Drivers and barriers of seasonal influenza vaccination 2015/16 & 2019/20 to 2022/23 - a survey on why most Norwegians don't get the flu vaccine.

BACKGROUND: This study aimed to explore the reasons adults in the general population, influenza risk groups (RGs) and health care workers (HCWs) in Norway give for their vaccination choices and whether these reasons vary between groups or over time in order to further improve influenza vaccination coverage. METHODS: Respondents of a nationally representative telephone survey conducted by Statistics Norway were asked "What was the most important reason why you did/did not get vaccinated?". The question on influenza non-vaccination was included in 2016 and in 2020 to 2023 and the question on influenza vaccination in 2021 to 2023. RESULTS: The study included 9 705 individuals aged 18-79 years. Influenza vaccination coverage in the RGs increased from 20.6% in 2016 to 63.1% in 2022, before a reduction to 58.3% in 2023. Common reasons for non-vaccination were similar in all groups. The most cited reasons were "no need" for the vaccine and "no specific reason", followed by "not recommended/offered the vaccine", "worry about side effects" and "vaccine refusal". The most frequent reasons for vaccination among the general population and RGs were protection against influenza and belonging to a RG, while the most frequent responses among HCWs were being offered the vaccine at work/work in health care, followed by a desire for protection against influenza. Receiving a vaccine recommendation from a health professional was mentioned in all groups. We also observed that the proportion reporting "no need" for the vaccine decreased over time, especially among HCWs, and that the proportions reporting vaccine refusal and worry about side effects as reasons for non-vaccination were temporarily reduced during the COVID-19 pandemic. CONCLUSIONS: The general population and RGs cite protection against influenza as their primary incentive for vaccination, while HCWs mainly refer to their professional role or workplace vaccination. For non-vaccination we see a similar pattern in all groups, with "no need" and "no specific reason" as the main reasons. Of note, worry about side effects and vaccine refusal is as frequent among HCWs as in other groups. Continued efforts to maintain and increase vaccine confidence are needed.

Vaccines and vaccination in prison settings: availability and model of service delivery in 20 European countries.

Prisons, due to various risk factors, are environments that are conducive to infectious disease transmission, with significantly higher prevalence of infectious diseases within prisons compared to the general population. This underscores the importance of preventive measures, particularly vaccination. As part of the international project "Reaching the hard-to-reach: Increasing access and vaccine uptake among the prison population in Europe" (RISE-Vac), this study aimed to map the availability and delivery framework of vaccination services in prisons across Europe and beyond. A questionnaire designed to collect data on the availability and delivery model of vaccination services in prisons was validated and uploaded in SurveyMonkey in July 2023. Then, it was submitted to potential participants, with at least one representative from each European country. Potential participants emailed an invitation letter by the RISE-Vac partners and by the European Organization of Prison and Correctional Services (EUROPRIS). Twenty European countries responded. Vaccines are available in European countries, although their availability differs by country and type of vaccine. The first dose is offered to people living in prisons (PLP), mostly within one month, COVID-19 is the most widely offered vaccine. In all countries, vaccines are actively offered by healthcare workers; in most countries, there is no evaluation of vaccination status among people who work in prison. The survey shows variance in vaccine availability for PLP and staff across countries and vaccine types. Quality healthcare in prisons is not only a matter of the right to health but also a critical public health investment: enhancing vaccine uptake consistently among PLP and staff should be prioritized.

Adenoviral fiber-knob based vaccination elicits efficient neutralizing antibodies and T cell responses against adenovirus infection.

