Driving more WHO-recommended vaccines in the National Immunization Program: Issues and challenges in China.

WHO-recommended vaccines substantially prevent and control vaccine-preventable diseases (VPDs), but their inclusion differs among countries and regions. We reviewed the application for WHO-recommended vaccines in China and described the concerns and obstacles in driving the inclusion of more vaccines into China's NIP, including immunization strategies, financial barriers, vaccination services, and behavioral and social supply-side and demand-side factors. China has made significant efforts, however, they may not be sufficient until the inclusion of more WHO-recommended vaccines in the National Immunization Program (NIP), ensuring that the vaccination encompasses the whole life course of individuals, establishment of more trustworthy vaccination finance and procurement, increasing vaccine development, optimizing vaccine demand forecasts, improving the accessibility and equity of vaccination services, capturing the key points of behavioral and social drivers of vaccination on the demand side, and establishing holistic prevention and control from a public health perspective.

The Coronavirus Disease and Vaccine Epidemiology in Malaysia

COVID-19 spread by the SARS-CoV-2 virus is one of the most pronounced ongoing communicable deathly disease outbreaks in Malaysia. The immunization programme is currently administering Pfizer–BioNTech, Oxford–AstraZeneca and Sinovac (CoronaVac) candidate vaccines in several phases targeting different categories of recipients per phase and is expected to be completed by February 2022. Issues pertaining to COVID-19 vaccine literacy, acceptance and hesitancy still need more investigation to generate baseline information as an initial step for interventions and building trust in vaccination efforts. This will accelerate the achievement of the immunization programme's target of immunizing at least 80% of Malaysian by 2022. © TheEditor(s) (ifapplicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2021, 2022.

Consistent neutralization of circulating omicron sub-variants by hybrid immunity up to 6 months after booster vaccination.

The current COVID-19 vaccination program requires frequent booster vaccination to maintain sufficient neutralization levels against immune evasive SARS-CoV-2 variants. However, prior studies found more potent and durable immune response in convalescing individuals, raising the possibility of less frequent booster vaccination for them. Here, we conducted a longitudinal immunological study based on two prospective cohorts of booster vaccinated convalescing COVID-19 patients or healthcare workers (HCW) without COVID-19 history in Xiangyang, China. Comparing to 1-month post-boosting, pseudovirus neutralization titers (pVNT50) of ancestral Wuhan-Hu-1 and circulating omicron sub-variants BA.5, BF.7, BA.4.6, BA.2.75, and BA.2.75.2 spikes were stable or even increased in convalescing samples at 6-month post-boosting, when HCW samples showed substantial drop of neutralization titers across the spectrum. Variant-to-Wuhan-Hu-1 pVNT50 ratios showed no significant variation during the 17 months from pre-vaccination to 6-month post-boosting in convalescing individuals, indicating that the high durability of hybrid immunity was likely sustained by continuously improving neutralization potency that compensated immune decay. Our data provide mechanistic insight into prior epidemiological findings that vaccine-elicited humoral immune response was more durable in convalescing individuals than those without SARS-CoV-2 infection, and suggest further research into potential extension of boosting intervals for convalescing individuals.

Lifelong vaccination strategy as a tool against pandemics in Hungary / Élethosszan át tartó oltási stratégia mint eszköz a pandémiák elleni védekezésben Magyarországon.

Összefoglaló. Különbözo tényezok következtében az új és újra felbukkanó fertozo betegségek megjelenésére a 21. században egyre nagyobb az esély, ezzel párhuzamosan a pandémiák kialakulása is nagyobb valószínuségu. A 2019-ben felbukkant COVID-19-járvány azt is közvetíti számunkra, hogy egyes új és újra jelentkezo fertozo betegségek - az eredményes intézkedések elmaradása, késlekedése esetén - gyorsan terjedhetnek. A fertozo betegségek elleni harc egyik fo eszköze a védooltás segítségével történo immunizáció. A jelen tanulmány célja bemutatni a védooltások elonyeit, fókuszba helyezve az elöregedo társadalomban az élethosszan tartó immunizációs stratégiának a személyes egészségre ható, közegészségügyi, gazdasági, valamint társadalmi érdekeit. Az oltás elonyeinek minél nagyobb fokú kihasználásához egy élethosszan tartó immunizációs stratégia felállítása javasolható, amelynek aspektusait és gyakorlatba ültetésének lehetséges lépéseit foglaltuk össze közleményünkben. Orv Hetil. 2022; 163(14): 535-543. Summary. Due to various factors, the chances of infectious disease emergence or re-emergence have increased in the 21st century, thus, the likelihood of new emerging pandemics has also increased. The COVID-19 pandemic, which appeared in 2019, has highlighted that certain new and re-emerging infectious diseases - in the case of lack or delay in effective measures - can spread very rapidly. The main tool for the fight against infectious diseases is immunization through vaccination. While focusing on the personal health, public health, economic and societal benefits of a lifelong immunization strategy, especially in light of the aging society, the goal of this paper is to present the benefits of vaccines. In order to increase the added value of vaccinations it is recommended to create a lifelong immunization strategy. Our paper summarizes the relevant aspects of such a strategy, highlighting potential practical steps towards implementation. Orv Hetil. 2022; 163(14): 535-543.

