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3.
Bull World Health Organ ; 100(6): 375-384, 2022 Jun 01.
Article in English | MEDLINE | ID: covidwho-1902860

ABSTRACT

Objective: To estimate the prevalence and explore the predictors of vaccine uptake among older adults in India. Methods: We used data from the national Longitudinal Ageing Study in India, a national household survey conducted during 2017-2018. Based on interviewees' self-reports, we calculated population-weighted estimates of the uptake of influenza, pneumococcal, typhoid and hepatitis B vaccines among 64 714 Indian adults aged 45 years or older. We performed multivariable binary logistic regression analysis to examine the sociodemographic and health-related predictors of uptake of the vaccinations. Findings: The coverage of each of the studied vaccinations was less than 2%. The estimated percentages of respondents reporting ever being vaccinated were 1.5% (95% confidence interval, CI: 1.4-1.6) for influenza, 0.6% (95% CI: 0.6-0.7) for pneumococcal disease, 1.9% (95% CI: 1.8-2.0) for typhoid and 1.9% (95% CI: 1.8-2.0) for hepatitis B. Vaccine uptake was higher among respondents with cardiovascular disease, diabetes or lung disease than those without any of these conditions. Uptake of influenza vaccine was higher among those with lung disease, while hepatitis B vaccine uptake was higher among those with cardiovascular disease or diabetes. Male sex, urban residence, wealthier household, more years of schooling, existing medical conditions and sedentary behaviours were significant predictors of vaccine uptake. Conclusion: Targeted policies and programmes are needed for improving the low vaccination coverage among older adults in India, especially among those with chronic diseases. Further research could examine vaccine access, vaccine hesitancy, and vaccine-related information and communication channels to older adults and their health-care providers.


Subject(s)
Cardiovascular Diseases , Influenza Vaccines , Influenza, Human , Lung Diseases , Typhoid Fever , Aged , Hepatitis B Vaccines , Humans , Influenza Vaccines/therapeutic use , Influenza, Human/epidemiology , Influenza, Human/prevention & control , Male , Vaccination , Vaccination Coverage
4.
Vaccine ; 40(26): 3597-3604, 2022 06 09.
Article in English | MEDLINE | ID: covidwho-1873314

ABSTRACT

BACKGROUND: At least one-half of adults beginning an immunization series with a three-dose hepatitis B virus (HBV) vaccine (ENGERIX-B, RECOMBIVAX-B) have been reported not to receive the third dose. Use of a two-dose vaccine may improve adherence and lead to greater overall levels of seroprotection. OBJECTIVE: To examine expected levels of adherence and overall seroprotection at one year among adults in routine clinical settings beginning an immunization series with either ENGERIX-B or the two-dose HBV vaccine, HEPLISAV-B. METHODS: Decision-analytic model comparing expected levels of adherence and overall seroprotection at one year among a hypothetical cohort of one million previously unvaccinated adults aged ≥ 30 years receiving first doses of either ENGERIX-B or HEPLISAV-B in a routine clinical setting. We stratified the population by age (30-49 years vs ≥ 50 years) to allow for possible differences in adherence and seroprotection. We estimated our model using published adherence rates for HBV vaccines, and reported seroprotection rates by number of doses administered. We also compared total expected costs of HBV immunization with each vaccine. RESULTS: Use of a two-dose rather than three-dose HBV vaccine would increase the expected number of adults seroprotected at one year by 275,000 per one million persons beginning immunization series, largely reflecting a gain of 290,000 in the expected number of persons fully vaccinated. Results were similar for the two age groups. While the cost per dose of HEPLISAV-B exceeds that of ENGERIX-B, its estimated mean cost per person seroprotected at one year is $50-$70 (∼15%) lower. CONCLUSIONS: Use of a two-dose HBV vaccine would increase the number of adults fully seroprotected at one year compared with the number expected with a three-dose vaccine. Notwithstanding its higher unit cost, mean expected cost per person seroprotected is substantially lower for HEPLISAV-B than ENGERIX-B as a result of much higher levels of seroprotection.


Subject(s)
Hepatitis B Vaccines , Hepatitis B , Adult , Cohort Studies , Hepatitis B/prevention & control , Hepatitis B Antibodies , Hepatitis B Surface Antigens , Humans , Immunization , Immunization Schedule
5.
West Afr J Med ; 39(4): 388-393, 2022 Apr 29.
Article in English | MEDLINE | ID: covidwho-1823623

