ABSTRACT
OBJECTIVES: To investigate the levels of MDR in the predominant serotypes of invasive Streptococcus pneumoniae isolated in Canada over a 10âyear period. METHODS: All isolates were serotyped and had antimicrobial susceptibility testing performed, in accordance with CLSI guidelines (M07-11 Ed., 2018). Complete susceptibility profiles were available for 13â712 isolates. MDR was defined as resistance to three or more classes of antimicrobial agents (penicillin MIC ≥2 mg/L defined as resistant). Serotypes were determined by Quellung reaction. RESULTS: In total, 14â138 invasive isolates of S. pneumoniae were tested in the SAVE study (S. pneumoniae Serotyping and Antimicrobial Susceptibility: Assessment for Vaccine Efficacy in Canada), a collaboration between the Canadian Antimicrobial Resistance Alliance and Public Health Agency of Canada-National Microbiology Laboratory. The rate of MDR S. pneumoniae in SAVE was 6.6% (902/13â712). Annual rates of MDR S. pneumoniae decreased between 2011 and 2015 (8.5% to 5.7%) and increased between 2016 and 2020 (3.9% to 9.4%). Serotypes 19A and 15A were the most common serotypes demonstrating MDR (25.4% and 23.5% of the MDR isolates, respectively); however, the serotype diversity index increased from 0.7 in 2011 to 0.9 in 2020 with a statistically significant linear increasing trend (Pâ<â0.001). In 2020, MDR isolates were frequently serotypes 4 and 12F in addition to serotypes 15A and 19A. In 2020, 27.3%, 45.5%, 50.5%, 65.7% and 68.7% of invasive MDR S. pneumoniae were serotypes included in the PCV10, PCV13, PCV15, PCV20 and PPSV23 vaccines, respectively. CONCLUSIONS: Although current vaccine coverage of MDR S. pneumoniae in Canada is high, the increasing diversity of serotypes observed among the MDR isolates highlights the ability of S. pneumoniae to rapidly evolve.
Subject(s)
Pneumococcal Infections , Streptococcus pneumoniae , Humans , Serogroup , Pneumococcal Infections/microbiology , Anti-Bacterial Agents/pharmacology , Canada/epidemiology , Microbial Sensitivity Tests , Serotyping , Pneumococcal VaccinesABSTRACT
BACKGROUND: V114 (15-valent pneumococcal conjugate vaccine [PCV]) contains all serotypes in 13-valent PCV (PCV13) and additional serotypes 22F and 33F. This study evaluated safety and immunogenicity of V114 compared with PCV13 in healthy infants, and concomitant administration with DTPa-HBV-IPV/Hib and rotavirus RV1 vaccines. METHODS: V114 and PCV13 were administered in a 2+1 schedule at 2, 4, and 11-15 months of age. Adverse events (AEs) were collected on Days 1-14 following each vaccination. Serotype-specific anti-pneumococcal immunoglobulin G (IgG) was measured 30 days post-primary series (PPS), immediately prior to a toddler dose, and 30 days post-toddler dose (PTD). Primary objectives included non-inferiority of V114 to PCV13 for 13 shared serotypes and superiority of V114 to PCV13 for the two additional serotypes. RESULTS: 1184 healthy infants 42-90 days of age were randomized 1:1 to V114 (n = 591) or PCV13 (n = 593). Proportions of participants with solicited AEs and serious AEs were comparable between vaccination groups. V114 met pre-specified non-inferiority criteria for all 13 shared serotypes, based on the difference in proportions of participants with serotype-specific IgG concentrations ≥0.35 µg/mL (response rate; lower bound of two-sided 95% confidence interval [CI] >-10.0) and IgG geometric mean concentration (GMC) ratios (lower bound of two-sided 95% CI >0.5), and pre-specified superiority criteria for serotypes 22F and 33F (lower bound of two-sided 95% CI >10.0 for response rates and >2.0 for GMC ratios). Antibody responses to DTPa-HBV-IPV/Hib and RV1 vaccines met pre-specified non-inferiority criteria, based on antigen-specific response rates to DTPa-HBV-IPV/Hib and anti-rotavirus IgA geometric mean titers. CONCLUSIONS: After a 2+1 schedule, V114 elicited non-inferior immune responses to 13 shared serotypes and superior responses to the two additional serotypes compared with PCV13, with comparable safety profile. These results support the routine use of V114 in infants. TRIAL REGISTRATION: ClinicalTrials.gov: NCT04031846; EudraCT: 2018-003787-31.