Neutralizing antibodies induced by homologous and heterologous boosters in CoronaVac vaccinees in Chile.

OBJECTIVES: To determine the impact of a booster dose on the humoral response in individuals inoculated with a complete schedule of any SARS-CoV-2 vaccine, we evaluated the neutralizing antibody (NAb) titers of homologous or heterologous booster doses over a 90-days period in CoronaVac vaccinees from three centers in Santiago, Chile. METHODS: Individuals previously inoculated with two doses of CoronaVac (N = 523) were recruited in the context of the REFUERZO clinical trial (NCT04992182) and received either placebo (N=129), or a booster dose of CoronaVac (N=134), BNT162b2 (N=133) or ChAdOx1 (N=127). Pseudovirus neutralizing antibody titers (pVNT) were determined at baseline (day 0) as well as days 14, 30, 60 and 90 post booster administration. RESULTS: Inoculating a booster dose increases the pVNTs titers at days 14 and 30 in all groups, (13.5 and 12.0 fold increase for the CoronaVac group; 247.0 and 212.3 fold increase for the BTN162b2 group; and 89.1 and 128.1 fold increased for ChAdOx1 at each time point, respectively) with a decline observed at days 60 and 90. However, while pVNTs remained significantly higher for the BTN162b2 and ChAdOx1 groups at days 60 and 90, neutralizing antibody titers reached baseline levels in the CoronaVac group at 90 days post-inoculation. CONCLUSIONS: A single heterologous booster (BTN162b2 or ChAdOx1) in individuals who completed the CoronaVac primary series resulted in an important increase in NAb titers remaining significantly higher at least for 90 days. These data may directly impact middle- and low-income countries currently using CoronaVac as the main vaccination strategy.

The COVID-19 Infodemic on Twitter: A Space and Time Topic Analysis of the Brazilian Immunization Program and Public Trust.

The context of the COVID-19 pandemic has brought to light the infodemic phenomenon and the problem of misinformation. Agencies involved in managing COVID-19 immunization programs are also looking for ways to combat this problem, demanding analytical tools specialized in identifying patterns of misinformation and understanding how they have evolved in time and space to demonstrate their effects on public trust. The aim of this article is to present the results of a study applying topic analysis in space and time with respect to public opinion on the Brazilian COVID-19 immunization program. The analytical process involves applying topic discovery to tweets with geoinformation extracted from the COVID-19 vaccination theme. After extracting the topics, they were submitted to manual annotation, whereby the polarity labels pro, anti, and neutral were applied based on the support and trust in the COVID-19 vaccination. A space and time analysis was carried out using the topic and polarity distributions, making it possible to understand moments during which the most significant quantities of posts occurred and the cities that generated the most tweets. The analytical process describes a framework capable of meeting the needs of agencies for tools, providing indications of how misinformation has evolved and where its dissemination focuses, in addition to defining the granularity of this information according to what managers define as adequate. The following research outcomes can be highlighted. (1) We identified a specific date containing a peak that stands out among the other dates, indicating an event that mobilized public opinion about COVID-19 vaccination. (2) We extracted 23 topics, enabling the manual polarity annotation of each topic and an understanding of which polarities were associated with tweets. (3) Based on the association between polarities, topics, and tweets, it was possible to identify the Brazilian cities that produced the majority of tweets for each polarity and the amount distribution of tweets relative to cities populations.

Attitudes and Beliefs around the Value of Vaccination in the United States.

Despite the benefits of immunization, differences in attitudes persist toward vaccines. We captured individuals' perceptions of vaccines and vaccination across the United States (US) to inform vaccine-related policy development. A survey was completed by 5000 respondents from 10 states. Respondents were screened for inclusion, which included individuals ≥ 18 years of age that had received a vaccine or were unvaccinated but indicated a favorable or neutral attitude towards vaccinations. Participants were excluded if they indicated they did not support the idea of vaccinations. Questions explored perceptions of vaccines for all age groups. Among unvaccinated individuals, the most common concerns were about safety (38%). Most respondents (95%) highlighted the importance of state immunization programs for disease prevention. Access to health and immunization records and immunization information systems were important to 96% and 88% of respondents, respectively, for future health planning. Doctors and healthcare professionals (HCPs) were considered trusted sources for vaccine information (95%). Overall, respondents recognized the importance of vaccination, but documented concerns among the unvaccinated indicated a need for greater promotion regarding vaccine safety. Doctors and HCPs, as trusted information sources, should continue to and increasingly advocate for the importance of immunization to increase vaccine uptake.