ABSTRACT

BACKGROUND: Adherence to standard precautions in hospitals is vital to control the spread of hospital-acquired infections (HAIs). OBJECTIVE: To determine the level of compliance to standard precautionary measures by clinical students and doctors in a Nigerian tertiary hospital to curb spread of infectious diseases, with focus on uptake of Hepatitis B Virus (HBV) vaccine. METHODS: This study which involved 228 participants used self-administered questionnaire to obtain data on respondents' biodata, history of exposure to patient's body fluids (PBF) in the last six months, HBV vaccination status, use and recapping of needles, handwashing, and use of Personal Protective Equipment (PPE). Data analysis was done using SPSS version18; associations were tested with Chi-square statistics, and p<0.05 was considered significant. RESULTS: Of the 228 respondents, 113(49.6%) were clinical students and 115 (50.4%) doctors with mean age of 27.61±7.48 years. A total of 140 (61.4%) respondents had been exposed to PBF: [89 (63.6%) doctors, 51(36.4%) students]. Age, student/doctor category, and number of years of practice all affected exposure to PBF (p<0.05). Recapping of needles was practiced by 167 (73.2%); hand-washing by 225 (98.7%), and lack of running water was the commonest reason for non-compliance. Also, 218 (95.6%) and 123 (53.9%) wore handgloves and face-masks respectively when attending to patients while 111 (48.7%) received at least a dose of HBV vaccine: [72 (64.9%) doctors, 39 (35.1%) students; p<0.05] but only 60.3% completed their doses. CONCLUSION: Majority had good hand-washing practice, but only about half wore face-masks while working, and recapping of needles was prominent. Doctors had more occupational exposure to PBF but received more HBV vaccine although many were yet to complete their doses. With COVID-19 added to existing list of HAIs, there is need to scale-up compliance to infection control practices through sustained training programs and better health policies which would also drive vaccine coverage in this population.


CONTEXTE: Le respect des précautions standard dans les hôpitaux est essentiel pour contrôler la propagation des infections nosocomiales (IHA). OBJECTIF: Déterminer le niveau de conformité aux mesures de précaution standard par les étudiants cliniques et les médecins d'un hôpital tertiaire nigérian pour limiter la propagation des maladies infectieuses, en mettant l'accent sur l'absorption du vaccin contre le virus de l'hépatite B (VHB). MÉTHODES: Cette étude qui a impliqué 228 participants a utilisé un questionnaire auto-administré pour obtenir des données sur les biodonnées des répondants, les antécédents d'exposition aux fluides corporels (PBF) du patient au cours des six derniers mois, le statut de vaccination contre le VHB, l'utilisation et le récapitulation des aiguilles, le lavage des mains et l'utilisation de l'équipement de protection individuelle (EPI). L'analyse des données a été effectuée à l'aide de SPSS version18; les associations ont été testées avec des statistiques sur le chi carré et inférieur ou égal à 0,05 a été considéré comme significatif. RÉSULTATS: Sur les 228 répondants, 113 (49,6%) étaient des étudiants cliniques et 115 (50,4%) des médecins avec un âge moyen de 27,61 ± 7,48 ans. Au total, 140 (61,4%) répondants avaient été exposés à la FPB: [89 (63,6%) médecins, 51 (36,4%) étudiants]. Âge, catégorie étudiant / médecin et nombre d'années de pratique, toutes les expositions au FPB (p <0,05) ont été affectées. Le récapitulation des aiguilles a été pratiqué par 167 (73,2%); lavage des mains par 225 (98,7%), et le manque d'eau courante était la raison la plus courante de non-conformité. De plus, 218 (95,6%) et 123 (53,9%) portaient des gants et des masques pour le visage respectivement lorsqu'ils s'occupaient de patients tandis que 111 (48,7%) recevaient au moins une dose de vaccin contre le VHB: [72 (64,9%) médecins, 39 (35,1%) étudiants. CONCLUSION: la majorité avait une bonne pratique de lavage des mains, mais seulement environ la moitié portait des masques faciaux pendant le travail, et le récapitulation des aiguilles était important. Les médecins étaient plus exposés au PBF mais ont reçu plus de vaccin contre le VHB, bien que beaucoup n'aient pas encore terminé leurs doses. Avec COVID-19 ajouté à la liste existante des HAI, il est nécessaire d'augmenter la conformité aux pratiques de contrôle des infections grâce à des programmes de formation soutenus et à de meilleures politiques de santé qui favoriseraient également la couverture vaccinale dans cette population. Mots clés: précautions standard, exposition professionnelle; Infections nosocomiales; Vaccin contre le VHB.


Subject(s)
COVID-19 , Cross Infection , Students, Medical , Adult , COVID-19/epidemiology , COVID-19/prevention & control , Cross Infection/prevention & control , Hepatitis B Vaccines , Hepatitis B virus , Humans , Infection Control , Nigeria/epidemiology , Tertiary Care Centers , Vaccination , Young Adult
7.
Viruses ; 14(1)2022 01 03.
Article in English | MEDLINE | ID: covidwho-1637925

ABSTRACT

In 2016, WHO member states at the World Health Assembly adopted a Global Health Sector Strategy that included a policy of eliminating viral hepatitis. Clear targets were established to assist in achieving this by 2030. The strategy, while achievable, has exposed existing global disparities in healthcare systems and their ability to implement such policies. Compounding this, the regions with most disparity are also those where the hepatitis B prevalence and disease burden are the greatest. Foundational to hepatitis B elimination is the identification of both those with chronic infection and crucially pregnant women, and primary prevention through vaccination. Vaccination, including the birth dose and full three-dose coverage, is key, but complete mother-to-child transmission prevention includes reducing the maternal hepatitis B viral load in the third trimester where appropriate. Innovations and simplified tools exist in order to achieve elimination, but what is desperately required is the will to implement these strategies through the support of appropriate investment and funding. Without this, disparities will continue.


