AbstractObjectiveTo estimate the effectiveness of mRNA covid-19 vaccines against symptomatic infection and severe outcomes (hospital admission or death).DesignTest negative design ...study.SettingOntario, Canada between 14 December 2020 and 19 April 2021.Participants324 033 community dwelling people aged ≥16 years who had symptoms of covid-19 and were tested for SARS-CoV-2.InterventionsBNT162b2 (Pfizer-BioNTech) or mRNA-1273 (Moderna) vaccine.Main outcome measuresLaboratory confirmed SARS-CoV-2 by reverse transcription polymerase chain reaction (RT-PCR) and hospital admissions and deaths associated with SARS-CoV-2 infection. Multivariable logistic regression was adjusted for personal and clinical characteristics associated with SARS-CoV-2 and vaccine receipt to estimate vaccine effectiveness against symptomatic infection and severe outcomes.ResultsOf 324 033 people with symptoms, 53 270 (16.4%) were positive for SARS-CoV-2 and 21 272 (6.6%) received at least one dose of vaccine. Among participants who tested positive, 2479 (4.7%) were admitted to hospital or died. Vaccine effectiveness against symptomatic infection observed ≥14 days after one dose was 60% (95% confidence interval 57% to 64%), increasing from 48% (41% to 54%) at 14-20 days after one dose to 71% (63% to 78%) at 35-41 days. Vaccine effectiveness observed ≥7 days after two doses was 91% (89% to 93%). Vaccine effectiveness against hospital admission or death observed ≥14 days after one dose was 70% (60% to 77%), increasing from 62% (44% to 75%) at 14-20 days to 91% (73% to 97%) at ≥35 days, whereas vaccine effectiveness observed ≥7 days after two doses was 98% (88% to 100%). For adults aged ≥70 years, vaccine effectiveness estimates were observed to be lower for intervals shortly after one dose but were comparable to those for younger people for all intervals after 28 days. After two doses, high vaccine effectiveness was observed against variants with the E484K mutation.ConclusionsTwo doses of mRNA covid-19 vaccines were observed to be highly effective against symptomatic infection and severe outcomes. Vaccine effectiveness of one dose was observed to be lower, particularly for older adults shortly after the first dose.
To assess awareness of cytomegalovirus (CMV); attitudes towards screening; and frequency of behaviors that could increase the risk of prenatal infection.
We conducted a survey among 726 women at the ...2017 Minnesota State Fair. Minnesota residents aged 18-44 were eligible if they had never been pregnant or had been pregnant within the past 10 years. We compared responses between never-pregnant and recently-pregnant women.
Only 20% of study participants had previously heard of CMV. Remarkably, recently-pregnant women were no more likely to be aware of CMV than never-pregnant women after adjusting for potential confounders. After receiving information about CMV, nearly all participants indicated they believed prenatal (96%) or newborn (96%) screening should be offered.
Although baseline awareness of CMV was low (even among recently-pregnant women), after learning more about the risks, women supported screening. Several states have passed or proposed legislation promoting CMV education and/or screening programs. We identified important gaps in knowledge about CMV among women who may benefit from education about how to reduce their risk of exposure and who may need to decide whether they would be willing to screen for CMV in the future.