BACKGROUND: Human adenoviruses (HAdVs) frequently cause common respiratory or gastrointestinal infections among children, adults, individuals with immune deficiencies, and other vulnerable populations with varying degree of symptoms, ranging from mild to server, and in some cases, even fatalities. Despite the significant clinical impact of HAdVs, there is currently no approved vaccine available. METHODS: This study explores the potential of the adenovirus type 5 fiber knob (Ad5-FK) to stimulate the production of Ad-specific neutralizing antibodies and T-cell responses in mice. Based on structure predictions, we first expressed Ad5-FK in E. coli and confirmed the assembly of FK into its trimeric form. After testing the binding capability of the trimeric FK to susceptible cells, the immunogenicity of the protein in combination with the c-di-AMP adjuvant was assessed in BALB/c mice. RESULTS: The purified Ad5-FK exhibited self-trimerization and maintained correct conformation akin to the authentic FK structure. This facilitated effective binding to susceptible HEK293 cells. Notably, the protein demonstrated significant inhibition of HEK293 cells infection by rAd5-GFP. Immunization of BALB/c mice with Ad5-FK, or Ad5-FK mixed with c-di-AMP yielded FK-specific antibodies with potent neutralization capacity. Significantly, Ad5-FK was found to elicit a vigorous CD4+ T-cell response in the immunized mice. CONCLUSION: Our findings underscore the efficacy of FK-based vaccine in eliciting anti-Ad humoral immune response and CD4 T-cell immune reactions essential for protection against viral infections.

Benefits of Repeated SARS-CoV-2 Vaccination and Virus-induced Cross-neutralization Potential in Immunocompromised Transplant Patients and Healthy Individuals.

Background: Current COVID-19 vaccines primarily target the Spike protein of defined virus variants, offering limited protection against emerging variants in immunocompetent individuals. Similarly, protective immunity following natural SARS-CoV-2 infection is variable and of short duration, raising concerns about immunocompromised individuals' vaccination strategies. Methods: This prospective multicenter study examined 66 sera from 59 immunocompromised and 451 sera from 215 immunocompetent individuals from different pandemic periods. We establish and validate a live virus-based neutralization assay to determine the virus-inactivating potential against ancestral and current SARS-CoV-2 isolates. Results: Our virus-based neutralization assay demonstrated superior performance over surrogate neutralization assays. We found strong but transient immunity after complete vaccination schemes, with single doses providing minimum neutralization, regardless of vaccine type. Combining vaccination-induced immunity with SARS-CoV-2 infection before or after vaccination yielded higher neutralizing titers than vaccination or infection alone, consistent across both study groups. Additional doses after a full vaccination course restored neutralization levels. Conclusions: Potentially protective SARS-CoV-2 neutralization is reliably induced in immunocompromised individuals by prior attenuation of immunosuppression. First-generation vaccines protect against various SARS-CoV-2 variants in immunocompetent individuals, with effective cross-neutralization demonstrated up to the Delta variant but largely absent for later Omicron variants. Continuous vaccine updates are necessary to address emerging SARS-CoV-2 variants.

Jenner's Legacy: How Edward Jenner's Smallpox Vaccine Changed Public Health.

Edward Jenner who discovered immunology and the smallpox vaccine conducted a smallpox vaccination test in 1796, which is considered a landmark in the history of modern immunization. This review focuses on describing Jenner and his accomplishments highlighting his discovery as a shift in the approaches toward disease control and prevention as well as the basis for further eradicating smallpox globally. Jenner's use of cowpox to protect people from smallpox was a revolution from other essential procedures such as variolation. His vaccine demonstrated how immunization could be used to combat diseases, and over the years the idea began to be deployed to other vaccines and other diseases. Besides the given medical profession, the work of Jenner was relevant to the changes or even enhancements of health policies and health systems globally. His vaccine provided not only the means to arrest a wide disease that could easily eliminate many human beings but also initiated procedures of disease prevention and control. Another important type of immunity, herd immunity, which determines an approach to managing specific diseases in the present, as well as knowledge of the degree of protection provided by the antigen in terms of the overall immune status of a population, was also achieved based on the actions taken after Jenner's procedure. As our society searches for vaccines for emergent diseases to date, this review reveals that Jenner's accomplishments are still relevant. In this article, analyzing Jenner's approach and the role of society and science at the time, along with the consequences of his work, the reader sees how Jenner changed the world of public health and laid a foundation for today's vaccination. Such an approach allows considering the changes and evolution of the topic that Jenner studied and contributed to and how people fight infections today.

Diagnosis of COVID-19: Is Fever the Best Indicator of COVID-19 in Vaccinated SARS-CoV-2-Positive Adults?