Subject(s)
Global Health , Healthcare Disparities , Hepatitis B, Chronic/prevention & control , Hepatitis B/prevention & control , Africa/epidemiology , Antiviral Agents/therapeutic use , Cost of Illness , Female , Hepatitis B/drug therapy , Hepatitis B/epidemiology , Hepatitis B/transmission , Hepatitis B Vaccines , Hepatitis B, Chronic/diagnosis , Hepatitis B, Chronic/drug therapy , Hepatitis B, Chronic/epidemiology , Humans , Infectious Disease Transmission, Vertical/prevention & control , Pregnancy , Pregnancy Complications, Infectious/prevention & control , Prevalence , Vaccination
8.
Vaccine ; 39(52): 7584-7589, 2021 12 20.
Article in English | MEDLINE | ID: covidwho-1569117

ABSTRACT

OBJECTIVE: To conduct a nationwide evaluation of vaccine bidding, procurement and distribution management for understanding and improving the current situation well in mainland China. METHODS: An institution survey was carried out to collect information on tendering, procurement, distribution and related issues to vaccines by structured questionnaires administered to 31 provinces in mainland China from April to July 2019. RESULTS: In 13 (41.9%) of 31 provinces, centralized bidding of National Immunization Program (NIP) vaccines was accomplished, and others conducted independent tendering and purchasing in 2018. For non-NIP vaccines, all provinces implemented unified bidding at the provincial level and over half (18, 58.1%) of them chose provincial public resource trading platforms, but their modes varied over provinces. Then procurement was undertaken by the district-level centers for disease control and prevention (CDC) while they were unable to choose the best option of too many vaccines targeted by the province-level CDC for local populations. The distribution modes of NIP and non-National Immunization Program (non-NIP) vaccines were similar overall in a province but very different over provinces. Main mode was that CDCs at different levels delivered about two thirds (64.5%) of NIP vaccines distribution and more than one third (35.5%) of non-NIP vaccines. Another distribution mode was occupied as fully buying the service from third parties in 3 municipalities. Some provinces mixed both modes, too. The total distribution volume of vaccines was 430.7 million doses in 2018. The top five non-NIP vaccines delivered in 2018 were human rabies vaccine, varicella vaccine, EV71 hand foot mouth disease vaccine, hepatitis B vaccine and influenza vaccine. CONCLUSION: The vaccine biding, procurement and distribution management varied over provinces in mainland China in 2018, especially for non-NIP vaccines. Specific policies and measures should be developed for different regions to improve the immunization management better.


Subject(s)
Hand, Foot and Mouth Disease , Immunization Programs , China , Hepatitis B Vaccines , Humans , Vaccination
9.
Nat Commun ; 12(1): 6223, 2021 10 28.
Article in English | MEDLINE | ID: covidwho-1510592

ABSTRACT

In 2016 the World Health Organization set the goal of eliminating hepatitis B globally by 2030. Horizontal transmission has been greatly reduced in most countries by scaling up coverage of the infant HBV vaccine series, and vertical transmission is therefore becoming increasingly dominant. Here we show that scaling up timely hepatitis B birth dose vaccination to 90% of new-borns in 110 low- and middle-income countries by 2030 could prevent 710,000 (580,000 to 890,000) deaths in the 2020 to 2030 birth cohorts compared to status quo, with the greatest benefits in Africa. Maintaining this could lead to elimination by 2030 in the Americas, but not before 2059 in Africa. Drops in coverage due to disruptions in 2020 may lead to 15,000 additional deaths, mostly in South-East Asia and the Western Pacific. Delays in planned scale-up could lead to an additional 580,000 deaths globally in the 2020 to 2030 birth cohorts.