Subject(s)
Pneumococcal Infections , Pneumococcal Vaccines , Vaccines, Conjugate , Humans , Infant , Antibodies, Bacterial , Double-Blind Method , Immunogenicity, Vaccine , Immunoglobulin G , Pneumococcal Infections/prevention & control , Pneumococcal Vaccines/administration & dosage , Pneumococcal Vaccines/adverse effects , Streptococcus pneumoniae , Vaccination/methods , Vaccines, Conjugate/administration & dosage , Vaccines, Conjugate/adverse effectsABSTRACT
The COVID-19 pandemic represents an unprecedented challenge for clinical research. The Pneumococcal Vaccine Schedules (PVS) study is a non-inferiority, interventional trial in which infants resident in 68 geographic clusters are randomised to two different schedules for pneumococcal vaccination. From September 2019 onwards, all infants resident in the study area became eligible for trial enrolment at all Expanded Programme on Immunisation (EPI) clinics in the study area. Surveillance for clinical endpoints is conducted at all 11 health facilities in the study area. PVS is conducted as a collaboration between the Medical Research Council Unit The Gambia (MRCG) at LSHTM and the Gambian Ministry of Health (MoH). The COVID-19 pandemic caused many disruptions to PVS. MRCG instructed interventional studies that participant enrolment be suspended on 26 March 2020, and a public health emergency was declared in The Gambia on 28 March 2020. Enrolment in PVS restarted on 1 July 2020 and was suspended again on 5 August 2020 after The Gambia experienced a sharp increase in COVID-19 cases in late July 2020 and restarted again on 1 September 2020. During periods of suspended enrolment of infants at EPI clinics, PVS continued safety surveillance at health facilities, albeit with disruptions. During the periods of suspended enrolment, infants who had been enrolled before 26 March 2020 continued to receive the PCV schedule to which they had been randomly allocated based on their village of residence, whereas all other infants received the standard PCV schedule. Throughout 2020 and 2021, the trial faced numerous technical and operational challenges: disruption to MoH delivery of EPI services and clinical care at health facilities; episodes of staff illness and isolation; disruption of MRCG transport, procurement, communications and human resource management; and also a range of ethical, regulatory, sponsorship, trial monitoring and financial challenges. In April 2021, a formal review concluded that the pandemic had not compromised the scientific validity of PVS and that the trial should continue as per protocol. The continuing challenges that COVID-19 poses to PVS, and other clinical trials will persist for some time.
Subject(s)
COVID-19 , Equivalence Trials as Topic , Pneumococcal Vaccines , Randomized Controlled Trials as Topic , Humans , Infant , COVID-19/prevention & control , COVID-19/epidemiology , Gambia/epidemiology , Pandemics/prevention & control , Pneumococcal Vaccines/adverse effects , VaccinationABSTRACT
BACKGROUND: Older adults and immunocompromised individulas are often excluded from vaccine trials. AIM: We hypothesised that during the coronavirus disease 2019 (COVID-19) pandemic, the proportion of trials excluding these patients decreased. METHODS: Using the US Food and Drug Administration and and European Medicines Agency search engines, we identified all vaccines approved against pneumococcal disease, influenza (quadrivalent vaccines), and COVID-19 from 2011 to 2021. Study protocols were screened for direct and indirect age exclusion criteria and exclusion of immunocompromised individuals. In addition, we reviewed the studies with no explicit exclusion criteria and investigated the actual inclusion of those individuals. RESULTS: We identified 2024 trial records; 1702 were excluded (e.g., use of other vaccine or risk group); and 322 studies were eligible for our review. Among the pneumococcal and influenza vaccine trials (n = 193), 81 (42%) had an explicit direct age exclusion, and 150 (78%) had an indirect age-related exclusion. In total, 163 trials (84%) trials were likely to exclude older adults. Among the COVID-19 vaccine trials (n = 129), 33 (26%) had direct age exclusion and 82 (64%) had indirect age exclusion; in total, 85 (66%) trials were likely to exclude older adults. Therefore was a 18% decrease in the proportion of trials with age-related exclusion between 2011 and 2021 (only influenza and pneumococcal vaccine trials) and 2020-2021 (only COVID-19 vaccine trials) (p = 0.014). In a sub-analysis assessing observational and randomised trials, the decrease was 25% and 9%, respectively. Immunocompromised individuals were included in 87 (45%) of the pneumococcal and influenza vaccine trials compared with 54 (42%) of the COVID-19 vaccine trials (p = 0.058). CONCLUSIONS: During the COVID-19 pandemic, we found a decrease in the exclusion of older adults from vaccine trials but no significant change in the inclusion of immunocompromised individulas.