OBJECTIVES: Coronavirus disease 2019 (COVID-19) vaccination is highly recommended to prevent the onset and severity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in Japan. However, the impact of COVID-19 vaccination on the manifestations or presenting symptoms of SARS-CoV-2 infection in daily clinical practice remains unclear. METHODS: This retrospective single-center study was conducted from April 2021 to July 2022 in Japan. We compared the clinical manifestations of SARS-CoV-2 infection in 636 COVID-19-positive patients who visited our outpatient fever clinic, both COVID-19-vaccinated and unvaccinated. RESULTS: During the study period, the COVID-19 vaccination rate at the time of infection was 77.2% (n=491/636), with a median of two doses. Most manifestations, including fever, were reduced in the vaccinated group (n=196) compared to the non-vaccinated group (n=142). The temperature at the clinic decreased significantly as the number of vaccinations increased. Fever was the most common manifestation in the non-vaccinated group (76%, n=108/142), while only 30% (n=59/196) of those who received three or more COVID-19 vaccinations experienced fever. However, sore throat and cough were observed more frequently in the vaccinated group compared to the non-vaccinated group. CONCLUSION: Fever may not be a reliable indicator of SARS-CoV-2 infection in vaccinated individuals, as its frequency is significantly reduced by vaccination. However, since sore throat and cough are more frequently observed in vaccinated individuals, these symptoms could be useful for recommending COVID-19 testing even in the absence of fever, aiding in the prevention of infectious outbreaks.

[Livedo reticularis following administration of COVID-19 vaccine: a case report]. / Livédo réticulaire post vaccin anti COVID-19: à propos d'un cas.

The emergence of severe acute respiratory syndrome coronavirus 2 has made it crucial to develop safe vaccines. Three main types of vaccines are currently available. Although they have proven to be very secure, they have caused various adverse effects. We here report a rare case of livedo reticularis following the administration of COVID-19 vaccine in a 54-year-old woman. It occurred 24 hours after vaccination, accompanied by respiratory, digestive, and neurological disorders and deterioration in general condition. Examinations revealed skin lesions compatible with livedo reticularis, mild inflammatory syndrome and hypercholesterolemia. Imaging showed no abnormalities. Immunological tests were positive for lupus anticoagulant. The patient received symptomatic treatment, with improvement in neurological and joint symptoms and a slight regression of skin rashes. After three months, the lupus anticoagulant test remained positive, confirming post-vaccination antiphospholipid syndrome (APS). The association of livedo reticularis with COVID-19 vaccine should not be underestimated and its degree of severity remains to be determined. More data and cases need to be collected for a more in-depth and detailed analysis.

Midwives' perceptions and experiences of recommending and delivering vaccinations to pregnant women following the Covid-19 pandemic: a qualitative study.

BACKGROUND: Pregnant women and their unborn babies are at an increased risk of hospitalisation, morbidity, and mortality from illness. However, uptake of influenza, pertussis and Covid-19 vaccinations offered during pregnancy is below the desired rate. This research aims to explore UK midwives' experiences of approaching and discussing vaccinations with pregnant women, and their perceived role in pregnant women's vaccination decisions. METHODS: Midwives in the West Midlands, UK were recruited via participating hospitals and midwife specific social media groups. Interviews were conducted remotely from April to July 2023 and analysed with a deductive codebook coding strategy using thematic analysis. FINDINGS: Semi-structured interviews were conducted with 16 midwives identifying the following key themes: Recommendations to have vaccinations reported on the contents of recommendations and how they are communicated; Messages and guidance included the importance of up-to-date informational needs for midwives to administer vaccinations and the barriers caused by uncertainty and conflicting messages about the Covid-19 vaccine during pregnancy; Delivery of vaccinations included the convenience of offering vaccinations during standard antenatal appointments; and Midwives' barriers explored the pandemic specific and other barriers midwives face in the administering of vaccinations. DISCUSSION: These findings contribute to the understanding of how midwives discuss the topic of vaccinations with pregnant women. This research highlights the importance for midwives to receive clear and consistent information. A strong emphasis on why vaccines are important when recommending to pregnant women in addition to standard information on the availability and timing may have a bearing in helping women to make informed decisions about accepting vaccinations.

COVID-19 mRNA booster vaccination induces robust antibody responses but few adverse events among SARS-CoV-2 naïve nursing home residents.

