on strengthening the use of epidemiological modeling of emerging and pandemic infectious diseases; methods for immunization coverage estimation; setting immunization research priorities in the South-East Asian Region; and modeling evidence related to typhoid conjugate vaccine schedules. This report summarizes the sessions, proceedings, and recommendations from that meeting., Competing Interests: Declaration of competing interest P. L. is supported financially by the Bill & Melinda Gates Foundation. S. S. was supported by the World Health Organization for this work. A. N. S. was financially supported by the World Health Organization for this work, and is additionally supported by the Bill & Melinda Gates Foundation, Gavi, the Vaccine Alliance, and the National Institutes of Health. M. K. is supported by the Bill & Melinda Gates Foundation. A. B. H. was supported by the Australian National Health and Medical Research Council for this work, is additionally supported by PATH, the World Health Organization, and Gavi, the Vaccine Alliance, and has received consulting fees from the Australian NSW Ministry of Health, WHO Europe and Asian Development Bank. A. P. is supported by Gavi, the Vaccine Alliance, Imperial College London, the Bill & Melinda Gates Foundation, and the World Health Organization. A. N. S. and A. B. H. report travel related support from the World Health Organization to attend previous IVIR-AC meetings. All other authors have no declarations., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Introduction: Allergen immunotherapy is the only modifying treatment of the natural course of respiratory allergic diseases; however, the lack of evidence leads to little inconclusive results. Real life studies are on the rise and are becoming a valuable tool to confirm and complement findings from clinical trials. The objective of this study was to evaluate the effectiveness and safety of a depigmented-polymerized undiluted subcutaneous extract of grass and olive pollen, under routine clinical practice conditions., Methods: This was an observational, retrospective, longitudinal, single-center study on the use of a 2-pollen (grass mix and Olea europaea) undiluted subcutaneous extract over at least 3 consecutive years. Data were collected from 76 patients (n = 44 female; median age: 12.5 years old) diagnosed with allergic rhinoconjunctivitis with/without allergic asthma due to sensitization to both grasses and O. europaea. Primary and secondary effectiveness endpoints were symptom severity, concomitant medication, and immunological profile before and after completing the immunotherapy. A 2-year follow-up of patients' symptoms and medication history after completing the subcutaneous immunotherapy (SCIT) was performed., Results: There was a significant improvement of symptoms and medication consumption after 3 years of SCIT treatment, and a significant decrease in specific IgE levels for grasses and O. europaea was observed after finishing the treatment., Conclusion: Three years treatment of allergic patients using an undiluted mixture of two allergen extracts was shown to be safe and effective for rhinitis and asthma, with efficacy maintained for at least 2 years after finishing SCIT. These results reinforce the importance of real life clinical data in addition to those from clinical trials, helping to individualize allergic treatments., (© 2024 S. Karger AG, Basel.)

Background/aim: Vaccine refusal or delay remains a significant public health concern, leading to lower vaccination rates and increasing the risk of preventable diseases., Patients and Methods: The study included 404 mothers and 413 children, assessing vaccination coverage and conducting telephone interviews with mothers who declined vaccines to understand their reasons., Results: Children of mothers who supported vaccination were more likely to be fully immunized compared to those with hesitant mothers. Among the incompletely vaccinated or unvaccinated children, 73.08% had mothers from the hesitant group (GNV). However, 90.05% of hesitant mothers still vaccinated their children with all recommended vaccines, while 9.95% maintained their refusal. Only 3.22% of the total sample, all from the GNV group, refused vaccination entirely. The primary reasons for refusal included fear of side effects, lack of trust in vaccines or the healthcare system, negative vaccination experiences, and influence from media or social platforms., Conclusion: While vaccination behaviors may improve as a child grows, a significant proportion of hesitant parents continue to exist across different population groups, contributing to suboptimal vaccination coverage rates. The consistent implementation of unified, nationwide strategies aimed at increasing trust in vaccines and the vaccination process is essential for achieving protective vaccination rates., (Copyright © 2025, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Vaccination is one of the greatest public health achievements of the 20th century, with a tremendous impact in the prevention and control of diseases. However, the recent reemergence of vaccine-preventable diseases calls for a need to evaluate current vaccination practices and disparities in vaccination between high-income countries and low-and-middle-income countries. There are massive deficits in vaccine availability and coverage in resource-constrained settings. Therefore, this perspective seeks to highlight the reemergence of vaccine-preventable diseases in Africa within the lens of health equity and offer recommendations on how the continent should be prepared to deal with the myriad of its health systems challenges. Among the notable factors contributing to the reemergence, stand health inequities affecting vaccine availability and the dynamic vaccine hesitancy. Strengthening health systems and addressing health inequities could prove useful in halting the reemergence of vaccine-preventable diseases.

