A Literature Review Assessing the Most Common Attributes Used in Stated-Preference Studies Assessing Influenza Vaccination: Do We Know What Health Care Professionals Value?

Objectives: Several attributes may be important in flu vaccine and since Covid-19, the role of health care professionals (HCPs) may have become more important in increasing flu vaccine uptake. We conducted a literature review to assess if previous preference research could inform future flu vaccination policies. Method(s): We conducted a literature review to assess the most common attributes used in stated-preference studies to determine seasonal flu vaccination preferences. PubMed with key terms such as "discrete choice", "stated preference" and "flu/vaccin*" was used to retrieve relevant research. Result(s): In total, twelve studies investigating consumer and HCP preferences for flu vaccines using a discrete-choice experiment were included. Six studies were conducted in vaccine-eligible populations, three were conducted with parents (specifically, two focused on older adults and one elicited preferences directly from HCPs in Hong Kong). Three studies were conducted in the Netherlands, two in Japan and four in China. Vaccine efficacy was most often framed in terms of percentage (n=7). Out of pocket cost and duration of immunity were common attributes. Source of recommendation for vaccination (i.e., regulatory or public health body) was assessed in 25% of the studies. In studies assessing parental preferences for their children influenza vaccination, risks of fewer side effects were, unsurprisingly, preferred. Finally, among HCPs, vaccine effectiveness and vaccination location (staff clinic/mobile vaccination center) were most important and could increase the probability of vaccination. Conclusion(s): Information incompleteness and asymmetry could play a role in vaccine hesitation and/or aversion. To increase vaccination rates, evidence on the attributes perceived to be important to both HCPs and the general population may help the design and delivery of vaccines that match consumers' preferences. Currently, there is a critical need for more stated-preference studies among HCPs to better understand the attributes likely to increase vaccination rates against seasonal influenza.Copyright © 2023

Asian Pacific Journal of Tropical Medicine COVID-19 vaccine uptake and its determinants among teenagers and their parents in Zhejiang, China: An online cross-sectional study

Objective: To examine COVID-19 vaccine uptake and its determinants among teenagers and their parents in Zhejiang, China. Method(s): An online cross-sectional study was conducted among parents of teenagers in Zhejiang, China from May 1 to 31, 2022. Data were interpreted via univariate and multivariate analyses using the statistical package for the social sciences (SPSS) program. Result(s): A total of 11115 (96.11%) participants and 11449 (99.00%) of their children in Zhejiang, China had been vaccinated against COVID-19. Children whose parents did not receive COVID-19 vaccination were 19 times (aOR 18.96, 95%CI 12.36-29.08) more likely to be unvaccinated than their counterparts. In addition, children with no previous influenza vaccination, those whose parents doubted the COVID-19 vaccine's safety or effectiveness, were 6.11 times (aOR 6.11, 95%CI 2.80-13.34), 8.27 times (aOR 8.27, 95%CI 5.33-12.83), and 2.69 times (aOR 2.69, 95%CI 1.11-6.50) more likely to be unvaccinated than their counterparts, respectively. COVID-19 vaccine uptake varied between different sociodemographic groups. However, the odds of receiving the COVID-19 vaccine decreased as age and education level increased. The main refusal reasons claimed by participants were that they had medical conditions that may not qualify them for vaccination (53.78%), followed by safety concerns about the vaccine (13.56%), not knowing where to get vaccinated (6.44%), and concerns about fertility issues (5.56%). Conclusion(s): Despite a highly encouraging level of COVID-19 vaccine uptake in Zhejiang, China, the elderly and highly educated people had lower COVID-19 vaccine uptake. It is suggested that tailored health education strategies should be taken to increase the COVID-19 vaccine uptake in such groups. Furthermore, with vaccination rates at such a high level, the pandemic is still ongoing, and public confidence in vaccines may decline. Thus, sufficient evidence-based information regarding COVID-19 vaccines should be provided to the public. Copyright © 2023 Asian Pacific Journal of Tropical Medicine.

Evaluation of increased antibody titer COVID-19 after astrazeneca vaccination based on the age at UTA'45 Jakarta Vaccine Center

Background: Vaccine is an essential tool to limit the health of the COVID-19 pandemic. AstraZeneca vaccine already provided promising effectiveness data. Still, the study must check the correlation between vaccination and antibody titer. Aim: This study aims to evaluate antibody titer after AstraZeneca vaccination based on the age group. Materials and Methods: This study used a prospective cross-sectional method with convenience sampling. Inclusion criteria were all Indonesian citizens above 18 years old who were vaccinated at UTA'45 Jakarta Vaccine Center with no history of COVID-19 before the vaccination and had filled up the informed consent. Results: This study's total sample was 102 females;51.90%, residents of Java Island;91.17% had comorbidities;50,98%, smokers;9,80%, alcohol drinker;9,80%, exercise;80,39%, blood pressure;128/73, SpO2: 97,82. Most participants aged around 30 years had a body mass index of 23.33. Age, comorbidity, smoking, alcohol, and exercise habit significantly correlate with the increase of the participants' antibodies (P < 0.001). The age shows that the younger the participant, the higher the titer antibody 2 will be (P = 0.001, 95% confidence interval [CI],-1.935,-0.694). The exercise shows that the participant with the routine practice will have a higher titer antibody 2 (P = 0.002, 95% CI, 12.016, 51.791). Antibody titer for participants younger than 35 years old increased 5.7 times while for participants between 35 and 45 years old was 3.9 times. Another group (>45-55 years old) has shown an improvement in antibody titer at 1.7 times, but the last group (>55 years old) described an increase in antibody titer at 232.3 times. Conclusions: Age, comorbidity, smoking, alcohol, and exercise contributed to the increase in titer antibody 2 value of the AstraZeneca vaccine participants. Participants in the age group <35 years have an excellent immune system.