Subject(s)
COVID-19 , Influenza Vaccines , Influenza, Human , Humans , Aged , Influenza, Human/epidemiology , Influenza, Human/prevention & control , Influenza Vaccines/therapeutic use , COVID-19 Vaccines/therapeutic use , Pandemics/prevention & control , COVID-19/epidemiology , COVID-19/prevention & control , Pneumococcal Vaccines/therapeutic useABSTRACT
BACKGROUND: Three pneumococcal conjugate vaccines (PCVs) are currently licensed and WHO prequalified for supply by UN agencies. Here, we aimed to investigate the safety and immunogenicity of SIIPL-PCV compared with PHiD-CV and PCV13, when administered to infants according to a 2 + 1 schedule. METHODS: This single-centre, double-blind, active-controlled, randomised, phase 3 trial was done in Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine clinical trial facilities within two government health centres in the western region of The Gambia. Healthy, PCV-naive infants aged 6-8 weeks were enrolled if they weighed at least 3·5 kg and had no clinically significant health complaints, as determined by history and clinical examination. Eligible infants were randomly assigned (1:1:1) to receive either SIIPL-PCV, PHiD-CV, or PCV13 using permuted blocks of variable size. Parents and the trial staff assessing all study outcomes were masked to vaccine group. The first PCV vaccine was given with other routine Expanded Programme on Immunization vaccines when infants were aged 6-8 weeks (visit 1). At visit 2, routine vaccines alone (without a PCV) were administered. At visit 3, the second dose of the PCV was administered alongside other routine vaccines. At visit 4, a blood sample was collected. Visits 1-4 took place at intervals of 4 weeks. The booster PCV was administered at age 9-18 months (visit 5), with final follow-up 4 weeks after the booster (visit 6). The primary immunogenicity outcome compared the serotype-specific IgG geometric mean concentrations (GMCs) generated by SIIPL-PCV with those generated by PHiD-CV and PCV13, 4 weeks after the booster. We used descriptive 95% CIs without adjustment for multiplicity. Immunogenicity analyses were done in the per protocol population (defined as all children who received all the assigned study vaccines, who had an immunogenicity measurement available, and who had no protocol deviations that might interfere with the immunogenicity assessment). This trial was registered with the Pan African Clinical Trials Registry, PACTR201907754270299, and ClinicalTrials.gov, NCT03896477. FINDINGS: Between July 18 and Nov 14, 2019, 745 infants were assessed for study eligibility. Of these, 85 infants (11%) were ineligible and 660 (89%) were enrolled and randomly assigned to receive SIIPL-PCV (n=220), PHiD-CV (n=220), or PCV13 (n=220). 602 infants (91%) were included in the per protocol immunogenicity population. The median age at vaccination was 46 days (range 42-56). 342 infants (52%) were female and 318 (48%) were male. Post-booster serotype-specific IgG GMCs generated by SIIPL-PCV ranged from 1·54 µg/mL (95% CI 1·38-1·73) for serotype 5 to 12·46 µg/mL (11·07-14·01) for serotype 6B. Post-booster GMCs against shared serotypes generated by PHiD-CV ranged from 0·80 µg/mL (0·72-0·88) for serotype 5 to 17·31 µg/mL (14·83-20·20) for serotype 19F. Post-booster GMCs generated by PCV13 ranged from 2·04 µg/mL (1·86-2·24) for serotype 5 to 15·54 µg/mL (13·71-17·60) for serotype 6B. Post-booster IgG GMCs generated by SIIPL-PCV were higher than those generated by PHiD-CV for seven of the eight shared serotypes (1, 5, 6B, 7F, 9V, 14, and 23F). The GMC generated by serotype 19F was higher after PHiD-CV. The SIIPL-PCV to PHiD-CV GMC ratios for shared serotypes ranged from 0·64 (95% CI 0·52-0·79) for serotype 19F to 2·91 (2·47-3·44) for serotype 1. The serotype 1 GMC generated by SIIPL-PCV was higher than that generated by PCV13, whereas serotype 5, 6A, 19A, and 19F GMCs were higher after PCV13. The SIIPL-PCV to PCV13 GMC ratios ranged from 0·72 (0·60-0·87) for serotype 19A to 1·44 (1·23-1·69) for serotype 1. INTERPRETATION: SIIPL-PCV was safe and immunogenic when given to infants in The Gambia according to a 2 + 1 schedule. This PCV is expected to provide similar protection against invasive and mucosal pneumococcal disease to the protection provided by PCV13 and PHiD-CV, for which effectiveness data are available. Generating post-implementation data on the impact of SIIPL-PCV on pneumococcal disease endpoints remains important. FUNDING: Bill & Melinda Gates Foundation.
