Pub Date : 2025-10-13DOI: 10.1016/j.jvacx.2025.100736
Kevin E. Tololiu , Arie A. Kurnianto , Wirda Y. Dulahu , Ferenc Kocsor , Krisztina Csokasi
Background
Despite the effectiveness of vaccination in decreasing the mortality rate, pain related to needle procedures contribute to the children's incompliance vaccination uptake. Digital technology, as a widely used distracting tool, requires investigation for its efficacy and consistency. This study aims to see and compare the effectiveness of each digital intervention in reducing pain in children's vaccination.
Method
A systematic review and meta-analysis were conducted from five databases: Cochrane Library, APAPsychNet, Embase, EBSCO, and PubMed from June to September 2024. Two group trials using any digital intervention to reduce children's vaccination pain were included. A classical meta-analysis using random effects was applied to measure the effect size of pain level between intervention and control for overall and per category of digital interventions.
Result
11 of 1665 records were analysed. Digital intervention showed an overall pain education during vaccination (SMD = −0.54, 95 % CI: −1.06, −0.02, I2 = 92.2 %, P = 0.04). All groups, including robots and mobile/computer technologies, showed more pain reduction than the control group. However, only virtual reality studies showed a statistically significant difference (SMD = −0.74, 95 % CI: −1.41, −0.08, I2 = 88.4 %, P = 0.03).
Conclusion
Digital interventions have enormous potential in reducing needle-related pain. While virtual reality has a prominent effect due to its immersive nature, robots have viable efficacy by considering the interaction and realistic presentation. Mobile technologies' flexibility enables customization to children's needs and synergy with combined interventions.
{"title":"A meta-analysis of digital interventions to reduce vaccination-related pain in children","authors":"Kevin E. Tololiu , Arie A. Kurnianto , Wirda Y. Dulahu , Ferenc Kocsor , Krisztina Csokasi","doi":"10.1016/j.jvacx.2025.100736","DOIUrl":"10.1016/j.jvacx.2025.100736","url":null,"abstract":"<div><h3>Background</h3><div>Despite the effectiveness of vaccination in decreasing the mortality rate, pain related to needle procedures contribute to the children's incompliance vaccination uptake. Digital technology, as a widely used distracting tool, requires investigation for its efficacy and consistency. This study aims to see and compare the effectiveness of each digital intervention in reducing pain in children's vaccination.</div></div><div><h3>Method</h3><div>A systematic review and meta-analysis were conducted from five databases: Cochrane Library, APAPsychNet, Embase, EBSCO, and PubMed from June to September 2024. Two group trials using any digital intervention to reduce children's vaccination pain were included. A classical meta-analysis using random effects was applied to measure the effect size of pain level between intervention and control for overall and per category of digital interventions.</div></div><div><h3>Result</h3><div>11 of 1665 records were analysed. Digital intervention showed an overall pain education during vaccination (SMD = −0.54, 95 % CI: −1.06, −0.02, I<sup>2</sup> = 92.2 %, <em>P</em> = 0.04). All groups, including robots and mobile/computer technologies, showed more pain reduction than the control group. However, only virtual reality studies showed a statistically significant difference (SMD = −0.74, 95 % CI: −1.41, −0.08, I<sup>2</sup> = 88.4 %, <em>P</em> = 0.03).</div></div><div><h3>Conclusion</h3><div>Digital interventions have enormous potential in reducing needle-related pain. While virtual reality has a prominent effect due to its immersive nature, robots have viable efficacy by considering the interaction and realistic presentation. Mobile technologies' flexibility enables customization to children's needs and synergy with combined interventions.</div></div>","PeriodicalId":43021,"journal":{"name":"Vaccine: X","volume":"27 ","pages":"Article 100736"},"PeriodicalIF":2.2,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145325795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Vaccine hesitancy, amplified by digital misinformation, represents a growing threat to global health. This case demonstrates its lethal consequences through rapid-onset subacute sclerosing panencephalitis (SSPE) in an unvaccinated 3.5-year-old girl whose parents refused measles-mumps-rubella (MMR) vaccination due to pandemic-amplified misinformation. A developmentally normal preschooler, vaccinated only at birth (BCG, oral polio vaccine, and hepatitis B vaccine), presented with head-drop seizures progressing to myoclonus and speech loss within weeks. Comprehensive diagnostic workup confirmed SSPE through fulfillment of Dyken's criteria, including characteristic clinical presentation, elevated measles-specific IgG in both CSF (titer 1:256 by ELISA) and serum (titer 1:128) with elevated CSF/serum antibody index (1.8), periodic complexes on EEG, symmetric white matter lesions on MRI, and exclusion of alternative infectious/autoimmune etiologies. Despite immunomodulatory therapy (intravenous immunoglobulins and ribavirin), she progressed to vegetative state by week 12, expiring at 4 months post-onset. Parental refusal of both vaccination and life-saving interventions reflected profound medical mistrust. Neuroimaging revealed rapid progression to diffuse atrophy within 6 weeks. MR spectroscopy showed marked reduction in N-acetylaspartate (NAA) and elevated lactate. This progression from symptom onset to death in 4 months represents one of the most rapid SSPE courses documented, highlighting the vulnerability of unvaccinated children and demonstrating how digital misinformation enables preventable tragedies. The case demands: (1) nuanced strategies to combat health misinformation, (2) heightened vigilance for fulminant SSPE in unvaccinated children, and (3) urgent reinforcement of measles vaccination programs. When vaccination rates decline, children become the tragic casualties of misinformation.