Impact of Influenza in South-East Asia

Influenza infection is asymptomatic in up to 75% of cases, but outbreaks result in significant morbidity. Reports found that severe influenza complications tend to occur among the very young (<5 years) and very old (>65 years), especially those with underlying co-morbidities like diabetes mellitus and heart disease. Even with no co-morbidity, some older persons with severe influenza may require hospitalisation or intensive care, with increased risk of myocardial infarction and stroke. In South-East Asia, influenza was often seen as a mild problem and was not deemed notifiable until the appearance of the Influenza A(H1N1) pandemic in 2009. For decades the data made available were based on extrapolated estimates collected mainly from paediatric populations, resulting in inconsistent findings. Following expanded surveillance across the region using national surveillance systems for influenza-like illness (ILI) and severe acute respiratory illness (SARI), and better diagnostic methods, improved estimates of disease burden was achieved in South-East Asia. However, two studies conducted in 2008-2010 reported findings ranging from 2-3% to 11%. With regards to increased risk of complications, the estimated global annual attack rates for influenza were 5-10% in adults and 20-30% in children, resulting in 3-5 million cases of severe illness and 290,000-650,000 deaths. A study In Singapore reported that influenza is associated with annual excess mortality rates (EMR) of 11-14.8 per 100 000 person-years, especially affecting the elderly;these rates are comparable to that of the USA. As for hospitalisation rates of children under 5 years with seasonal influenza, the USA estimated a rate of 1.4 per 100,000. Comparable rates were reported in Singapore (0.7-0.9), Thailand (2.4), Viet Nam (3.9-4.7), and the Philippines (4.7). In 2018, an updated study reported a mean annual influenza-associated respiratory EMR of 4.0-8.8 per 100 000 individuals, with South-East Asia showing a high mortality rate of 3.5-9.2 per 100,000 individuals. It was already estimated in Thailand in 2004 that influenza resulted in USD23-63 million in economic costs, with the main contribution from lost productivity due to missed workdays. Thus, comparable to countries in temperate climate, the clinical and socioeconomic impact of influenza in South-East Asia appear to be just as substantial. With the emergence of the COVID-19 pandemic in 2020, global influenza incidence dropped dramatically. In South-East Asia, the trend in influenza detections was similar to the rest of the world, with numbers slightly higher than average in early 2020, followed by a quick drop-off by the end of April 2020. After April 2020, the detection rate remained low until late July 2020, when Influenza A(H3N2) predominated in Cambodia, Malaysia, the Philippines, Singapore, Thailand and Timor-Leste;influenza B in Lao People's Democratic Republic but with an upsurge in A(H3N2) activity. Following a two-year hiatus, influenza outbreaks began to re-emerge significantly since early 2022. From February through August 2022, influenza activity in the southern hemisphere remained lower than in pre-COVID-19 pandemic years, but was at the highest level compared to similar periods since the start of the COVID-19 pandemic. Reasons for the reduction during the COVID-19 pandemic include non-pharmaceutical interventions (NPIs), reduced population mixing and reduced travel, and possibly viral interference between SARS-CoV-2 and influenza virus in the same host. In general, the reduction in influenza detections however does not appear to be associated with lack of testing. The World Health Organisation (WHO) continues to recommend that vaccination is the most effective way to prevent infection and severe outcomes caused by influenza viruses. Although influenza vaccine is not commonly used in most countries in South-East Asia, its burden is similar in other parts of the world where influenza vaccine is now routinely used. Currently, the countries in South-East Asia that are providing free influenza vacc na ion for those at high risk include Thailand, Singapore, the Philippines and Lao People's Democratic Republic.Copyright © 2023

