Vaccine最新文献

Background: Limited data exists regarding the safety of the COVID-19 2023-2024 vaccine formulations and whether the safety profiles differ from the original formulations. We evaluated the association between the BNT162b2 XBB COVID-19 vaccine and the risk of 20 pre-specified adverse events of special interest (AESIs).

Methods: We identified commercially-insured individuals in the US age ≥ 6 months who received the BNT162b2 XBB COVID-19 vaccine between September 11, 2023 and January 15, 2024 within the Optum pre-adjudicated database. The self-controlled risk interval design was used to compare the incidence of 20 pre-specified AESIs during a risk period following vaccination to a control period. Relative incidence and 95 % confidence intervals (CI) were estimated using exact conditional Poisson regression.

Results: The analysis included 113,459 individuals who received the BNT162b2 XBB COVID-19 vaccine (median [interquartile range] age: 47.1 [33.0-59.1] years). Relative incidence was calculated when ≥1 event occurred in either the risk or control period. For these 10 AESIs, there was no significant association between receipt of the BNT162b2 XBB COVID-19 vaccine and the incidence of any of these AESIs. Point estimates were higher in the risk period compared to the control period for ischemic stroke (relative incidence: 1.52; 95 % CI: 0.44-5.94), myocarditis/pericarditis (relative incidence: 1.50; 95 % CI: 0.22-12.61), immune-mediated myositis (relative incidence: 1.44; 95 % CI: 0.83-2.52), herpes zoster (relative incidence: 1.24; 95 % CI: 0.69-2.28), and non-febrile convulsions/seizures (relative incidence: 1.22; 95 % CI: 0.86-1.73). These estimates were not statistically significant, though most were based on few events. Results were generally similar in subgroup analyses of individuals administered a concomitant seasonal influenza vaccine.

Conclusions: There was no increased risk of 20 pre-specified AESIs following receipt of the BNT162b2 XBB COVID-19 vaccine among US commercially insured individuals aged ≥6 months. Findings are consistent with the current evidence on the safety of BNT162b2 COVID-19 vaccines. Public registration: EUPAS108135.

Germany primarily relies on a practice-based, opportunistic immunisation system. Despite the introduction of the Human papillomavirus (HPV) vaccine into the German vaccination schedule in 2007, coverage remains low. International experience suggests that school-based vaccination can increase HPV coverage. Therefore, in 2013/14 Bremen's public health department offered HPV vaccinations within a school programme, targeting all 8th-graders. We aimed to evaluate the programme, with a focus on vulnerable groups. In a retrospective cohort design, we analysed vaccination status and uptake among all 8th-graders from 2015/16 to 2018/19 (girls) and 2022/23 (girls and boys). Sub-analyses were based on the School Social Index (SSI), which ranges from 1 (higher socio-economic position, SEP) to 5 (lower SEP), considering factors like poverty, migration, and living environment. The study included 13,550 students from 1,440 classes in 56 schools. Among previously unvaccinated students, 26-35 % of girls and 39 % of boys annually accepted and received the school-based HPV vaccination. Uptake was higher among students from lower as compared to higher SEP schools (SSI 5: 37 % vs. SSI 1: 30 %, p = 0.022). Vaccine uptake among unvaccinated students remained stable over time, with one-third receiving at least one HPV vaccination at school. The remaining two-thirds of unvaccinated did not make use of the vaccination offer at school. It needs to be investigated if this is possibly due to vaccine hesitancy or a preference for practice-based vaccinations. While school vaccination programmes can improve uptake, implementing a nationwide programme in Germany will be challenging and may not address all existing major uptake barriers.

Objectives: SARS-CoV-2 mRNA vaccine reactogenicity has raised concerns regarding the risk of rejection in solid organ transplant recipients. We explored whether SOT recipients diagnosed with acute rejection had previously received a vaccine injection within a timeframe consistent with a causal link.

Methods: We identified all SOT recipients with a diagnosis of acute rejection from 2020 to 2022 and who had previously received a SARS-CoV-2 vaccination, and analysed whether the delay between vaccination and rejection was constant.

Results: In the 45 identified patients, median delay between the last SARS-CoV-2 vaccination and the rejection was 102 days [IQR 48-178]; the continuous distribution of this delay, with no identifiable time pattern, is not in favor of a role of vaccination in rejection.

Conclusion: SARS-CoV-2 mRNA vaccination is unlikely to trigger rejection in SOT recipients.

Background: COVID-19 profoundly impacted First Nation peoples. Historically, records of on- and off-reserve vaccine delivery have been fragmented. For the first time in Canada, we aimed to describe complete immunization rates, on- and off-reserve vaccine delivery, for COVID-19 in Alberta, Canada among First Nations on-reserve.

Methods: Fifteen First Nations in Alberta, Canada participated in this prospective, descriptive cohort study whereby real-time integration (RTI) was deployed to reconcile COVID-19 vaccine delivery records on-reserve (local database) to those reported off-reserve (provincial database) between January 3, 2021-December 1, 2022. Immunization data (individuals ≥ 6 months) were aggregated into 100 one-week intervals. Weekly immunization rates were assessed by age, sex, community size, and location of vaccine administration (on- or off-reserve) using multiple linear regressions and chi2 tests.