Vaccination with the 2-dose HPV vaccine series among adolescent girls in Uganda remains low after almost 5 years since the vaccine was included into the routine national immunization program and ...barriers are not well understood. We explored barriers that prevent eligible girls from initiating or completing the recommended 2-dose HPV vaccine series in Oyam District, Northern Uganda. A qualitative study was conducted in Oyam District, Northern Uganda. Forty interviews were conducted with adolescent girls, their caregivers, Village Health Team Members, health workers and school administrators involved in HPV vaccination. All interviews were audio recorded and transcribed. NVivo version 11 was used for data management and content thematic approach for analysis guided by the Social Ecological Model. At individual level, low levels of knowledge about the vaccine, girls' frequent mobility between vaccine doses, school absenteeism and drop out, fear of injection pain and discouragement from caregivers or peers were key barriers. At the health facilities level, reported barriers included: few healthcare workers, inadequate knowledge about HPV vaccine, limited social mobilization and community engagement to promote the vaccine, limited availability of the HPV vaccine, unreliable transportation, lack of reminder strategies after the first dose of the vaccine, lack of vaccination strategy for out-of-school girls and un-friendly behaviour of some healthcare workers. Concerns about safety and efficacy of the vaccine, negative religious and cultural beliefs against vaccination, rumors and misconceptions about the vaccine, mistrust in government intentions to introduce the new vaccine targeting girls, busy schedules and the gendered nature of care work were key community level barriers. Our study revealed an interplay of barriers at individual, health facility and community levels, which prevent initiation and completion of HPV vaccination among adolescent girls. Strengthening HIV vaccination programs and ensuring high uptake requires providing appropriate information to the girls plus the community, school and health facility stakeholders; addressing cold chain challenges as well as adequate training of vaccinators to enable them respond to rumors about HPV vaccination.
Lassa fever vaccine candidates: A scoping review of vaccine clinical trials Sulis, Giorgia; Peebles, Alexandra; Basta, Nicole E.
TM & IH. Tropical medicine and international health/TM & IH. Tropical medicine & international health,
June 2023, 2023-06-00, 20230601, Letnik:
28, Številka:
6
Journal Article
Recenzirano
Odprti dostop
Objective
Lassa fever (LF) is caused by a viral pathogen with pandemic potential. LF vaccines have the potential to prevent significant disease in individuals at risk of infection, but no such ...vaccine has been licensed or authorised for use thus far. We conducted a scoping review to identify and compare registered phase 1, 2 or 3 clinical trials of LF vaccine candidates, and appraise the current trajectory of LF vaccine development.
Method
We systematically searched 24 trial registries, PubMed, relevant conference s and additional grey literature sources up to 27 October 2022. After extracting key details about each vaccine candidate and each eligible trial, we qualitatively synthesised the evidence.
Results
We found that four LF vaccine candidates (INO‐4500, MV‐LASV, rVSV∆G‐LASV‐GPC, and EBS‐LASV) have entered the clinical stage of assessment. Five phase 1 trials (all focused on healthy adults) and one phase 2 trial (involving a broader age group from 18 months to 70 years) evaluating one of these vaccines have been registered to date. Here, we describe the characteristics of each vaccine candidate and trial and compare them to WHO's target product profile for Lassa vaccines.
Conclusion
Though LF vaccine development is still in early stages, current progress towards a safe and effective vaccine is encouraging.
Influenza vaccination is recommended for those at increased risk of influenza complications and their household contacts to help reduce influenza exposure. Adults who require care often experience ...health issues that could increase the risk of severe influenza and have close contact with caregivers. Assessing influenza vaccination prevalence in caregivers and care recipients can provide important information about uptake.
We aimed to (1) estimate influenza non-vaccination prevalence and (2) assess factors associated with non-vaccination among caregivers aged ≥ 45 years and among care recipients aged ≥ 65 years.
We conducted an analysis of cross-sectional data from the Canadian Longitudinal Study on Aging collected 2015-2018. We estimated non-vaccination prevalence and reported adjusted odds ratios with 95% confidence intervals from logistic regression models to identify factors associated with non-vaccination among caregivers and care recipients.
Of the 23,500 CLSA participants who reported providing care, 41.4% (95% CI: 40.8%, 42.0%) reported not receiving influenza vaccine in the previous 12 months. Among the 5,559 participants who reported receiving professional or non-professional care, 24.8% (95% CI: 23.7%, 26.0%) reported not receiving influenza vaccine during the same period. For both groups, the odds of non-vaccination were higher for those who had not visited a family doctor in the past year, were daily smokers, and those who identified as non-white.
