Expert Review of Vaccines最新文献

Background: Live-attenuated vaccines (LAVs) are typically contraindicated for immunocompromised patients and pregnant women, although the potential benefits of vaccination with LAV in these populations should not be overlooked. This systematic literature review was conducted to evaluate the safety of LAVs in immunocompromised patients and pregnant women.

Research design and methods: The searches were conducted across PubMed, Embase, and Cochrane databases. We included studies reporting on safety outcomes of LAV use in immunocompromised patients and pregnant women. A narrative synthesis was employed to present the primary findings.

Results: A total of 96 studies were included, reporting outcomes on 18 LAVs, mostly for varicella-zoster, measles-mumps-rubella, and influenza vaccines. Comparative studies revealed minor differences in adverse events (AEs) between immunocompromised LAV recipients and placebo recipients, and between immunocompromised and healthy vaccinated individuals. Severe AEs and fatalities were infrequent, primarily noted in oncology patients in case studies. Twelve studies addressed LAV safety in pregnant women, with no instances of vertical transmission reported, and no conclusive link found between LAVs and serious AEs.

Conclusions: LAVs appeared generally safe and well-tolerated for immunocompromised patients and pregnant women. However, evidence is still limited, and more research is needed to address data gaps and support evidence-based decision-making.

Introduction: In Canada, vaccines are authorized by Health Canada but publicly funded programs are of provincial/territorial jurisdiction. Off-label (OL) use of vaccines has been frequently implemented in Quebec over the last 30 years.

Areas covered: The first part of this manuscript describes 11 recommendations from the Quebec Immunization Committee on meningococcal, pneumococcal, hepatitis A and B, HPV, rotavirus, and COVID-19 vaccines that were clearly OL. In the second part, challenges associated with OL use are discussed, including (i) the justifications of OL recommendations, (ii) the level of supporting scientific evidence, (iii) effectiveness and safety considerations, (iv) vaccine confidence and acceptability, (v) liability risks and informed consent.

Expert opinion: With one exception, OL vaccine use in Quebec was successful. Reducing the number of doses or recommending the use of two different vaccines in a single immunization regimen (one vaccine having a much lower purchase cost than the other) allowed for more cost-effective immunization programs. Another OL's justification was to increase protection, by extending the age limit or interval between doses, or allowing an interchangeability of available vaccines. OL vaccine use should always be considered when properly justified by scientific evidence and vaccinology principles, and carefully evaluated when implemented.

Objectives: The attitudes and perceptions of healthcare consumers (HCCs) are increasingly becoming more relevant in decision-making with healthcare providers and incorporated into healthcare decision-making by national immunization technical advisory groups and health technology assessment agencies. With newer pneumococcal vaccine options available, HCCs' attitudes and perceptions play a key role in gauging potential acceptance. The objective of this study was to assess HCCs' knowledge, attitudes, and perceptions toward pneumococcal vaccines for adults.

Methods: Between March and May 2024, eligible U.S. adult HCCs were invited to participate in an online survey focusing on experiences and attitudes toward vaccines.

Results: Among 141 participating HCCs, average age was 53.1 years. The majority of participants were male (51.1%) and 64.5% identified as White. Most HCCs received at least one vaccine in the past year (81.6%). HCCs most often received vaccines at medical offices and pharmacies. HCCs supported lowering the age-based pneumococcal vaccine recommendation to all adults 50 years and older and were willing to receive a supplemental pneumococcal vaccine dose following completion of the recommended series for additional protection.

Conclusions: These findings indicate that new adult pneumococcal vaccines would be accepted and valued by HCCs if recommended by HCPs.

Background: The dynamic evolution of the virus causing COVID-19 necessitates the development of adapted vaccines to protect against emerging variants.

Research design and methods: A combined Markov-decision tree model estimated the outcomes of alternative vaccination strategies. The Saudi Arabian population was stratified into standard-risk and high-risk subpopulations, defined as either the population comprising individuals aged ≥ 65 years and individuals with at least one comorbidity. The model estimated the health and economic outcomes of vaccination based on age-specific inputs taken from published sources and national surveillance data.

Results: The vaccination strategy targeting the elderly and high-risk subpopulation (was estimated to prevent 156,694 cases 12,800 hospitalizations, and 2,919 deaths and result in cost savings of SAR 1,239 million in direct costs and SAR 4,145 million in indirect costs. These gains increased with the vaccination strategies additionally targeting other subpopulations. Compared to the base case (aged ≥65 and those at high-risk), expanding vaccination coverage to 75% of the standard-risk population prevented more cases (323%), hospitalizations (154%), and deaths (60%) and increased the direct (232%) and indirect (270%) cost savings.

Conclusions: The adoption of broad vaccination strategies using a vaccine adapted to the dominant variant in circulation would yield substantial benefits in Saudi Arabia.

