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ShamaeiZadeh PA, Jaimes CV, Knoll MD, Espié E, Chandler RE. Landscape review of active vaccine safety surveillance activities for COVID-19 vaccines globally. Vaccine X 2024; 18:100485. [PMID: 38655548 PMCID: PMC11035105 DOI: 10.1016/j.jvacx.2024.100485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 03/27/2024] [Accepted: 04/10/2024] [Indexed: 04/26/2024] Open
Abstract
Background Evidence of COVID-19 vaccine safety relied upon the global vaccine monitoring infrastructure due to shortened clinical development timelines and emergency use licensure. Differences in AVSS capacity between high-income countries (HICs) versus low- and middle-income countries (LMICs) were known prior to the pandemic. Objective To assess the global landscape of COVID-19 vaccine AVSS activities to identify gaps in safety evidence generation across vaccine products and populations with a focus on LMICs. Methods A cross-sectional survey was conducted in January 2022 on AVSS activities evaluating adverse events following immunization (AEFI). Data collected included country, targeted population, COVID-19 vaccine product(s), design of surveillance/monitoring activities or study, and AEFIs to be monitored.To supplement these findings, we conducted a literature review of COVID-19 vaccine safety activities published in PubMed through January 2023. Observational activities assessing AEFI, specifically adverse events of special interest (AESI), following routine use of COVID-19 vaccines in medical practice were included; systematic reviews, benefit/risk assessments, clinical trials, and case reports/series were excluded. Results The survey, completed by 34 respondents and compiled with reviews of 7 publicly available Risk Management Plans from five vaccine manufacturers, identified 79 monitoring activities in HICs, 24 in LMICs, and 9 in multiple regions. Most activities in LMICs were planned cohort event monitoring (CEM) studies (n = 18); two multi-national hospital-based sentinel surveillance studies for AESI were ongoing. Activities in LMICs evaluated multiple COVID-19 vaccine products simultaneously and were sponsored by health authorities. The literature review identified 1245 unique citations, of which 379 met inclusion criteria. The majority evaluated vaccines primarily used in high-income countries: Pfizer BioNTech (Comirnaty; n = 303), Moderna (mRNA-1273; n = 164), AstraZeneca (AZD1222; n = 126), and Janssen (Ad26.COV2.S); n = 62); 14 citations assessed vaccines used exclusively in LMICs: Sinovac (CoronaVac), Beijing CNBG (BBIBP-Corv), Bharat (Covaxin), SII (Covashield), and Gamaleya (Gam-Covid-Vac) vaccines. Conclusions Robust safety evidence for input into benefit/risk assessments is likely unavailable for most COVID-19 vaccines used primarily in LMICs due to emphasis on cohort event monitoring methods. Goals for equitable vaccine access should be coupled with investment and support for building infrastructure and capacity for safety evidence generation to inform policy and regulatory decisions at local levels.
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Affiliation(s)
- Parisa A. ShamaeiZadeh
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- University of Kentucky, College of Medicine, Lexington, KY, United States
| | - Carmen Villamizar Jaimes
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Maria Deloria Knoll
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Emmanuelle Espié
- Coalition of Epidemic Preparedness Innovations, London, UK
- Coalition of Epidemic Preparedness Innovations, Oslo, Norway
| | - Rebecca E. Chandler
- Coalition of Epidemic Preparedness Innovations, London, UK
- Coalition of Epidemic Preparedness Innovations, Oslo, Norway
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Chandler RE, Balakrishnan MR, Brasseur D, Bryan P, Espie E, Hartmann K, Jouquelet-Royer C, Milligan J, Nesbitt L, Pal S, Precioso A, Takey P, Chen RT. Collaboration within the global vaccine safety surveillance ecosystem during the COVID-19 pandemic: lessons learnt and key recommendations from the COVAX Vaccine Safety Working Group. BMJ Glob Health 2024; 9:e014544. [PMID: 38453518 PMCID: PMC10921508 DOI: 10.1136/bmjgh-2023-014544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 01/01/2024] [Indexed: 03/09/2024] Open
Abstract
This analysis describes the successes, challenges and opportunities to improve global vaccine safety surveillance as observed by the Vaccine Safety Working Group from its role as a platform of exchange for stakeholders responsible for monitoring the safety of vaccines distributed through the COVAX mechanism. Three key elements considered to be essential for ongoing and future pandemic preparedness for vaccine developers in their interaction with other members of the vaccine safety ecosystem are (1) the availability of infrastructure and capacity for active vaccine safety surveillance in low-income and middle-income countries (LMICs), including the advancement of concepts of safety surveillance and risk management to vaccine developers and manufacturers from LMICs; (2) more comprehensive mechanisms to ensure timely exchange of vaccine safety data and/or knowledge gaps between public health authorities and vaccine developers and manufacturers; and (3) further implementation of the concept of regulatory reliance in pharmacovigilance. These aims would both conserve valuable resources and allow for more equitable access to vaccine safety information and for benefit/risk decision-making.