Recurrent Liver Abscess in a Non-Toxic Patient

Introduction: Liver abscesses are caused by direct spread from peritonitis, biliary tract infection or via hematogenous seeding from a distant source. Most are polymicrobial, however Escherichia coli and Klebsiella pneumoniae are the most common offending pathogens. Patients usually present with pain, fever, and clinical signs of infection. We describe a case of spontaneous liver abscess in a non-toxic patient that recurred 10 years after a previous abscess. Case Description/Methods: A 73-year-old-man with a history of type 2 diabetes mellitus, hypertension, CAD status post CABG and PCI 3 years ago, and abdominal aortic aneurysm status post endovascular aneurysm repair presented with 2 weeks of dark urine. After receiving his COVID-19 booster and influenza vaccinations, he developed flu-like symptoms with a self-resolving fever of 101.8degreeF. He had dark amber urine without dysuria or hematuria. Later, he experienced generalized weakness and decreased oral intake. Outpatient labs showed elevated liver function tests, and he was told to present to the ED. On arrival, he was afebrile with stable vitals. Physical exam was unremarkable. Laboratory evaluation showed a hemoglobin of 11.7 g/dL, sodium of 133 mEq/L, creatinine of 1.4 mg/dL, aspartate aminotransferase of 117 U/L, alanine aminotransferase of 212 U/L, alkaline phosphatase of 825 U/L, total bilirubin of 4.1 mg/dL, and direct bilirubin of 2.1 mg/dL. Triple-phase CT showed a 2.8 cm mass in the right liver lobe with linear enhancement. Ultrasound showed mixed echogenicity measuring 3.6 x 2.9 x 3.3 cm in segment 8 of the liver. On further evaluation, patient had an E. coli abscess diagnosed 10 years prior, managed with antibiotics and drainage. At that time, the abscess was within the right inferior liver lobe, similar to his current abscess. LFTs downtrended. Abscess was aspirated, with culture growing oxidase negative, gramnegative rods, likely E. coli. Patient started on ceftriaxone and metronidazole, to undergo colonoscopy as an outpatient and rule out colonic bacterial translocation. Discussion(s): Pyogenic liver abscess can result in significant morbidity and mortality because of worsening infection and sepsis. Abscesses occur because of spread from adjacent infection or after recent surgeries. Recurrence is very rare. Here, we describe a very unusual case of a pyogenic liver abscess growing E. coli in a non-toxic patient, with the same location and causative organism as an abscess managed 10 years prior. (Figure Presented).

Covid-19 Vaccination Impact on Atrial Arrhythmias - Real-World Evidence from the Certitude Registry

Background: The COVID-19 vaccines were developed unprecedentedly and have proven safe and efficacious in reducing transmissibility and severe infection. The impact of mRNA-based COVID-19 vaccines on atrial arrhythmias (AA) incidence is unknown. Objective(s): To analyze the incidence of AA after COVID-19 vaccination in patients with a cardiac implantable electronic device (CIED). Method(s): BIOTRONIK Home Monitoring data and Medicare claims data from CERTITUDE patients implanted with a CIED between 2010-20 were utilized to identify recipients of one or more doses of the COVID-19 vaccine in 2021. Those who had influenza vaccination in 2020 were also identified in the same cohort as a control. From remote monitoring data, the number of atrial high rate events (AHR) and % burden of AA in the three months post-vaccination was compared to the preceding three months using Wilcoxon signed rank test. Kruskal-Wallis test was used for group difference comparisons. New AF diagnosis was determined from ICD-10 diagnosis codes in Medicare claims. Result(s): First and 2nd doses of COVID vaccine (50% Pfizer, 47% Moderna, and 3% J&J) were administered to 7757 and 6579 individuals with a CIED (age 76.2 (+/-9.0) y, 49% males), respectively. In the same cohort, 4723 (61%) individuals received the influenza vaccine. A statistically significant increase in the number of AHR episodes and % burden of AA was noted in the three months post-vaccination compared to the preceding three months after the 1st and 2nd doses of the COVID-19 vaccine (Figure). No such association was noted following influenza vaccination. In subgroup analysis, AHR episodes increased significantly in age groups >70 and men. Post-vaccination increase in AHR episodes was more significant in those without a pre-vaccination history of AHR episodes (mean increase of AHR 6.9+/-88.4, p<0.001) and was non-significant in those with a preceding history of AHR (p=0.8). Among the 764 patients with no AF diagnosis in claims preceding the first COVID-19 vaccine, 87 (11.4%) developed a new AF diagnosis or AHR event in the first three months post-vaccination. Conclusion(s): We report a small but significant increase in the number of CIED-detected atrial arrhythmias following vaccination for COVID-19 but not influenza, specifically in men and age >70 years. Acknowledging the immense public health benefit of COVID-19 vaccines, our results should prompt increased awareness of evaluating for AF in this high-risk group following vaccination. [Formula presented]Copyright © 2023

Postoje sester a studentu osetrovatelstvi k ockovani proti covid-19 - prehled, Postoje sester a studentu osetrovatelstvi k ockovani proti covid-19 - prehled