Data on routine childhood vaccination coverage can only tell us who is under-vaccinated; it cannot explain why vaccine coverage is low. Collecting data on the reasons behind under-vaccination is necessary to implement cost-effective strategies that address key barriers and target interventions appropriately. However, no instruments that measure both vaccine acceptance and access factors among parents of children <5 y have been validated in high-income countries. This study aims to develop and validate the Vaccine Barriers Assessment Tool (VBAT) for Australia. We applied three phases of mixed methods data collection and analysis. In Phase 1, we developed a comprehensive list of 80 items reflecting all potential parental barriers to childhood vaccination, derived from published literature and behavioral theory. Through cognitive interviews ( n  = 28), we refined this list to 45 items. In Phase 2, we conducted a two-wave online survey to test the reliability and validity of these items in an Australian sample of parents ( n  = 532) with structural equation modeling, further refining the list to 35 items. In Phase 3, we conducted a final parent survey ( n  = 156), administering these items along with the Parent Attitudes toward Childhood Vaccination (PACV) scale for comparison. We reviewed participants' immunization register data to assess the predictive validity of the proposed models. The final 6-item short form and 15-item long form Vaccine Barriers Assessment Tool assess access, communal benefit, personal risk, equity, commitment, social norms, and trust in health-care workers. It is being applied for national surveillance in Australia and will be adapted for additional populations and vaccines.

The contribution of vaccination to global health, especially in low-middle-income countries is one of the achievements in global governance of modern medicine, averting 2-3 million child deaths annually. However, in Nigeria, vaccine-preventable-diseases still account for one-in-eight child deaths before their fifth-year birthday. Nigeria is one of the ten countries where 4.3 million children under five are without complete immunization. Therefore, the goal of this contribution is to shed light on the reasons to set a foundation for future interventions. To conduct focus groups, a simplified quota sampling approach was used to select mothers of children 0-12 months old in four geographical clusters of Nigeria. An interview guide developed from the 5C psychological antecedence model was used (assessing confidence, complacency, calculation, constraints, collective responsibility); two concepts were added that had proved meaningful in previous work (religion and masculinity). The data were analyzed using a meta-aggregation approach. The sample was relatively positive toward vaccination. Still, mothers reported low trust in vaccine safety and the healthcare system (confidence). Yet, they had great interest in seeking additional information (calculation), difficulties in prioritizing vaccination over other equally competing priorities (constraints) and were aware that vaccination translates into overall community wellbeing (collective responsibility). They had a bias toward God as ultimate giver of good health (religion) and their husbands played a dominant role in vaccination decision-making (masculinity). Mothers perceived their children vulnerable to disease outbreaks, hence, motivated vaccination (complacency). The study provided a useful qualitative tool for understanding mothers' vaccination decision-making in low resources settings.

Vaccines are an effective way to prevent the emergence and spread of antibiotic resistance by preventing diseases and establishing herd immunity. However, the reduced effectiveness of vaccines in the elderly due to immunosenescence is one of the significant contributors to the increasing antibiotic resistance. To counteract this decline and enhance vaccine effectiveness in the elderly, adjuvants play a pivotal role. Adjuvants are designed to augment the effectiveness of vaccines by activating the innate immune system, particularly through pattern recognition receptors on antigen-presenting cells. To improve vaccine effectiveness in the elderly using adjuvants, it is imperative to select the appropriate adjuvants based on an understanding of immunosenescence and the mechanisms of adjuvant functions. This review demonstrates the phenomenon of immunosenescence and explores various types of adjuvants, including their mechanisms and their potential in improving vaccine effectiveness for the elderly, thereby contributing to developing more effective vaccines for this vulnerable demographic.

The aim of this study was to analyze the incidence and characteristics of adverse events following immunization (AEFI) with post-licensure vaccines used in Hebei province from 2018 to 2020 and to evaluate the safety of vaccines. All information of AEFI was gained from national adverse event following immunization surveillance system (NAEFISS) in Hebei Province from 2018 to 2020. Descriptive epidemiology method was used to analyze the data about AEFI in Hebei province. Reporting rates of AEFI were calculated by sex, age, city, categories of AEFI, severity of AEFI, reaction categories, etc. A total of 35,999 AEFI were reported through NAEFISS, and the average annual rate was 47.64/100,000 doses. The reporting rates of common adverse reactions and rare adverse reactions were 46.37/100,000 doses and 1.05/100,000 doses. The male-to-female ratio was 1.26:1. Most of the AEFI were concentrated in the ≤1 year age group and were reported in the second quarter and third quarter. The majority of AEFI were reported to be recovered or improved, and about 62% of the AEFI occurred within 24 hours after vaccination. Vaccines associated with the highest reporting rate of AEFI were diphtheria, tetanus and acellular pertussis combined vaccine (DTaP, 170.45/100,000 doses). The reporting rate of allergic rash was found to be the highest in the adverse reactions (0.29/100,000 doses). The majority of AEFI cases were common adverse reactions, while serious rare adverse reactions caused by vaccines were extremely uncommon, and all vaccines used in Hebei Province were safe.