Subject(s)
Antibodies, Bacterial , Pneumococcal Infections , Pneumococcal Vaccines , Child , Female , Humans , Infant , Male , Gambia , Immunogenicity, Vaccine , Immunoglobulin G , Pneumococcal Infections/prevention & control , Pneumococcal Vaccines/adverse effects , Vaccines, Conjugate/adverse effectsABSTRACT
The introduction of pneumococcal conjugate vaccines (PCV) into the childhood vaccination programme has reduced invasive pneumococcal disease (IPD). Although anticipated from data elsewhere, surveillance in Ireland has confirmed reductions in IPD amongst those ⩾65 years of age due to a decline of PCV serotypes in this age group. Currently, direct protection against IPD in the elderly is focused on immunisation with the 23-valent pneumococcal polysaccharide vaccine (PPV23). However, immunity may not be as effective as with PCV and, furthermore, PPV23 uptake is poor in Ireland. Hence, consideration should be given to providing a PCV to this age group.
Subject(s)
Pneumococcal Infections , Streptococcus pneumoniae , Humans , Aged , Vaccines, Conjugate , Pneumococcal Vaccines , Pneumococcal Infections/epidemiology , Pneumococcal Infections/prevention & control , SerogroupABSTRACT
Objective: This study aims to analyze the serotype distribution and drug resistance of Streptococcus pneumoniae isolated from children aged 8 days to 7 years in Urumqi, China, between 2014 to 2021, during which PCV13 was introduced in the private sector's immunization program and COVID-19 control was administrated in the last 2 years. Methods: Serotypes of S. pneumoniae isolates were determined by Quellung reaction, and their susceptibility against 14 antimicrobials were tested. According to the start year of PCV13 administration (2017) and COVID-19 control (2020), the study period was divided into three stages: 2014-2015, 2018-2019, and 2020-2021. Results: A total of 317 isolates were involved in this study. The most common serotypes were type 19F (34.4%), followed by 19A (15.8%), 23F (11.7%), 6B (11.4%), and 6A(5.0%). The coverage rate of both PCV13 and PCV15 was 83.0%. The coverage of PCV20 was a little higher at 85.2%. The resistance rate against penicillin was 28.6% according to the breakpoints of oral penicillin, which would reach up to 91.8% based on the breakpoints of parenteral penicillin for meningitis. The resistance rates to erythromycin, clindamycin, tetracycline, and sulfamethoxazole-trimethoprim were 95.9%, 90.2%, 88.9%, and 78.8%, respectively. The PCV13 isolate was more resistant to penicillin than the non-PCV13 ones. There was not any significant change found in the serotype distribution since the PCV13 introduction and the COVID-19 control. The resistance rate against oral penicillin slightly elevated to 34.5% in 2018-2019 from 30.7% in 2014-2015 and then decreased significantly to 18.1% in 2020-2021 (χ 2 = 7.716, P < 0.05), while the resistance rate to ceftriaxone (non-meningitis) continuously declined from 16.0% in 2014-2015 to 1.4% in 2018-2019 and 0% in 2020-2021 (Fisher = 24.463, P < 0.01). Conclusion: The common serotypes of S. pneumoniae isolated from children in Urumqi were types 19F, 19A, 23F, 6B, and 6A, which we found to have no marked change since the PCV13 introduction and the COVID-19 control However, the resistance rate to oral penicillin and ceftriaxone significantly declined in the COVID-19 control stage.
Subject(s)
Anti-Infective Agents , COVID-19 , Pneumococcal Infections , Child , Humans , Infant , Streptococcus pneumoniae , Anti-Bacterial Agents/pharmacology , Serogroup , Ceftriaxone , Pneumococcal Infections/epidemiology , Pneumococcal Infections/prevention & control , Drug Resistance, Bacterial , COVID-19/epidemiology , Penicillins , China/epidemiology , Pneumococcal Vaccines , SerotypingABSTRACT
INTRODUCTION: The aim of the study is to understand the evolution of COVID-19 vaccine acceptance over the key 7-month vaccine campaign in Italy, a period in which the country moved from candidate vaccines to products administered to the public. The research focus points to evaluate COVID-19 vaccine attitudes in adults and their children, propension towards compulsory vaccination, past and present adherence to anti-flu and anti-pneumococcal vaccines, and the reasons for trust/mistrust of vaccines. METHODS: Italian residents aged 16->65 years were invited to complete an online survey from September 2020 to April 2021. The survey contained 13 questions: 3 on demographic data; 8 on vaccine attitudes; and 2 open-ended questions about the reasons of vaccine confidence/refusal. A preliminary word frequency analysis has been conducted, as well as a statistical bivariate analysis. RESULTS: Of 21.537 participants, the confidence of those in favor of the COVID-19 vaccine increases of 50 % and the number of people who wanted more information decreases by two-third. Willingness to vaccinate their children against COVID-19 also increased from 51 % to 66.5 %. Only one-third of the strong vaccine-hesitant participants, i.e. 10 %, remained hostile. Compulsory vaccination showed a large and increasing favor by participants up to 78 %, in a way similar to their propensity for children's mandatory vaccination (70.6 %). Respondents' past and present adherence to anti-flu and anti-pneumococcal vaccines does not predict their intentions to vaccinate against COVID-19. Finally, a semantic analysis of the reasons of acceptance/refusal of COVID-19 vaccination suggests a complex decision-making process revealed by the participants' use of common words in pro-and-cons arguments. CONCLUSION: The heterogeneity in the COVID-19 vaccine hesitancy, determinants and opinions detected at different ages, genders and pandemic phases suggests that health authorities should avoid one-size-fits-all vaccination campaigns. The results emphasize the long-term importance of reinforcing vaccine information, communication and education needs.