{"title":"Fatal measles complication in the misinformation era: A case of catastrophically rapid SSPE in an unvaccinated child","authors":"Ali Manafi Anari , Ladan Teymoorzadeh , Ramez Nasiri , Sajjad Narimani","doi":"10.1016/j.jvacx.2025.100733","DOIUrl":"10.1016/j.jvacx.2025.100733","url":null,"abstract":"<div><div>Vaccine hesitancy, amplified by digital misinformation, represents a growing threat to global health. This case demonstrates its lethal consequences through rapid-onset subacute sclerosing panencephalitis (SSPE) in an unvaccinated 3.5-year-old girl whose parents refused measles-mumps-rubella (MMR) vaccination due to pandemic-amplified misinformation. A developmentally normal preschooler, vaccinated only at birth (BCG, oral polio vaccine, and hepatitis B vaccine), presented with head-drop seizures progressing to myoclonus and speech loss within weeks. Comprehensive diagnostic workup confirmed SSPE through fulfillment of Dyken's criteria, including characteristic clinical presentation, elevated measles-specific IgG in both CSF (titer 1:256 by ELISA) and serum (titer 1:128) with elevated CSF/serum antibody index (1.8), periodic complexes on EEG, symmetric white matter lesions on MRI, and exclusion of alternative infectious/autoimmune etiologies. Despite immunomodulatory therapy (intravenous immunoglobulins and ribavirin), she progressed to vegetative state by week 12, expiring at 4 months post-onset. Parental refusal of both vaccination and life-saving interventions reflected profound medical mistrust. Neuroimaging revealed rapid progression to diffuse atrophy within 6 weeks. MR spectroscopy showed marked reduction in <em>N</em>-acetylaspartate (NAA) and elevated lactate. This progression from symptom onset to death in 4 months represents one of the most rapid SSPE courses documented, highlighting the vulnerability of unvaccinated children and demonstrating how digital misinformation enables preventable tragedies. The case demands: (1) nuanced strategies to combat health misinformation, (2) heightened vigilance for fulminant SSPE in unvaccinated children, and (3) urgent reinforcement of measles vaccination programs. When vaccination rates decline, children become the tragic casualties of misinformation.</div></div>","PeriodicalId":43021,"journal":{"name":"Vaccine: X","volume":"27 ","pages":"Article 100733"},"PeriodicalIF":2.2,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145268223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-29DOI: 10.1016/j.jvacx.2025.100735
Xiaoyi Fu
Vaccines have emerged as a prominent strategy for the prevention and treatment of diseases. Adjuvants, as immune enhancers and delivery systems, play a crucial role in improving the efficiency and effectiveness of vaccines. Adjuvants can be categorized into three groups based on their mechanisms: immune enhancers, delivery systems, and a combination of both. While aluminum salt-based adjuvants have been the long-standing choice for many commercial vaccines, the adjuvant landscape in FDA-approved vaccines has evolved. Emulsions, liposomes, virus-like particles (VLPs), and newer platforms have been integrated into specialized vaccine formulations. In the context of modern vaccine platforms, the need for optimized adjuvant-delivery systems is increasing. For messenger RNA (mRNA) vaccines, lipid nanoparticles (LNPs) serve as efficient delivery vehicles, enhancing mRNA stability and cellular uptake. Additionally, LNPs can also function as immune-activating adjuvants, which further enhance the immune response. Similarly, viral vector vaccines leverage adjuvants that improve immune activation, while DNA vaccines benefit from adjuvants that promote both antigen stability and uptake. Emerging systems, such as bacterial outer membrane vesicles (OMVs), programmable nanoparticles (responsive to pH, enzymes, or light), and cell membrane-coated systems (e.g., red blood cell or macrophage membranes), offer advanced ways to enhance vaccine delivery and immune responses. These systems also enable better targeting and control of immune activation, addressing challenges in immune memory and long-lasting vaccine efficacy. However, the development of adjuvant systems also faces safety concerns, including the potential for excessive immune activation and toxicity in certain populations. Overall, this review discusses the current and evolving landscape of adjuvant-delivery systems for vaccines, with an emphasis on systems that support diverse vaccine platforms and optimize immune balance, biocompatibility, and long-term immunity, crucial for the success of future vaccine development.