A growing body of research indicates the promising potential of vaccines in both preventing and treating atherosclerosis (AS). To gain a comprehensive understanding of the current research landscape and emerging trends in this field, this study conducted a bibliometric analysis of publications on AS vaccines using the Web of Science Core Collection (WoSCC) database, based on the "bibliometric" R package and VOSviewer software. From 1991 to 2024, a total of 462 publications were identified in the WoSCC. The United States appeared as the leading contributor in terms of both total publications and citations. The Vaccine journal exhibited the highest publications output. Nilsson J from the Lund University in Sweden was the author with the most published articles, total citations and Hirsch index (H-index). Keywords analysis and thematic maps analysis revealed the passive immunotherapy (AS protective antibodies vaccines) was a hot mature theme, the active immunotherapy (AS antigens vaccines) was an emerging and booming theme, while the efficacy and safety of AS vaccines was a niche and well-developed theme. These findings offered valuable insights into the AS vaccination and provided guidance for future research in this domain.

Many pathogens enter the host through mucosal sites. Thus, interfering with pathogen entry through local neutralization at mucosal sites therefore is an effective strategy for preventing disease. Mucosally administered vaccines have the potential to induce protective immune responses at mucosal sites. This manuscript delves into some of the latest developments in mucosal vaccination, particularly focusing on advancements in adjuvant technologies and the role of these adjuvants in enhancing vaccine efficacy against respiratory pathogens. It highlights the anatomical and immunological complexities of the respiratory mucosal immune system, emphasizing the significance of mucosal secretory IgA and tissue-resident memory T cells in local immune responses. We further discuss the differences between immune responses induced through traditional parenteral vaccination approaches vs. mucosal administration strategies, and explore the protective advantages offered by immunization through mucosal routes.

The exchange of knowledge and best practices in adult immunization are essential to improve vaccination strategies across the European region. Italy has made groundbreaking progress in the field, being one of the first countries to propose a life-course vaccination schedule, broadening the traditional focus on childhood immunization to include adults. All vaccines included in Italy's vaccination schedule are free of charge. Moreover, the country's National Immunization Plan sets clear coverage targets, immunization priorities, and actions to reduce disparities. However, the fragmentation of its National Health System following the constitutional reform of 2001 has led to an increased complexity and regional inequalities regarding immunization. Other challenges the country faces include growing vaccine hesitancy, data gaps and underserved populations. This review describes Italy's adult immunization system, from policy to implementation. The successes, challenges and lessons learned were shared during the first Adult Immunization Board country meeting in Italy, where local experts, healthcare providers, public health representatives, and policymakers engaged in collaborative discussions and shared insights through case studies and presentations (December 2023). These insights are reviewed and discussed in this manuscript.

Healthcare workers (HCW) perceptions toward vaccines influence patient and community vaccine decision making. In an era of rising vaccine hesitancy, understanding HCW vaccine confidence is critical. This systematic review aims to review instruments that have been validated to measure HCW vaccine confidence. We conducted a search in five databases in June 2023. Data was descriptively synthesized. Twelve articles describing 10 different tools were included. Most tools included dimensions or items on vaccine knowledge ( n  = 9), safety ( n  = 8), vaccine usefulness ( n  = 8), recommendation behavior ( n  = 8), and self-vaccination practice ( n  = 7). All, except one study, were conducted in high-income countries. There was variability in the quality of the validation process. There is limited existing literature on development and validation of tools for HCW vaccine confidence. Based on the tools currently available, the Pro-VC-Be tool is the most well validated. Further research needs to include low- and middle-income contexts.

Vaccine literacy (VL) is an important part of health literacy (HL), which is of great significance in reducing vaccine hesitancy and improving vaccine coverage rate. We aimed to perform a bibliometric analysis of VL research conducted from 1982 to 2023 to evaluate its current status and prospects. All relevant publications were retrieved from the Web of Science Core Collection database and the Scopus database. The Bibliometrix R-package and VOSviewer software were used to analyze the publication outputs, countries, organizations, authors, journals, cited publications, and keywords. In total, 1,612 publications were included. The number of articles published on VL generally showed an increasing trend. The United States was in a leading position among all countries and had the closest connections with other countries and organizations. Its in-depth study of vaccine hesitancy provided a good foundation for VL research. Harvard University was the most productive organization. Bonaccorsi G was the most productive and cited author. VACCINES was the most productive journal. Research topics primarily revolved around vaccination, HL, vaccine hesitancy, and COVID-19 vaccine. In conclusion, the current research on the conceptual connotation and influencing factors of VL is insufficiently deep and should be further improved in the future to distinguish it from HL in a deeper manner. More tools for measuring VL need to be developed, such as those applicable to different populations and vaccines. The more complex relationship between VL, vaccine hesitancy and vaccination needs to be further explored. Gender differences deserve further investigation.