Subject(s)
COVID-19 Vaccines , COVID-19 , Male , Adult , Child , Female , Humans , COVID-19/prevention & control , Vaccination , Immunization Programs , Italy/epidemiology , Pneumococcal VaccinesABSTRACT
PURPOSE: This study aimed to evaluate clinical pharmacist's contribution to the pneumococcal vaccination rate by providing education to cancer patients in hospital settings. METHODS: This study was conducted in 2 tertiary-care hospitals' medical oncology outpatient clinics. Patients over 18 years of age and diagnosed with cancer for less than 2 years, in remission stage, and have not previously received the pneumococcal vaccine were included. Patients were randomized to intervention and control groups. The intervention group was provided vaccination education and recommended to receive the PCV13 vaccine. The control group received routine care. Patients' knowledge about pneumonia/pneumococcal vaccine, Vaccine Attitude Examination Scale (VAX) score, and vaccination rates were evaluated at baseline and 3 months after the education. RESULTS: A total of 235 patients (intervention: 117, control: 118) were included. The mean age ± SD was 57.86 ± 11.88 years in the control and 60.68 ± 11.18 years in the intervention groups. The numbers of correct answers about pneumonia/pneumococcal vaccine (p = 0.482) and VAX scores (p = 0.244) of the groups were similar at baseline. After the intervention, the median (IQR) number of correct answers in intervention group [10(3)] was higher than control group [8(4)] (p < 0.001). After the education, the total VAX score (mean ± SD) was less in intervention group (33.09 ± 7.018) than the control group (36.07 ± 6.548) (p = 0.007). Three months after the education, 20.2% of the patients in the intervention and 6.1% in the control groups were vaccinated with pneumococcal vaccine (p = 0.003). CONCLUSIONS: The pneumococcal vaccination rate in cancer patients has increased significantly by the education provided by a clinical pharmacist in hospital settings.
Subject(s)
Neoplasms , Pharmacists , Humans , Adolescent , Adult , Research Design , Vaccination , Pneumococcal VaccinesABSTRACT
BACKGROUND: This phase III study evaluated safety, tolerability, and immunogenicity of V114 (15-valent pneumococcal conjugate vaccine) in healthy infants. V114 contains all 13 serotypes in PCV13 and additional serotypes 22F and 33F. METHODS: Healthy infants were randomized to two primary doses and one toddler dose (2+1 regimen) of V114 or PCV13 at 3, 5, and 12 months of age; diphtheria, tetanus, pertussis (DTaP), inactivated poliovirus (IPV), Haemophilus influenzae type b (Hib), hepatitis B (HepB) vaccine was administered concomitantly. Adverse events (AEs) were collected on Days 1-14 following each vaccination. Serotype-specific anti-pneumococcal immunoglobulin G (IgG) was measured 30 days post-primary series, immediately prior to toddler dose, and 30 days post-toddler dose. Primary objectives included non-inferiority of V114 to PCV13 for 13 shared serotypes and superiority of V114 to PCV13 for serotypes 22F and 33F. RESULTS: 1191 healthy infants were randomized to V114 (n = 595) or PCV13 (n = 596). Proportions of participants with solicited AEs and serious AEs were comparable between groups. V114 met non-inferiority criteria for 13 shared serotypes, based on difference in proportions with serotype-specific IgG ≥0.35 µg/mL (lower bound of two-sided 95% confidence interval [CI] >-10.0) and IgG geometric mean concentration (GMC) ratios (lower bound of two-sided 95% CI >0.5) at 30 days post-toddler dose. V114 met superiority criteria for serotypes 22F and 33F, based on response rates (lower bound of two-sided 95% CI >10.0) and IgG GMC ratios (lower bound of two-sided 95% CI >2.0) at 30 days post-toddler dose. Antibody responses to DTaP-IPV-Hib-HepB met non-inferiority criteria, based on antigen-specific response rates. CONCLUSION: A two-dose primary series plus toddler dose of V114 was well-tolerated in healthy infants. Compared with PCV13, V114 provided non-inferior immune responses to 13 shared serotypes and superior immune responses to additional serotypes 22F and 33F.