AIM: There is a discussion about COVID-19 vaccination rates among healthcare workers (HCW), especially nurses. The primary question for this review was: "What are the attitudes of nurses, compared to other HCW, towards COVID-19 vaccination?" The secondary questions included the proportion of nurses with intention to get vaccinated, what prevents the nurses from accepting the vaccine and what enables them to accept the vaccine. METHODS: The PRISMA-ScR format for scoping reviews was chosen to respect the novelty of COVID-19 vaccines. Database search (PubMed/MEDLINE, PROquest and EBSCO) was performed for original studies in English language, from all geographies, with most recent search on March 20, 2022. Vaccination acceptance rates were charted for nurses and nursing students in one category, and HCW other than nurses in the other category. The evolution in time of the nurses attitude to vaccine acceptance relative to that of HCW other than nurses was charted post hoc. The factors associated with COVID-19 vaccination intention according to the WHO categories (contextual influences, individual/ group influences, and vaccine/vaccination specific issues) were reviewed as narrative summary. RESULTS: Total 58 eligible studies were selected, all with cross-sectional study design, including 95418 healthcare workers of whom 33130 were nurses and 7391 were nursing students, from 44 countries in Europe, Americas, Africa and Asia. Trust in science, in doctors, in experts and in governments were the main contextual factors increasing vaccination acceptance mentioned in the studies, while altruism and collective protection, or protecting a person at risk at home was mentioned only few times. The nurses were less likely to accept vaccination compared to doctors and other HCWs at the onset, eg. before vaccine rollout, and this difference decreased with time (p = 0.022). Being older (n = 25 studies), being male (n = 23), having higher degree of education (n = 7), and having more years of clinical practice (n = 4) were associated with higher vaccination acceptance. Percieved individual risk of having severe COVID-19 (n = 14) or working in a COVID-19 dedicated units (n = 5) was mentioned in a minority of studies. The main vaccine-releated factors associated with higher vaccination intention were trust in the vaccine and its efficacy and safety, general vaccinatoin acceptance and specifically having had influenza vaccination in previous years (n = 21 studies). A significant factor associated with higher vaccine acceptance was high "vaccine knowledge", "vaccine literacy", "understanding the vaccine" or "understanding benefits and barriers of vaccination" (n = 17 studies). CONCLUSIONS: Nurses have been more hesitant to accept COVID-19 vaccination than other healthcare professions at the beginning, but with time this difference disappeared. This general nurse attitude of wait-and-see reported in the studies corresponds with real-life data from practicing healthcare workers as reported by the Czech Institute of Health Information and Statistics on vaccination against COVID-19. Trust in scientific structures and vaccine makers increases the vaccine acceptance. The acceptance increases also with higher age, increasing level of education, longer clinical experience, and also with being a male. Vaccine literacy and having participated in previous vaccination programmes, especially influenza vaccine, were identified as independent modifiable factors increasing vaccination acceptance.

COVID-19 vaccination attitudes in nurses and nursing students - a scoping review

Aim: There is a discussion about COVID-19 vaccination rates among healthcare workers (HCW), especially nurses. The primary question for this review was: "What are the attitudes of nurses, compared to other HCW, towards COVID-19 vaccination?" The secondary questions included the proportion of nurses with intention to get vaccinated, what prevents the nurses from accepting the vaccine and what enables them to accept the vaccine. Method(s): The PRISMA-ScR format for scoping reviews was chosen to respect the novelty of COVID-19 vaccines. Database search (PubMed/MEDLINE, PROquest and EBSCO) was performed for original studies in English language, from all geographies, with most recent search on March 20, 2022. Vaccination acceptance rates were charted for nurses and nursing students in one category, and HCW other than nurses in the other category. The evolution in time of the nurses attitude to vaccine acceptance relative to that of HCW other than nurses was charted post hoc. The factors associated with COVID-19 vaccination intention according to the WHO categories (contextual influences, individual/ group influences, and vaccine/vaccination specific issues) were reviewed as narrative summary. Result(s): Total 58 eligible studies were selected, all with cross-sectional study design, including 95418 healthcare workers of whom 33130 were nurses and 7391 were nursing students, from 44 countries in Europe, Americas, Africa and Asia. Trust in science, in doctors, in experts and in governments were the main contextual factors increasing vaccination acceptance mentioned in the studies, while altruism and collective protection, or protecting a person at risk at home was mentioned only few times. The nurses were less likely to accept vaccination compared to doctors and other HCWs at the onset, eg. before vaccine rollout, and this difference decreased with time (p = 0.022). Being older (n = 25 studies), being male (n = 23), having higher degree of education (n = 7), and having more years of clinical practice (n = 4) were associated with higher vaccination acceptance. Percieved individual risk of having severe COVID-19 (n = 14) or working in a COVID-19 dedicated units (n = 5) was mentioned in a minority of studies. The main vaccine-releated factors associated with higher vaccination intention were trust in the vaccine and its efficacy and safety, general vaccinatoin acceptance and specifically having had influenza vaccination in previous years (n = 21 studies). A significant factor associated with higher vaccine acceptance was high "vaccine knowledge", "vaccine literacy", understanding the vaccine" or "understanding benefits and barriers of vaccination" (n = 17 studies). Conclusion(s): Nurses have been more hesitant to accept COVID-19 vaccination than other healthcare professions at the beginning, but with time this difference disappeared. This general nurse attitude of wait-and-see reported in the studies corresponds with real-life data from practicing healthcare workers as reported by the Czech Institute of Health Information and Statistics on vaccination against COVID-19. Trust in scientific structures and vaccine makers increases the vaccine acceptance. The acceptance increases also with higher age, increasing level of education, longer clinical experience, and also with being a male. Vaccine literacy and having participated in previous vaccination programmes, especially influenza vaccine, were identified as independent modifiable factors increasing vaccination acceptance.Copyright © 2023, Czech Medical Association J.E. Purkyne. All rights reserved.