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Affiliation(s)
| | | | | | - Philip Bryan
- P95 Epidemiology and Pharmacovigilance, Leuven, Belgium
| | | | | | | | | | - Linda Nesbitt
- Biovac Institute, Pinelands, Cape Town, South Africa
| | | | | | | | - Robert T Chen
- The Task Force for Global Health, Decatur, Georgia, USA
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3
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Sharan A, Jahagirdar S, Stuurman AL, Elango V, Riera-Montes M, Kumar Kashyap N, Kumar Arora N, Mathai M, Mangtani P, Devlieger H, Anderson S, Whitaker B, Wong HL, Cutland CL, Guillard Maure C. Operational lessons learned in conducting an international study on pharmacovigilance in pregnancy in resource-constrained settings: The WHO Global Vaccine safety Multi-Country collaboration project. Vaccine X 2022; 11:100160. [PMID: 35434599 PMCID: PMC8993756 DOI: 10.1016/j.jvacx.2022.100160] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 02/03/2022] [Accepted: 04/04/2022] [Indexed: 01/21/2023] Open
Abstract
The WHO Global Vaccine Safety Multi-Country Collaboration study on safety in pregnancy aims to estimate the minimum detectable risk for selected perinatal and neonatal outcomes and assess the applicability of standardized case definitions for study outcomes and maternal immunization in low- and middle-income countries (LMICs). This paper documents the operational lessons learned from the study. A prospective observational study was conducted across 21 hospitals in seven countries. All births occurring at sites were screened to identify select perinatal and neonatal outcomes from May 2019 to August 2020. Up to 100 cases per outcome were recruited to assess the applicability of standardized case definitions. A multi-pronged study quality assurance plan was implemented. The impact of the COVID-19 pandemic on site functioning and project implementation was also assessed. Multi-layered ethics and administrative approvals, limited clinical documentation, difficulty in identifying outcomes requiring in-hospital follow-up, and poor quality internet connectivity emerged as important barriers to study implementation. Use of electronic platforms, application of a rigorous quality assurance plan with frequent interaction between the central and site teams helped improve data quality. The COVID-19 pandemic disrupted data collection for up to 6 weeks in some sites. Our study succeeded in establishing an international hospital-based surveillance network for evaluating perinatal and neonatal outcomes using common study protocol and procedures in geographically diverse sites with differing levels of infrastructure, clinical and health-utilization practices. The enhanced surveillance capacity of participating sites shall help support future pharmacovigilance efforts for pregnancy interventions.
