Spatial determinants affected maternal mortality of East Java province during the covid-19 pandemic era, in 2020-2021

Background. Every life aspect and group of the community have changed during the COVID-19 pandemic, including the group of pregnant, childbirth, and postpartum woman. COVID-19 Pandemic occurred in 2020-2021. Maternal mortality in East Java Province was the highest in Indonesia during the pandemic. Objective. This study analyzed the effect of spatial determinants that consist of antenatal, childbirth, and post-partum care on maternal mortality in East Java Province during the Pandemic. Methods. This study used a crossectional method with the unit of analysis in this study was all pregnant, childbirth and postpartum women in 38 districts of East Java Province from 2020 until 2021. Data were analyzed with spatial regression by using Geographically Weighted Regression Software. Results. Maternal mortality in East Java had a spreading pat-tern and negative value of the diff criterion, so we concluded that there was a spatial influence. The variables of antenatal care, accessibility of healthcare service, third postpartum visit, and complication service had significant effects on maternal mortality in all regions (P<0,05). There were four groups of districts that showed a similarity of significant factors. This result showed that each region's diversity of the accessibility of health services affects maternal mortality during the COVID-19 era. Antenatal services, access to health facilities and complication services affected maternal mortality in regions with high maternal mortality rate. Conclusion. Every region has its spatial determinants of maternal mortality. The top government should give authority to local government to have programs to reduce maternal mortality according to the condition in their region. r.Copyright © the Author(s), 2023.

Organ transplantation and vaccination

Organ transplant recipients are at a high risk of infection with high hospitalization rate, critical rate and fatality, due to low immune function caused by taking immunosuppressants for a period of long time after organ transplantation. Currently, vaccination is recognized as an effective approach to prevent infection. Organ transplant recipients may be vaccinated according to individual conditions. However, the sensitivity to vaccines may decline in organ transplant recipients. The types, methods and timing of vaccination have constantly been the hot spots of clinical trials. In this article, the general principles, specific vaccines and SARS-CoV-2 vaccines of vaccination in organ transplant recipients were briefly reviewed, aiming to provide reference for the vaccination of organ transplant recipients. Moreover, current status of SARS-CoV-2 vaccination for organ transplant recipients was illustrated under the global outbreak of novel coronavirus pneumonia pandemic.Copyright © 2022 Journal of Zhongshan University. All Rights Reserved.

Vaccines for the prevention of infections in adults with haematological malignancies

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.

Adult Vaccination

Adult vaccination rates are low in the United States, despite clear benefits for reducing morbidity and mortality. Vaccine science is evolving rapidly, and family physicians must maintain familiarity with the most recent guidelines. The recommended adult immunization schedule is updated annually by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention. All eligible patients should receive SARS-CoV-2 vaccines according to the current guidelines. Adults without contraindications should also receive an annual influenza vaccine. Hepatitis A vaccine is recommended for adults with specific risk factors. All pregnant patients, adults younger than 60 years, and those 60 years and older who have risk factors should receive a hepatitis B vaccine. A 15- or 20-valent pneumococcal conjugate vaccine is recommended for all patients who are 65 years and older. Patients who receive 15-valent pneumococcal conjugate vaccine should receive a dose of 23-valent pneumococcal polysaccharide vaccine one year later. Adults 19 to 64 years of age should receive a pneumococcal vaccination if they have medical risk factors. A single dose of measles, mumps, and rubella vaccine is recommended for adults without presumptive immunity, and additional doses are recommended for patients with HIV and postdelivery for pregnant patients who are not immune to rubella. A tetanus and diphtheria toxoids booster is recommended every 10 years. For pregnant patients and those in close contact with young infants, a tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine should be administered. The human papillomavirus vaccine is recommended for all people through 26 years of age. Herpes zoster vaccine is indicated for all adults 50 years and older.Copyright © 2022 American Academy of Family Physicians.