Immunological awareness plays a pivotal role in promoting adherence to health instructions during public health emergencies. This study assessed the influence of specialized immunology education on compliance behaviors among higher education students. To assess the influence of specialized immunology education on compliance behaviors toward health instructions and necessary vaccines during epidemics and pandemics among higher education students. A cross-sectional survey was conducted among 532 students at King Faisal University, Saudi Arabia using stratified random sampling. A validated questionnaire examined demographics, health awareness, and specific immunological knowledge. Regression analysis was performed to assess predictors of compliance with health instructions. Considerable knowledge gaps were found around fundamental immunological concepts despite fair awareness about vaccines. Marked disparities existed across gender and academic disciplines. Regression modeling established specialized immunology training as a significant predictor of compliance with guidelines like masking and vaccination during epidemics ( p  < .001). The findings highlight the need for customized immunology curricula targeting students from nonscientific backgrounds. Incorporating immunology training in continuing education programs for healthcare professionals and public officials can further promote compliance. Multifaceted public health campaigns combining immunology education with initiatives to address socio-cultural barriers are warranted. Further research should explore sustainable educational interventions to enhance long-term retention and integration of immunology knowledge into health behaviors.

Maternal immunization (MI) is an emerging strategy to combat infant mortality in low-income (LIC) and lower-middle income countries (LMIC). We conducted a systematic review to identify the facilitators and barriers to MI and strategies that improve uptake in LICs and LMICs. We searched PubMed, Cochrane Library, and Scopus for quantitative, qualitative, and mixed-methods studies published in English from January 1, 2011, to October 31, 2021, from all LICs and LMICs. Data was appraised using the Mixed Methods Appraisal Tool. 55 studies were included. The major barriers were low knowledge and concern of vaccine safety among pregnant women and healthcare providers (HCP). HCP's recommendation, maternal knowledge, vaccine confidence and ≥4 antenatal care (ANC) visits facilitated uptake. The key strategies encompassed health financing, reminders, intersectoral coordination, integration, community engagement, capacity building, and education. Community-based delivery models were effective. Tailored programs are needed to improve ANC access, and educate pregnant women and HCPs.

Community pharmacists were recently authorized to provide vaccination services in Saudi Arabia. However, the implementation is still limited. Consequently, this study aimed to assess the knowledge, beliefs, and views of community pharmacists in the Qassim region regarding vaccines and vaccination services and to identify the barriers to providing such services. A total of 170 community pharmacists participated in the study (response rate = 73.91%). The mean overall knowledge of vaccines and vaccination was 10.25 ± 1.35 out of a maximum score of 14. The majority stated that vaccines are rigorously tested for their safety (92.94%), go through a stringent approval process to ensure their quality and efficacy (93.53%), and vaccines play a key role in preventing and controlling infectious disease outbreaks (97.06%). However, only 48.82% were aware that community pharmacists are legally authorized to provide adult vaccination services. Few participants were also aware of the dosing of the varicella vaccine (14.12%) and indications of the herpes zoster vaccine (21.18%). The overall mean score on beliefs/views was 31.91 ± 5.53 out of a maximum of 40, indicating positive beliefs/views regarding vaccination services. The study identified many barriers to implementing vaccination services. These included lack of support staff and technicians in community pharmacies (79.41%), lack of requirements and equipment to provide the service (74.11%), the service will add extra workload (72.94%), and lack of formal certification in pharmacy-based immunization delivery (66.48%). Consequently, a holistic strategy is required to improve pharmacists' clinical knowledge of vaccines and to address the barriers to the implementation of vaccination services at community pharmacies.

Vaccination decisions are influenced by various psychological and practical factors. In China, non-National Immunization Program (non-NIP) vaccines, which are voluntary and self-paid, add uncertainty and autonomy to the decision-making process. Effective communication between providers and recipients is crucial but understudied. This study aims to integrate their perspectives, identify strategies for facilitating vaccination decisions, and analyze their mechanisms. From July to December 2023, semi-structured interviews were conducted with 17 caregivers and 12 vaccination providers across five Chinese provinces. Participants shared their experiences and decision-making processes regarding non-NIP vaccines. The Behaviour Change Wheel framework guided the analysis, utilizing iterative coding and directed content analysis. Thirteen Behavior Change Techniques were identified, with feedback, monitoring, and environmental restructuring being the most common. Key intervention functions included Persuasion, Education, and Training. We further mapped how these interventions influence non-NIP vaccine decisions. Capability was enhanced through education and effective communication, providing necessary knowledge and skills. Opportunity was increased via infrastructural improvements and societal support, making vaccines more accessible and endorsed by the community. Motivation was driven by clear communication of vaccination benefits and risks, reinforced by societal norms through public health messaging. By understanding the mechanisms influencing vaccination behaviors and interacting with stakeholders, tailored strategies can be developed. Healthcare providers can enhance service accessibility and offer evidence-based guidance with reminders, monitoring, and incentives to ensure compliance. For recipients, reliable information, sustained engagement, timely communication, and motivational opportunities are essential. A multi-dimensional approach involving multiple stakeholders is crucial for promoting non-NIP vaccine uptake.