Subject(s)
Haemophilus influenzae type b , Pneumococcal Infections , Tetanus , Humans , Infant , Pneumococcal Vaccines , Antibodies, Bacterial , Streptococcus pneumoniae , Tetanus Toxoid , Vaccines, Conjugate , Hepatitis B Vaccines , Immunoglobulin G , Pneumococcal Infections/prevention & control , Immunogenicity, VaccineABSTRACT
Although COVID-19 vaccination remains at the forefront, ACIP has offered guidance on MMR, pneumococcal, influenza, and travel vaccines. Here's a round-up.
Subject(s)
COVID-19 , Influenza Vaccines , Influenza, Human , Humans , United States , COVID-19 Vaccines , COVID-19/prevention & control , Influenza, Human/prevention & control , Pneumococcal Vaccines , Vaccination , Immunization Schedule , Advisory CommitteesABSTRACT
This article reviews the relevant studies on the efficacy and safety of influenza, pneumococcal and COVID-19 vaccination among tumor patients worldwide in recent years. By combing and analyzing the retrieved literature, the results show that influenza and pneumococcal vaccination can significantly reduce the morbidity and hospitalization rate of infectious diseases in tumor patients, reduce the risk of cardiovascular events and death, and significantly improve survival prognosis. COVID-19 vaccination can also protect tumor patients, especially those who have completed full dose vaccination. Authoritative guidelines and consensuses worldwide all recommend that tumor patients receive influenza, pneumococcal and COVID-19 vaccines. We should carry out relevant researches, as well as take effective measures to strengthen patient education, so that tumor patients can fully experience the health protection brought by the vaccine to this specific group.
Subject(s)
COVID-19 , Influenza Vaccines , Influenza, Human , Neoplasms , Humans , Influenza, Human/prevention & control , COVID-19 Vaccines , COVID-19/prevention & control , Influenza Vaccines/therapeutic use , Vaccination , Pneumococcal Vaccines/therapeutic use , Streptococcus pneumoniaeABSTRACT
OBJECTIVES: To explore barriers and facilitators to COVID-19, influenza, and pneumococcal vaccine uptake in immunosuppressed adults with immune-mediated inflammatory diseases (IMIDs). METHODS: Recruiting through national patient charities and a local hospital, participants were invited to take part in an in-depth, one-to-one, semi-structured interview with a trained qualitative researcher between November 2021 and January 2022. Data were analysed thematically in NVivo, cross-validated by a second coder and mapped to the SAGE vaccine hesitancy matrix. RESULTS: Twenty participants (75% female, 20% non-white) were recruited. Barriers and facilitators spanned contextual, individual/group and vaccine/vaccination-specific factors. Key facilitators to all vaccines were higher perceived infection risk and belief that vaccination is beneficial. Key barriers to all vaccines were belief that vaccination could trigger IMID flare, and active IMID. Key facilitators specific to COVID-19 vaccines included media focus, high incidence, mass-vaccination programme with visible impact, social responsibility, and healthcare professionals' (HCP) confirmation of the new vaccines' suitability for their IMID. Novel vaccine technology was a concern, not a barrier. Key facilitators of influenza/pneumococcal vaccines were awareness of eligibility, direct invitation, and, clear recommendation from trusted HCP. Key barriers of influenza/pneumococcal vaccines were unaware of eligibility, no direct invitation or recommendation from HCP, low perceived infection risk, and no perceived benefit from vaccination. CONCLUSIONS: Numerous barriers and facilitators to vaccination, varying by vaccine-type, exist for immunosuppressed-IMID patients. Addressing vaccine benefits and safety for IMID-patients in clinical practice, direct invitation, and public-health messaging highlighting immunosuppression as key vaccination-eligibility criteria may optimise uptake, although further research should assess this.