Identifying groups at high risk of severe influenza and their close contacts can inform public health efforts to reduce the risk of influenza. Our results suggest sub-optimal influenza vaccination uptake among caregivers and care recipients. Efforts are needed to increase influenza vaccination and highlight the direct and indirect benefits for caregiver-care recipient pairs.
The proportions of both caregivers and care recipients who had not been vaccinated for influenza was high, despite the benefits of vaccination. Influenza vaccination campaigns could target undervaccinated, high-risk groups to increase coverage.
The proportion of individuals protected against a specific pathogen determines the timing and scale of outbreaks, and the pace of evolution for infections that can evade prevailing humoral immunity. ...Serological surveys provide the most direct measurement to define the immunity landscape for many infectious diseases, yet this methodology remains underexploited. To address this gap, we propose a World Serology Bank and associated major methodological developments in serological testing, study design, and quantitative analysis, which could drive a step change in our understanding and optimum control of infectious diseases.
Vaccine uptake rates have been historically low in correctional settings. To better understand vaccine hesitancy in these high-risk settings, we explored reasons for COVID-19 vaccine refusal among ...people in federal prisons.
Three maximum security all-male federal prisons in British Columbia, Alberta, and Ontario (Canada) were chosen, representing prisons with the highest proportions of COVID-19 vaccine refusal. Using a qualitative descriptive design and purposive sampling, individual semi-structured interviews were conducted with incarcerated people who had previously refused at least one COVID-19 vaccine until data saturation was achieved. An inductive-deductive thematic analysis of audio-recorded interview transcripts was conducted using the Conceptual Model of Vaccine Hesitancy.
Between May 19-July 8, 2021, 14 participants were interviewed (median age: 30 years; n = 7 Indigenous, n = 4 visible minority, n = 3 White). Individual-, interpersonal-, and system-level factors were identified. Three were particularly relevant to the correctional setting: 1) Risk perception: participants perceived that they were at lower risk of COVID-19 due to restricted visits and interactions; 2) Health care services in prison: participants reported feeling "punished" and stigmatized due to strict COVID-19 restrictions, and failed to identify personal benefits of vaccination due to the lack of incentives; 3) Universal distrust: participants expressed distrust in prison employees, including health care providers.
Reasons for vaccine refusal among people in prison are multifaceted. Educational interventions could seek to address COVID-19 risk misconceptions in prison settings. However, impact may be limited if trust is not fostered and if incentives are not considered in vaccine promotion.
•58 countries have authorized at least one protein-based vaccine for group B meningococcus (MenB)•We found evidence of a national MenB vaccination policy in 24 countries.•Recommendations for MenB ...vaccination are highly heterogeneous across countries.•More robust and publicly available data about MenB vaccination programs could inform prevention efforts.
To understand the global landscape of prevention and control efforts targeting serogroup B meningococcal (MenB) disease and to identify the key challenges and gaps yet to be addressed.
We conducted a comprehensive review of policies and practices for the use of protein-based MenB vaccines (Bexsero® GlaxoSmithKline and Trumenba® Pfizer) in all countries (n = 58) where either or both vaccine is authorized for use. We searched the literature (PubMed) and websites of health ministries and other relevant agencies to identify policy documents and plans and collect information about implementation timelines, target groups, vaccines being used, recommended schedules, and coverage data. Experts in the field were contacted for additional details andclarifications, as needed.
We found evidence of a national MenB vaccination policy in 24 out of 58 countries where one or both protein-based MenB vaccines are authorized. Of these, 15 countries have included MenB vaccination in their immunization plans for at least one age-based risk group (mostly infants), 21 have issued recommendations for various risk groups based on underlying medical conditions (e.g. asplenia), and 13 have done so for select groups at increased risk of exposure (e.g. laboratory staff). Recommended vaccination schedules and number of doses, where available, varied widely. Vaccination coverage data for age-based risk groups were not obtained for most countries.
Our findings highlighted the significant heterogeneity in recommendations for MenB vaccination across countries. Greater transparency in reporting MenB vaccination recommendations and more robust data on implementation and the impact of vaccination would better facilitate optimizing MenB prevention strategies.