Vaccination in Patients with Inflammatory Rheumatic Diseases: Preliminary Results of an International, Real-World Life Panlar's Register

Objectives: To evaluate vaccination among patients with inflammatory rheumatic diseases initiating disease-modifying antirheumatic drugs (DMARD) Methods: Data from the real-world life PANLAR's register of consecutive patients diagnosed with RA, PsA, and axSpa (2010 ACR-EULAR /2006 CASPAR-2009 ASAS) from Dec 2021 to Dec 2022 were analyzed. Prevalence of recommended vaccinations were compared between different inflammatory rheumatic diseases. Categorical variables were expressed as %. Tables were analyzed with chi2 or Fisher tests, continuous variables (median, IQR)with the Kruskal-Wallis test, according with the variables type. A p value <=0.05 was considered significant. Result(s): 608 patients were included. Among patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), and axial Spondyloarthritis (axSpA) are presented in the table. RA and axSpA seemed to have lower vaccination rate of pneumococcal vaccines than PsA. (p = 0.045 for conjugate anti pneumococcal vaccine in RA vs PsA). A large percentage of the population was vaccinated against COVID-19. There was a high rate of influenza vaccination in all three diseases. Conclusion(s): In Latin America, anti-pneumococcal vaccination is low, especially in patients with RA and axSpA. For other vaccines there was an acceptable level of vaccination without differences between diseases.

Retrospective analysis of risk factors for COVID-19 in the working population

Aim - the discutability of existing scientific publications prompted a retrospective analysis of COVID-19 risk factors among the working population using the example of Russian Railways. Material and methods. Based on the archival documentation of medical institutions of Russian Railways, an analysis of the incidence of employees of the holding was carried out. Data from 2452 cases were analysed, for which full medical documentation was available. The comparison group randomly included 2911 workers who did not have COVID-19, comparable in sex, age, and area of residence. Results. Significant factors of difference between the groups of patients and those who were not ill were: sex, the presence of influenza vaccination, smoking and established diabetes mellitus. There was a trend towards an association of COVID-19 incidence and the presence of cardiovascular disease. In the comparison group, unlike the group of COVID-19 cases, there are 23% more persons who were vaccinated against influenza. In the group of patients with diabetes mellitus was found 3 times more often than in the group of non-patients. In both groups, the incidence rates of cardiovascular disease did not differ. However, as the severity of the disease increased, there was a tendency to increase the incidence of cardiovascular diseases. Meanwhile, the presence of other cardiovascular risk factors (male sex, smoking, diabetes mellitus, obesity) was significantly associated with a higher incidence in the disease group compared to non-patients. Multifactorial analysis also revealed other significant combinations of risk factors with COVID-19 risk: lack of influenza vaccination and the presence of diabetes mellitus;lack of vaccination, smoking and the presence of diabetes mellitus. Conclusion. For the working population, male sex and diabetes may be a significant risk factor for developing COVID-19. Influenza vaccination should be considered as a factor in anti- COVID-19 protection. Cardiovascular diseas e and smoking may serve as additional risk factors.Copyright © 2021 Infectious Diseases: News, Opinions, Training. All rights reserved.

- Mass gatherings and vaccines usefulness.

Introduction: Mass gatherings (MGs) are usually pre-planned large events that are known to amplify the risk of infectious disease (1). Although, the risk and pattern of diseases at mass gatherings vary depending on the features of the event such as crowding, shared accommodation, possibilities of the participants to prolonged exposure and close contact with infectious individuals, type of activities, and also the characteristics of the participants including their age & immunity to infectious agents, many of these can be prevented by appropriate vaccinations (2, 3). The aim of this article is to present a summary of the risk of vaccine-preventable diseases in MGs. Method(s): The method used to develop this article weas based on a litterature review. A summaryzing process of the documented risk of vaccine-preventable diseases in MGs was conducted to extract the most useful knowledge on this topic. It explored also available evidence on the effectiveness of vaccination policies for reducing disease transmission associated with these events and also the outstanding questions that need to be addressed for future consideration of some new and promising vaccines. Pubmed- Medline, Scopus, web of science and google Scholar were used to search over the published litterature. Result(s): The current Hajj vaccination policy includes mandatory vaccination for all pilgrims against meningococcal disease. This is in addition to mandatory vaccination against yellow fever, polio and Sarscov2 for pilgrims coming from endemic region. The Saudi Ministry of Health also strongly recommends seasonal influenza vaccination for all pilgrims, particularly those at high risk of infection complications. Data on the vaccination requirements for other mass gathering events such as Kumbh Mela and other religious, sports and entertainment events are still clearly lacking. Travelers to the FIFA 2022, Qatar, were advised to remain up-to-date with routine vaccines. Apart from the hajj settings, no data are available on the possible impact of the current vaccination policy on the control of infectious disease transmission in mass gatherings. The available data demonstrate that the current vaccination policy and health requirement for hajj is effectively contributing towards controlling the transmission of infectious diseases associated with Hajj pilgrimage (37), however evidence on effectiveness is clearly lacking. Moreover, there is no vaccination policy as part of health requirements for attendance in Kumbh Melain India. Conclusion(s): While taking into account local immunization policies of countries of origin and countries of travel, for diseases with known effective prequalified vaccines, WHO recommends that travelers at risk of developing complications, or at increased risk of acquiring and spreading infection such as those attending mass events, should consider vaccination as a preventive measure. Such policies are effective when these are driven by evidence and its effectiveness are measured through large scale studies. Mots cles: Mass Gatherings, Vaccines, Vaccination, Prevention Declaration de liens d'interets: Les auteurs n'ont pas precise leurs eventuels liens d'interets.Copyright © 2023