Residents in nursing homes face heightened COVID-19 risks. We aimed to assess the adverse events (AEs) rates and antibody responses after the first to the fifth dose of COVID-19 mRNA vaccination in a nursing home cohort. Ninety-five SARS-CoV-2 naïve participants consisted of 26 staff (median age, 51 years) and 69 residents (median age, 88 years). Life-threatening AEs were reported in neither residents nor staff. The severity of non-life-threatening AEs was graded, and severe AEs were reported only in staff. The AEs rates were considerably lower in residents, compared to those in staff. Anti-RBD IgG and the neutralizing titers (NTs) against Wuhan and Omicron BA.4/BA.5 did not differ significantly between those with 'any AE' and 'no AE' among both staff and residents two months after the second, third and fifth doses, while the anti-RBD IgG significantly differed between two groups after third dose in residents. These findings suggest that the anti-RBD IgG and the NTs increase regardless of the occurrence of AEs. Our study underscores a robust antibody response in both in staff and residents, and fewer AEs following COVID-19 vaccination in SARS-CoV-2 naïve residents than staff, supporting the recommendation for mRNA booster doses in older adults at high-risk care facilities.

School health services in the Southern District of Israel-between privatization and nationalization.

BACKGROUND: For decades, Israel's economic policy has favored either outsourcing or privatization of public services, including healthcare, generating an ongoing and prolonged debate of this approach. In 1997 school health services (SHS) for elementary and middle school pupils was outsourced to a sub-contractor firm, reducing budget, but also standards, for nurses and physicians. Consequently, the service has dwindled and was focused more and more on vaccinations. Between 2007 and 2012, under full private contractor delivery, SHS quality diminished substantially, leading to a significant decline in vaccination coverage in the Southern District. In 2012, a decision was made to return SHS to state control. METHODS: This study analyzes the delivery parameters of SHS between the period when the service was operated by a private contractor from 2011to 2/2012, and the subsequent provision of the service directly by Ministry of Health (MoH) between 3/2012 and 2013. We compared the rates of vaccination coverage, screening tests and health education programs. RESULTS: A statistically significant increase in SHS delivery for vaccinations and screening was observed in the Southern District of MoH after the transfer of service from contractor. The increase was variable in different population subgroups, and especially notable in the Bedouin schools of the District, where the MMRV vaccination rose from 19.3% to 96.8%. However, a substantial and significant reduction in health education activities was also noted, overall from 24.9% to 5.0%. CONCLUSIONS: The findings suggest that substantial benefits can be derived from direct provision of SHS by MoH and its regional offices, especially in the areas of reduced accessibility and lower socio-economic status. The case study of SHS in the Southern District of Israel can serve as an important example highlighting the impacts of privatization vs nationalization, with potential implications in other fields. These insights should be integral to future discussions of healthcare service provision.

Out of focus but still relevant? Influenza-related resource utilization and vaccination coverage gaps in adults below 60 years of age with underlying conditions: an analysis of 2016-2024 real-world data in Germany.

Background: In 2003, the WHO aimed for a 75% or higher influenza vaccination rate among at-risk populations. However, this target was achieved in a few groups during selected seasons in some European countries, and never in Germany. Adults with underlying conditions (UCs) are a critical negleted group for influenza vaccination. This study aimed to identify data gaps in influenza burden and vaccination coverage among adults under 60 with UCs in Germany and bridge these gaps using real-world data.Material and Methods: We conducted systematic research and analyses using German administrative and claims databases from June 2016 to April 2024. We report on epidemiology, direct care costs, indirect costs from work incapacity, vaccination coverage rates, and describe data gaps.Results: Influenza data for high-risk populations are limited. Comprehensive data on influenza epidemiology and vaccination coverage rates (VCR) is available, though with a delay in data availability. Before and after the pandemic, individuals aged 50-59 had the highest rates of influenza-related hospitalization and ICU admission compared to younger age groups. Across all age groups and seasons, individuals with UC experienced higher rates of medically attended influenza cases, hospitalizations, and healthcare costs, with those aged 35-59 being particularly vulnerable. Vaccine coverage was higher in adults aged 35-59 compared to those aged 18-24, and in females compared to males.Limitations: Discrepancies of vaccination status, limited data availability, and variations among the extent of UCs.Conclusion: In Germany, recent policy measures have mainly targeted those aged 60 and above. While this elderly population experiences the highest disease-related impact, influenza can also lead to substantial healthcare resource utilization (HCRU) and costs in younger populations with chronic UCs; Facilitating vaccination access for this group, such as through pharmacies, is essential. Definition of quantifiable vaccination targets and measures to increase vaccination rates based on these targets are required.

