ABSTRACT
Objectives: To describe the use of economic evaluation to update the antigens dispensed by the Colombian Expanded Program on Immunization (EPI) from 2000 and 2021. Method(s): a review of economic evaluation of vaccines (EEV) studies conducted by the Expanded Program of Immunization in Colombia between 2000 and 2021. A literature search was carried out in different databases complemented with information obtained from different stakeholders who participated in the updating process. Result(s): In 2000, sponsored by the Pan-American Health Office of the World Health Organization (PAHO/WHO), was conducted the cost-effectiveness analysis of vaccination against Hemophilus influenzae type b was the first economic evaluation of vaccines (EEV) conducted ever in Colombia. Between 2005 and 2007, 4 EEV (Rotavirus, Heptavalent Pneumococcus, Influenza and Hepatitis A) were carried out in order to inform the decision process at local level in Bogota DC, the Colombian capital. Between 2007 and 2010, the Ministry of Health sponsored 8 EEV (Rotavirus, 7- and 10-valent pneumococcus, Influenza, Hepatitis A, chickenpox, tetanus in men, and HPV) which were used to decide about the introduction of new vaccines at national level. Subsequently, with the support of PAHO's PROVAC initiative, Colombia went from having 6 EPI vaccines in the 1990s, to 21 EPI vaccines that currently protect against 29 diseases, not including the vaccines used against COVID-19 which Colombia have been using since March 2021. Conclusion(s): Colombia has been one of the middle-income countries with the highest number of vaccines included in its EPI in the last 20 years and the use of the EEV has been essential for decision-making.Copyright © 2023
ABSTRACT
Haemophilus influenzae (Hi) causes invasive disease (IE). Capsulated strains are distinguished, such as serotype b (Hib), and non-typeable strains (HNT). One year after the COVID-19 pandemic was declared, we observed an increase in cases.The clinical-epidemiological characteristics of children with IE due to Hi admitted to the hospital (July 2021-July 2022) are described. There were 14 cases;12 previously healthy. Isolates: Hib (n = 6), Hi serotype a (n = 2), HNT (n = 5), 1 was not typed. Median age: 8.5 months (IQR 4-21). Manifestations: meningitis (n = 5), pneumonia (n = 6), cellulitis (n = 2), arthritis (n = 1). Nine had incomplete vaccination for Hib.We observed a 2.5-fold increase in EI per Hi compared to previous years. These data suggest a resurgence of Hib due to the fall in vaccination coverage and because other Hib non-b strains are on the rise.
ABSTRACT
Objectives: This is a protocol for a Cochrane Review (intervention). The objectives are as follows:. To assess the benefits and adverse effects of vaccines for the prevention of infections in adults with haematological malignancies.Copyright © 2023 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
ABSTRACT
Haemophilus influenzae (Hi) causes invasive disease. There are encapsulated strains, such as serotype b (Hib), and non-typeable strains (NTHi). One year after the outbreak of the COVID-19 pandemic, the number of cases increased. In this report we describe the clinical and epidemiological characteristics of children hospitalized with invasive Hi disease (July 2021-July 2022). There were 14 cases; 12 were previously healthy children. Isolations: Hib (n = 6), Hi serotype a (n = 2), NTHi (n = 5); 1 case was not typified. Median age: 8.5 months (IQR: 421). Manifestations: meningitis (n = 5), pneumonia (n = 6), cellulitis (n = 2), arthritis (n = 1). Incomplete Hib immunization was observed in 9 children. Invasive Hi disease increased 2.5 times from previous years. These data suggest the reemergence of Hib due to a decline in vaccination coverage and an increase in other non-b-type Hi serotypes.
El Haemophilus influenzae (Hi) causa enfermedad invasiva (EI). Se distinguen cepas capsuladas, como el serotipo b (Hib), y cepas no tipificables (HNT). Al año de declarada la pandemia por COVID-19, observamos un aumento de casos. Se describen las características clínico-epidemiológicas de niños con EI por Hi internados en el hospital (julio 2021-julio 2022). Hubo 14 casos; 12 previamente sanos. Aislamientos: Hib (n = 6), Hi serotipo a (n = 2), HNT (n = 5), 1 no se tipificó. Mediana de edad: 8,5 meses (RIC 4-21). Manifestaciones: meningitis (n = 5), neumonía (n = 6), celulitis (n = 2), artritis (n = 1). Nueve presentaron vacunación incompleta para Hib. Observamos un incremento de EI por Hi de 2,5 veces respecto a años previos. Estos datos sugieren el resurgimiento de Hib por la caída de las coberturas de vacunación y porque otras cepas de Hi no b están en aumento.