Impact of the COVID-19 pandemic on human papillomavirus (HPV) vaccination among a national sample of United States adults ages 18–45: A cross-sectional study

To assess how the COVID-19 pandemic affected catch-up HPV vaccination among age-eligible adults (ages 18–45). The current study leverages a national, cross-sectional sample of US adults ages 18–45 years to assess the prevalence and determinants of COVID-19 pandemic-related disruptions to catch-up HPV vaccination in 2021. The sample was restricted to adults intending to receive the HPV vaccine. Multinomial logistic regression analysis was conducted to assess the probability of 1) pandemic-related HPV vaccination disruption and 2) uncertainty about pandemic-related HPV vaccination disruption. Report of ‘no pandemic-related HPV vaccination disruption' served as the reference category. Among adults intending to get the HPV vaccine (n = 1,683), 8.6 % reported pandemic-related HPV vaccination disruption, 14.7 % reported uncertainty about vaccination disruption, and 76.7 % reported no disruption. Factors associated with higher odds of pandemic-related vaccination disruption included non-English language preference (OR: 3.20;95 % CI: 1.99–5.13), being a parent/guardian (OR: 1.77;95 % CI: 1.18–2.66), having at least one healthcare visit in the past year (OR: 1.97;95 % CI: 1.10–3.53), being up-to-date on the tetanus vaccine (OR: 1.81;95 % CI: 1.19–2.75), and being a cancer survivor (OR: 2.57;95 % CI: 1.52–4.34). Catch-up HPV vaccination for age-eligible adults is a critical public health strategy for reducing HPV-related cancers. While a small percentage of adults reported pandemic-related disruptions to HPV vaccination, certain adults (e.g., individuals with a non-English language preference and cancer survivors) were more likely to report a disruption. Interventions may be needed that increase accessibility of catch-up HPV vaccination among populations with reduced healthcare access during the pandemic. © 2022 The Authors

Administration of Tetanus Toxoid Immunization to Pregnant Mothers during the Covid-19 Pandemic

Background: The outbreak of the Covid-19 pandemic in Indonesia impacts women's reproductive health services, including pregnant women services that meet the standard, namely the administration of TT immunization. Officers at the Community Health Center (Puskesmas) are more focused on controlling the spread of COVID-19. The problem that arises due to pregnant women who are not administered Tetanus Toxoid during pregnancy is the occurrence of tetanus in the mother and baby. Objective(s): To determine the relationship between knowledge, attitudes, and support of MCH officers towards the administration of Tetanus Toxoid immunization during the COVID-19 pandemic at UPT PuskesmasPasundan, Garut Regency, for the period of June-July 2021. Method(s): Analytic observational with the cross-sectional approach. The study was conducted from June to July 2021. The population and research sample consisted of 50 people. A questionnaire was used as a research instrument.Analysis: Univariate to explain the research variables and bivariate analysis to explain the relationship between knowledge, attitudes of pregnant women, and the support of MCH officers in administering Tetanus Toxoid immunization during the covid-19 pandemic. Hypothesis testingused a statistical test, namely the Chi-Square test with SPSS 2013, and the significance level was 0.05. Result(s): Relationship between Knowledge and Administration of Tetanus Toxoid Immunization, p-value = 0.015 (p < 0.05). Relationship between Attitude and Administration of Tetanus Toxoid Immunization, p-value = 0.0001 (P <0.05). Relationship between support of MCH officers and Administration of Tetanus Toxoid immunization, p-value = 0.0001 (p < 0.05). Conclusion(s): There is a relationship between knowledge, attitudes, and support of MCH officerstowards the administration of Tetanus Toxoid immunization. It illustrates that the presence of COVID-19 slightly interferes with the administration of TT immunization to pregnant women.Suggestion: It is important to make various efforts and ways to increase the coverage of TT immunization for pregnant women during the covid-19 pandemic. Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.