The research analysed real-world data on the impact of influenza among adults under 60 years old with underlying medical conditions in Germany. The key findings include:Low vaccination rates: The flu vaccination rate among adults with underlying conditions, such as asthma, diabetes, and heart disease, is low.High disease burden: This group has a significantly higher risk of severe influenza complications, experiencing notable rates of illness, hospitalization, and healthcare costs due to the flu. Given the high disease burden and low vaccine coverage, there is a need for improved public health strategies to increase flu vaccine access and uptake among this vulnerable population.These findings contribute to growing evidence supporting the importance of influenza vaccination for adults with underlying medical conditions. The insights provided can inform policymakers, healthcare providers, and public health officials working to improve vaccination rates and protect the health of these vulnerable populations.

A prospective, observational, multi-center, post-marketing safety surveillance study of the GSK combined vaccine against diphtheria, tetanus, pertussis, poliomyelitis, and Haemophilus influenzae type b invasive infections (DTaP-IPV/Hib) in South Korean infants.

In South Korea, a combined vaccine against diphtheria, tetanus, pertussis, poliomyelitis, and Haemophilus influenzae type b invasive infections (DTaP-IPV/Hib) is available since 2018 for vaccination of infants from the age of 2 months. This prospective, observational, non-comparative, post-marketing study evaluated the real-world safety of DTaP-IPV/Hib primary vaccination in eligible South Korean infants from the age of 2 months between 2018 and 2022. Infants were followed up for 30 days after each vaccine dose to assess the proportion of infants experiencing any adverse event (AE), including adverse drug reactions (ADRs), unexpected AEs, and serious AEs/serious ADRs (SAEs/SADRs). Of 660 infants vaccinated during the study period, 646 were included in the total safety cohort. A total of 194 AEs were reported in 143 (22.1%) infants; 158 AEs occurred after the first dose in 130 (20.1%) infants, 21 after the second dose in 20 (13.4%) infants, and 11 after the third dose in ten (8.1%) infants. The most frequent AEs by Medical Dictionary for Regulatory Activities Preferred Terms terminology were pyrexia (13.3%), injection site swelling (5.1%), and irritability (1.7%). Most of the AEs were mild, resolved without a medical visit, and were classified as possibly related to vaccination. The incidence proportions of ADRs, unexpected AEs, and SAEs/SADRs were 19.4%, 4.3%, and 0.9%, respectively. All SAEs/SADRs resolved after hospitalization or emergency room visit, and one event was possibly related to vaccination. These results are in line with the approved label and other national/international studies, confirming the acceptable safety profile of DTaP-IPV/Hib in the South Korean pediatric population.

In South Korea, a vaccine to help protect infants against five childhood diseases (diphtheria, tetanus, whooping cough, poliomyelitis, and Haemophilus influenzae type b invasive infections) called DTaP-IPV/Hib vaccine, has been available since 2018. As required by Korean regulation, this study aimed to confirm that DTaP-IPV/Hib was well tolerated by South Korean infants during its first 4 years of use in the country (2018­2022). This study followed 646 healthy infants aged 2­3 months who received up to three vaccine doses with 2-month intervals between doses, according to the Korean vaccination recommendations. The infants were followed for 30 days after each vaccination to evaluate how often adverse events (AEs) occurred during that period. An AE was defined as any untoward medical event after exposure to the vaccine, but not necessarily caused by that same vaccine. Overall, 194 AEs occurred during the study. On average, at least one AE was reported in 22% of infants within 30 days following vaccination. These AEs were mostly fever (body temperature >38.0°C), swelling at vaccine injection site, and irritability. A serious AE (SAE) was reported for 0.9% of infants. The infants always recovered from these SAEs after hospitalization or emergency room visit. The reported AEs are indicated in the vaccine package insert, meaning they were possibly expected to occur after vaccination. This study therefore confirms the acceptable safety profile of DTaP-IPV/Hib when given to South Korean infants in accordance with local prescribing recommendations and as part of routine childhood immunization.