Resilience learning from the COVID-19 pandemic and its relevance for routine immunization programs.

INTRODUCTION: The COVID-19 pandemic represents a threat that has posed a challenge to public health response and threatens immunization programs globally. Despite recommendations to continue routine immunization services, disruptions have been observed to these and mass vaccination campaigns. This may result in setbacks to immunization initiative successes and a rise in cases of vaccine-preventable diseases. AREAS COVERED: We conducted a systematic literature review to identify studies globally that described how indicators of health system resilience, defined using the Resilient Health System Framework, enabled routine immunizations to continue during the COVID-19 pandemic. A systematic search was conducted in Embase, Web of Science, PsychInfo, medRxiv, bioRxiv, and the gray literature between 1 January 2020, and 12 November 2021. Information was extracted from the studies identified describing how the specific elements of resiliency (being aware, diverse, self-regulating, integrated, and adaptive) were applied to their routine immunization programs. EXPERT OPINION: Our study demonstrates the use of tools that contributed to immunization program resilience during the COVID-19 pandemic in all geographic regions and for countries with different income levels. These tools may help inform preparations for other immunization programs to catch up from the COVID-19 pandemic or mitigate the impact of future threats.

Resumption of active recommendation of the human papillomavirus vaccine in Japan and future challenges for the National Immunization Program.

Japan's immunization program resumed proactively recommending the use of the human papillomavirus (HPV) vaccine nationwide in April 2022, after suspending this recommendation in June 2013. The promotion of catch-up vaccinations is an urgent issue to reduce the increase in cervical cancer and other cancers caused by low vaccination rates. In addition, the National Immunization Program still has issues to be considered, such as the adoption of the 9-valent vaccine, establishment of an appropriate number of vaccinations according to age, and routine immunization of males. There is a history of eliminating the use of the measles, mumps, and rubella vaccine and the mouse brain-derived, purified inactivated Japanese encephalitis vaccine, as well as suspending the HPV vaccine recommendation in Japan. These decisions have led to the current preventable infectious disease burden. In order to make the right policy decisions based on science-based assessments, it is necessary to establish a safety assessment platform to evaluate the causal relationship between vaccines and adverse events following immunization. Information technology, which has been promoted with the coronavirus disease 2019 vaccine in the current pandemic, may assist in providing more detailed vaccine safety evaluations for other vaccines.

Telemedicine in the National Immunization Program (Brazil): A promising tool.

The coronavirus disease 2019 pandemic abruptly changed the dynamics of basic health care, with the consequent need for adjustments in essential services. The objective of this study was to evaluate the acceptance and impact of telemedicine at a Reference Center for Special Immunobiologicals (CRIE). Methods: Patients aged 18 years or older who had a medical referral to CRIE and agreed to have a telemedicine consultation were included. After the medical appointments, participants answered a satisfaction survey. Results: From April 2021 to February 2022, 702 telemedicine consultation were conducted. Over 3,380 vaccines were prescribed via telemedicine. Of all the participants who answered the satisfaction questionnaire, 99.8% stated that they would recommend the service to other people. Conclusions: Telemedicine proved to be promising tool for healthcare at CRIE and had good acceptance by users, potentially improving access and extending the reach of the National Immunization Program.

COVID-19 and Vaccination Coverage of the Regular Calendar of Paraguay, effect of the Pandemic