Findings: 50,758 First Nation people were included, approximately 50% of whom were female. RTI data showed that 64% received at least one dose of vaccine with higher rates in older First Nation adults. No sex differences were observed. Nearly half received their first dose off-reserve and would have been missed by local public health on-reserve (local database) without the implementation of RTI. First dose immunization rates rapidly increased with graduated First Nation-specific eligibility and provincial incentives promoting uptake (p < 0.001).

Interpretation: We accurately assessed complete immunization rates among First Nation people receiving services on-reserve irrespective of delivery of immunizations on- or off-reserve through deployment of an innovative RTI approach. Without these RTI advances, immunization rates would have been substantially under-reported and may have misdirected public health initiatives around vaccine uptake. RTI should be a priority for all provinces in Canada to ensure accurate coverage rates for First Nation people.

Importance: Childhood vaccination rates have declined in recent years; there is also concern that resistance to COVID-19 vaccines could spill over to childhood vaccines.

Objectives: To use local-level data to study trends in childhood vaccination rates and heterogeneity in local rates; including how many areas are below herd-immunity thresholds, and assess the association between COVID-19 vaccine hesitancy and childhood vaccination.

Design: We report, for 11 states with available data, vaccination rates for measles, mumps, rubella (MMR), and diphtheria, tetanus, acellular pertussis (DTaP) vaccines, including percentage of schools/counties with rates ≥95 %, 90-95 %, 80-90 %, and < 80 %. We also study the association between county-level COVID-19 vaccination rates and change from 2019 to 2022 in MMR and DTaP vaccination rates.

Exposure: School/county level vaccination rates; county-level COVID-19 vaccine hesitancy, proxied by the percent of the adult population in each county that did not complete primary COVID-19 vaccination.

Main outcomes: Percentage of school/counties with MMR/DTaP vaccination rates within specified ranges, mean vaccination rates, and change in MMR/DTaP vaccination rates between 2019 and 2022.

Results: On average, childhood vaccination rates declined from 2019 to 2022 in states that allow non-medical exemptions, but with substantial heterogeneity within and across states. The largest declines were in already low-vaccination schools. COVID-19 vaccine hesitancy was associated with a somewhat larger 2019-to-2022 decline in childhood vaccination rates in rural counties and strongly Republican-leaning counties.

Conclusion: Vaccination rates fell from 2019 to 2022, continuing a longer trend toward lower rates. For measles and pertussis, childhood vaccination rates are below herd-immunity levels in many local communities, sometimes substantially so. We used two proxies for potential spillover of COVID-19 vaccine hesitancy to childhood vaccines (rural indicator and Republican-leaning indicator); these proxies can explain a modest part of the decline childhood vaccination in rural and Republican-leaning counties, but most of the explanation lies elsewhere.

Background: Myriad risk factors contribute to pediatric influenza vaccination disparities. Digital stories are compelling accounts of lived experience that have been useful in health promotion, especially in minoritized communities. Little is known about how they are perceived as a behavioral intervention to improve influenza vaccination confidence in safety-net healthcare systems.

Objective: To explore staff and caregivers' perceptions of Digital Storytelling (DST) as a behavioral intervention to improve influenza vaccine confidence among caregivers of children.

Methods: This qualitative study was set in two federally qualified health centers in historically Black neighborhoods in Denver, Colorado, USA. Informal group discussions with clinic staff probed perceptions of vaccine disparities, clinic priorities, and DST. Individual interviews with key staff and caregivers of children 6 months to 5 years old explored perceptions of and preferences for DST to improve vaccine confidence. Interviews were recorded and transcribed verbatim. Three researchers analyzed transcripts via directed content analysis using a deductive approach based off the IM4Equity framework. Final themes were member-checked with clinic staff, pediatric providers, and community advisors.

Results: Approximately 70 staff attended informal group discussions; 13 staff and 12 caregivers participated in key informant interviews. Transcripts from group discussions (n = 6) and individual interviews (n = 23) were included in final analyses. Staff felt existing influenza vaccination strategies were inadequate, perceived digital stories meaningfully, and desired equitable implementation without responsibility for implementing them. Caregivers perceived DST as compelling, noted the importance of trusted storytellers, and suggested relatable stories from diverse caregivers could be sent via text messages in the winter to cue caregivers to action.

Conclusions: In this qualitative study, staff and caregivers perceived DST favorably, with preferences specific to DST implementation in a large, diverse health system. Work to develop and implement text-based DST for pediatric influenza vaccination in this context is warranted.

Objectives: To identify demographic, clinical and immunological factors associated with adverse COVID-19 outcomes.

Methods: A large randomised controlled trial of ChAdOx1 nCoV-19 was undertaken in Brazil. Participants were randomised 1:1 either to receive ChAdOx1 nCov-19 or to a control group. COVID-19 infections were confirmed by nucleic acid amplification test (NAAT) and classified using the WHO clinical progression scale. Anti-spike antibody responses and serum neutralising activity were measured 28 days after second vaccination in some participants. Exploratory analyses were conducted into factors associated with COVID-19 infection severity and hospitalisation, using logistic regression models adjusted for demographic and clinical factors.