Understanding the communication dynamics between vaccine-hesitant parents and healthcare professionals (HCPs) is vital for addressing parent concerns and promoting informed decision-making. This paper focuses on strategies used by HCPs to communicate with vaccine-hesitant parents. It draws on empirical evidence generated as part of the international project VAX-TRUST. More specifically, 60 hours of observations were carried out in three different pediatric practices during vaccination-related visits, and 19 physicians and nurses were interviewed. We focused on the specific context of the Czech Republic, which represents a country with a mandatory vaccination system and in which children's immunization is the responsibility of pediatric general practitioners. We demonstrate that the dynamics between parents and HCPs and their willingness to invest time in the vaccination discussion are influenced by how HCPs categorize and label parents. Furthermore, we outline some of the different strategies HCPs employ while addressing concerns regarding vaccination. We identified two different strategies HCPs use to manage the fears of vaccine-hesitant parents. The first strategy focused on the communication of risks associated with vaccination (and lack thereof). HCPs used a variety of discursive practices to familiarize the unfamiliar risks of vaccine-preventable diseases (by mobilizing representations that are part of collective memory, incorporating personal experiences to materialize the presence of risk and the confidence in the safety of vaccines and by situating risk as embedded in everyday processes and integral to the uncertainty of the global world). The second strategy involved the conscious employment of medical procedures that may contribute to reducing vaccination fears.

Identifying effective interventions to promote children's vaccination acceptance is crucial for the health and wellbeing of communities. Many interventions can be implemented to increase parental awareness of the benefits of vaccination and positively influence their confidence in vaccines and vaccination services. One potential approach is using narratives as an intervention. This study aims to evaluate the effects of a narrative-based intervention on parents' attitudes and vaccination intentions. In a pre-post experiment, 2,000 parents of young children recruited from an online pan-Canadian panel were randomly exposed to one of the three videos presenting narratives to promote childhood vaccination or a control condition video about the importance and benefits of physical activity in children. Pre-post measures reveal a relatively modest but positive impact of the narratives on parents' attitudes and intention to vaccinate their child(ren). The results also suggest that narratives with more emotional content may be more effective in positively influencing vaccine attitudes than the more factual narrative. Using narratives to promote vaccination can positively influence parents' views and intentions toward childhood vaccines, but research is still required to identify the best components of such interventions.

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.

The role of immunization in public health is crucial, offering widespread protection against infectious diseases and underpinning societal well-being. However, achieving optimal vaccination coverage is impeded by vaccine hesitancy, a significant challenge that necessitates comprehensive strategies to understand and mitigate its effects. We propose the integration of Population Health Management principles with Immunization Information Systems (IISs) to address vaccine hesitancy more effectively. Our approach leverages systematic health determinants analysis to identify at-risk populations and tailor interventions, thereby promoting vaccination coverage and public health responses. We call for the development of an enhanced version of the Italian National Vaccination Registry, which aims to facilitate real-time tracking of individuals' vaccination status while improving data accuracy and interoperability among healthcare systems. This registry is designed to overcome current barriers by ensuring robust data protection, addressing cultural and organizational challenges, and integrating behavioral insights to foster informed public health campaigns. Our proposal aligns with the Italian National Vaccination Prevention Plan 2023-2025 and emphasizes proactive, evidence-based strategies to increase vaccination uptake and contrast the spread of vaccine-preventable diseases. The ultimate goal is to establish a data-driven, ethically sound framework that enhances public health outcomes and addresses the complexities of vaccine hesitancy within the Italian context and beyond.

Improving vaccine confidence is a topic of major public health importance. Reasons for vaccine hesitancy are multifactorial, making it challenging to find strategies to address them. This systematic review aimed to synthesize the literature on how co-design has been used to reduce vaccine hesitancy. We searched six databases in March and October 2024. Eligible studies described the co-design process used to develop interventions for addressing vaccine hesitancy and increasing vaccine confidence. We assessed the quality of included studies, extracted and descriptively summarized the key data. Twenty-seven articles were included, 20 of which were based in a high-income setting. Most studies centered on the COVID-19 ( n  = 9) and HPV ( n  = 9) vaccines. Co-design yielded diverse interventions, with videos being the most common intervention format ( n  = 11). We observed substantial variations in the reporting style and terminology used within the studies and limited attempts to assess intervention effectiveness.