Subject(s)
Hepatitis B Vaccines/administration & dosage , Hepatitis B/prevention & control , Africa/epidemiology , Americas/epidemiology , Asia, Southeastern/epidemiology , Disease Eradication/statistics & numerical data , Female , Hepatitis B/epidemiology , Hepatitis B/mortality , Hepatitis B/virology , Hepatitis Viruses/genetics , Hepatitis Viruses/immunology , Humans , Infant , Infant, Newborn , Male , Vaccination , World Health Organization
10.
J Med Virol ; 94(3): 918-925, 2022 03.
Article in English | MEDLINE | ID: covidwho-1442018

ABSTRACT

Given recent downward trends in daily rates of COVID-19 vaccinations, it is important to reassess strategies to reach those most vulnerable. The success and efficacy of vaccination campaigns for other respiratory illnesses, such as influenza, may help inform messaging around COVID-19 vaccinations. This cross-sectional study examines the individual-level factors associated with, and the spatial distribution of, predictors of COVID-19 severity, and uptake of influenza and hepatitis B (as a negative control) vaccines across NYC. Data were obtained from the 2018 Community Health Survey (CHS), including self-reported influenza and hepatitis B vaccine uptake, diabetes, asthma, hypertension, body mass index (BMI), age, race/ethnicity, educational attainment, borough, and United Hospital Fund (UHF) neighborhood of residence. A CDC-defined COVID-19 severity risk score was created with variables available in the CHS, including diabetes, asthma, hypertension, BMI ≥ 30 kg/m2 , and age ≥65 years old. After adjustment, there was a significant positive association between COVID-19 severity risk score and influenza vaccine uptake (1: ORadj = 1.49, 95% CI 1.28-1.73; 2: ORadj = 1.99; 95% CI: 1.65-2.41; 3+: ORadj = 2.89; 95% CI: 2.32-3.60, compared to 0). Hepatitis B vaccine uptake was significantly inversely associated with COVID-19 severity risk score (1: ORadj = 0.67; 95% CI: 0.57-0.79; 2: ORadj = 0.54; 95% CI: 0.44-0.66; 3+: ORadj = 0.45; 95% CI: 0.36-0.56, compared to 0). The influenza vaccination campaign template is effective at reaching those most at risk for serious COVID-19 and, if implemented, may help reach the most vulnerable that have not yet been vaccinated against COVID-19.


Subject(s)
Asthma , COVID-19 , Hypertension , Influenza Vaccines , Influenza, Human , Aged , Asthma/epidemiology , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19 Vaccines , Cross-Sectional Studies , Hepatitis B Vaccines , Humans , Immunization Programs , Influenza, Human/epidemiology , Influenza, Human/prevention & control , Vaccination
11.
Hum Vaccin Immunother ; 17(11): 4578-4586, 2021 11 02.
Article in English | MEDLINE | ID: covidwho-1348031

ABSTRACT

Children with hematological malignancies are at increased risk of hepatitis B virus infection. This study assessed the immunogenicity and safety profile of HBV vaccination in pediatric hemato-oncological children. A nonrandomized interventional study was conducted from January 2017 to February 2020 in Shanghai, China. Seventy-three pediatric hemato-oncological children with hepatitis B surface antibody (anti-HBs) titers <10 mIU/ml were recruited. The participants received three doses of recombinant HBV vaccine according to the 0-, 1-, and 6- month immunization schedule. Adverse events following immunization and anti-HBs titers (at baseline, 1 month, and 6 months after inoculation) were recorded. Forty-three males and thirty females with median ages of 9.12 and 9.60 years, respectively, were included. The mean anti-HBs titer was 4.88 ± 2.61 mIU/ml, 893.12 ± 274.12 mIU/ml, and 711.45 ± 337.88 mIU/ml at baseline, one month, and six months after inoculation, respectively (P< .001). A total of fourteen adverse events following immunization were reported, and among them, 5 (6.85%), 5 (6.85%), and 4 (5.48%) events were reported after the first, second, and third inoculation, respectively (P= .927). In conclusions, the HBV vaccine is immunogenic and safe in children with hematological malignancies. It is worth noting that the anti-HBs titer was decreased at the 6-month follow-up, and periodic monitoring of the anti-HBs titer accompanied by timely booster vaccination should be carefully considered.Abbreviations: AEFI: Adverse events following immunization; HBV: Hepatitis B virus; Anti-HBs: Antibody against hepatitis B surface antigen; HBsAg: Hepatitis B surface antigen; APC: Antigen-presenting cell; HSCT: Hemopoietic stem cell transplantation; COVID-19: Corona Virus Disease 2019.


Subject(s)
Hematologic Neoplasms , Hepatitis B Vaccines , Hepatitis B , COVID-19 , Child , China , Female , Hematologic Neoplasms/complications , Hematologic Neoplasms/therapy , Hepatitis B/prevention & control , Hepatitis B Antibodies , Hepatitis B Surface Antigens , Hepatitis B Vaccines/adverse effects , Humans , Immunization, Secondary , Male , Prospective Studies , SARS-CoV-2 , Vaccination
12.
J Am Soc Nephrol ; 32(9): 2153-2158, 2021 09.
Article in English | MEDLINE | ID: covidwho-1341564