Results: 10,416 participants were enrolled; 1790 had NAAT-positive COVID-19 infection; 63 cases required hospitalisation. More severe infection was associated with greater body-mass index (BMI) (odds ratio [OR] = 1.06 [95 %CI: 1.01-1.10], p = 0.01) and diabetes (OR = 3.67 [1.59-8.07], p = 0.003). Hospitalisation risk increased with greater age (OR = 1.06 [1.03-1.08], p < 0.001) and BMI (OR = 1.10 [1.05-1.16], p < 0.001). More severe infection and hospitalisation risks increased >180 days after last vaccination. In the fully vaccinated subgroup (n = 841), only greater age predicted hospitalisation (OR = 1.07 [1.03-1.12], p < 0.001). Serological responses to two vaccine doses diminished with age.

Conclusions: Unvaccinated individuals with high BMI and diabetes risked more severe COVID-19 outcomes. Vaccination mitigated this risk.

Clinical trial registration number: NCT04536051.

Background: The introduction of the 10-valent pneumococcal conjugate vaccine (PCV10) for nationwide childhood immunization in 2010 led to a significant reduction in colonization and invasive pneumococcal disease (IPD) by vaccine serotypes in young. However, non-vaccine serotypes have emerged, and serotype 19A is now the leading cause of IPD in Brazil.

Methods: We analyzed 32 serotype 19A isolates of Streptococcus pneumoniae recovered from children and adults who attended different health facilities in the state of Rio de Janeiro, Brazil, between 2010 and 2023. The capsular types of the isolates were determined by sequential multiplex PCR or by cpsB gene sequencing. All isolates were subjected to antimicrobial susceptibility testing and MLST.

Results: Of the 32 serotype 19A isolates, 29 (90.6 %) isolates were recovered from children aged ≤5 years and three (9.4 %) isolates were recovered from adults. Nineteen (59.4 %) isolates were associated with colonization, and 13 (40.6 %) isolates were from diseases. All isolates were susceptible to chloramphenicol, levofloxacin, linezolid, rifampin, and vancomycin. The highest frequencies of non-susceptibility (intermediate + resistant) were observed for sulfamethoxazole-trimethoprim (n = 30; 93.8 %), penicillin (n = 24; 75 %), and erythromycin (n = 23; 71.9 %). Twenty-two (68.8 %) isolates were multidrug resistant (MDR). MICs for penicillin among penicillin-non-susceptible pneumococci (PNSP) ranged from 0.12 to 8.0 μg/mL. MICs for erythromycin ranged from 0.064 to >256 μg/mL. MICs for ceftriaxone ranged from 0.023 to 4 μg/mL. The most common genetic lineages were ST733 (n = 7; 21.9 %), mostly found before and in the early years of PCV10 introduction, and CC320 (n = 25; 78.1 %), mostly found in the late-PCV10 period. All 25 isolates within CC320 were PNSP and mostly (n = 22; 88 %) MDR.

Conclusions: We observed a shift in antimicrobial susceptibility profiles and genetic lineages after long-term use of PCV, mostly PCV10, for routine childhood immunization, characterized by clonal expansion of the MDR lineage CC320.

Malignant catarrhal fever (MCF), caused by alcelaphine herpesvirus-1 (AIHV-1) transmitted from wildebeest, is a lethal cattle disease with significant impacts on East African pastoralists. Development of a live attenuated MCF vaccine has prompted research into its use in communities at risk. This study reports results from the first utilisation of the MCF vaccine in locally-owned cattle under field conditions. The study involved a primary two-dose course vaccination of 1634 cattle, followed a year later, by boost vaccination of 385 of these cattle. It aimed to: (a) evaluate the antibody response to a two-dose AlHV-1 primary vaccination course, including initial response, antibody levels after one year, and clinical events post-vaccination; (b) assess how factors like age, reproductive status, body condition, and breed influence the initial response; and (c) compare antibody responses to single- and two-dose booster protocols one year after primary vaccination. Analyses were carried out using linear mixed-effects models and paired t-tests. Clinical incidents were reported in 11/1634 cattle vaccinated during the primary course and in 0/385 cattle during the boost regimens. The primary vaccination resulted in a 9-fold increase in comparison to pre-vaccination antibody levels and the response was consistent across animals of different ages, reproductive statuses and body conditions. While antibody levels declined 11 months after primary vaccination, they remained high, and a single-dose booster vaccination was sufficient to elicit a strong immune response, with only marginal increases after a second booster. The study provides evidence of high immunogenicity and low incidences of clinical events of the vaccine in cattle across individual host factors and immunologically vulnerable groups, under prevailing environmental conditions. It also indicates the utility of a single-dose booster regimen. These findings will support progress towards commercial production and larger-scale adoption which could generate important benefits for the livelihoods, and sustainability of pastoral livestock systems.