Vaccines are complex and a very diverse group of products with relatively long product life cycles. The manufacturing programs for these vaccines need to be continually updated to comply with evolving regulatory expectations. Members of the Parenteral Drug Association (PDA) Vaccines Interest Group (VIG) authored and published PDA Technical Report No. 89: Strategies for Vaccine Development and Lifecycle Management (TR 89), which seeks to provide context to vaccine developers and manufacturers regarding key aspects of new or legacy vaccines such as control strategy from process development to vaccine life cycle management, comparability and life cycle management including technical, validation, quality, and regulatory perspectives. To further explain and illustrate the concepts and topics discussed, seven relevant situations were selected as either case studies associated with changes implemented or proposed process development strategies, which are discussed in this article. The situations described are: working cell bank, modification or update of externally supplied product contact components for vaccine manufacturing, raw material change, new product at an existing site, vaccine development acceleration by leveraging existing platforms, selection and implementation of potency method, and modeling for stability forecast prediction. For each situation, the applicable key concepts from TR 89 are discussed as follows: Control Strategy, Prior Knowledge, Relying on Pharmaceutical Quality System (PQS), Classification of Parameters, Validation Approach, Use of a Risk-Based Approach, Comparability, Use of ICH Q12, and Additional Regulatory Considerations., (© PDA, Inc. 2024.)

In this manuscript, we carried out an exhaustive analysis of the global recommendations for immunization in inborn errors of immunity patients. We examined the mechanisms of action and types of vaccines, and we described the vaccines included in the Colombian immunization program together with the specific guidelines for immunization in patients with the most frequent inborn errors of immunity in Colombia. These recommendations were adjusted according to the severity and subclassifications of each immunodeficiency, considering variations in the immune response to offer evidencebased recommendations for vaccination in children with these conditions. We included the most common inborn errors of immunity worldwide and considered the vaccines included in the Colombian immunization program to avoid delays in vaccination schedules. This work was achieved through a narrative, non-systematic review of articles indexed in Spanish and English, using MeSH terms such as: “inborn errors of immunity”, “primary immunodeficiencies”, “vaccination in inborn errors of immunity, “types of vaccines”, “mechanism of action of vaccines”, and “live vaccines in inborn errors of immunity”. We used search engines such as: PubMed, Medline, ScienceDirect, and websites of recognized institutions such as the Centers for Disease Control and Prevention (CDC).

Echinococcosis, a neglected zoonotic disease caused by Echinococcus tapeworms, presents significant public health challenges worldwide. Cystic and alveolar echinococcosis has substantial health and economic impacts, necessitating effective prevention and control strategies. The present review provides a framework to expand our knowledge regarding key components of echinococcosis prevention and control, including phases, options, targets and available tools as well as current gaps and challenges in the field. Furthermore, we discuss the progress made in developing vaccines for the intermediate and definitive hosts and review the limitations and obstacles in vaccine development for definitive hosts. Abundant information is available on various aspects of the Echinococcus vaccine in sheep. Livestock vaccination effectively reduces Echinococcus transmission to sheep, offering a feasible control measure in intermediate hosts. However, vaccine development for the definitive host, i.e. dogs, exhibits significant challenges. Information gaps regarding the immune-mediated protective responses in dogs, repeatability of results, factors influencing the immune response, reinfection resistance, potential age-related decreases in worm burden and factors associated with the antifecundity effect are key challenges that should be addressed in canine vaccine development, and research collaboration, innovative technologies, and a deeper understanding of transmission dynamics are crucial. Multisectoral coordination under the One Health framework, with long-term political commitment and national and international cooperation, is critical for effective control in endemic areas., Competing Interests: Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Objective: To analyze factors associated with full vaccination coverage with valid doses, in children from four state capitals and three other cities in Southeast Brazil., Method: Analysis of a population survey conducted in 2020-2021, with a sample stratified according to socioeconomic levels of children born in 2017-2018, with data collected through photographic records of their vaccination cards. Odds ratios (OR) and 95% confidence intervals (95%CI) for full vaccination coverage were estimated based on the characteristics of the family, mother and child., Results: Among 8703 children, lowest coverage occurred in strata A and B (OR=0.39; 95%CI 0.23;0.67 and OR=0.38; 95%CI 0.25;0.58); in consumption level A/B (OR=0.38; 95CI% 0.28;0.52); among those with income >BRL8000/month (OR=0.23; 95%CI 0.12;0.42); in children of mothers with higher education (OR=0.47; 95%CI 0.32;0.71); in children not vaccinated exclusively in the public service (OR=0.37; 95%CI 0.26;0.51) and in children with a vaccination delay of up to 6 months (OR=0.28; 95%CI 0.22;0.37)., Conclusion: Coverage did not reach the targets for controlling vaccine-preventable diseases and was negatively associated with higher socioeconomic status., Main Results: Vaccination coverage for the full schedule with valid doses was very low, putting the control of vaccine-preventable diseases at risk in the four state capitals and three other cities in the interior region of Southeast Brazil., Implications for Services: Brazilian National Health System managers and workers need to know the factors associated with low vaccination coverage and increased risk of abandoning the schedule, access problems and National Immunization Program difficulties., Perspectives: Understanding determinants of low vaccination coverage provides support for the discussion and design of effective public policies to address barriers and qualify health services for vaccination.