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Affiliation(s)
- Apoorva Sharan
- The INCLEN Trust International, New Delhi, India.,Swiss Tropical and Public Health Institute (Swiss TPH), Basel, Switzerland.,University of Basel, Basel, Switzerland
| | | | | | | | | | | | | | - Mathews Mathai
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Punam Mangtani
- Department of Infectious Disease Epidemiology, London School of Tropical Medicine, London, UK
| | | | - Steven Anderson
- Center for Biologics Evaluation and Research (CBER), U.S. Food and Drug Administration (FDA), Silver Spring, MD, USA
| | - Barbee Whitaker
- Center for Biologics Evaluation and Research (CBER), U.S. Food and Drug Administration (FDA), Silver Spring, MD, USA
| | - Hui-Lee Wong
- Center for Biologics Evaluation and Research (CBER), U.S. Food and Drug Administration (FDA), Silver Spring, MD, USA
| | - Clare L Cutland
- African Leadership in Vaccinology Expertise (Alive), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Stuurman AL, Sharan A, Jahagirdar S, Elango V, Riera-Montes M, Kashyap N, Biccler J, Poluru R, Arora N, Mathai M, Mangtani P, DeVlieger H, Anderson S, Whitaker B, Wong HL, Cutland C, Guillard Maure C. WHO global vaccine safety multi-country collaboration project on safety in pregnancy: Assessing the level of diagnostic certainty using standardized case definitions for perinatal and neonatal outcomes and maternal immunization. Vaccine X 2021; 9:100123. [PMID: 34825164 PMCID: PMC8605263 DOI: 10.1016/j.jvacx.2021.100123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/31/2021] [Accepted: 10/29/2021] [Indexed: 11/19/2022] Open
Abstract
Standardized case definitions strengthen post-marketing safety surveillance of new vaccines by improving generated data, interpretation and comparability across surveillance systems. The Global Alignment of Immunization Safety Assessment in Pregnancy (GAIA) project developed standardized case definitions for 21 key obstetric and neonatal terms following the Brighton Collaboration (BC) methodology. In this prospective cohort study, we assessed the applicability of GAIA definitions for maternal immunization exposure and for low birth weight (LBW), preterm birth, small for gestational age (SGA), stillbirth, neonatal death, neonatal infection, and congenital microcephaly. We identified the missing data elements that prevented identified cases and exposures from meeting the case definition (level 1-3 of BC diagnostic certainty). Over a one-year period (2019-2020), all births occurring in 21 sites (mostly secondary and tertiary hospitals) in 6 Low Middle Income Countries and 1 High Income Country were recorded and the 7 perinatal and neonatal outcome cases were identified from routine medical records. Up to 100 cases per outcome were recruited sequentially from each site. Most cases recruited for LBW, preterm birth and neonatal death met the GAIA case definitions. Birth weight, a key parameter for all three outcomes, was routinely recorded at all sites. The definitions for SGA, stillbirth, neonatal infection (particularly meningitis and respiratory infection) and congenital microcephaly were found to be less applicable. The main barrier to obtaining higher levels of diagnostic certainty was the lack of sonographic documentation of gestational age in first or second trimester. The definition for maternal immunization exposure was applicable, however, the highest level of diagnostic certainty was only reached at two sites. Improved documentation of maternal immunization will be important for vaccine safety studies. Following the field-testing of these 8 GAIA definitions, several improvements are suggested that may lead to their easier implementation, increased standardization and hence comparison across studies.
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Affiliation(s)
| | - Apoorva Sharan
- INCLEN Trust International, New Delhi, India
- Swiss Tropical and Public Health Institute (Swiss TPH), Basel, Switzerland
- University of Basel, Basel, Switzerland
| | | | | | | | | | - Jorne Biccler
- P95 Pharmacovigilance and Epidemiology, Leuven, Belgium
| | | | | | - Matthews Mathai
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Punam Mangtani
- Department of Infectious Disease Epidemiology, London School of Tropical Medicine, London, UK
| | | | - Steven Anderson
- Center for Biologics Evaluation and Research (CBER), U.S. Food and Drug Administration (FDA), Silver Spring, MD, USA
| | - Barbee Whitaker
- Center for Biologics Evaluation and Research (CBER), U.S. Food and Drug Administration (FDA), Silver Spring, MD, USA
| | - Hui-Lee Wong
- Center for Biologics Evaluation and Research (CBER), U.S. Food and Drug Administration (FDA), Silver Spring, MD, USA
| | - Clare Cutland
- African Leadership in Vaccinology Expertise (Alive), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Christine Guillard Maure
- African Leadership in Vaccinology Expertise (Alive), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Dodd C, Andrews N, Petousis-Harris H, Sturkenboom M, Omer SB, Black S. Methodological frontiers in vaccine safety: qualifying available evidence for rare events, use of distributed data networks to monitor vaccine safety issues, and monitoring the safety of pregnancy interventions. BMJ Glob Health 2021; 6:bmjgh-2020-003540. [PMID: 34011501 PMCID: PMC8137251 DOI: 10.1136/bmjgh-2020-003540] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/23/2020] [Accepted: 09/28/2020] [Indexed: 01/28/2023] Open
Abstract
While vaccines are rigorously tested for safety and efficacy in clinical trials, these trials do not include enough subjects to detect rare adverse events, and they generally exclude special populations such as pregnant women. It is therefore necessary to conduct postmarketing vaccine safety assessments using observational data sources. The study of rare events has been enabled in through large linked databases and distributed data networks, in combination with development of case-centred methods. Distributed data networks necessitate common protocols, definitions, data models and analytics and the processes of developing and employing these tools are rapidly evolving. Assessment of vaccine safety in pregnancy is complicated by physiological changes, the challenges of mother-child linkage and the need for long-term infant follow-up. Potential sources of bias including differential access to and utilisation of antenatal care, immortal time bias, seasonal timing of pregnancy and unmeasured determinants of pregnancy outcomes have yet to be fully explored. Available tools for assessment of evidence generated in postmarketing studies may downgrade evidence from observational data and prioritise evidence from randomised controlled trials. However, real-world evidence based on real-world data is increasingly being used for safety assessments, and new tools for evaluating real-world evidence have been developed. The future of vaccine safety surveillance, particularly for rare events and in special populations, comprises the use of big data in single countries as well as in collaborative networks. This move towards the use of real-world data requires continued development of methodologies to generate and assess real world evidence.
