Vaccine最新文献

Background: The economic and public health benefits of adult pneumococcal vaccines vary across countries due to different epidemiology and costs. We systematically reviewed and summarized findings and assumptions of cost-effectiveness analyses (CEA) of the recently introduced 15- and 20-valent pneumococcal conjugate vaccines (PCV15 and PCV20) in adults.

Methods: We performed a systematic search for CEA studies of PCV15 and/or PCV20 versus existing strategies via PubMed, EMBASE, CEA Registry, EconLit, HTA Database, and NITAG resource center through April 23, 2024. Study characteristics, methods, assumptions, and findings were extracted independently by two reviewers; quality was assessed using ECOBIAS. Results were synthesized qualitatively to summarize key attributes and conclusions.

Results: Of 137 identified records, 26 studies were included; the majority (24/26) concerned high-income countries. All employed static Markov-type models comparing higher-valent PCVs used alone or in combination with 23-valent pneumococcal polysaccharide vaccine (PPSV23) to current recommendations (PPSV23 alone, PCV13 alone, PCV13 + PPSV23, no vaccination). Most studies (22/26) concluded PCV20 used alone was cost-saving (dominant) or cost-effective compared to other adult pneumococcal strategies (PPSV23 alone, PCV13 ± PPSV23, PCV15 ± PPSV23, or no vaccination). PCVs were generally assumed to have serotype-specific effectiveness equal to PCV13 efficacy in the pivotal trial, though four studies used estimates from a Delphi panel; protection was assumed to last between 10 and 20 years. PPSV23 was assumed to have lower effectiveness against non-bacteremic pneumonia and shorter duration of protection. Herd effects from higher-valent PCVs in childhood (12/26), serotype replacement (2/26), or both (1/26) were included in half (13/26) of studies, which attenuated adult vaccine impact. Most studies were assessed as low risk of bias; five abstracts did not provide sufficient information for assessment.

Conclusion: Current evidence indicates that 20-valent PCV used alone is likely to be cost-effective or dominate other adult pneumococcal strategies. Future research is needed to address remaining uncertainties in assumptions and to support evidence-based policymaking.

Recombinant influenza viruses are promising vectors that can bolster antibody and resident lymphocyte responses within mucosal sites. This study evaluates recombinant influenza viruses with SARS-CoV-2 RBD genes in eliciting mucosal and systemic responses. Using reverse genetics, we generated replication-competent recombinant influenza viruses carrying heterologous RBD genes in monomeric, trimeric, or ferritin-based nanoparticle forms. Following intranasal immunisation, mice developed potent serological anti-RBD responses, with ferritin nanoparticles superseding monomeric or trimeric RBD responses. While parenteral and mucosal immunisation elicited robust anti-RBD IgG in serum, mucosal immunisation seeded respiratory IgA, RBD-specific lung-resident memory and germinal centre (GC) B cells. In animals with prior intramuscular vaccination, intranasal boosting with recombinant influenza vectors augmented mucosal IgG, IgA, GC and memory B cells, and SARS-CoV-2 lung neutralising titres. Recall of RBD-specific memory B cells via antigen re-exposure in the lung increased antibody-secreting cells in the lung-draining lymph nodes, with maintenance of lung GC B cells. Recombinant influenza-based vaccines effectively deliver highly immunogenic self-assembling nanoparticles, generating antibodies and B cells in the respiratory mucosa. This strategy provides a tractable pathway to augment lung-localised responses against recurrent respiratory viral infections.

Background: The COVID-19 pandemic has significantly impacted people with cancer. Initial vaccine studies excluded patients with malignancy. Immunocompromised individuals remain vulnerable to SARS-CoV-2, necessitating detailed understanding of vaccine response. The epidemiology of COVID-19 in Australia offered unique opportunities to study cancer populations with minimal community exposure to SARS-CoV-2.

Methods: SerOzNET prospectively examined previously unvaccinated patients with solid and haematological malignancies receiving up to five COVID-19 vaccine doses. Antibody response was measured by live virus neutralisation assay (neutralising antibody (NAb); positive titre ≥1:20; study primary endpoint) and commercial assay. T cell response was measured by cytometric bead array; positive defined as interferon gamma (IFN-γ) ≥10 pg/mL in response to Spike antigen. Patient and physician-reported adverse events were secondary endpoints.