Covid-19 Vaccine Coverage among People with Hiv in the Vaccine Safety Datalink

Background: People with HIV (PWH) may be at increased risk for severe COVID-19 outcomes compared with people without HIV. However, COVID-19 vaccination coverage among PWH is largely unknown, especially among those with advanced HIV or comorbidities. Method(s): We conducted a cohort study to evaluate coverage of the initial COVID-19 vaccine primary series and factors associated with the completion in adult PWH (>=18 years) enrolled in 8 healthcare organizations participating in the Vaccine Safety Datalink (VSD) project during December 1, 2020- December 31, 2021. Completion of two doses of the Pfizer-BioNTech or Moderna mRNA COVID-19 vaccines or one dose of the single-dose Janssen COVID-19 vaccine was assessed. Multivariable analysis was conducted using a robust Poisson regression model to estimate the rate ratio (RR) for factors associated with primary series completion, accounting for follow-up time. Result(s): A total of 22,063 PWH were identified, among which 89% were male and 93% were viral suppressed (viral load, VL <=200 copies/ml). Chronic comorbid conditions were prevalent, with 25% having a Charlson comorbidity score of 1-2 and 13% having a score of 3 or greater. About 23% were overweight and 17% were obese. The majority (90%) completed the primary series and 1,782 PWH (8%) did not receive any dose during the study period. A rapid uptake was achieved within the 6 months after the national COVID-19 vaccination program launched on December 14, 2020. (Figure 1) PWH who received one dose of mRNA vaccine (i.e., partially vaccinated) were excluded (n=314) from the analysis for the primary series completion. Having received an influenza vaccination in the past 2 years was the strongest predictor of completion (RR=1.17, 95%CI: 1.15, 1.20). Males (RR= 1.06, 95%CI: 1.04-1.08) and those of Asian race (RR=1.05, 95%CI: 1.03-1.06, vs. White) were more likely to complete the primary series. However, PWH with baseline CD4 counts < 200 (RR=0.97, 95%CI: 0.94-0.99) and those failing to achieve viral suppression (VL= 201-10k: RR= 0.89, 95%CI: 0.85-0.94;VL >10k: RR= 0.92, 95%CI: 0.87-0.98) were less likely to complete the primary series. Body mass index, Charlson comorbidity score, and neighborhood household income level were not associated with completion. Conclusion(s): Coverage of the COVID-19 vaccine primary series was high in adult PWH in the VSD. However, targeted vaccination outreach is warranted for PWH with low CD4 counts and uncontrolled HIV viral load.

Vaccine Uptake in a Predominantly Black and Latinx Cohort Hospitalized for Covid-19

Background: Vaccine uptake has been notably lower in minoritized populations in the United States. The impact of previous infection with SARSCoV- 2, disease severity, and persistent symptoms on the uptake of COVID-19 vaccines and boosters in predominantly Black and Latinx communities has not been examined. We aimed to describe correlates of vaccine uptake in a minoritized cohort hospitalized for COVID-19 during the first pandemic wave in New York City, and investigate whether those with more severe initial COVID-19 and persistent symptoms would be less likely to get vaccinated. Method(s): This retrospective cohort study included the electronic medical records of the first 894 consecutive adult patients who survived hospitalization for COVID-19 at a large quaternary care medical center in Northern Manhattan between 1 March and 8 April 2020. We ed data regarding demographics, comorbidities, oxygen requirements during hospitalization, persistence of symptoms at 3- and 6-months after admission, COVID-19 vaccinations through November 2022, and influenza vaccination during the 2018-2019 through 2021-2022 seasons. Unadjusted and adjusted logistic regression analyses were conducted to describe the predictors of COVID-19 vaccination, delayed vaccination (first dose after 6 May 2021), and receipt of a booster vaccine. Statistical analyses were performed using R V.4.2.1. Result(s): The cohort of 894 patients was predominantly Latinx (54%) and Non- Hispanic Black (15%). 41% received at least one influenza vaccine pre-COVID, and 67% had at least one comorbidity. 22% (199/894) remained COVID-19 unvaccinated. Of the individuals who received at least one dose of COVID-19 vaccine, 57% (397/695) received at least one booster. Exactly 31% (212/695) delayed vaccination. 25% (27/106) of unvaccinated individuals reported persistent generalized symptoms compared to 18% (78/436) of vaccinated individuals. Multiple logistic regression showed that Hispanic/Latinx ethnicity, age 35-64, and concurrent influenza vaccination were associated with increased COVID-19 vaccine uptake. No association was found between vaccine uptake and disease severity or persistence of symptoms. Conclusion(s): Achieving a deeper understanding of the factors driving vaccine hesitancy is critical to increasing and sustaining acceptance of COVID-19 vaccination especially in communities with historically low uptake of annual vaccines.