Exploring COVID-19 vaccine adverse events among pregnant women: a cross-sectional study, 2022.

Background: Clear and trustworthy information is crucial to improving public acceptance of COVID-19 vaccinations, especially among pregnant women. Given the increased risk of severe viral pneumonia in pregnant women, it is critical to foster confidence in the vaccine's safety and understand any potential adverse events (AEs). So, we did this study in Jeddah, Saudi Arabia (SA), from March to May 2022 to compare women who did not get any doses of the COVID-19 vaccine during pregnancy (Group A) to women who did get at least one dose during pregnancy (Group B) regarding (1) the frequency, types, AEs, and management of its AEs of the COVID-19 vaccination; and (2) exploring pregnancy, delivery, and fetus-related complications (e.g., miscarriage, birth defects, and preterm labor). Methods: A cross-sectional study targeted 438 women who gave birth or were pregnant within the previous 8 weeks. Data was collected through face-to-face interviews with skilled nurses in 13 randomly selected primary healthcare facilities, using a validated, well-structured questionnaire that included the Centers for Disease Control (CDC) COVID-19 vaccination-related AEs. We analyzed the collected data using SPSS version 27. Results: Most participants were aged 25 to less than 35 (58.8%), and 287 (61.3%) were university graduates. There was no statistically significant difference among the studied groups regarding demographics. However, women in Group B had a significantly higher rate of abortions, oligohydramnios (24.4%), abnormal placentas (size and location), 103 (42.7%) abnormal fetal growth, 122 (53.7%) problems breastfeeding, blood pressure problems, and more cases of malaise, headaches, chest pain, breathing problems, and sleep problems than women in Group A. After the second and third doses, the confirmed post-vaccination COVID-19 rates in Group B were lower than those in Group A. Conclusion: The COVID-19 vaccine significantly reduces post-vaccination COVID-19. Although COVID-19 vaccine-related AES are prevalent, analgesics and antipyretics effectively treat most of them.

Background: Clear and trustworthy information is essential for increasing public acceptance of COVID-19 vaccinations, particularly among pregnant women who face higher risks of severe illness. This study, conducted from March to May 2022 in Jeddah, Saudi Arabia, aimed to explore issues related to COVID-19 vaccination in pregnant women. The study focused to compare those who did not receive any vaccination doses during pregnancy (Group A) and those who received at least one dose or more during pregnancy (Group B) regarding 1) the frequency, types, AEs, and management of the COVID-19 vaccination among moms; and 2) exploring pregnancy, delivery, and fetus-related complications (e.g., miscarriage, birth defects, preterm labor, etc.). Methods: We conducted the study on 438 women who had given birth within the past 8 weeks. Data were collected through face-to-face interviews with skilled nurses at 13 randomly selected primary healthcare facilities using a validated questionnaire. Results: In this study, it is observed:• Most participants were aged 25 to less than 35 years old (58.8%), and 61.3% were university graduates.• No significant demographic differences were found between groups.• The study groups showed a statistically significant difference in the occurrence of spontaneous abortions, oligohydramnios, abnormal placentas (size and location), abnormal fetal growth, blood pressure problems, breastfeeding problems, malaise, headaches, chest pain, breathing problems, and sleep problems. However, most reported AEs required only analgesics and antipyretics.• Post-vaccination COVID-19 rates were lower in vaccinated women after the second and third doses. Conclusions: The COVID-19 vaccine significantly reduces post-vaccination COVID-19. Although COVID-19 vaccine-related AES are prevalent, analgesics and antipyretics effectively treat most of them.

Prevalence and issues of COVID-19 vaccine adverse events among pregnant women.

Atypical Mumps; are We Heading Towards an Outbreak?