Outcomes: 395 adults were enrolled prior to receiving mRNA vaccine (BNT162b2 = 347; mRNA-1273 = 1) or viral vector vaccine (ChadOx1-S = 43) for initial two-dose course, plus up to three additional doses. Median age was 58 years (range: 20-85); 60 % were female; 35 % had haematological malignancy, 2/395 (0.5 %) had baseline positive nucleocapsid antibody indicating prior SARS-CoV-2 exposure. NAb response post dose three was demonstrated in 84 % overall; 96 % of patients with solid cancers and 64 % with haematological cancer (p < 0·001). Risk factors for non-response were haematological cancer and anti B-cell therapies. Some patients with haematological cancer seroconverted for the first time after the fourth or fifth dose. IFN-γ response was seen in many patients with haematological cancer who lacked NAb response. Serious adverse events were rare. COVID-19 infection occurred in 29 % with no deaths.

Interpretation: COVID-19 vaccination elicits B and T cell responses in patients with solid and haematological cancers, with an acceptable safety profile. A significant proportion of haematological cancer patients require >3 doses to elicit NAb, with many demonstrating T cell response, which may be an alternative pathway of immune protection.

Background: Herpes zoster is a potential risk factor for dementia. The effectiveness of the recombinant zoster vaccine for preventing dementia is uncertain.

Methods: This retrospective cohort study used de-identified claims data from the Optum Labs Data Warehouse database from January 1, 2017, to December 31, 2022, to determine whether the recombinant zoster vaccine is associated with a reduced risk of dementia. Immunocompetent patients with ≥365 days of continuous enrollment were included, with the risk period starting upon age-eligibility for the recombinant zoster vaccination. Cox regression adjusted for time-fixed and time-updated measures every six months was implemented to estimate hazard ratios for dementia. Herpes zoster diagnosis and antiviral therapy were also assessed.

Results: There were 4,502,678 individuals (median [IQR] age, 62 [54-71] years; 51 % female) included in this study: 206,297 (4.6 %) were partially vaccinated, and 460,413 (10.2 %) were fully vaccinated. The incidence rate of dementia was 99.1 cases per 10,000 person-years in the fully vaccinated group, 108.2 cases per 10,000 person-years in the partially vaccinated group, and 135.0 cases per 10,000 person-years in the unvaccinated group. After adjustment, vaccination was significantly associated with a decreased risk of dementia for two doses (hazard ratio (HR): 0.68; 95 % CI: 0.67-0.70; P < .001) and for one dose (HR 0.89; 95 % CI: 0.87-0.92; P < .001). Having a herpes zoster diagnosis before the first vaccination dose was associated with an increased hazard of dementia (HR 1.47; 95 % CI: 1.42-1.52; P < .001) compared to those with no diagnosis. Antivirals used to treat zoster infection were protective against dementia (HR 0.42; 95 % CI: 0.40-0.44; P < .001).

Conclusions: These findings suggest that the recombinant zoster vaccine is associated with a decreased risk of dementia and highlight an additional benefit of vaccination beyond preventing herpes zoster.