Mpox Awareness, Risk Reduction, and Vaccine Acceptance among Pwh in Washington, Dc

Background: PWH are disproportionally affected by mpox and at high risk for severe complications. The recent mpox outbreak response included increasing awareness, encouraging behavioral changes and pre- and post-exposure vaccination. We assessed knowledge and perceptions of mpox, adoption of preventive behaviors, and attitudes towards vaccination among PWH in Washington, DC. Method(s): Data from a cross-sectional mpox survey were collected between August and December 2022 from PWH enrolled in a longitudinal HIV cohort, the DC Cohort. We conducted uni- and bivariable analyses comparing participants by vaccination status (vaccinated, plan to vaccinate, no plan to vaccinate) and by HIV risk group (MSM vs. non-MSM). We conducted multinomial regression to identify factors associated with vaccine acceptance. Result(s): Among 178 PWH completing the survey (median age 55;71% male, 81% non-Hispanic Black, 37% MSM), 162 (91%) had heard of mpox. Among 159 PWH who had heard of mpox and answered vaccination questions, 21% (n=33) were vaccinated, 43% (n=69) planned to vaccinate and 36% (n=57) did not plan to vaccinate. Comparing the 3 groups, significant differences were observed by age, gender, education, income, HIV risk group, and level of worry about mpox (all p< 0.01). Viral suppression, prior COVID and influenza vaccination, access to STI services, and STI diagnoses in the last year were not associated with vaccine status. Behaviorally, a higher proportion of vaccinated participants reported limiting their number of sexual partners (p< 0.001) and using more preventive behaviors (e.g., limiting gatherings, increased condom use, avoiding skin-to-skin contact;p=0.034) in response to mpox. A higher proportion of MSM reported limiting their number of sexual partners compared to non-MSM (33% vs 7%, p< 0.0001) and were more likely to be vaccinated or plan to vaccinate vs non-MSM (p< 0.001). In adjusted multinomial regression models comparing vaccinated PWH and those planning to vaccinate to those not planning to vaccinate, age (p= 0.0231) and HIV risk factor/gender (p< 0.0001) were significantly associated with vaccination status with younger PWH and MSM more likely to vaccinate (Figure). Conclusion(s): High levels of mpox awareness were observed among this cohort of PWH in Washington, DC with more MSM employing risk reduction behaviors and vaccination as mpox prevention strategies. Ensuring that all PWH, regardless of gender, sexual orientation, or age, understand the risks of mpox may improve vaccination uptake.

STRUCTURAL RACISM AND INCOME-RELATED HEALTH INEQUITIES IN THE ONTARIO GOvERNMENT AND ITS PUBLIC HEALTH UNITS' RESPONSE TO THE COvID-19 PANDEMIC

Early reports in Canada indicated that the health impacts of COVID-19 would be disproportionately worse for marginalized groups due to existing health inequities. While the federal, provincial, and territor-ial governments had extensive emergency powers at their disposal, the bulk of the pan-demic response came from the provinces and territories. Despite warnings about the anticipated disparate impact of the pandem-ic, data from Ontario indicates that racial-ized populations and individuals in lower-income households were the worst hit by the pandemic. This paper explores four aspects of the Ontario government and its 34 public health units' emergency response: (1) data collection on COVID-19 and health inequi-ties, (2) administration of COVID-19 test-ing, (3) the provision of medical services to those with COVID-19, and (4) distribution of COVID-19 vaccines. For each of these four aspects of the Ontario government and its 34 public health units' response, we highlight central areas where structural ra-cism and income-related health inequities were apparent. We acknowledge the sig-nificant practical barriers, such as lack of information and severe resource constraints, involved in pursuing health equity goals during the COVID-19 pandemic. However, for each of these areas, we recommend steps that could have been taken by the Ontario government and the public health units, in part through the province's emergency pow-ers, to redress the disparate impact of the pandemic. We suggest that the Ontario gov-ernment had a moral duty to combat these inequities, as well as a possible legal duty to do so in light of the Canadian Charter of Rights and Freedoms and certain inter-national human rights obligations.

Simulation based adaptive vaccine delivery strategy

Inoculation is one of the most common intervention methods to mitigate the number of incidents during an outbreak. It is a crucial point to decide which age or target groups in a society are priorly vaccinated. In this study, we considered this challenge and a late vaccine distribution scenario with a new vaccine delivery strategy. A given population is divided into five age groups with different contact and transmission rates. The proposed strategy distributes weekly shots to people in an age group or groups according to results of simulation modelling different vaccination strategies for a week time horizon by considering historical incident rates of the outbreak. The method is tested against the strategy of vaccinating schoolchildren considered in many related publications in the literature. According to results, for 20 scenarios based on different contact and transmission rates and under three coverage levels, our method outperforms the benchmark strategy under 20% and 30% coverage levels for each scenario. Both strategies mostly follow same distributions and come up with same results under 10% coverage level. We can conclude that the proposed method is robust to changes in contact and transmission rates and provides superior results when coverage levels are relatively high. The method can provide effective vaccination strategies by considering disease dynamics for primarily COVID-19 and future pandemics.