{"title":"Current landscape and challenges in adjuvant and antigen delivery systems for vaccine","authors":"Xiaoyi Fu","doi":"10.1016/j.jvacx.2025.100735","DOIUrl":"10.1016/j.jvacx.2025.100735","url":null,"abstract":"<div><div>Vaccines have emerged as a prominent strategy for the prevention and treatment of diseases. Adjuvants, as immune enhancers and delivery systems, play a crucial role in improving the efficiency and effectiveness of vaccines. Adjuvants can be categorized into three groups based on their mechanisms: immune enhancers, delivery systems, and a combination of both. While aluminum salt-based adjuvants have been the long-standing choice for many commercial vaccines, the adjuvant landscape in FDA-approved vaccines has evolved. Emulsions, liposomes, virus-like particles (VLPs), and newer platforms have been integrated into specialized vaccine formulations. In the context of modern vaccine platforms, the need for optimized adjuvant-delivery systems is increasing. For messenger RNA (mRNA) vaccines, lipid nanoparticles (LNPs) serve as efficient delivery vehicles, enhancing mRNA stability and cellular uptake. Additionally, LNPs can also function as immune-activating adjuvants, which further enhance the immune response. Similarly, viral vector vaccines leverage adjuvants that improve immune activation, while DNA vaccines benefit from adjuvants that promote both antigen stability and uptake. Emerging systems, such as bacterial outer membrane vesicles (OMVs), programmable nanoparticles (responsive to pH, enzymes, or light), and cell membrane-coated systems (e.g., red blood cell or macrophage membranes), offer advanced ways to enhance vaccine delivery and immune responses. These systems also enable better targeting and control of immune activation, addressing challenges in immune memory and long-lasting vaccine efficacy. However, the development of adjuvant systems also faces safety concerns, including the potential for excessive immune activation and toxicity in certain populations. Overall, this review discusses the current and evolving landscape of adjuvant-delivery systems for vaccines, with an emphasis on systems that support diverse vaccine platforms and optimize immune balance, biocompatibility, and long-term immunity, crucial for the success of future vaccine development.</div></div>","PeriodicalId":43021,"journal":{"name":"Vaccine: X","volume":"27 ","pages":"Article 100735"},"PeriodicalIF":2.2,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145221120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-25DOI: 10.1016/j.jvacx.2025.100731
Yongping Xie, Xin Cong, Yan Li, Lisu Huang
Respiratory syncytial virus (RSV) is a leading cause of acute lower respiratory tract infections in children under 5 years of age worldwide. Currently, there are no approved curative treatments, and clinical management remains primarily focused on symptomatic support. As a result, preventive strategies are crucial for controlling RSV infections. Recent advancements have been made in the development of monoclonal antibody therapies aimed at protecting infants and young children from RSV. This review explores the application and real-world outcomes of passive immunization strategies in various international settings, particularly in developed countries, with a focus on their effectiveness and safety. The findings are intended to offer insights into the potential use of RSV passive immunization agents in developing countries.
{"title":"Real-world data and clinical management experience in passive immunization for respiratory syncytial virus prevention in children","authors":"Yongping Xie, Xin Cong, Yan Li, Lisu Huang","doi":"10.1016/j.jvacx.2025.100731","DOIUrl":"10.1016/j.jvacx.2025.100731","url":null,"abstract":"<div><div>Respiratory syncytial virus (RSV) is a leading cause of acute lower respiratory tract infections in children under 5 years of age worldwide. Currently, there are no approved curative treatments, and clinical management remains primarily focused on symptomatic support. As a result, preventive strategies are crucial for controlling RSV infections. Recent advancements have been made in the development of monoclonal antibody therapies aimed at protecting infants and young children from RSV. This review explores the application and real-world outcomes of passive immunization strategies in various international settings, particularly in developed countries, with a focus on their effectiveness and safety. The findings are intended to offer insights into the potential use of RSV passive immunization agents in developing countries.</div></div>","PeriodicalId":43021,"journal":{"name":"Vaccine: X","volume":"27 ","pages":"Article 100731"},"PeriodicalIF":2.2,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145221121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Invasive pneumococcal disease (IPD) persists despite the effectiveness of 7-valent and 13-valent pneumococcal conjugate vaccines (PCV). As the protection offered by different dosing regimens remains uncertain, we evaluated the vaccine effectiveness (VE) against vaccine-type (VT) IPD in children based on the number of vaccine doses.
Methods
We searched MEDLINE/Embase/Web of Science/CENTRAL databases from January 2000 to December 2024 for studies on PCV7 and/or PCV13 VE against VT-IPD in children ≤18 years. VE estimates were recorded by vaccination status at IPD onset, classified into four groups (1) primary + booster group (1–3 primary doses <12 months of age plus 1 booster dose ≥12 months), (2) 1 primary dose group, (3) 2 primary doses group, and (4) 3 primary doses group (primary doses given <12 months of age and no booster).
Results
From 1982 studies, 25 studies were included, reporting 525 cases in the primary + booster group and 821 cases in the 1–3 primary dose(s) groups. Pooled VE from 14 studies was 94.4 % for the primary + booster group, and 66.8 %, 78.8 %, and 82.0 % for the 1-, 2-, and 3- primary dose(s) groups, respectively. Among VT-IPD breakthrough cases, serotype 19A was most common (27.9 %), followed by 19F (20.5 %) and 3 (18.9 %). Sensitivity analyses showed a VE of ∼95 % for the 2 + 1 and 3 + 1 schedules, versus 78.9 % for 3 + 0.
Conclusions
Our findings strongly support schedules that include a booster dose, such as the 2 + 1 regimen, as an optimal strategy for preventing VT-IPD in children.