Subject(s)
COVID-19 , Influenza Vaccines , Influenza, Human , Pneumonia, Pneumococcal , Adult , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19 Vaccines , Female , Humans , Influenza, Human/epidemiology , Influenza, Human/prevention & control , Male , Pandemics , Pneumococcal Vaccines/therapeutic use , Pneumonia, Pneumococcal/epidemiology , Pneumonia, Pneumococcal/prevention & control , Qualitative Research , VaccinationABSTRACT
Immunizations for influenza and pneumococcus are effective interventions in reducing morbidity and mortality. The objective of this study was to describe the vaccination rates in volunteers from three regions of Argentina during the COVID-19 pandemic. In 2020, 3853 adults were surveyed, 61.6 % were females, 45 % were aged between 40 and 60 and 18.6 % were > 60 years old. The commonest comorbidities were hypertension (12.9 %), dyslipidemia (8.5 %), and smokers or former smokers (9.2 %). The global influenza vaccination rate was 37.7 %, pneumococcal vaccination 24.7 %, and both 17.8 %. Multivariable regression showed that the vaccination rate increased with age and the presence of comorbidities. However, in the subgroup with indications for both vaccines, 71.7 % had the influenza vaccine, 59 % had the pneumococcal vaccine, and 28.3 % received neither. Our study suggests that influenza and pneumococcal vaccine percentages in high-risk patients in Argentina remain sub-optimal. Immunizations with proven reductions in morbimortality could have also been relegated during the COVID pandemic.
Subject(s)
COVID-19 , Influenza Vaccines , Influenza, Human , Female , Humans , Adult , Male , Influenza, Human/prevention & control , Pneumococcal Vaccines , Argentina , Pandemics , VaccinationABSTRACT
BACKGROUND: In 2016, the travel subcommittee of the UK Joint Committee on Vaccination and Immunisation (JCVI) recommended that 13-valent PCV (PCV13) could be offered to travellers aged over 65 years, visiting countries without infant PCV immunization programmes. This study aimed to identify, collate and review the available evidence to identify specific countries where UK travellers might be at an increased risk of developing pneumococcal infection. The data were then used to develop an algorithm, which could be used to facilitate implementation of the JCVI recommendation. METHODS: We conducted a systematic search of the published data available for pneumococcal disease, PCV vaccine implementation, coverage data and programme duration by country. The primary data sources used were World Health Organization databases and the International Vaccine Access Centre Vaccine Information and Epidemiology Window-hub database. Based on the algorithm, the countries were classified into 'high overall risk', 'intermediate overall risk' and 'low overall risk' from an adult traveller perspective. This could determine whether PCV13 should be recommended for UK adult travellers. RESULTS: A data search for a total of 228 countries was performed, with risk scores calculated for 188 countries. Overall, 45 countries were classified as 'high overall risk', 86 countries as 'intermediate overall risk', 57 countries as 'low overall risk' and 40 countries as 'unknown'. CONCLUSION: To our knowledge this is the first attempt to categorize the risk to UK adult travellers of contracting pneumococcal infection in each country, globally. These findings could be used by national travel advisory bodies and providers of travel vaccines to identify travellers at increased risk of pneumococcal infection, who could be offered PCV immunization.
Subject(s)
Pneumococcal Infections , Pneumococcal Vaccines , Adult , Aged , Algorithms , Humans , Infant , Pneumococcal Infections/epidemiology , Pneumococcal Infections/prevention & control , United Kingdom/epidemiology , Vaccination , Vaccines, ConjugateABSTRACT
OBJECTIVE: The article describes a strategy to facilitate access to pneumococcal conjugate vaccine 13 (PCV-13) for people living with HIV/AIDS (PLHIV) during the COVID-19 pandemic. METHOD: report on the experience regarding the organization of a care service for PLHIV in the city of São Paulo to facilitate access to PCV-13 in the framework of the 2020 influenza vaccination campaign during the COVID-19 pandemic. RESULTS: through the integration between a PLHIV care service and an Immunization Center (CRIE in Portuguese), it was possible to offer PCV-13 to PLHIV at the point of care, reducing physical barriers to access to immunization. Thus, of the 1,906 PLHIV who passed through the service during the period March 23-July 31, 2020, 84.4% (1,609) received the influenza vaccine, PCV-13 or both. Of the 1609 vaccinated, 50.6% (814) were eligible and received PCV-13. CONCLUSION: offering the vaccine at the point of care and orienting PLHIV on the importance of vaccination as a disease prevention strategy, identifying those eligible to receive it, was an important action carried out by the institution together with the nursing team, as a strategy to facilitate access to vaccination.