In Canada, pneumococcal vaccination is recommended to all adults aged greater than or equal to65 and those <65 who have one or more chronic medical conditions (CMCs). Understanding vaccine uptake and ...its determinants among eligible groups has important implications for reducing the burden of pneumococcal disease. Using data from a large national cohort of Canadian residents aged greater than or equal to47 years between 2015-2018, we calculated self-reported pneumococcal vaccine uptake among eligible groups, estimated associations between key factors and non-vaccination, assessed missed opportunities for vaccination (MOV) and examined risk factors for MOV. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for relevant associations were estimated through logistic regression. 45.8% (95% CI: 45.2-46.5) of 22,246 participants aged greater than or equal to65 and 81.3% (95% CI: 80.5-82.0) of 10,815 individuals aged 47-64 with greater than or equal to1 CMC reported never having received a pneumococcal vaccine. Receipt of influenza vaccination in the previous year was associated with the lowest odds of pneumococcal non-vaccination (aOR = 0.14 95% CI: 0.13-0.15 for older adults and aOR = 0.23 95% CI: 0.20-0.26 for those aged 47-64 with greater than or equal to1 CMC). Pneumococcal vaccine uptake was also more likely in case of contact with a family doctor in the previous year (versus no contact), increased with age and varied widely across provinces. Among individuals recently vaccinated against influenza, 32.6% (95% CI: 31.9-33.4) of those aged greater than or equal to65 and 71.1% (95% CI: 69.9-72.3) of those aged 47-64 with greater than or equal to1 CMC missed an opportunity to get a pneumococcal vaccine. Among individuals who had contact with a family doctor, 44.8% (95% CI: 44.1-45.5) of those aged greater than or equal to65 and 80.4% (95% CI: 79.6-81.2) of those aged 47-64 with greater than or equal to1 CMC experienced a MOV. Pneumococcal vaccine uptake remains suboptimal among at-risk Canadian adults who are eligible for vaccination. Further research is needed to clarify the reasons behind missed opportunities for vaccination and adequately address the main barriers to pneumococcal vaccination.
Influenza vaccination is recommended in Canada for older adults and those with underlying health conditions due to their increased risk of severe outcomes. Further research is needed to identify who ...within these groups is not receiving influenza vaccine to identify opportunities to increase coverage. We aimed to 1) estimate influenza non-vaccination prevalence and 2) assess factors associated with non-vaccination among Canadian adults aged greater than or equal to65 and adults aged 46-64 with greater than or equal to1 chronic medical condition (CMC) due to their high risk of severe influenza outcomes. We conducted a secondary analysis of cross-sectional data collected from 2015-2018 among participants of the Canadian Longitudinal Study on Aging. For both groups of interest, we estimated non-vaccination prevalence and used logistic regression models to identify factors associated with non-vaccination. We report adjusted odds ratios and 95% confidence intervals for the investigated variables. Overall, 29.5% (95% CI: 28.9%, 30.1%) of the 23,226 participants aged greater than or equal to65 years and 50.4% (95% CI: 49.4%, 51.3%) of the 11,250 participants aged 46-64 years with greater than or equal to1 CMC reported not receiving an influenza vaccination in the past 12 months. For both groups, lack of recent contact with a family doctor and current smoking were independently associated with non-vaccination. Influenza vaccination helps prevent severe influenza outcomes. Yet, half of adults aged 46-64 years with greater than or equal to1 CMC and more than one-quarter of all adults aged greater than or equal to65 years did not receive a recommended influenza vaccine in the year prior to the survey. Innovation in vaccination campaigns for routinely recommended vaccines, especially among those without annual family doctor visits, may improve coverage. Influenza vaccination coverage among Canadian adults aged 46-64 years with greater than or equal to1 CMC and adults aged greater than or equal to65 years remains suboptimal. Vaccination campaigns targeting those at high risk of severe outcomes without routine physician engagement should be evaluated to improve uptake.
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