{"title":"Effectiveness of vaccine dosing schedules for pneumococcal invasive disease in children: A systematic review and meta-analysis","authors":"Chia-Yuan Chang , Sharifa Nasreen , Manish Sadarangani , Kenny Aquino , Jacquelyn J. Cragg , Fawziah Marra","doi":"10.1016/j.jvacx.2025.100734","DOIUrl":"10.1016/j.jvacx.2025.100734","url":null,"abstract":"<div><h3>Objectives</h3><div>Invasive pneumococcal disease (IPD) persists despite the effectiveness of 7-valent and 13-valent pneumococcal conjugate vaccines (PCV). As the protection offered by different dosing regimens remains uncertain, we evaluated the vaccine effectiveness (VE) against vaccine-type (VT) IPD in children based on the number of vaccine doses.</div></div><div><h3>Methods</h3><div>We searched MEDLINE/Embase/Web of Science/CENTRAL databases from January 2000 to December 2024 for studies on PCV7 and/or PCV13 VE against VT-IPD in children ≤18 years. VE estimates were recorded by vaccination status at IPD onset, classified into four groups (1) primary + booster group (1–3 primary doses <12 months of age plus 1 booster dose ≥12 months), (2) 1 primary dose group, (3) 2 primary doses group, and (4) 3 primary doses group (primary doses given <12 months of age and no booster).</div></div><div><h3>Results</h3><div>From 1982 studies, 25 studies were included, reporting 525 cases in the primary + booster group and 821 cases in the 1–3 primary dose(s) groups. Pooled VE from 14 studies was 94.4 % for the primary + booster group, and 66.8 %, 78.8 %, and 82.0 % for the 1-, 2-, and 3- primary dose(s) groups, respectively. Among VT-IPD breakthrough cases, serotype 19A was most common (27.9 %), followed by 19F (20.5 %) and 3 (18.9 %). Sensitivity analyses showed a VE of ∼95 % for the 2 + 1 and 3 + 1 schedules, versus 78.9 % for 3 + 0.</div></div><div><h3>Conclusions</h3><div>Our findings strongly support schedules that include a booster dose, such as the 2 + 1 regimen, as an optimal strategy for preventing VT-IPD in children.</div></div>","PeriodicalId":43021,"journal":{"name":"Vaccine: X","volume":"27 ","pages":"Article 100734"},"PeriodicalIF":2.2,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145159113","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-19DOI: 10.1016/j.jvacx.2025.100732
Wenming Wei , Chongyang Wu , Xi Wang , Xinyue Cui , Yuanzi Huo , Xinyu Li , Yuexia Liang , Bo Ma , Shuyuan Pan , Song Gao
Pertussis toxin (PTx) is a key virulence factor of the organism Bordetella pertussis, which must undergo proper detoxification as a component of acellular pertussis vaccines. Chemical detoxification using glutaraldehyde causes significant changes to the toxin surface, reducing its toxicity and potentially affecting its antigen properties. Although previous studies have thoroughly investigated the toxicity of chemically detoxified PT toxoid (PTd), there is limited understanding regarding how detoxification influences its antigenic properties and immunogenicity. Moreover, the specific parameters—such as glutaraldehyde concentration and buffer pH—and their effects on toxicity and immunogenicity are poorly defined. This study began by examining the influence of these parameters on the structural profiles of PTd. Subsequently, the toxicity and antigenic properties of PTd were characterized in vitro. Next, neutralizing epitopes remaining on PTd were quantified to assess the antigenicity. Finally, the immunogenicity of acellular pertussis vaccine candidates containing PTd was further evaluated in vivo. We found that the glutaraldehyde treatment caused more dramatic structural changes in B oligomer than A protomer of PTx, independent of variance in glutaraldehyde concentration and buffer pH. As a result, residual toxicity was reduced, and antigenic properties were altered. Following this, changes in antigenic properties were proved to be related to compromised immunogenicity. This study demonstrates that glutaraldehyde modulates the two functional domains of PTx, affecting both its toxicity and immunogenicity; two factors-glutaraldehyde concentration and buffer pH reduce the biochemical activities by bias influencing A protomer and B-oligomer. This work also underscores the importance of maintaining a delicate balance between immunogenicity and toxicity in detoxification.
{"title":"Glutaraldehyde modifies the catalytic and binding subunits of pertussis toxin, affecting its toxicity and immunogenicity","authors":"Wenming Wei , Chongyang Wu , Xi Wang , Xinyue Cui , Yuanzi Huo , Xinyu Li , Yuexia Liang , Bo Ma , Shuyuan Pan , Song Gao","doi":"10.1016/j.jvacx.2025.100732","DOIUrl":"10.1016/j.jvacx.2025.100732","url":null,"abstract":"<div><div>Pertussis toxin (PTx) is a key virulence factor of the organism <em>Bordetella pertussis</em>, which must undergo proper detoxification as a component of acellular pertussis vaccines. Chemical detoxification using glutaraldehyde causes significant changes to the toxin surface, reducing its toxicity and potentially affecting its antigen properties. Although previous studies have thoroughly investigated the toxicity of chemically detoxified PT toxoid (PTd), there is limited understanding regarding how detoxification influences its antigenic properties and immunogenicity. Moreover, the specific parameters—such as glutaraldehyde concentration and buffer pH—and their effects on toxicity and immunogenicity are poorly defined. This study began by examining the influence of these parameters on the structural profiles of PTd. Subsequently, the toxicity and antigenic properties of PTd were characterized in vitro. Next, neutralizing epitopes remaining on PTd were quantified to assess the antigenicity. Finally, the immunogenicity of acellular pertussis vaccine candidates containing PTd was further evaluated in vivo. We found that the glutaraldehyde treatment caused more dramatic structural changes in B oligomer than A protomer of PTx, independent of variance in glutaraldehyde concentration and buffer pH. As a result, residual toxicity was reduced, and antigenic properties were altered. Following this, changes in antigenic properties were proved to be related to compromised immunogenicity. This study demonstrates that glutaraldehyde modulates the two functional domains of PTx, affecting both its toxicity and immunogenicity; two factors-glutaraldehyde concentration and buffer pH reduce the biochemical activities by bias influencing A protomer and B-oligomer. This work also underscores the importance of maintaining a delicate balance between immunogenicity and toxicity in detoxification.</div></div>","PeriodicalId":43021,"journal":{"name":"Vaccine: X","volume":"27 ","pages":"Article 100732"},"PeriodicalIF":2.2,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145118943","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-19DOI: 10.1016/j.jvacx.2025.100728
Katia Alves , Karen Kotloff , R. Scott McClelland , E. Adrianne Hammershaimb , Alex Kouassi , Joyce S. Plested , Raj Kalkeri , Mingzhu Zhu , Shane Cloney-Clark , Zhaohui Cai , Katherine Smith , Muneer Kaba , Joy Nelson , Raburn M. Mallory , Fernando Noriega , on behalf of the 2019nCoV-313 Study Investigators
Background
Seasonal (2023–2024) COVID-19 vaccine recommendations included updates against Omicron XBB.1.5. NVX-CoV2601 contains XBB.1.5 recombinant spike (rS) protein, Matrix-M® adjuvant, and is based on authorized prototype vaccine (NVX-CoV2373) technology. Immunogenicity and safety outcomes 6 months after vaccination following a single dose of monovalent NVX-CoV2601 in previously vaccinated and vaccine-naive, SARS-CoV-2–seropositive participants aged ≥18 years are reported here.