Introduction: The COVID-19 pandemic produced a health crisis affecting countries' vaccination coverage statistics. Objective: To describe the coverage of recommended vaccines during the pre-pandemic (2015-2019) and pandemic (2020-2021) periods in Paraguay. Materials and Methods: This was a descriptive, observational cross-sectional study, comprising children from 0 to 5 years of age, from the Country's 18 Health Regions. The vaccination coverage of the National Expanded Immunization Program, pre-pandemic (2015-2019) and pandemic (2020-201) periods were analyzed. The recommended vaccinations included were: BCG, DTP1, DTP3, IPV1 and bOPV3, MMR1, MMR2 and yellow fever vaccine (AA), the calculation of vaccination coverage at the country level was carried out through the analysis of the weekly electronic report of doses of vaccines administered by Health Region. The comparison of vaccination coverage by recommended vaccine was established, by periods and age range. Results: During the pandemic, a decrease in vaccination coverage of the recommended vaccines was observed, for BCG: 4% (2020), 15% (2021);DTP1: 5% (2020), 13% (2021);DTP3: 9% (2020), 22% (2021);IPV1: 5% (2020), 16% (2021);bOPV3: 7% (2020), 19% (2021);MMR1: 9%, MMR2: 13% (2020), MMR1: 17%, MMR2: 16% (2021) and AA: 7% (2020), 15% (2021). Conclusion: During the Covid-19 pandemic, vaccination coverage of all recommended vaccines decreased, a similar decrease was found in other countries in the Americas, there is a risk of outbreaks of vaccine-preventable diseases due to the accumulation of susceptible populations.

Impact of a two-dose varicella immunization program on the incidence of varicella: a multi-year observational study in Shanghai, China.

BACKGROUND: It remains hesitant to include a two-dose varicella vaccine (VarV) in a national routine immunization program in China. We aimed to quantify the impact of the two-dose VarV on varicella incidence in Shanghai. RESEARCH DESIGN AND METHODS: We directly extracted the data of varicella cases and VarV doses in 2013-2020 in Shanghai, and then estimated the effects of two-dose VarV using a Serfling model. RESULTS: A two-dose VarV immunization program has been extensively implemented since October 2017 and become free since August 2018 in Shanghai. Before and after this program, varicella cases significantly declined in children (P < 0.01), whereas did not in adults aged >18 years (P = 0.22). Compared to the predicted number of varicella cases, actual number was significantly lower by 8% in 2018 and 28% in 2019. Among children aged 4-6 years, the reduction in varicella cases was largest. Moreover, there was a significant reduction in varicella cases throughout 2020 (P < 0.001), in which the decrease due to social distancing for the COVID-19 was 54%. CONCLUSIONS: A two-dose VarV immunization program may further reduce approximately one-third of varicella cases in Shanghai. Children <4 years and adults benefit less in this program, which warrants enhancing the immunization.

Burden of vaccine-preventable diseases, trends in vaccine coverage and current challenges in the implementation of the expanded program on immunization: A situation analysis of Cameroon.

The discovery and development of vaccines remain one of the major successes of global health with millions of lives saved every year through routine vaccination. Although vaccines provide a safe and cost-effective solution to vaccine-preventable diseases (VPDs), VPDs are still a serious public health problem in most parts of the world, especially in sub-Saharan Africa (SSA) and Asia. In this review, we discuss the burden of VPDs and vaccine coverage several decades after the introduction of the Expanded Program on Immunization (EPI) in Cameroon. We also discuss how different factors affect the implementation of the EPI, highlighting context-specific factors such as the ongoing civil conflict in Cameroon, and the presence of other infectious diseases like COVID-19.

Willingness to Be Vaccinated against COVID-19 in Spain before the Start of Vaccination: A Cross-Sectional Study.

Vaccine hesitancy has increased in the past few years, influenced by the socio-cultural differences, political populism, or concerns related to the effectiveness and safety of some vaccines, resulting a feeling of distrust. This feeling can become a barrier against the achievement of the immunity necessary to stop the expansion of COVID-19. The aim of this study was to evaluate the acceptance of the vaccine against COVID-19 in Spain, as well as to identify the factors that have an influence on the concerns and attitudes of people against accepting the vaccine in the months prior to the start of vaccination on December 2020. An online questionnaire was created to obtain information about (1) sociodemographic characteristics; (2) concerns and sources of information about vaccines; and (3) attitudes about vaccination and state of health. A multivariate logistic regression was performed to identify the influencing factors. Of the 2501 participants, 1207 (48.3%) would accept the COVID-19 vaccine, 623 (24.9%) were hesitant, and 671 (26.8%) would reject it. The logistic regression showed that being male, older than 60, married, retired, with a high level of education, or with a leftist political inclination, could increase the probability of accepting the COVID-19 vaccine. Disinformation and the lack of political consensus were the main sources of distrust. The patients with hypertension, immunodepression, hypercholesterolemia, or respiratory disease, or were overweight, showed a greater acceptance to the vaccine, while those with cancer took the longest to accept it. A low acceptance of the vaccine against COVID-19 was observed among the Spanish population in the phase prior to its availability, and the main fears of the population were identified. It is necessary to offer correct and transparent information about these vaccines to reduce the concerns and increase the trust of the population, to thereby guarantee the success of the vaccination campaigns.

Changes and remaining challenges for the Japanese immunization program: Closing the vaccine gap.