ABSTRACT

BACKGROUND: Kidney transplant recipients and patients receiving hemodialysis are immunocompromised populations that are prioritized for COVID-19 vaccination but were excluded from clinical trials of SARS-CoV-2 mRNA vaccines. Antibody titers and rates of seroconversion after vaccination are lower among patients with CKD and those taking immunosuppressants compared with controls. Data are lacking regarding their humoral response to vaccination to prevent COVID-19. METHODS: This investigation of early serological response after COVID-19 vaccination with the Pfizer/BioNTech (BNT162b2) mRNA vaccine included 78 patients undergoing hemodialysis, 74 kidney transplant recipients, and seven healthy controls. We recorded data from the medical file for various clinical parameters, including response to hepatitis B vaccination, and measured antibody titers against SARS-CoV-2 at 0, 14, 28, 36, and 58 days after the first injection. RESULTS: In controls, we detected antibodies at a positive level (>13 arbitrary units per ml; AU/ml) at day 14 postinjection, which increased progressively to peak at day 36 (1082 AU/ml; interquartile range [IQR], 735.0-1662.0). Patients undergoing hemodialysis had lower titers that peaked at day 58 (276 AU/ml; IQR, 83.4-526.0). We detected a positive antibody level in only three transplant recipients at day 36. In patients on hemodialysis, those aged <75 years had a higher antibody response versus those aged >75 years, and serum albumin and Kt/V were positively correlated with serological response (P<0.04 and P<0.0, respectively); nonresponders to HBV vaccine had the lowest anti-SARS-CoV-2 antibody titers. CONCLUSIONS: Our results suggest that the postvaccination humoral response is strongly inhibited by immunosuppressant therapy in kidney transplant recipients, and is reduced by the uremic condition in patients undergoing hemodialysis.


Subject(s)
Antibodies, Viral/biosynthesis , COVID-19 Vaccines/pharmacology , COVID-19/immunology , COVID-19/prevention & control , Kidney Transplantation , Renal Dialysis , SARS-CoV-2/immunology , Age Factors , Aged , Antibodies, Viral/blood , COVID-19/complications , COVID-19 Vaccines/administration & dosage , Case-Control Studies , Cohort Studies , Female , Hepatitis B Vaccines/pharmacology , Humans , Immunocompromised Host , Immunosuppressive Agents/adverse effects , Kidney Failure, Chronic/complications , Kidney Failure, Chronic/immunology , Kidney Failure, Chronic/therapy , Male , Middle Aged , Pandemics , Retrospective Studies , Spike Glycoprotein, Coronavirus/immunology , Time Factors , Transplant Recipients
13.
Vaccine ; 39(3): 554-563, 2021 01 15.
Article in English | MEDLINE | ID: covidwho-1203317

ABSTRACT

TRIAL DESIGN: An interventional, phase 4, single group assignment, without masking (open label), preventive clinical trial was carried out in health workers with biological risk in their tasks, who have been filed as non-responders to conventional vaccination against Hepatitis B. METHODS: 67 health workers with biological risk in their tasks, who have been filed as non-responders to conventional vaccination against Hepatitis B, were enrolled in the Clinical Trial. All participants were from 18 years up to 64 years old. INCLUSION CRITERIA: NHS workers -including university students doing their internships in health centres dependent on the National Health System (inclusion of students is regulated and limited by specific instructions on labour prevention in each autonomous community)- classified as non-responders. The criteria defining them as non-responders to the conventional hepatitis B vaccine is anti HBsAb titers < 10 mUI/ml following the application of six doses of conventional vaccine at 20 µg doses (two complete guidelines). The objective of this study was to provide Health workers-staff with an additional protection tool against hepatitis B infection, and to evaluate the efficacy of the adjuvanted vaccine in healthy non-responders to conventional hepatitis B vaccine. The primary outcome was the measurement of antibody antiHBs before the first Fendrix® dose and a month after the administration of each dose. Other outcome was collection of adverse effects during administration and all those that could be related to the vaccine and that occur within 30 days after each dose. In this study, only one group was assigned. There was no randomization or masking. RESULTS: The participants were recruited between April 13, 2018 and October 31, 2019. 67 participants were enrolled in the Clinical Trial and included the analyses. The primary immunisation consists of 4 separate 0.5 ml doses of Fendrix®, administered at the following schedule: 1 month, 2 months and 6 months from the date of the first dose. Once the positivity was reached in any of the doses, the participant finished the study and was not given the following doses. 68.66% (46 out 67) had a positive response to first dose of Fendrix®. 57.14% (12 out 21) had a positive response to second dose of Fendrix®. 22.22% (2 out 9) had a positive response to third dose of Fendrix and 42.96% (3 out 7) had a positive response to last dose of Fendrix®. Overall, 94.02% (64 out 67) of participants had a positive response to Fendrix®. No serious adverse event occurred. CONCLUSIONS: The use of Fendrix®, is a viable vaccine alternative for NHS workers classified as "non-responders". Revaccination of healthy non-responders with Fendrix®, resulted in very high proportions of responders without adverse events. TRIAL REGISTRATION: The trial was registered in the Spanish National Trial Register (REEC), ClinicalTrials.gov and inclusion has been stopped (identifier NCT03410953; EudraCT-number 2016-004991-23). FUNDING: GRS 1360/A/16: Call for aid for the financing of research projects in biomedicine, health management and socio-health care to be developed in the centres of the Regional Health Management of Autonomous Community of Castile-Leon. In addition, this work has been supported by the Spanish Platform for Clinical Research and Clinical Trials, SCReN (Spanish Clinical Research Network), funded by the Subdirectorate General for Research Evaluation and Promotion of the Carlos III Health Institute (ISCIII), through the project PT13/0002/0039 and project PT17/0017/0023 integrated in the State Plan for R&D&I 2013-2016 and co-financed by and the European Regional Development Fund (ERDF).