Methods
The phase 2/3 open-label, single-arm 2019nCoV-313 study consisted of two parts (part 1: participants with ≥3 prior mRNA vaccines; part 2: unvaccinated participants with a clinical history of COVID-19). Participants received a single dose of NVX-CoV2601. Primary endpoint analyses through day 28 were previously published. This final analysis assessed immunogenicity and safety through the end of the study (day 180). Immunogenicity data (e.g., neutralizing antibodies [nAbs] and anti-rS IgG antibodies) were summarized using geometric mean antibody levels and fold rise and seroresponse rate (SRR).
Results
The safety analysis set included 332 participants in part 1 and 338 participants in part 2. In previously vaccinated participants, nAb geometric mean titers (GMTs; 95% CIs) were 120.7 (101.5–143.6) at day 0, increased to 955.5 (814.0–1121.4) at day 28, and decreased to 454.8 (382.9–540.3) at day 180. SRR decreased from 64.3% at day 28 to 41.1% at day 180. Similar results were seen in vaccine-naive, SARS-CoV-2–seropositive participants, with GMTs of 67.0 (56.6–79.3), 1296.7 (1082.6–1553.2), and 303.6 (258.5–356.4) at day 0, 28, and 180, respectively. SRR waned from 74.3% at day 28 to 45.0% at day 180. Anti-rS IgG responses similarly increased at day 28 and had moderate decreases at day 180 in both groups. No new safety signals were reported.
Conclusions
A single dose of NVX-CoV2601 showed robust, durable immunogenicity in adult participants from study 2019nCoV-313 parts 1 and 2. These data support the use of NVX-CoV2601 in both populations.
{"title":"Phase 2/3 open-label study on NVX-CoV-2601 (XBB.1.5) vaccine in previously COVID-19 mRNA vaccinated and vaccine-naive, SARS-CoV-2–seropositive participants: A 6-month follow-up","authors":"Katia Alves , Karen Kotloff , R. Scott McClelland , E. Adrianne Hammershaimb , Alex Kouassi , Joyce S. Plested , Raj Kalkeri , Mingzhu Zhu , Shane Cloney-Clark , Zhaohui Cai , Katherine Smith , Muneer Kaba , Joy Nelson , Raburn M. Mallory , Fernando Noriega , on behalf of the 2019nCoV-313 Study Investigators","doi":"10.1016/j.jvacx.2025.100728","DOIUrl":"10.1016/j.jvacx.2025.100728","url":null,"abstract":"<div><h3>Background</h3><div>Seasonal (2023–2024) COVID-19 vaccine recommendations included updates against Omicron XBB.1.5. NVX-CoV2601 contains XBB.1.5 recombinant spike (rS) protein, Matrix-M® adjuvant, and is based on authorized prototype vaccine (NVX-CoV2373) technology. Immunogenicity and safety outcomes 6 months after vaccination following a single dose of monovalent NVX-CoV2601 in previously vaccinated and vaccine-naive, SARS-CoV-2–seropositive participants aged ≥18 years are reported here.</div></div><div><h3>Methods</h3><div>The phase 2/3 open-label, single-arm 2019nCoV-313 study consisted of two parts (part 1: participants with ≥3 prior mRNA vaccines; part 2: unvaccinated participants with a clinical history of COVID-19). Participants received a single dose of NVX-CoV2601. Primary endpoint analyses through day 28 were previously published. This final analysis assessed immunogenicity and safety through the end of the study (day 180). Immunogenicity data (e.g., neutralizing antibodies [nAbs] and anti-rS IgG antibodies) were summarized using geometric mean antibody levels and fold rise and seroresponse rate (SRR).</div></div><div><h3>Results</h3><div>The safety analysis set included 332 participants in part 1 and 338 participants in part 2. In previously vaccinated participants, nAb geometric mean titers (GMTs; 95% CIs) were 120.7 (101.5–143.6) at day 0, increased to 955.5 (814.0–1121.4) at day 28, and decreased to 454.8 (382.9–540.3) at day 180. SRR decreased from 64.3% at day 28 to 41.1% at day 180. Similar results were seen in vaccine-naive, SARS-CoV-2–seropositive participants, with GMTs of 67.0 (56.6–79.3), 1296.7 (1082.6–1553.2), and 303.6 (258.5–356.4) at day 0, 28, and 180, respectively. SRR waned from 74.3% at day 28 to 45.0% at day 180. Anti-rS IgG responses similarly increased at day 28 and had moderate decreases at day 180 in both groups. No new safety signals were reported.</div></div><div><h3>Conclusions</h3><div>A single dose of NVX-CoV2601 showed robust, durable immunogenicity in adult participants from study 2019nCoV-313 parts 1 and 2. These data support the use of NVX-CoV2601 in both populations.</div><div><em>Trial registration:</em> <span><span>NCT05975060</span><svg><path></path></svg></span></div></div>","PeriodicalId":43021,"journal":{"name":"Vaccine: X","volume":"27 ","pages":"Article 100728"},"PeriodicalIF":2.2,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145110002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-18DOI: 10.1016/j.jvacx.2025.100729
Mohammed Mohammed Manga , Adeola Fowotade , Zara Isah Modibbo , Mashudu Madhivhandila , Tidiane Ndao , Olufemi Abayomi , Yahaya Mohammed
Background
Human papilloma virus (HPV) is a significant contributor to various cancers, notably cervical cancer, which poses a major health challenge in sub-Saharan Africa (SSA), including Nigeria. Despite the availability and effectiveness of HPV vaccines, many SSA countries have yet to reach the World Health Organization's vaccination goals. Nigeria introduced the HPV vaccine for girls (9–14 years) as part of the national immunization program in October 2023. This was heralded with certain misconceptions among both healthcare workers and the general populace. This study aimed to identify and rank these misconceptions via the modified Delphi technique to increase HPV vaccination coverage in Nigeria.