The Japanese immunization program has made considerable progress since 2009: several new vaccines have been introduced and most are included in the National Immunization Program (NIP). In October 2020, the Japanese law on immunization was revised, which resulted in a few laudable achievements. First, rotavirus vaccines were added to the NIP, 10 years after their introduction, and noteworthy studies of vaccine effectiveness and the incidence of intussusception in Japanese children were published. Second, rules on vaccine intervals-which had been a longstanding concern-were withdrawn. In addition to this revision of the law, the Japanese version of the Vaccine Information Statement (VIS) was released by the Japan Pediatric Society in 2018. The VIS provides useful caregiver information on general immunization concepts and individual vaccines. Further challenges for the Japanese immunization program include (1) administering a booster dose of pertussis-containing vaccine to preschool children or teenagers, (2) reestablishing the active recommendation for human papilloma virus vaccines, (3) adding the mumps and influenza vaccines to the NIP, and (4) ensuring optimal dosing of seasonal influenza vaccines. During the current coronavirus disease 2019 (COVID-19) pandemic, vaccination rates among children have been decreasing in many countries. In Japan, vaccination rates have been stable in infants, but declining among toddlers and school-aged children, despite public awareness of the need for timely administration of vaccines during the pandemic. Clearly, further action is needed if we are to adequately protect children living in Japan from vaccine-preventable diseases.

Immunization funding across 28 European countries.

INTRODUCTION: Disease prevention and improving vaccination coverage in Europe are key elements contributing to resilient health systems and ensuring better health outcomes for all. The aim of this study was to describe the immunization funding landscape across all European Union 28 countries (EU28). AREAS COVERED: Data collected in a targeted literature review supported descriptive analysis on the different indicators that were looked at: vaccines included in the EU28 national immunization programs (NIP), national immunization funding, immunization funding per capita (2015-2019) and percentage of health-care budget allocated to immunization. EXPERT OPINION: Immunization funding represents a small proportion of total healthcare spend in Europe (median 0.3%). In the context of the current COVID-19 pandemic, demographic changes, and the potential introduction of new vaccines; the need for adequate financing of immunization programs will be important, to establish resilient immunization systems and provide sustainable protection of the population against vaccine-preventable diseases.

PLAIN LANGUAGE SUMMARYWhat is the context?Herpes zoster, or shingles, is a viral disease characterized by a painful, localized skin rash. It affects approximately 32% of US citizens at least once in their lifetime.The risk of contracting shingles increases with age.Most American adults over 50 years have not received the shingles vaccine, and vaccination rates are especially low for African-Americans.What is new?This is the first study to evaluate what drives shingles vaccination decisions among US adults ≥ 50 years of age. We also assessed the differences between African-American and non-African-American adults, and inside the African-American group.In this choice experiment, 1,454 people ≥ 50 years completed a survey of 8 choice questions, as well as questions on their previous experiences with vaccines, socioeconomic, and demographic characteristics. Seven factors were evaluated.We found that American adults preferred to get vaccinated, and the most influential factors were costs and vaccine effectiveness while location of vaccination was the least important. There were differences in preferences between African-American and non-African-American adults, mainly driven by costs and vaccine effectiveness. 3 different groups of African-American adults with systematically different preferences could be identified; two were likely to vaccinate, with one being more cost sensitive at lower price thresholds, and the third was unlikely to vaccinate.What is the impact?Decisions on shingles vaccination appear to be mostly driven by costs, which could be a barrier to those who do not have appropriate insurance, especially among some African-Americans.However, healthcare professionals should continue to educate patients on other vaccine characteristics, as they also influence vaccination decisions.

Ancillary benefits of seasonal influenza vaccination in middle-income countries.

While seasonal influenza vaccines (SIV) remain the best method to prevent influenza-associated illnesses, implementing SIV programs may benefit countries beyond disease reduction, strengthening health systems and national immunization programs, or conversely, introduce new challenges. Few studies have examined perceived impacts of SIV introduction beyond disease reduction on health systems; understanding such impacts will be particularly salient in the context of COVID-19 vaccine introduction. We collected qualitative data from key informants-Partnership for Influenza Vaccine Introduction (PIVI) contacts in six middle-income PIVI vaccine recipient countries-to understand perceptions of ancillary benefits and challenges from SIV implementation. Respondents reported benefits associated with SIV introduction, including improved attitudes to SIV among risk groups (characterized by increased demand) and perceptions that SIV introduction improved relationships with other ministries and collaboration with mass media. Challenges included sustaining investment in SIV programs, as vaccine supply did not always meet coverage goals, and managing SIV campaigns.