Mumps, caused by the mumps virus, is a contagious disease primarily affecting children and young adults. While typically presenting with salivary gland swelling and systemic symptoms, mumps can lead to various complications including SNHL, orchitis/ oophoritis, aseptic meningitis. Recent observations suggest atypical features in mumps cases, raising concerns of a potential outbreak in India. To discuss the etiopathogenesis and clinical presentation in cases of atypical mumps with increasing number of cases, a prospective multicentric study was conducted across five major centers - SMS Medical College Jaipur, RDBP Jaipuria Hospital, Jaipur, Shri Ashwini Saxena ENT Hospital Rewari, AIIMS Bhubaneswar and SP Medical College Bikaner, in India to evaluate patients with acute salivary gland swellings. Clinical and laboratory data were collected, including demographics, presenting symptoms, history of vaccination, imaging findings, and treatment outcomes. Patients were followed for four weeks post-treatment to monitor for delayed complications. Among 53 patients, a bimodal age distribution was observed, with peaks in early adolescents and middle-aged individuals. Vaccination status was recorded based on recall. Fever and salivary gland swelling were predominant symptoms, with a significant proportion experiencing submandibular gland involvement. Elevated serum amylase and CRP levels correlated with disease severity and prolonged symptomatic resolution. Notably, cases of sensorineural hearing loss (SNHL) and airway complications emerged as significant concerns. The study highlights a shift in mumps demographics, with higher age groups affected and increased incidence of complications like SNHL and airway compromise. International trends also suggest periodic outbreaks and evolving clinical manifestations post-COVID-19 pandemic. Factors contributing to mumps resurgence include lack of vaccination or vaccine efficacy, population immunity, and seasonal variations. India appears to be facing a potential mumps outbreak, characterized by atypical features and increased risk of complications like SNHL and airway compromise. Serum amylase and CRP serve as valuable markers for disease severity. Early recognition and management of complications are crucial, emphasizing the importance of mumps immunization to mitigate the impact of the disease. ENT specialists should remain vigilant for emerging complications, particularly SNHL, advocating for comprehensive immunization strategies.

Awareness and knowledge of human papillomavirus, vaccine acceptability and cervical cancer among college students in Saudi Arabia.

Human papillomavirus (HPV) is the most prevalent sexually transmitted infection among teenagers and young adults. HPV vaccination and screening are vital preventive measures to reduce the incidence of HPV-related complications, including cervical cancer. Given the rising global incidence of cervical cancer, understanding the factors influencing awareness and knowledge among young adults in Saudi Arabia is essential for developing effective prevention strategies. This study investigates the levels of awareness, knowledge, and vaccine acceptability regarding HPV and cervical cancer among college students in Saudi Arabia. A cross-sectional study was conducted between May and September 2023 among 442 students in Saudi Arabia using a structured questionnaire to assess their knowledge and awareness of HPV, HPV vaccination, and cervical cancer. Multivariate logistic regression analysis was employed to examine the associations between predictor and dependent variables. Among participants, 54.1% were aware of HPV, and 66.5% had heard of cervical cancer. However, only 17% correctly identified HPV16 and HPV18 as high-risk genotypes for cervical cancer. Awareness of the HPV vaccine was reported by 36.2% of participants, with just 10% having received the vaccine. Female students exhibited significantly higher knowledge levels than males (p = .018). The primary barrier to vaccination was identified as a lack of education and awareness (80.1%). The study highlights a significant gap in knowledge and awareness regarding HPV, its vaccine, and cervical cancer among college students in Saudi Arabia. Targeted educational programs and awareness campaigns are essential to enhance understanding and promote preventive practices, including vaccination and regular screening.

COVID-19 Disease Incidence and Severity in Previously Infected Unvaccinated Compared with Previously Uninfected Vaccinated Persons.

Using the VA COVID-19 National Database, we created matched pairs of previously uninfected vaccinated (≥2 doses of an mRNA vaccine) and previously infected unvaccinated individuals. The incidence rate (per 1000 person-days) of breakthrough infection among vaccinated individuals (0.30, 95% CI 0.29-0.32) was similar to reinfection rate among unvaccinated individuals (0.31, 95% CI 0.30-0.32; p=0.5). The incidence rate of hospitalization/death was higher after reinfection (7.31, 95% CI 6.66-8.03) compared with rate after breakthrough infection (4.69, 95% CI 4.06-5.42; P<0.0001). Conclusion: The incidence of hospitalization/death is significantly higher after reinfection among unvaccinated individuals compared with breakthrough infection after vaccination.

A systematic review of student vaccine attitudes and vaccine policy on college and university campuses, 2000-2022.