As a type of transdermal drug delivery system (TDDS), Microneedles (MNs) have garnered significant attention from researchers due to their ability to penetrate the stratum corneum (SC) of the skin, enhance drug permeability and bioavailability, avoid first-pass metabolism, and cause minimal damage to the skin. This makes them particularly suitable for localized transdermal drug delivery. Dissolvable microneedles (DMNs) can encapsulate sensitive particles, provide high drug-loading capacity, and possess biodegradability and biocompatibility, attracting extensive research interest. Chitosan (CS) has been selected as the matrix for manufacturing DMNs due to its excellent properties, including not eliciting an immune response in vivo and having active functional groups such as hydroxyl and amino groups that allow for modifications to impart appropriate mechanical strength and functionality to DMNs for specific applications. This paper provides a comprehensive review of the research status of various chitosan-based microneedles (CSMNs), explores the mechanisms of their dissolution in vivo, and discusses their applications in promoting wound healing, delivering macromolecular drugs, vaccine delivery, and anti-tumor therapies., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 Li et al.)

Access to vaccination has emerged as a growing global public health concern; however, there has been limited research on characteristics of local governments that are associated with vaccination coverage. The objective of this study was to evaluate predictors of vaccination coverage in Brazil for the first year of life between 2013 and 2022. We focused on variables pertaining to the available resources of local governments and their investments in infrastructure and human resources in the health sector. We used binomial generalized linear mixed models to estimate the association of these variables with vaccination coverage in Brazilian municipalities. Our results show that municipalities with better fiscal capacity were more effective in delivering vaccines. Municipalities that rely more on federal and state resources had lower vaccination coverage. Additionally, investment in health professionals was often negatively correlated with vaccination coverage. The study underscores the importance of better understanding the relationship between local government characteristics and vaccination coverage, particularly in regions where local governments are responsible for vaccine delivery., Competing Interests: Declaration of competing interest The authors declare that there are no competing interests., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Immunization coverage across numerous African nations has, unfortunately, shown little improvement and, in some cases, has even decreased over the past decade, leaving millions of children vulnerable to vaccine-preventable diseases. While efforts to improve immunization performance have primarily focused on the health system, effective delivery of immunization services is intricately linked to a country's governance, which, in this context, reflects a government's ability to provide comprehensive services to its citizens. This study investigated the relationship between governance, measured using the Mo Ibrahim Index for African Governance, and the trajectory of immunization coverage for three vaccines in 54 African countries from 2012 to 2021., Methods: We conducted an ecological study utilizing publicly available datasets, the WHO/UNICEF estimates of National Immunization Coverage and the Ibrahim Index of African Governance score (IIAG). We described the trends in routine immunization performance, evaluated and assessed the impact of governance on immunization coverage across 54 African countries for the period 2012 to 2021, using linear mixed models and focusing on three vaccines provided through the Expanded Program on Immunization (DTPCV1, DTPCV3, and MCV1)., Results: Among the 54 African countries studied, 32 (59.3 %) witnessed an overall decrease (slope of change in immunization coverage over time < 0) in immunization coverage, with 16 (29.6 %) experiencing a significant decline (slope of change significantly different from zero (P < 0.05)) in coverage. For DTPCV3, 31 countries (57.4 %) demonstrated a decline in coverage, with 12 (22.2 %) being significant declines. Thirty-two countries (59.2 %) reported a decrease in MCV1 coverage over the analysis period, with 17 (31.5 %) significant. Across all three antigens, the IIAG overall score was positively associated with immunization coverage over time. One unit increase in the IIAG score correlated with an average annual increase of 0.64 (95 % CI: 0.35-0.93) percentage points in DTPCV1 coverage, 0.74 percentage points (95 % CI: 0.42-1.07) in DTPCV3 coverage, and 0.60 (95 % CI: 0.30-0.91) percentage points in MCV1 coverage. These findings suggest that an African country with an average IIAG score just one unit higher than their observed average value over the study period, would have achieved a 6.4 %, 7.4 %, and 6.0 % coverage for DTPCV1, DTPCV3, and MCV1, respectively, above its 2021 coverage levels., Conclusion: The Expanded Program on Immunization aspires to reach all eligible populations with life-saving vaccines, regardless of the context. We found that country governance may be an important determinant of immunization performance, potentially explaining the observed stagnation or decline in immunization performance and the heightened vulnerability of immunization programs to external shocks. Understanding the nexus between governance and service delivery suggests that immunization actors, funders, and other stakeholders may need to adjust their expectations of countries' immunization performance accordingly., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. The authors declare no competing interest., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: The aim of this study was to explore the relationship between parental vaccine hesitancy and vaccine coverage for all recommended vaccines for children under five years residing in Statistical Areas Level 3 (SA3). SA3 groupings represent clustering groups of smaller areas, such as regional towns and cities or clusters of related suburbs, which share similar regional characteristics, administrative boundaries or labour markets, and generally have populations between 30,000 and 130,000 persons., Methods: We used parental vaccine hesitancy data from the VBAT (Vaccine Barrier Assessment Tool) study and vaccine coverage by postcode data from the Australian Immunisation Coverage Report 2020/21. Binary logistic regression analysis explored the association., Results: There were complete data for 1110 participants. We found lower vaccine concerns in parents residing in medium coverage (adjusted odds ratio (aOR) 0.36, 95 % confidence interval (CI): 0.22 to 0.59) and high coverage (aOR 0.37, 95 % CI: 0.22 to 0.60) SA3 areas compared to low coverage geographical areas., Conclusions: Developing effective policies to vaccinate children under five in low coverage areas will help reduce vaccine inequity in Australia. Future strategies to improve vaccine coverage should consider ways to address both access and acceptance barriers., Competing Interests: Declaration of competing interest JT is an investigator on a project grant sponsored by Industry. Her institution has received funding from Industry (GlaxoSmithKline) for investigator-led research. She does not receive any personal payments from Industry. The other authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