Additional Dose of SARS-CoV-2 Vaccine Increases Neutralization Capacity in Solid Organ Transplant Recipients

Purpose: Solid organ transplant recipients (SOTR) develop weak antibody responses after SARS-CoV-2 vaccination. Published data on neutralizing activity of plasma, a better measure of protection, in SOTR following an additional dose of SARSCoV- 2 vaccine is limited. Method(s): Plasma was longitudinally collected from SOTR following initial COVID- 19 vaccination. Neutralizing activity against SARS-CoV-2 was assessed using the cPass Neutralization Antibody Detection Kit (GenScript, Biotech). ELISAs were performed against SARS-CoV-2 proteins (S1, N, RBD), CMV (glycoprotein B), Influenza A H1N1 (nucleoprotein), HSV-1, EBV glycoprotein (gp350), and tetanus toxoid for comparison. Result(s): Demographic and clinical characteristics are summarized in table 1. No participants had evidence of COVID-19 infection as IgG titers to SARS-CoV-2 N protein were low. Neutralizing activity against SARS-CoV-2 RBD was observed in 39.6% of individuals (N=21/53) ~93 days after initial vaccination. Participants with neutralizing activity were more likely to have received a liver transplant (47.6% vs 6.25%, p=0.001), and less likely to be on an anti-metabolite (52.4% vs. 87.5%, p=0.009) or triple immunosuppression (14.3% vs. 53.1%, p=0.008). After an additional vaccine dose, 78.1% (N=25/32) of participants developed neutralizing activity with significant increases in viral neutralization (figure 1, median 36.8% [95%CI 18.9-64.6] to 97.2% [95%CI 74.0-98.9], p<0.0001). Participants with low neutralizing activity demonstrated adequate antibody titers to other microbial antigens (figure 2). Conclusion(s): An additional dose of SARS-CoV-2 vaccine increased the number of SOTR with neutralizing activity and the magnitude of the seroresponse. SOTR with low neutralizing activity maintain humoral responses to other microbial antigens suggesting the diminished seroresponse might be related to inhibition of new B cell responses.

Immune response to COVID-19 vaccination in patients with B-cell malignancies after CD19 CART cell therapy

Introduction: Patients with hematologic malignancies are at an increased risk of morbid/mortality from COVID-19. Our prospective clinical study evaluated immune responses to COVID-19 mRNA vaccines in patients with B-cell lymphoma who had received CD19-directed chimeric antigen receptor (CAR) T cell therapy. Methods: We measured SARS-CoV-2 neutralizing activity of plasma from 18 patients and 4 healthy controls (HC) and antibody titers against viral spike proteins (S1, S2, RBD) including their delta variants using an enzyme-linked immunoassay (ELISA). We measured B cell subpopulations in the patients' blood using flow cytometry. Results: We found that the peripheral blood plasma from 3/4 HCs showed substantial SARS-CoV-2 neutralizing activity already at 4 weeks after the first dose of COVID-19 mRNA vaccine while none of the CD19 CART patients evidenced any antibody-mediated neutralizing activity at the same point in time. At 4 weeks after receiving the second dose of the vaccine, all 4 HCs showed complete neutralizing activity. In marked contrast, only 1 of 14 CART patients evidenced any relevant antibody-mediated SARS-CoV-2 neutralizing activity. Assessing whether a globally insufficient antibody-mediated immunity was the underlying cause of the lack of a response to the COVID-19 vaccine in our CART patients, we found that IgG antibody levels against common microbial and viral antigens like influenza, Epstein-Barr virus (EBV), Cytomegalovirus (CMV), and tetanus toxoid, were comparable to those observed in HCs. However, while at 4 weeks post second dose of the vaccine the HCs showed high levels of vaccine-induced IgG antibody titers against all the viral spike proteins (S1, S2, RBD), including the delta variants of the S1 and RBD proteins, the vast majority of our CART patients did not evidence any SARS-CoV-2-specific antibodies. Importantly, a third booster vaccination did not lead to an improvement in the antiviral immunity in the 4 CART patients analyzed. When we assessed B cell subpopulations in the blood of patients and HCs, we found that prior treatments had completely eradicated all CD19+/CD20+ B cells in the patients while numbers of long-lived memory plasma cells were comparable to those of HCs. Conclusions: In this study, 17 of 18 patients with lymphoma who received CD19 CART therapy had very poor immunoreactivity to 1-3 doses of mRNA-based COVID-19 vaccines. Importantly, antibody responses to common recall antigens were preserved, suggesting impaired immune response primarily against novel antigens like SARS-COV-2. This lack of immunoreactivity against novel antigens was probably based on the eradication of earlier-stage B cell subpopulations after treatment with anti-CD19 and anti-CD20 immunotherapies.