Introduction: The early 21st century witnessed three consecutive public health emergencies caused by Betacoronavirus infections, drawing considerable global attention to the hazards posed by Betacoronaviruses. Vaccines have proved instrumental in mitigating the coronavirus disease 2019 (COVID-19) pandemic, yet the persistent emergence of novel variants underscores the necessity for continuous development of updated vaccines tailored to circulating strains. In addition, new coronavirus outbreaks or the reemerging of previously prevalent coronaviruses may occur in the future.

Areas covered: Broad-spectrum coronavirus vaccines, especially pan-coronavirus vaccines, can serve as powerful weapons against known and unknown coronavirus risks. This article presents a comprehensive review of recent advancements in broad-spectrum coronavirus vaccine development, identifies persistent challenges, and outlines strategic directions for vaccine development. It aims to provide essential references and strategic considerations for broad-spectrum or universal coronavirus vaccines.

Expert opinion: Prioritizing Betacoronavirus-focused vaccines may provide practical near-term solutions, while long-term success hinges on integrating AI and structural biology for precision engineering. Future efforts must emphasize durable immunity, mucosal strategies, and adaptability to viral diversity. Collaboration across computational, immunological, and virological fields will be essential to achieve universal coronavirus protection.

Background: Respiratory infections such as pneumococcal disease (PD), RSV, influenza (flu), and COVID-19 impose a major socio-economic burden in the UK. Adult vaccination programs cost-effectively reduce this burden, yet their societal value remains under-assessed.

Methods: A benefit-cost analysis (BCA) using life-table-based disease modeling estimated morbidity and mortality reductions from current age- and risk-based recommendations. Mortality risk reduction was monetized using two approaches: value of a statistical life year (VSLY) and hence adjusting for remaining life expectancy, and value of a statistical life (VSL), assuming equal valuation across ages. Scenarios included current and expanded eligibility. Outcomes were reported as benefit-cost ratios (BCRs) and net benefits (NBs).

Results: Over each cohort's lifetime, vaccinations prevented 313,000 hospitalizations, freed up 1.9 million bed days, and averted over 86,000 deaths. First-year BCRs were 5.1 (VSLY) and 19.3 (VSL), with NBs of £5.1 billion and £23 billion, respectively. Lifetime net benefits ranged from £35.5 billion to £200.1 billion, with BCRs of 5.8 and 27.8. Expanded eligibility further increased NBs but lowered the BCR.

Conclusion: Adult respiratory vaccination delivers socio-economic benefits well beyond direct health-care savings, yet investment remains low. Considering broader impacts beyond standard cost-effectiveness can better align policy with public health and economic goals.

Introduction: Cancer vaccine immunotherapy has shifted from traditional cytotoxic treatments toward strategies aimed at enhancing anti-tumor immunity, offering new therapeutic possibilities. Montanide ISA-51, a water-in-oil (W/O) emulsion, has shown considerable promise as an adjuvant in cancer vaccines.

Areas covered: This review examines the current applications of Montanide ISA-51 in cancer vaccines, explores its immunoregulatory mechanisms, highlights the challenges in its use as a vaccine adjuvant, and proposes avenues for future optimization.

Expert opinion: Montanide ISA-51 enhances anti-tumor immune responses by improving antigen release and facilitating immune cell aggregation and activation, thereby boosting the effectiveness of vaccines against melanoma, glioma, and HPV-related cancers. When combined with TLR agonists or other immunomodulatory agents, Montanide ISA-51 further amplifies the immune response. However, despite its potential, the precise mechanisms underlying its effects in the complex immune environment remain to be fully understood. These insights will accelerate the translation of Montanide ISA-51 into clinical use as an adjuvant for cancer vaccines.

Background: Vaccines are one of the most effective healthcare tools to prevent morbidity and mortality from infectious diseases.

Research design and methods: A decision tree model was used to evaluate the public health and economic impact of the Greek pediatric national immunization program (NIP) over the lifetime of the 2022 Greek birth cohort. The model included nine Greek NIP routine vaccines for children aged 2 months to 11 years, targeting 14 vaccine-preventable diseases: diphtheria, hepatitis A, hepatitis B, Haemophilus influenzae type B, measles, meningococcal disease, mumps, pertussis, pneumococcal disease, poliomyelitis, rotavirus, rubella, tetanus, and varicella. The outcomes (discounted 3% annually) included estimated disease cases and deaths averted, life-years (LYs) and quality-adjusted life-years (QALYs) gained, total costs averted (2022 euros), and benefit-cost ratios (BCR) from healthcare-sector and societal perspectives.

Results: The Greek pediatric NIP prevented 447,221 disease cases and 242 deaths, resulting in 6,682 LYs and 9,741 total QALYs gained for the 2022 birth cohort. Costs averted were €23.2 million (BCR = 1.3) from the healthcare-sector perspective; costs averted from the societal perspective were €201.4 million (BCR = 3.1), plus €514.0 million in value of QALYs gained (BCR = 8.5).

Conclusion: The Greek pediatric NIP provides extensive public health and economic benefits for Greece by reducing morbidity and mortality from vaccine-preventable diseases.