Geographical disparities exist in human papillomavirus (HPV) vaccination rates with Southern states having the lowest rates. Parental attitudes remain understudied in different Southern locations. We assessed factors related to HPV vaccination receipt among children aged 9-17 years in Tennessee, and if those factors differed by child's age and gender. A cross-sectional survey of 506 parents was performed via random digit dial from May to August 2022. A multivariable logistic regression model was used to estimate adjusted odds ratios and 95 % confidence intervals to predict sociodemographic and overall vaccine-related factors associated with HPV vaccine receipt or non-receipt (referent) for their child, and exploratory analyses to determine if those factors differed by child's age and gender. In adjusted logistic regression models, HPV vaccine receipt was significantly positively associated with the child's age (13-17 years) and the parent and child having had the influenza vaccine this season and the COVID-19 vaccine, and negatively associated with children who were male and had a parent employed part-time/unemployed/retired/student/disabled. Significant associations for HPV vaccine receipt were with increased levels of agreement of the parent having enough information for decision-making, belief the vaccine was beneficial, and increased levels of trust and perceived effectiveness of the vaccine. Increased levels of hesitancy and increased levels of agreement that the vaccine might cause infertility issues in the child, was unsafe, and natural immunity is better than vaccine immunity had negative associations with HPV vaccine receipt. All associations were more pronounced among older than younger children, and all but one association (overall vaccine trust) was more pronounced among males compared with females. Strategies to improve HPV vaccine uptake should be targeted to and/or include males and parents with children aged 9-12 years, and include education on the importance and process of protecting the body through HPV vaccination and vaccines in general.

Social media is used to promote the HPV vaccine through various strategies, including the use of stories and narratives. Understanding the ethical concerns related to the use of social media in this capacity are important. The purpose of this study is to identify ethical concerns of using fictional stories to share information and emotions about the HPV vaccine on social media, ultimately to influence parents on their decision to vaccinate their child.

Methods: We conducted a cross-sectional survey with researchers in the fields of health communication, cancer prevention, social media, and public health ethics from October to December 2021. Respondents were presented with a fictional story that consisted of seven connected vignettes about the HPV vaccine. For each vignette, respondents were asked to rate the potential benefits and risk, as well as the potential for ethical concerns of using the fictional narrative style to share information about the HPV vaccine. Descriptive statistics summarized responses, and qualitative data were analyzed thematically.

Results: On average, respondents (n = 41) perceived more benefits than risks when it comes to 1) using social media for health education generally and 2) using a story with connected vignettes for vaccine communication. The vignettes prioritizing vaccine hesitancy, positive emotion, and health equity were seen as having the most potential benefit, while the vignettes highlighting vaccine confidence and skepticism were seen as having the most potential risk. Overall, respondents felt there were several ethical concerns of note - persuasion was the most common (15 % of respondents) followed by deception (9 %) and manipulation (8 %). Qualitative data highlighted the importance of transparency and trust to avoid ethical violations and negative outcomes.

Conclusions: Ethical concerns exist when using fictional stories to share health information on social media, particularly as new online technologies make it harder to tell fact from fiction. Practical and actionable recommendations for researchers must be developed, defining a range of ethical responsibilities.

Respiratory syncytial virus (RSV) is increasingly a recognized cause of severe respiratory infection among adults. This retrospective observational study compared the costs of RSV and influenza hospitalizations in adults aged ≥18 years admitted to the Spanish National Healthcare System between 2016 and 2019. Mean costs per hospitalization episode were compared using a multivariable log-gamma generalized linear model adjusted by age, risk group and calendar year. Total annual hospitalization costs were estimated from population incidence rates (for RSV we used model-based rates reported in a published study due to the substantial under-ascertainment of cases) and the mean cost per episode. ICD-10 codes identified a total of 11,662 adults hospitalized with RSV and 79,319 with influenza. The mean length of stay was longer for RSV than for influenza in low-risk patients aged 60-79 years, moderate-risk patients (those with chronic medical conditions) aged ≥50 years and in high-risk (those with immunocompromising conditions) patients aged <80 years. There were no differences in intensive care unit (ICU) admission (except for higher admission in high-risk RSV patients aged 70-79 years), ICU stay or in-hospital case fatality rate. Mean costs per hospitalization episode were also similar: RSV €3870 (95 % CI 3773-3942) vs influenza €3888 (95 % CI 3836-3931). Total annual costs for RSV-attributable hospitalizations were estimated at M€194, twice than that of influenza (M€83). Annual costs increased by 11 % over the study period for RSV and by 47 % for influenza. In 2019, adults aged ≥60 years and ≥ 70 years contributed 91 % and 82 %, respectively, of the total RSV-attributable hospitalization costs in adults. RSV has a significant economic burden to the Spanish National Healthcare System, likely greater than influenza. Efficacious RSV vaccines and antivirals have the potential for high public health impact.