Subject(s)
COVID-19 , Hepatitis B , Delivery of Health Care , Hepatitis B/prevention & control , Hepatitis B Vaccines , Humans , SARS-CoV-2 , Vaccination
14.
Eur Rev Med Pharmacol Sci ; 25(7): 3132-3135, 2021 04.
Article in English | MEDLINE | ID: covidwho-1194854

ABSTRACT

OBJECTIVE: Vulnerable populations are being more severely impacted by the ongoing pandemic, and the recent release of vaccines for Coronavirus Disease 19 (COVID-19) may offer them protection. The aim of this study was to investigate the willingness of homeless persons to be vaccinated against COVID-19; secondary aims were to analyze the immunization coverage for other conditions. PATIENTS AND METHODS: The acceptance of COVID-19 vaccine and immunization coverage for other conditions were investigated through a form in 112 persons experiencing homelessness referring to the primary care medical services of the Eleemosynaria Apostolica, Holy See. RESULTS: Most subjects, with a male preponderance, were willing to be vaccinated against COVID-19 (64.3%), 3.6% were unsure and 32.1% preferred not to be vaccinated. When answering questions on the immunization coverage for tuberculosis and hepatitis A and B, most subjects reported not to be vaccinated (48.2%, 56.2% and 55.3%, respectively) or did not know (33%, 28.6% and 27.7%). CONCLUSIONS: A significant portion of our sample declared to be willing to be vaccinated against COVID-19. It would be auspicious that the recent statements from several countries on the importance to extend COVID-19 vaccination to fragile populations be followed by the distribution of the vaccine to these populations.


Subject(s)
Attitude to Health , COVID-19 Vaccines/therapeutic use , COVID-19/prevention & control , Homeless Persons , Vaccination Coverage/statistics & numerical data , Adult , Aged , Female , Hepatitis A/prevention & control , Hepatitis A Vaccines/therapeutic use , Hepatitis B/prevention & control , Hepatitis B Vaccines/therapeutic use , Humans , Influenza Vaccines/therapeutic use , Influenza, Human/prevention & control , Male , Middle Aged , Patient Acceptance of Health Care , Rome , SARS-CoV-2 , Tuberculosis/prevention & control , Tuberculosis Vaccines/therapeutic use , Young Adult
15.
RMD Open ; 7(1)2021 04.
Article in English | MEDLINE | ID: covidwho-1175192

ABSTRACT

OBJECTIVE: To evaluate the prevalence of infections, prevalence of hospitalisation due to infections, the vaccination status and perceived screening of infections prior to the start of biologic disease modifying antirheumatic drugs (bDMARDs) of a patient cohort with chronic inflammatory rheumatic diseases (CIRD). METHODS: Consecutive CIRD patients reporting to our specialised centre were prospectively included (n=975) in this cross-sectional study. Data on comorbidities including infections, treatment, vaccination status, screening for latent tuberculosis infection (LTBI) and hepatitis B (HepB) were collected. Antibodies against measles and HepB were measured by ELISA. The vaccination status was assessed by a predefined vaccination score (0-26) categorising patients into four immunisation states: low (0-6), moderate (7-13), good (14-20), high (21-26). RESULTS: All patients on bDMARDs (n=499) were screened for LTBI, and 469 for HepB (94%). All LTBI patients (n=16) received isoniazid (3.2%) and 16 chronic HepB patients received lamivudine (3.4%). Protective measles specific IgG-antibodies were found in 901 patients (92.4%). Although 629 patients were educated about vaccination strategies (64.5%), only 540 showed a vaccination card (55.4%). Only 49% of patients had undergone pneumococcal vaccination and less than 30% were protected against HepB and influenza, while 7.6% have not protective antibody titres against measles. No patient met the German national vaccination recommendations requiring a complete documentation of vaccines. The mean vaccination score was 13.3±4.2 with 5.7% of patients having a low, 43.9% a moderate, 47.0% a good and 3.3% a high score. CONCLUSIONS: The majority of CIRD patients are n0t sufficiently vaccinated against pneumococci, HepB, influenza and measles. Although CIRD patients and general practitioners regularly receive professional information about the need of vaccination, vaccination rates were low to moderate. Interdisciplinary quality projects should be planned to change that inacceptable result.