Subject(s)
COVID-19 , Haemophilus Infections , Child , Humans , Infant , Pandemics , COVID-19/epidemiology , Incidence , Haemophilus Infections/epidemiology , Haemophilus influenzae , Disease OutbreaksABSTRACT
Background: Infections occur with up to twofold increased risk in patients with monoclonal gammopathy of undetermined significance (MGUS) and tenfold increased risk in multiple myeloma (MM). To reduce risk, revaccination following autologous hematopoietic cell transplantation (AHCT) is recommended to restore humoral immunity. We have previously shown that vaccine titers after AHCT have prognostic significance. In the COVID era, reliable clinical data about antibody titers is relevant yet scarce. We investigated the significance of different vaccine titers in newly diagnosed patients in different stages of the disease. Methods: The study population comprised of 77 patients with MGUS, smoldering multiple myeloma (SMM) and MM who were seen at a tertiary cancer center from 2018- 2022. All patients had antibody titers (B. pertussis, Diptheria, H. Influenzae B, Hepatitis, Influenza, Meningitis, Mumps, Rubeola, Rubella, Poliovirus, S. pneumoniae, Varicella Zoster and Tetanus) tested at the time of diagnosis, prior to start of treatment if indicated. Titers were interpreted in accordance with the manufacturers' recommendations. Patient characteristics were compared using the Kruskal- Wallis and Fisher's exact tests. Associations with % titer positivity were evaluated using the Kruskal- Wallis test. Results: There was significant difference in antibody titer positivity between the different patient groups (51.4% in MGUS, 40.5% in SMM and 34.2% in MM) (p < 0.001). There was no difference in antibody titer positivity depending on age, sex or race. Among individual pathogens, there was a significant difference between the three groups in regards to titers for Diphtheria, Mumps, Poliovirus 3, Strep pneumoniae 19, Strep pneumoniae 56 and Varicella Zoster. Conclusions: Antibody titers for vaccine preventable diseases are significantly different between patients with MGUS, SMM and MM at the time of diagnosis, with MGUS having the highest and MM having the lowest positivity. Patient related factors such as age, sex or race were not associated with antibody titer positivity. Current guidelines for revaccination are not extended to patients with MGUS and SMM and can be considered in prospective trials.
ABSTRACT
Background: Infections are a common cause of morbidity and mortality after allogeneic hematopoietic stem cell transplantation (HSCT). Prolonged immune recovery post-HSCT increases the risk of infection and raises concern for poor response to vaccinations. Reimmunization is recommended for all pediatric HSCT patients by transplant and infectious disease organizations1,2, and individual institutions often develop revaccination guidelines. Objective: At Vanderbilt Children's Hospital (VCH), the clinical practice guideline (CPG) instituted in June 2015 recommends early initiation (6 months) of reimmunization in immunologically appropriate patients, starting with Haemophilus influenzae type B (Hib) and pneumococcal conjugate (PCV13) vaccinations. Therefore, we examined the feasibility of early vaccination for allogeneic HSCT patients and determined the causes of delayed or lack of vaccination. Methods:A retrospective chart review of the electronic medical record was conducted under an IRB-approved protocol. Data was gathered and entered in a REDCap database, including dates of vaccination, immune reconstitution studies (IgG concentration, T/B cell subsets) and clinical outcomes [e.g., intravenous immunoglobulin (IVIg) administration, graft versus host disease (GvHD), relapse] through 6-month (+/- 30 days) post-HSCT. Early revaccination was defined as Hib and PCV13 administration within 210 days post-HSCT. Patients not meeting this definition were further examined for factors that led to delay or lack of vaccinations. Patients were included if they were alive without underlying disease progression or graft failure 6-months post-HSCT. Results: Between June 15, 2015 and June 30, 2021, 66 patients met inclusion criteria. Early revaccination occurred in 21/66 patients (32%). Of the 45/66 (68%) that did not receive 6-month vaccinations, the most common reason was concern for impaired immune reconsti- tution (n = 33/45, 73%). Indicators of poor immune recovery included recent IVIg administration (n = 15), ongoing immunosuppression (n = 24), and poor B cell recovery (n = 4);many patients had multiple indications. Other reasons for delay included patient or parent refusal (n = 4), prioritization of COVID vaccinations (n = 3), scheduling conflicts (n = 4), and other (n = 1). Conclusions: Early vaccination occurred in 32% of patients. At 6 months post-HSCT, 50% of patients had poor immune reconstitution resulting in appropriate vaccination delays. However, scheduling conflicts and vaccine hesitancy despite eligibility were small but significant contributors, accounting for 17% of delays. This is a small, single center study but highlights significant challenges with delivery of best practice guidelines. Future directions could include engagement with other institutions regarding best practices to address vaccine hesitancy and to further explore if early revaccination reduces risk of infectious complications post-HSCT.