Objective: To summarize the literature 1) evaluating college student knowledge and attitudes toward vaccines and 2) examining associations between vaccine uptake and school-dependent variables. Methods: We reviewed all U.S.-based English-language primary literature published between January 1, 2000 and September 20, 2022 available online in PubMed/MEDLINE and SCOPUS databases. The initial search included studies mentioning college/university, vaccine/immunization, and one of the following terms: prevention, delivery, acceptance, uptake, or policy. Study screening, quality assessment, and data extraction were performed by author pairs using Covidence, a web-based screening and data extraction tool for conducting systematic reviews. Results: Out of 58 studies, 37 (64%) used survey methodology and 5 (9%) were randomized controlled trials. Forty studies focused on HPV vaccines. Easy access to vaccines, perceived vulnerability to disease, self-efficacy, and social norms influenced vaccine decision-making. Conclusion: While studies assessing student awareness, social norms, and message framing for vaccine uptake on campuses exist, mostly for the HPV vaccine, few have evaluated college vaccine policy.

Influenza vaccine allocation in tropical settings under constrained resources.

Influenza virus seasonality, synchronicity, and vaccine supply differ substantially between temperate and tropical settings, and optimal vaccination strategy may differ on this basis. Many national vaccine recommendations focus on high-risk groups, elderly populations, and healthcare workers despite previous analyses demonstrating broad benefits to vaccinating younger high-contact age groups. In this study, we parameterized an age-structured nonseasonal asynchronous epidemiological model of influenza virus transmission for a tropical low-income setting. We evaluated timing and age allocation of vaccines across vaccine supplies ranging from 10 to 90% using decade-based age groups. Year-round vaccination was beneficial when compared with more concentrated annual vaccine distribution. When targeting a single age group for vaccine prioritization, maximum vaccine allocation to the 10-19 high-contact age group minimized annual influenza mortality for all but one vaccine supply. When evaluating across all possible age allocations, optimal strategies always allocated a plurality of vaccines to school-age children (10-19). The converse, however, was not true as not all strategies allocating a plurality to children aged 10-19 minimized mortality. Allocating a high proportion of vaccine supply to the 10-19 age group is necessary but not sufficient to minimize annual mortality as distribution of remaining vaccine doses to other age groups also needs to be optimized. Strategies focusing on indirect benefits (vaccinating children) showed higher variance in mortality outcomes than strategies focusing on direct benefits (vaccinating the elderly). However, the indirect benefit approaches showed a lower mean mortality and a lower minimum mortality than vaccination focused on the elderly.

Unique Kinetics of the Human Milk Antibody Response to JYNNEOS Vaccine for Prevention of Monkey Pox: A Case Study.

Background: JYNNEOS is a nonreplicating modified vaccinia Ankara vaccine currently licensed to prevent monkeypox infection, and its milk immunogenicity remains unstudied. Objective: Investigate the human milk immunogenicity of the JYNNEOS vaccine in one individual and examine the milk for evidence of vaccine components. Methods: Immunogenicity of milk and plasma samples were tested by Luminex assays against Vaccinia antigens, and vaccine components were tested using PCR and sandwich ELISA. Results: Plasma antibody (Ab) response increased up to 3.7-fold in immunoglobulin G (IgG) titer and 1.4-fold in IgA compared with baseline, confirming vaccine immunogenicity in this participant 2 weeks post dose 2. Specific plasma IgG remained 1.2- to 1.7-fold above baseline 12 weeks post dose 2, while IgA returned to baseline levels. Notably, the milk response exhibited unique kinetics, particularly for IgA. Milk IgA against all three antigens increased 0.9- to 2.2-fold 2 weeks post dose 2, reaching a peak titer increase of 1.1- to 2.7-fold at 12 weeks post dose 2. Secretory (s) Ab levels increased to 1.1- to 2-fold at 2 weeks post dose 2 and reached a peak of 2- to 3.2-fold increase at the 12-week time point. Importantly, IgA and sAb responses in milk exhibited correlation, suggesting most milk IgA was sIgA. Notably, no vaccine components (VACV protein or DNA) were detected in the milk samples. Conclusion: These data suggest that the milk Ab response to this intradermal (ID) VACV-based vaccine is distinct from that observed systemically, indicating a unique mucosal immune response and highlighting its potential to elicit protective long-lasting sIgA. This case report provides strong evidence for inclusion of this vaccine platform in future studies of maternal vaccines aimed to elicit a protective milk Ab response.