Subject(s)
Hepatitis B , Rheumatic Diseases , Cross-Sectional Studies , Hepatitis B/epidemiology , Hepatitis B/prevention & control , Hepatitis B Vaccines , Humans , Rheumatic Diseases/drug therapy , Rheumatic Diseases/epidemiology , Vaccination
16.
Science ; 371(6532)2021 02 26.
Article in English | MEDLINE | ID: covidwho-1066801

ABSTRACT

Immunoglobulin G (IgG) antibodies are crucial for protection against invading pathogens. A highly conserved N-linked glycan within the IgG-Fc tail, which is essential for IgG function, shows variable composition in humans. Afucosylated IgG variants are already used in anticancer therapeutic antibodies for their increased activity through Fc receptors (FcγRIIIa). Here, we report that afucosylated IgG (approximately 6% of total IgG in humans) are specifically formed against enveloped viruses but generally not against other antigens. This mediates stronger FcγRIIIa responses but also amplifies brewing cytokine storms and immune-mediated pathologies. Critically ill COVID-19 patients, but not those with mild symptoms, had high concentrations of afucosylated IgG antibodies against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), amplifying proinflammatory cytokine release and acute phase responses. Thus, antibody glycosylation plays a critical role in immune responses to enveloped viruses, including COVID-19.


Subject(s)
Antibodies, Viral/immunology , COVID-19/immunology , Immunoglobulin G/immunology , SARS-CoV-2/immunology , Adult , Aged , Antibodies, Viral/blood , Antibodies, Viral/chemistry , COVID-19/physiopathology , Cells, Cultured , Critical Illness , Cytomegalovirus/immunology , Female , Fucose/analysis , Glycosylation , HIV/immunology , Hepatitis B Vaccines/immunology , Humans , Immunoglobulin Fc Fragments/chemistry , Immunoglobulin Fc Fragments/immunology , Immunoglobulin G/blood , Immunoglobulin G/chemistry , Inflammation , Interleukin-6/biosynthesis , Interleukin-6/immunology , Macrophages/immunology , Male , Middle Aged , Parvovirus B19, Human/immunology , Severity of Illness Index , Spike Glycoprotein, Coronavirus/immunology , Vaccines, Subunit/immunology , Young Adult
17.
PLoS One ; 15(11): e0242658, 2020.
Article in English | MEDLINE | ID: covidwho-992689

ABSTRACT

BACKGROUND: Hepatitis B imposes a major public health problem with an increased risk of occupational exposure among unvaccinated health care workers. This study was conducted to determine the Hepatitis B vaccination status, along with the knowledge, attitude, and practice regarding Hepatitis B, among preclinical medical students of a medical college in Nepal. MATERIALS AND METHODS: This descriptive study was conducted among preclinical students of a medical college in Kathmandu, Nepal from 6th July to 14th July 2020. The whole sampling technique was used. Data were collected using a pretested, self-administered questionnaire which was emailed to individuals and analyzed with the statistical package for social sciences version-22. RESULTS: A total of 181 students participated in the study out of 198, giving a response rate of 91.4%. Among the study participants, only 67 (37%) were fully vaccinated against Hepatitis B while 71 (39.2%) were never vaccinated. For the majority (74.6%) of the non-vaccinated participants, the main reason for not getting vaccination was a lack of vaccination programs. Half the study participants (n = 92, 50.8%) had good knowledge, attitude and practice regarding hepatitis B. The median knowledge, attitude and practice scores towards Hepatitis B were 61.00 (57.00-66.00), 20(18.00-21.00) and 21(19.00-23.00) respectively. CONCLUSIONS: The majority of preclinical medical students were not fully vaccinated against Hepatitis B and only half of them had acceptable knowledge, attitude and practice towards Hepatitis B, which makes them vulnerable to the infection. This might represent the situation of not only Nepal, but also all South Asian countries, and creates concern about whether students take the vaccination programs seriously. Since unavailability of vaccination program is the main cause of non-vaccination, we strongly recommend the provision of the Hepatitis B vaccination program to the preclinical medical students.


Subject(s)
Health Knowledge, Attitudes, Practice , Hepatitis B Vaccines/therapeutic use , Hepatitis B/prevention & control , Students, Medical , Surveys and Questionnaires , Vaccination , Adult , Cross-Sectional Studies , Female , Hepatitis B/epidemiology , Humans , Male , Nepal/epidemiology
18.
Vaccine ; 39(5): 780-785, 2021 01 29.
Article in English | MEDLINE | ID: covidwho-989367

ABSTRACT

Although the direct health impact of Coronavirus disease (COVID-19) pandemic on child health is low, there are indirect impacts across many aspects. We compare childhood vaccine uptake in three types of healthcare facilities in Singapore - public primary care clinics, a hospital paediatric unit, and private paediatrician clinics - from January to April 2020, to baseline, and calculate the impact on herd immunity for measles. We find a 25.6% to 73.6% drop in Measles-Mumps-Rubella (MMR) uptake rates, 0.4 - 10.3% drop for Diphtheria-Tetanus-Pertussis-inactivated Polio-Haemophilus influenza (5-in-1), and 8.0-67.8% drop for Pneumococcal conjugate vaccine (PCV) across all 3 sites. Consequent herd immunity reduces to 74-84% among 12-month- to 2-year-olds, well below the 95% coverage that is protective for measles. This puts the whole community at risk for a measles epidemic. Public health efforts are urgently needed to maintain efficacious coverage for routine childhood vaccines during the COVID-19 pandemic.