A Preliminary Study on the Frequency of Influenza Infections during the Early 2022 Amid COVID-19 Epidemic in Libya

Background At the time of conducting this study, we were at the peak of the influenza season, and influenza vaccinations were not readily accessible throughout the country. Thus, predisposing many high-risk individuals to influenza infections in a time when coronavirus disease 2019 (COVID-19) was also highly circulating, and the emerging Omicron variant of concern was peaking in many countries worldwide.Methods We conducted a brief survey to prospectively estimate the frequency of influenza A and B and severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) in samples received at our laboratories at Libyan Biotechnology Research Center, Tripoli, Libya, between December 1, 2021, and January 31, 2022, for patients complaining of respiratory symptoms using a multiplex reverse transcription-polymerase chain reaction test for SARS-COV-2, influenza A and B, and RSV.Results We analyzed nasopharyngeal swabs in viral transport media from 2,186 samples. About 27% (589/2186) of study patients tested positive for SARS-COV-2, 2.8% (61/2186) were positive for influenza A virus, 0.18% (4/2186) for influenza B virus, and 1.4% (31/2186) tested positive for RSV.Conclusions These results revealed that along with COVID-19, influenza infections were also rising. As the COVID-19 pandemic continues, the most significant concern is the development of an influenza outbreak in the upcoming months. Therefore, continuing annual influenza vaccination is critical to increasing population immunity. National influenza surveillance and testing should also be conducted. Furthermore, sequencing and antigenic characterization should be performed regularly. There is a need for continuous monitoring in national laboratories to detect any zoonotic cases and substantial viral evolution.

Examination of the Effect of Switching Dialysis Membranes on the Immune Response to Influenza Virus Vaccination in Hemodialysis Patients.

INTRODUCTION: In this study, we examined the effect of switching dialysis membranes on the response to influenza virus vaccination in HD patients. METHODS: This study consisted of two phases. In phase 1, antibody titers were measured and compared between HD patients and healthy volunteers (HVs) before and after vaccination against influenza virus. Using antibody titers 4 weeks after vaccination, HD patients and HVs were classified according to seroconversion (i.e., antibody titers against all four strains were >20-fold) or non-seroconversion (i.e., antibody titer against at least one strain was <20-fold). In the phase 2, we examined whether the change in the dialysis membrane from a polysulfone (PS) to a polymethyl methacrylate (PMMA) membrane affected the response to vaccination in HD patients without seroconversion in response to the vaccine the previous year. Patients with seroconversion and non-seroconversion were classified as responders and nonresponders, respectively. Additionally, we compared clinical data. RESULTS: In the phase 1, 110 HD patients and 80 HVs were enrolled, and their seroconversion rates were 58.6% and 72.5%, respectively. In the phase 2, 20 HD patients without seroconversion in response to the vaccine the previous year were enrolled, and the dialyzer membrane was changed to PMMA 5 months before annual vaccination. After annual vaccination, 5 and 15 HD patients were categorized as responders and nonresponders, respectively. In the responders, ß2-microglobulin, white blood cell counts, platelet counts, and serum albumin levels (Alb) were all higher than in the nonresponders. CONCLUSION: The responsiveness to vaccination against influenza virus was lower in HD patients compared with HVs. Changing the dialysis membrane from PS to PMMA appeared to affect the response to vaccination in HD patients.

Pediatric initiative on improving uptake of seasonal influenza vaccination among children during the COVID-19 pandemic.

In the time of regular COVID-19 prevention and control, it has been a medical priority to standardize the management of other diseases (like seasonal influenza) and relevant vaccination, especially to prevent the epidemic of both seasonal influenza and COVID-19 in winter and spring. In the influenza season of winter and spring, children are among those most vulnerable to influenza, making primary schools, secondary schools and nursing centers an influenza epicenter. To reduce the chance of infection among children, Global Pediatric Pulmonology Alliance (GPPA )has organized an expert team to make a proposal. This proposal introduces the epidemiologic features of child influenza, the status quo of the COVID-19 pandemic, and the necessity of child influenza shots during the COVID-19 pandemic. Besides, vaccination strategies based on national and international guidelines/consensuses are elaborated for the reference of relevant people from all walks of life.Copyright © 2020 by the Chinese Medical Association.

Influenza A and influenza B antibody determination in an Austrian cohort

Influenza is an infectious respiratory disease caused by influenza A and B, which is a virus characterized by a high mutation rate with new strains appearing regularly, making regular booster vaccinations necessary. In this study, we evaluated the immune status of Influenza A and B by using ELISA. A questionnaire was utilized to appraise the immunization anamnesis and the stance on vaccination. In total, 202 probands participated in this study. 35.6% of the probands were vaccinated, 10.9% indicated a confirmed influenza infection. 88.1% had a positive influenza A titer, whereas a positive influenza B titer was determined in only 38.6%. Additionally, a correlation between vaccination and titer could be observed. In this study, we were able to show a higher vaccination rate in our cohort than the Austrian average. Additionally, a higher percentage showed a positive influenza A titer compared to influenza B titer.Copyright © 2022