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Those affected by sickle cell disease have an increased susceptibility to infection by encapsulated bacteria and hepatitis B virus due to reduced splenic function and increased likelihood of receiving blood transfusions. Sickle cell disease patients are also more likely to suffer from complications, such as vaso-occlusive crises or acute chest syndrome, following infection with influenza or COVID-19. Standards for Clinical Care of Adults with Sickle Cell Disease in the UK (2018) outline that that those with sickle cell disease are recommended to be vaccinated against invasive pneumococcal disease, Haemophilus influenza type B, Neisseria meningitis types ACWY and type B, hepatitis B, and influenza . These patients are also recommended to have their hepatitis B immunity reviewed annually and to receive a hepatitis B vaccination booster if hepatitis B surface antibody (HBsAb) levels are less than 100 mIU/ml. According to the Standards , hospital staff is advised to remind and check with the patients' primary care teams whether these vaccinations have been administered. In this audit, we examined the records of 64 patients with sickle cell disease who receive regular care at the Cambridge University Hospitals NHS Foundation Trust. We collected data on the uptake of the pneumococcal conjugate vaccine (PCV13), pneumococcal polysaccharide vaccine (PPV23 or Pneumovax) within 5 years, two doses of Meningitis B vaccine, Meningitis ACWY vaccine (MenACWY), Haemophilus influenzae type b vaccine (Hib/MenC), influenza vaccine within 1 year, hepatitis B vaccine (HepB), whether HBsAb levels have been reviewed within 1 year, HepB booster if HBsAb levels were less than 100 mIU/ml, and two doses of COVID-19 vaccine. These records were obtained from electrical medical records provided by patients' general practitioners. Data collection took place from 23 September to 4 November 2021. The uptake of vaccinations was 67.4% for PCV13, 61.0% for PPV23 or Pneumovax within 5 years, 75.0% for Hib/MenC, 45.3% for MenACWY, 42.2% for the first dose of MenB and 29.3% for the second dose of MenB, 54.7% for influenza within 1 year, 75.0% for HepB, 71.9% for the first dose of the COVID-19 vaccine, and 68.3% for the second dose of the COVID-19 vaccine. 43.8% had their HbsAB reviewed and 20.0% received a HepB booster following HBsAb levels of less than 100mIU/ml. The uptake levels for the recommended vaccinations are lower than expected in our hospital trust. The COVID-19 pandemic has highlighted the effect of health inequalities and the uptake of the vaccination programme by patients of different ethnicities. During our patient support group, patients identified the Tuskegee syphilis experiment as one of the reasons why there is still distrust of the medical profession by those with Afro-Caribbean heritage. Beyond directed patient education, more communication is needed with the primary care teams to raise awareness of which vaccinations are required for sickle cell patients. Certain vaccinations, such as MenACWY and MenB were only introduced in 2015, meaning that some general practitioners may be still unaware of their necessity in adults with sickle cell disease..
ABSTRACT
The incidence of most respiratory-transmitted diseases decreased during the COVID-19 pandemic as a result of containment measures. In contrast, in the Netherlands we noted an increase in invasive disease caused by Haemophilus influenzae b (Hib) (from <â¯0.3/100,000 before 2019 to 0.39 and 0.33/100,000 in 2020 and 2021) in vaccinated and unvaccinated age groups. We did not find a change in vaccine effectiveness against Hib invasive disease (effectiveness > 90%). We discuss factors that may have contributed to this rise.