A Case of Acute Eosinophilic Pneumonia Following Tdap Vaccine

Introduction: Acute eosinophilic pneumonia (AEP) is an uncommon lung disease. Its incidence and epidemiology remain understudied till date. The hypothesized etiology of AEP is an acute hypersensitivity reaction to an inhaled antigen such as tobacco smoke and other peculiar environmental factors. Vaccines as triggers of AEP, albeit very rare, have been reported in the literature. Case presentation: A 64-year-old male with history of hyperlipidemia on atorvastatin presented to the emergency room with complaints of cough productive of pink tinged sputum, exertional shortness of breath, chills and fever with maximum recorded temperature of 101 °F. His symptoms started within a few hours of receiving tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine two days ago. He denied any recent travel. He was a lifelong non-smoker and was employed as hospital case manager. His vitals were significant for tachycardia 116/min, tachypnea 30 breaths/min and SaO2 of 93 % on 10L. On physical examination, he was noted to have coarse and diminished breath sounds in both lung fields. Initial lab work showed elevated leukocyte count of 20.4 k/uL with absolute eosinophil count of 1.6 k/uL. Other labs were unremarkable. Diffuse bilateral reticulonodular and alveolar opacities were visualized on chest X-ray. Computed tomography (CT) of the chest showed profuse pulmonary nodules, scattered ground glass opacities and septal thickening concerning for bilateral multifocal pneumonia (figure 1). Blood cultures and sputum cultures were obtained and he was empirically treated with ceftriaxone and azithromycin. Sputum eosinophil smear was positive raising concerns for fungal and parasitic infections. Cultures remained negative and his hypoxia worsened. Thus, infectious diseases and pulmonology were consulted. Extensive infective disease work-up for bacterial, fungal, parasitic and viral pathogens came back negative. CT guided biopsy of a lung nodule demonstrated interalveolar eosinophil and fibrin deposition consistent with eosinophilic pneumonia (figure 2). Patient was started on glucocorticoids with dramatic improvement in his symptoms, imaging and oxygen needs. With his symptom onset following Tdap vaccine and negative infective work-up, AEP was suspected to be triggered by the vaccine. Discussion: AEP provoked by vaccination is rare. Cases have been reported with influenza, pneumococcal and also COVID-19 vaccines. To the best of our knowledge, this is the first report of AEP following Tdap vaccine in adults. Only up to 30% of patients with AEP will have peripheral eosinophilia. Diagnosis is usually confirmed on lung biopsy and patients respond very well to glucocorticoids.

Repeat-dose and local tolerance toxicity of SARS-CoV-2 FINLAY-FR-02 vaccine candidate in Sprague Dawley rats.

This study evaluates safety of FINLAY-FR-02, a vaccine candidate against SARS-CoV-2 based on the recombinant receptor binding domain conjugated to tetanus toxoid, in a preclinical, repeat-dose toxicity and local tolerance study. Sprague Dawley rats were randomly allocated to three experimental groups: control (receiving physiological saline solution); placebo (receiving all vaccine components except antigens) and vaccine group (receiving three doses of the vaccine candidate, 37.5 µg of RBD) administered intramuscularly in hind limbs at 24 h intervals during three days. We evaluated physiological condition, pain, food and water consumption, body temperature, dermal irritability, injection site temperature and inflammation, immunological response, blood chemistry, relative organ weight, histopathology and immunotoxicology. The product was well tolerated; no clinically relevant changes, pain, local effects or adverse systemic toxicological changes or deaths were observed. These preliminary results permitted the Cuban regulatory authorities to authorize clinical trials in humans.