Objectives
The primary objective of this study was to identify and rank predominant HPV vaccine misconceptions in Nigeria, summarize the stability of expert judgments across rounds and to translate the prioritized list into communication and training recommendations.
Methods
We conducted desk review, expert validation and a two-round modified Delphi with immunization stakeholders from across Nigeria's 36 states and the Federal Capital Territory. Thirteen candidate misconceptions were generated from desk review and validation meetings, then rated on a five-point Likert “criticality” scale reflecting perceived prevalence, barrier importance, and likely impact on uptake if unaddressed. Descriptive statistics summarized item rankings and round-to-round changes; a paired t-test assessed aggregate stability.
Results
Forty-nine panelists completed both rounds. Rank order at the top was stable: the infertility/population-control misconception consistently ranked first, followed by the belief that vaccination promotes adolescent promiscuity, safety/“Western conspiracy” and “unknown long-term side-effects” clustered next. Aggregate ratings did not change significantly between rounds (paired t-test t (8) = 0.39, p = 0.71).
Conclusion
The stability of ratings between rounds indicate that observed differences were compatible with random variation rather than systematic shifts in opinion. A decision-ready prioritization of HPV vaccine misconceptions highlights a set of high-level misconceptions, like infertility, promiscuity, and safety/conspiracy narratives that should anchor first-wave communication in Nigeria.
Programs can translate these findings into audience-specific strategies like caregiver and community‑leader engagement with clear, safety-affirming messages, brief provider scripts and micro-training for school and clinic encounters and concise briefs for local decision-makers. Future iterations should pre-specify formal consensus thresholds and incorporate public prevalence measures to refine priority setting.
人类乳头瘤病毒(HPV)是导致多种癌症的重要因素,尤其是宫颈癌,对包括尼日利亚在内的撒哈拉以南非洲(SSA)构成了重大的健康挑战。尽管有HPV疫苗的可用性和有效性,但许多SSA国家尚未达到世界卫生组织的疫苗接种目标。尼日利亚于2023年10月将针对女童(9-14岁)的人乳头瘤病毒疫苗纳入国家免疫规划。这在卫生保健工作者和普通民众中引起了某些误解。本研究旨在通过改进的德尔菲技术对这些误解进行识别和排序,以提高尼日利亚的HPV疫苗接种覆盖率。本研究的主要目的是确定尼日利亚主要的HPV疫苗误解并对其进行排名,总结各轮专家判断的稳定性,并将优先列表转化为沟通和培训建议。方法我们对来自尼日利亚36个州和联邦首都直辖区的免疫利益攸关方进行了案头审查、专家验证和两轮改进德尔菲调查。从案头审查和验证会议中产生了13个候选误解,然后根据5分李克特“临界性”量表进行评分,该量表反映了感知的流行程度、障碍的重要性以及如果不加以解决可能对吸收的影响。描述性统计汇总了项目排名和轮间变化;配对t检验评估总体稳定性。结果49名小组成员完成了两轮调查。排名最靠前的是稳定的:不孕症/人口控制的误解一直排在第一位,其次是认为接种疫苗会促进青少年滥交的信念,其次是安全性/“西方阴谋”和“未知的长期副作用”。总评分在两轮之间没有显著变化(配对t检验t (8) = 0.39, p = 0.71)。结论轮次评分的稳定性表明,观察到的差异与随机变化相一致,而不是系统性的意见转变。对人乳头瘤病毒疫苗误解的决定优先次序突出了一系列高级误解,如不孕、滥交和安全/阴谋叙事,这些误解应该成为尼日利亚第一波传播的基础。项目可以将这些发现转化为针对特定受众的策略,如护理人员和社区领导人的参与,提供明确、肯定安全的信息,为学校和诊所提供简短的提供者脚本和微型培训,并为当地决策者提供简明的简报。未来的迭代应该预先指定正式的共识阈值,并纳入公共流行度量以改进优先级设置。
{"title":"Misconceptions leading to human papillomavirus vaccination hesitancy in Nigeria: Findings from a modified Delphi panel with stakeholders of the immunization ecosystem","authors":"Mohammed Mohammed Manga , Adeola Fowotade , Zara Isah Modibbo , Mashudu Madhivhandila , Tidiane Ndao , Olufemi Abayomi , Yahaya Mohammed","doi":"10.1016/j.jvacx.2025.100729","DOIUrl":"10.1016/j.jvacx.2025.100729","url":null,"abstract":"<div><h3>Background</h3><div>Human papilloma virus (HPV) is a significant contributor to various cancers, notably cervical cancer, which poses a major health challenge in sub-Saharan Africa (SSA), including Nigeria. Despite the availability and effectiveness of HPV vaccines, many SSA countries have yet to reach the World Health Organization's vaccination goals. Nigeria introduced the HPV vaccine for girls (9–14 years) as part of the national immunization program in October 2023. This was heralded with certain misconceptions among both healthcare workers and the general populace. This study aimed to identify and rank these misconceptions via the modified Delphi technique to increase HPV vaccination coverage in Nigeria.</div></div><div><h3>Objectives</h3><div>The primary objective of this study was to identify and rank predominant HPV vaccine misconceptions in Nigeria, summarize the stability of expert judgments across rounds and to translate the prioritized list into communication and training recommendations.