Self-assembling protein nanoparticles are beneficial platforms for enhancing the often weak and short-lived immune responses elicited by subunit vaccines. Their benefits include multivalency, similar sizes as pathogens and control of antigen orientation. Previously, the design, preparation, and characterization of self-assembling protein vesicles presenting fluorescent proteins and enzymes on the outer vesicle surface have been reported. Here, a full-size model antigen protein, ovalbumin (OVA), was genetically fused to the recombinant vesicle building blocks and incorporated into protein vesicles via self-assembly. Characterization of OVA protein vesicles showed room temperature stability and tunable size. Immunization of mice with OVA protein vesicles induced strong antigen-specific humoral and cellular immune responses. This work demonstrates the potential of protein vesicles as a modular platform for delivering full-size antigen proteins that can be extended to pathogen antigens to induce antigen specific immune responses., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Julie A. Champion and Mariela R. Rodriguez-Otero report financial support was provided by National Science Foundation., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objective: To enhance documentation on programming decisions in Real World Evidence (RWE) studies., Materials and Methods: We analyzed several statistical analysis plans (SAP) within the Vaccine Monitoring Collaboration for Europe (VAC4EU) to identify study design sections and specifications for programming RWE studies. We designed a machine-readable metadata schema containing study sections, codelists, and time anchoring definitions specified in the SAPs with adaptability and user-friendliness., Results: We developed the RWE-BRIDGE, a metadata schema in form of relational database divided into four study design sections with 12 tables: Study Variable Definition (two tables), Cohort Definition (two tables), Post-Exposure Outcome Analysis (one table), and Data Retrieval (seven tables). We provide a guide to populate this metadata schema and a Shiny app that checks the tables. RWE-BRIDGE is available on GitHub (github.com/UMC-Utrecht-RWE/RWE-BRIDGE)., Discussion: The RWE-BRIDGE has been designed to support the translation of study design sections from statistical analysis plans into analytical pipelines and to adhere to the FAIR principles, facilitating collaboration and transparency between researcher and programmers. This metadata schema strategy is flexible as it can support different common data models and programming languages, and it is adaptable to the specific needs of each SAP by adding further tables or fields, if necessary. Modified versions of the RWE-BRIGE have been applied in several RWE studies within VAC4EU., Conclusion: RWE-BRIDGE offers a systematic approach to detailing variables, time anchoring, and algorithms for RWE studies. This metadata schema facilitates communication between researcher and programmers., (© 2024 The Author(s). Pharmacoepidemiology and Drug Safety published by John Wiley & Sons Ltd.)

Introduction: Dissolving microneedles (DMN) offer advantages in vaccine delivery, such as enhanced immunogenicity and simplified administration, by targeting immune-rich layers of the skin. However, these benefits require precise and consistent delivery, which poses practical challenges. To address this, specialized applicators are essential for ensuring the accurate deployment of DMNs, making this technology a viable alternative to traditional methods, particularly in low- and middle-income countries (LMICs), where healthcare infrastructure is limited., Areas Covered: In this review, we examine the advancements in DMN-based vaccination and applicator design, focusing on their joint effort. These innovations have improved the precision and efficiency of DMN vaccine delivery. Complex and costly early-stage applicators have evolved into simpler and more cost-effective designs. We highlight these developments in this review, with the latch applicator as a key example of a feature that enhances vaccine delivery., Expert Opinion: Although applicator development has advanced DMN-based vaccination toward practical use, challenges remain. Key areas for further optimization include user friendliness, cost, packaging volume, and wear time. Once optimized, DMN vaccination may become a highly effective and accessible tool for global immunization, supporting efforts to achieve worldwide vaccine equality.