Assessing Community Acceptance of Maternal Immunisation in Rural KwaZulu-Natal, South Africa: A Qualitative Investigation.

Despite the significant benefits of maternal immunisation, uptake remains low in many parts of the world. In this qualitative study, we aimed to assess the factors that influence pregnant women's decision to engage with maternal immunisation in rural KwaZulu-Natal, South Africa. We conducted in-depth interviews with a total of 28 purposively sampled pregnant women and key informants using semi-structured topic guides. Data analysis was conducted using a modified Health Belief Model framework that included constructs of barriers to action, modifying factors of cue to action and perceived social norms. The findings show that traditional customs and institutional barriers such as low-quality health service delivery, long queues, and distance to the health facilities, immunisation vaccine stockouts and low levels of maternal knowledge influence the choice and decision to engage with maternal immunisation. Understanding health-related behaviours and addressing barriers to care is important in facilitating vaccination uptake. This study contributes to the understanding of maternal immunisation uptake in low-resource settings.

Machine Learning Method to Discover the Novel Association of Vaccine and Vitamin A Supplement on Covid 19 Infection: A Biclustering Approach

This article attempts to discover the novel association of vaccines (administered for other diseases) and vitamin A supplement coverage across different countries and the spread of COVID-19.This relation may be affected by several unknown factors as the disease spreads over regions with diverse economic, cultural and climatic conditions. In this situation, relevant associations between features may exist for a subset of countries rather than the entire set of countries.We use a machine learning method named RelDenClu to identify the effects of vaccines or vitamin supplements on the spread of COVID-19. RelDenClu is a non-linear relation based biclustering technique. From the experiment, it was found that countries providing the Tetanus-Toxoid vaccine have lower COVID-19 infection rates. The performance of the proposed technique is also compared with decision tree, LASSO and CBSC and it is noticed that all these methods discover the same association (i.e., countries with a higher rate of administering Tetanus-Toxoid vaccine show lower COVID-19 infection). However, the proposed method can discover the said association in less computation time. Additionally, the proposed method is general enough to be applied to other datasets for finding associations between different local factors affecting the proliferation of any disease across different regions. © 2021 IEEE.

Maternal and Neonatal Tetanus Elimination: Where are We Now?

The maternal and neonatal tetanus elimination (MNTE) program was envisaged by the World Health Organization to overcome the mortality and morbidity caused by maternal and neonatal tetanus (MNT). Although preventable by simple cost-effective practices like universal immunization, clean delivery practices, and healthy umbilical cord care, as of date MNT is still prevalent in 12 developing countries of Asia and Africa. Definitive approaches need to be microplanned by these countries to successfully accomplish the three stages of MNTE, ie, achieving, validating, and sustaining. Once a country achieves MNTE, this status is required to be validated and sustained according to the high-risk and low-risk categorization of the districts. The three-pronged strategies for achieving and sustaining MNTE include (a) rigorous immunization of women of reproductive age with tetanus toxoid-containing vaccines, (b) strengthening of clean delivery services for pregnant women, and (c) effective surveillance for MNT. Although the deadlines for achieving MNTE globally have been missed many times, yet there has been a significant progress to date as evident by 80% reduction in countries requiring validation for MNTE (59 countries in 1999 to 12 countries in 2020). Huge strides have been made in the overall coverage of two doses of tetanus toxoid (13.79% to 65.27%), neonates being protected at birth (12% to 88%), global coverage of third-dose DPT (more than doubled), and reduction of 88% estimated deaths due to NT in the last four decades. Identification of the most vulnerable populations, systematic planning at all levels of health care, involvement of local community support, tackling the implementation gap, strong political will, good financial support, and continued robust surveillance will go a long way in achieving MNTE.