Subject(s)
Acquired Immunodeficiency Syndrome , COVID-19 , Humans , Infant , Pneumococcal Vaccines , Pandemics , Brazil , Vaccination , Vaccines, ConjugateABSTRACT
Routine childhood vaccination improves health and prevents morbidity and mortality from vaccine-preventable diseases. There are indications that the COVID-19 pandemic has negatively impacted immunization rates globally, but systematic studies on this are still lacking in Canada. This study aims to add knowledge on the pandemic's effect on children's immunization rates with pneumococcal vaccine using self-reported immunization data from CANImmunize. An interrupted time series analysis was conducted on aggregated monthly enrollment of children on the platform (2016-2021) and their pneumococcal immunization series completion rates (2016-2020). Predicted trends before and after the onset of the COVID19-related restriction (March 1, 2020) were compared by means of an Autoregressive Integrated Moving Average (ARIMA). The highest monthly enrollment was 3,474 new infant records observed in January 2020, and the lowest was 100 records in December 2021. The highest Self-reported pneumococcal immunization series completion rate was 78.89%, observed in February 2017, and the lowest was 6.94% in December 2021. Enrollment decreased by 1177.52 records (95% CI: -1865.47, -489.57), with a continued decrease of 80.84 records each month. Completion rates had an immediate increase of 14.57% (95% CI 4.64, 24.51), followed by a decrease of 3.54% each month. The onset of the COVID-19 related restrictions impacted the enrollment of children in the CANImmunize digital immunization platform and an overall decrease in self-reported pneumococcal immunization series completion rates. Our findings support efforts to increase catch-up immunization campaigns so that children who could not get scheduled immunization during the pandemic are not missed.
Subject(s)
COVID-19 , Infant , Child , Humans , COVID-19/epidemiology , COVID-19/prevention & control , Pandemics , Self Report , Vaccination , Pneumococcal Vaccines , Streptococcus pneumoniae , Canada/epidemiology , Immunization ProgramsABSTRACT
BACKGROUND AND AIMS: Parapneumonic empyema, a severe pneumonia complication, decreased shortly after 13-valent pneumococcal conjugate vaccine (PCV13) introduction in US children, though the long-term impact remains poorly described. It is also unclear whether PCV13 introduction in 2010 or the 2014 US recommendation for PCV13 use in older adults was associated with declines in empyema among adults. We examined overall and organism-specific parapneumonic empyema rates among US children and adults from 2006 to 2019, prior to the SARS-CoV-2 pandemic and the updated recommendations for PCV15 and PCV20 in the US. METHODS: We used the National Inpatient Sample and US Census Data to calculate national annual all-cause and pneumococcal empyema hospitalization rates by age group (2006-2019). We examined rates during the late-PCV13 era (October 2015-2019) after transition to ICD10 codes compared to rates in the late-PCV7 (2006-2009) and early-PCV13 era (2011-September 2015). We also examined the rate of empyema with thoracentesis-related procedures and according to the causative organism type. RESULTS: Compared to the late-PCV7 era, all-cause empyema hospitalization rates were lower among child age groups (<1, 1, 2-4 and 5-17 years) in the late-PCV13 era. In contrast, among most adult age groups (18-34, 50-64, 65+ years), all-cause empyema rates were higher in the late-PCV13 era compared to the late-PCV7 era. CONCLUSION: Early declines in all-cause empyema-related hospitalizations observed right after PCV13 introduction among children in 2010 were sustained through 2019, though rates did not decline among adults.
Subject(s)
COVID-19 , Empyema , Pneumococcal Infections , Child , Humans , United States/epidemiology , Infant , Aged , Adolescent , SARS-CoV-2 , Pandemics , COVID-19/complications , COVID-19/epidemiology , Pneumococcal Vaccines , Hospitalization , Empyema/epidemiology , Empyema/prevention & control , Pneumococcal Infections/prevention & control , IncidenceABSTRACT
The pneumonia vaccine is the best way to prevent pneumococcal disease and the high cost of readmission for patients and payors. The readmission rate at a skilled nursing facility (SNF) for a patient with a diagnosis of pneumonia was 24%, whereas the vaccination rate at the SNF was only 28%. This finding is significant because patients aged ≥65 years have a 35% reduction in pneumonia influenzas and all-cause mortality with appropriate pneumococcal vaccination. The current initiative sought to increase the pneumococcal vaccine rate at a SNF through implementation of a structured vaccine initiative. After implementation of a pneumococcal vaccination bundle, vaccine uptake increased from 28% to 66%. The success of the pneumococcal vaccination bundle showed that a focused effort using context-specific, evidence-based interventions can increase vaccine uptake. Adapting an evidence-based bundle to fit the needs of the user's context is an important component to the success of vaccination initiatives. [Journal of Gerontological Nursing, 48(12), 52-56.].