Subject(s)
COVID-19/epidemiology , Child Health/statistics & numerical data , Public Health/standards , Vaccination Coverage/statistics & numerical data , COVID-19/prevention & control , Child, Preschool , Diphtheria-Tetanus-Pertussis Vaccine/administration & dosage , Haemophilus Vaccines/administration & dosage , Hepatitis B Vaccines/administration & dosage , Humans , Immunity, Herd , Immunization Schedule , Infant , Measles-Mumps-Rubella Vaccine/administration & dosage , Poliovirus Vaccine, Inactivated/administration & dosage , Retrospective Studies , Singapore/epidemiology
19.
Blood ; 137(2): 185-189, 2021 01 14.
Article in English | MEDLINE | ID: covidwho-953565

ABSTRACT

Vaccinations are effective in preventing infections; however, it is unknown if patients with chronic lymphocytic leukemia (CLL) who are treatment naïve (TN) or receiving Bruton tyrosine kinase inhibitors (BTKi's) respond to novel adjuvanted vaccines. Understanding the effect of BTKi's on humoral immunity is timely because BTKi's are widely used and vaccination against coronavirus disease 2019 is urgently needed. In 2 open-label, single-arm clinical trials, we measured the effect of BTKi's on de novo immune response against recombinant hepatitis B vaccine (HepB-CpG) and recall response against recombinant zoster vaccine (RZV) in CLL patients who were TN or on BTKi. The primary end point was serologic response to HepB-CpG (anti-hepatitis B surface antibodies ≥10 mIU/mL) and RZV (≥fourfold increase in anti-glycoprotein E). The response rate to HepB-CpG was lower in patients on BTKi (3.8%; 95% confidence interval [CI], 0.7-18.9) than patients who were TN (28.1%; 95% CI, 15.6-45.4; P = .017). In contrast, the response rate to RZV did not differ significantly between the BTKi (41.5%; 95% CI, 27.8-56.6) and TN cohorts (59.1%; 95% CI, 38.7-76.7; P = .2). BTKi's were associated with a decreased de novo immune response following HepB-CpG, whereas recall immune response following RZV was not significantly affected by BTKi therapy. These trials were registered at www.clinicaltrials.gov as #NCT03685708 (Hep-CpG) and #NCT03702231 (RZV).


Subject(s)
Hepatitis B Vaccines/immunology , Herpes Zoster Vaccine/immunology , Immunity , Leukemia, Lymphocytic, Chronic, B-Cell/immunology , Protein Kinase Inhibitors/adverse effects , Vaccines, Synthetic/immunology , Adjuvants, Immunologic , Agammaglobulinaemia Tyrosine Kinase/antagonists & inhibitors , Aged , Female , Humans , Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy , Male , Middle Aged , Patient Outcome Assessment , Protein Kinase Inhibitors/pharmacology , Protein Kinase Inhibitors/therapeutic use , Vaccination
20.
Am J Gastroenterol ; 115(11): 1797-1798, 2020 11.
Article in English | MEDLINE | ID: covidwho-809646

ABSTRACT

Prevention of hepatitis B (HBV) infection is particularly important for patients with inflammatory bowel disease because of risks of HBV reactivation on immunosuppressive therapies. However, immune responses to standard HBV vaccination regimens are suboptimal. Chaparro et al. compared immune responses to 2 vaccines, an adjuvanted HBV vaccine (Fendrix) and double-dosed standard vaccine (Engerix-B) using an accelerated, 4-dose regimen (0, 1, 2, and 6 months). Although the study did not demonstrate superiority of one vaccine over another, several lessons can be derived regarding immune response to vaccinations among patients with inflammatory bowel disease, including the need to consider nonstandard regimens for patients on immunosuppression. These lessons can be translated broadly, including to a potential future severe acute respiratory syndrome coronavirus 2 vaccine when one becomes available.


Subject(s)
Coronavirus Infections/prevention & control , Hepatitis B Vaccines/administration & dosage , Hepatitis B/prevention & control , Inflammatory Bowel Diseases/immunology , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Viral Vaccines/administration & dosage , Betacoronavirus , COVID-19 , COVID-19 Vaccines , Humans , SARS-CoV-2
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