Expert Review of Vaccines最新文献

Introduction: Despite extensive efforts, global influenza vaccination rates remain suboptimal, particularly among high-risk populations.

Research design and methods: We conducted a comprehensive literature search up to April 2023. Experimental studies assessing the effectiveness of interventions on influenza vaccination uptake were included, expressed as risk ratios (RR) with 95% confidence intervals (CI). Random-effects meta-analysis models were utilized for pooled estimates, with heterogeneity assessed through I². Subgroup analyses and meta-regressions were performed.

Results: This meta-analysis includes 180 studies involving 2,390,119 participants and comprehensively evaluates the effectiveness of recipient-, provider-, health system-based, and multitarget interventions. Overall, interventions significantly increased vaccination rates, with a pooled RR of 1.26 (95% CI, 1.21 to 1.32). Notably, provider-based interventions were more effective for healthcare workers (RR = 1.56; 95% CI, 1.46 to 1.66), whereas recipient-based interventions were more efficacious for pregnant women (RR = 1.42; 95% CI, 1.09 to 1.85). Multitarget strategies were the most effective among older adults (RR = 2.10; 95% CI, 1.61 to 2.72) and population under age of 18 (RR = 1.53; 95% CI, 1.23 to 1.90).

Conclusions: These findings provide critical insights for optimizing public health strategies, underscoring the need for innovative and tailored approaches to enhance global vaccination uptake.

Introduction: Fifty-eight million people worldwide are chronically infected with hepatitis C virus (HCV) and are at risk of developing cirrhosis and hepatocellular carcinoma (HCC). Direct-acting antivirals are highly effective; however, they are burdened by high costs and the unchanged risk of HCC and reinfection, making prophylactic countermeasures an urgent medical need. HCV high genetic diversity is one of the main obstacles to vaccine development. The protective role of the humoral response directed against the HCV E2 glycoprotein is well established, and broadly neutralizing antibodies play a crucial role in effective viral clearance.

Areas covered: This review explores the HCV targets and the different vaccination approaches, encompassing different expression systems, antigen selection strategies, and delivery methods, focusing on those aimed at eliciting a broad and effective humoral response. Our search criteria included the keywords 'HCV,' 'Hepatitis C,' and 'vaccine' using publicly available databases. Following the screening, 54 papers were selected.

Expert opinion: The investigation of novel vaccine platforms beyond traditional approaches is necessary. While progress has been made in this direction, continued investigations on the HCV virology, immunology, and vaccinology are essential to surmount associated obstacles, heling in the development of an HCV vaccine that can benefit the global public health.

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: In the U.S.A. three prophylactic interventions are approved for the prevention of respiratory syncytial virus (RSV) lower respiratory tract disease (LRTD) in infants: nirsevimab and clesrovimab (extended half-life monoclonal antibodies) and the maternal RSVpreF vaccine. We compared the impact of these interventions on RSV-LRTD events and costs versus the previous standard-of-practice (SoP; palivizumab-only strategy).

Research design and methods: Using a static decision-analytic model, we estimated the public health impact of nirsevimab, clesrovimab, and RSVpreF following the latest recommendations on RSV-related outcomes and costs in a US birth cohort during their first RSV season compared to the pre-2023 SoP.

Results: The model estimated that nirsevimab would avert 364,204 RSV-LRTDs including 32,404 hospitalizations, saving $1,289 million in direct and indirect costs. Depending on the assumed duration of protection, clesrovimab was estimated to avert 173,276-261,358 RSV-LRTDs of which 23,957-30,483 were hospitalizations, resulting in savings of $912-$1,150 million in total costs. RSVpreF maternal vaccination would avert 76,915 RSV-LRTDs including 9,649 hospitalizations, equating to $345 million in total cost savings.

Conclusions: While all three interventions are estimated to reduce RSV-LRTD burden in infants, all-infant protection with nirsevimab was estimated to avert more events and associated medical costs for all infant subgroups compared to clesrovimab or RSVpreF.

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.