</div></div><div><h3>Methods</h3><div>We conducted desk review, expert validation and a two-round modified Delphi with immunization stakeholders from across Nigeria's 36 states and the Federal Capital Territory. Thirteen candidate misconceptions were generated from desk review and validation meetings, then rated on a five-point Likert “criticality” scale reflecting perceived prevalence, barrier importance, and likely impact on uptake if unaddressed. Descriptive statistics summarized item rankings and round-to-round changes; a paired <em>t</em>-test assessed aggregate stability.</div></div><div><h3>Results</h3><div>Forty-nine panelists completed both rounds. Rank order at the top was stable: the infertility/population-control misconception consistently ranked first, followed by the belief that vaccination promotes adolescent promiscuity, safety/“Western conspiracy” and “unknown long-term side-effects” clustered next. Aggregate ratings did not change significantly between rounds (paired <em>t</em>-test t (8) = 0.39, <em>p</em> = 0.71).</div></div><div><h3>Conclusion</h3><div>The stability of ratings between rounds indicate that observed differences were compatible with random variation rather than systematic shifts in opinion. A decision-ready prioritization of HPV vaccine misconceptions highlights a set of high-level misconceptions, like infertility, promiscuity, and safety/conspiracy narratives that should anchor first-wave communication in Nigeria.</div><div>Programs can translate these findings into audience-specific strategies like caregiver and community‑leader engagement with clear, safety-affirming messages, brief provider scripts and micro-training for school and clinic encounters and concise briefs for local decision-makers. Future iterations should pre-specify formal consensus thresholds and incorporate public prevalence measures to refine priority setting.</div></div>","PeriodicalId":43021,"journal":{"name":"Vaccine: X","volume":"27 ","pages":"Article 100729"},"PeriodicalIF":2.2,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145110001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-18DOI: 10.1016/j.jvacx.2025.100727
Tove Hoffman , Bo Albinsson , Linda Kolstad , Marika Nordberg , Sirkka Vene , Patrik Ellström , Bengt Rönnberg , Olli Vapalahti , Dag Nyman , Åke Lundkvist
Background
The Åland Islands included tick-borne encephalitis (TBE) vaccination in the general vaccination program in 2006.
Aim
Investigate the effect of the vaccination on the number of reported TBE cases and the TBEV IgG seroprevalence in blood donors in the Åland Islands.
Methods
We used reported data on TBE cases (1995–2018) and sera collected from blood donors in 1995 (n = 300) and 2018 (n = 300). Samples were analyzed by a Luminex-based method that can differentiate antibodies induced by a TBE virus (TBEV) infection from those produced after TBE vaccination.
Results
A weak negative trend but no significant relationship between the number of reported TBE cases and year was observed. Of the blood donors, 3.3 % and 7.0 % tested positive for a previous TBEV infection in 1995 and 2018, respectively. There was no significant difference between the blood donor cohorts regarding the number of TBEV-infected and non-infected individuals. The proportion of TBE vaccinated blood donors increased from 2.7 % in 1995 to 81.0 % in 2018. The proportion of previously TBEV-infected unvaccinated blood donors increased from 3.4 % in 1995 to 36.8 % in 2018. The estimated number of unvaccinated individuals decreased 3.8-fold from 1995 to 2018. The rate of TBE cases in the estimated unvaccinated population increased 3.9-fold between the years 1995 and 2018. The risk of being infected by TBEV tended to be higher in 2018, reduced for men, and to increase with age.
Conclusion
The strong increase in seroprevalence of anti-NS1 antibodies and increase of TBE cases in the estimated unvaccinated population seen in this study suggest that the low number of TBE cases in the Åland Islands is explained by the high vaccination coverage, suggesting a positive effect of the free TBE vaccination on public health in the Åland Islands.
{"title":"The effect of the TBE vaccination program in the Åland Islands","authors":"Tove Hoffman , Bo Albinsson , Linda Kolstad , Marika Nordberg , Sirkka Vene , Patrik Ellström , Bengt Rönnberg , Olli Vapalahti , Dag Nyman , Åke Lundkvist","doi":"10.1016/j.jvacx.2025.100727","DOIUrl":"10.1016/j.jvacx.2025.100727","url":null,"abstract":"<div><h3>Background</h3><div>The Åland Islands included tick-borne encephalitis (TBE) vaccination in the general vaccination program in 2006.</div></div><div><h3>Aim</h3><div>Investigate the effect of the vaccination on the number of reported TBE cases and the TBEV IgG seroprevalence in blood donors in the Åland Islands.</div></div><div><h3>Methods</h3><div>We used reported data on TBE cases (1995–2018) and sera collected from blood donors in 1995 (<em>n</em> = 300) and 2018 (<em>n</em> = 300). Samples were analyzed by a Luminex-based method that can differentiate antibodies induced by a TBE virus (TBEV) infection from those produced after TBE vaccination.</div></div><div><h3>Results</h3><div>A weak negative trend but no significant relationship between the number of reported TBE cases and year was observed. Of the blood donors, 3.3 % and 7.0 % tested positive for a previous TBEV infection in 1995 and 2018, respectively. There was no significant difference between the blood donor cohorts regarding the number of TBEV-infected and non-infected individuals. The proportion of TBE vaccinated blood donors increased from 2.7 % in 1995 to 81.0 % in 2018. The proportion of previously TBEV-infected unvaccinated blood donors increased from 3.4 % in 1995 to 36.8 % in 2018. The estimated number of unvaccinated individuals decreased 3.8-fold from 1995 to 2018. The rate of TBE cases in the estimated unvaccinated population increased 3.9-fold between the years 1995 and 2018. The risk of being infected by TBEV tended to be higher in 2018, reduced for men, and to increase with age.</div></div><div><h3>Conclusion</h3><div>The strong increase in seroprevalence of anti-NS1 antibodies and increase of TBE cases in the estimated unvaccinated population seen in this study suggest that the low number of TBE cases in the Åland Islands is explained by the high vaccination coverage, suggesting a positive effect of the free TBE vaccination on public health in the Åland Islands.</div></div>","PeriodicalId":43021,"journal":{"name":"Vaccine: X","volume":"27 ","pages":"Article 100727"},"PeriodicalIF":2.2,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145118942","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-17DOI: 10.1016/j.jvacx.2025.100726
M.E. Ames , C.A. Sierra Hernandez , A.F. Chung , H. Elgharbawy , T.O. Afifi , S. Craig , C.A. McMorris , H. Samji , K.D. Schwartz , S.E. Stewart , B. Turner , T.P. Paterson , The Youth Vaccine Confidence Team
Vaccines are essential for preventing infectious diseases, yet vaccine hesitancy—particularly among youth—remains a growing concern. This study investigated factors influencing COVID-19 vaccine acceptance among Canadian youth (aged 12–29 years) across three pandemic stages using data from five rapid-response surveys. Multivariable logistic regression analyses identified sociodemographic, pandemic-related impacts, and mental health factors associated with vaccine acceptance. Results showed increasing vaccine acceptance over time across samples (i.e., Stage 1: 52.3 %–65.4 %; Stage 2: 73.8 %–83.2 %; and, Stage 3: 85.3 %–96.0 %). Although findings varied across samples, overall, parental education (significant adjusted odds ratios [aOR] range across samples and Stages = 0.16 to 2.07), living area (i.e., rural/urban; aORs range = 2.07 to 2.18), and COVID-19 stress (aOR range = 1.06 to 2.34) emerged as consistent factors across time. Other factors, such as being older (Stage 1 aOR = 1.15 to 3.21; Stage 3 aOR = 0.58), White (Stage 1 aOR = 1.55 to 1.69; Stage 2 aOR = 1.48), female (Stage 1 a OR = 0.60 to 0.72) or having a family member diagnosed with COVID-19 (Stage 1 aOR = 1.89; Stage 2 aOR = 0.55; Stage 3 aOR = 0.52) appeared as potential context-specific factors related to vaccine acceptance. Mental health had limited influence. These findings underscore the need for targeted vaccination campaigns addressing stable and dynamic sociodemographic and stress-related factors among youth.
{"title":"Factors associated with youth vaccine acceptance during the COVID-19 pandemic: Coordinated analyses across 5 Canadian datasets","authors":"M.E. Ames , C.A. Sierra Hernandez , A.F. Chung , H. Elgharbawy , T.O. Afifi , S. Craig , C.A. McMorris , H. Samji , K.D. Schwartz , S.E. Stewart , B. Turner , T.P. Paterson , The Youth Vaccine Confidence Team","doi":"10.1016/j.jvacx.2025.100726","DOIUrl":"10.1016/j.jvacx.2025.100726","url":null,"abstract":"<div><div>Vaccines are essential for preventing infectious diseases, yet vaccine hesitancy—particularly among youth—remains a growing concern. This study investigated factors influencing COVID-19 vaccine acceptance among Canadian youth (aged 12–29 years) across three pandemic stages using data from five rapid-response surveys. Multivariable logistic regression analyses identified sociodemographic, pandemic-related impacts, and mental health factors associated with vaccine acceptance. Results showed increasing vaccine acceptance over time across samples (i.e., Stage 1: 52.3 %–65.4 %; Stage 2: 73.8 %–83.2 %; and, Stage 3: 85.3 %–96.0 %). Although findings varied across samples, overall, parental education (significant adjusted odds ratios [aOR] range across samples and Stages = 0.16 to 2.07), living area (i.e., rural/urban; aORs range = 2.07 to 2.18), and COVID-19 stress (aOR range = 1.06 to 2.34) emerged as consistent factors across time. Other factors, such as being older (Stage 1 aOR = 1.15 to 3.21; Stage 3 aOR = 0.58), White (Stage 1 aOR = 1.55 to 1.69; Stage 2 aOR = 1.48), female (Stage 1 a OR = 0.60 to 0.72) or having a family member diagnosed with COVID-19 (Stage 1 aOR = 1.89; Stage 2 aOR = 0.55; Stage 3 aOR = 0.52) appeared as potential context-specific factors related to vaccine acceptance. Mental health had limited influence. These findings underscore the need for targeted vaccination campaigns addressing stable and dynamic sociodemographic and stress-related factors among youth.</div></div>","PeriodicalId":43021,"journal":{"name":"Vaccine: X","volume":"27 ","pages":"Article 100726"},"PeriodicalIF":2.2,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145118945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}