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Affiliation(s)
- Caitlin Dodd
- Julius Center, UMC Utrecht, Utrecht, The Netherlands
| | - Nick Andrews
- Statistics Modelling and Economics Department, Public Health England, London, UK
| | - Helen Petousis-Harris
- Department of General Practice and Primary Health Care, The University of Auckland, Auckland, New Zealand
| | | | - Saad B Omer
- Institute for Global Health, Yale University, New Haven, Connecticut, USA
| | - Steven Black
- Global Vaccine Data Network, Berkeley, California, USA
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Liu Z, Meng R, Yang Y, Li K, Yin Z, Ren J, Shen C, Feng Z, Zhan S. Active Vaccine Safety Surveillance: Global Trends and Challenges in China. HEALTH DATA SCIENCE 2021; 2021:9851067. [PMID: 38487501 PMCID: PMC10880162 DOI: 10.34133/2021/9851067] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 05/03/2021] [Indexed: 03/17/2024]
Abstract
Importance. The great success in vaccine-preventable diseases has been accompanied by vaccine safety concerns. This has caused vaccine hesitancy to be the top 10 in threats to global health. The comprehensive understanding of adverse events following immunization should be entirely based on clinical trials and postapproval surveillance. It has increasingly been recognized worldwide that the active surveillance of vaccine safety should be an essential part of immunization programs due to its complementary advantages to passive surveillance and clinical trials.Highlights. In the present study, the framework of vaccine safety surveillance was summarized to illustrate the importance of active surveillance and address vaccine hesitancy or safety concerns. Then, the global progress of active surveillance systems was reviewed, mainly focusing on population-based or hospital-based active surveillance. With these successful paradigms, the practical and reliable ways to create robust and similar systems in China were discussed and presented from the perspective of available databases, methodology challenges, policy supports, and ethical considerations.Conclusion. In the inevitable trend of the global vaccine safety ecosystem, the establishment of an active surveillance system for vaccine safety in China is urgent and feasible. This process can be accelerated with the consensus and cooperation of regulatory departments, research institutions, and data owners.
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Affiliation(s)
- Zhike Liu
- Department of Epidemiology and Biostatistics, Peking University Health Science Center, Beijing, China
| | - Ruogu Meng
- National Institute of Health Data Science, Peking University, Beijing, China
| | - Yu Yang
- National Institute of Health Data Science, Peking University, Beijing, China
| | - Keli Li
- National Immunization Programme, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zundong Yin
- National Immunization Programme, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jingtian Ren
- Center for Drug Reevaluation, National Medical Products Administration, BeijingChina
| | - Chuanyong Shen
- Center for Drug Reevaluation, National Medical Products Administration, BeijingChina
| | - Zijian Feng
- National Immunization Programme, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Siyan Zhan
- Department of Epidemiology and Biostatistics, Peking University Health Science Center, Beijing, China
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Abstract
Vaccines against COVID-19 are being developed at speeds not previously achieved. With this unprecedented effort comes challenges for post-marketing safety monitoring and challenges for vaccine safety communication. To deploy these new vaccines fast across diverse populations, it is vital that robust pharmacovigilance and active surveillance systems are in place. Not all countries have the capability or resources to undertake adequate surveillance and will rely on data from those who can. The tools exist to assess COVID-19 vaccines as they are deployed such as surveillance systems, administrative data and case definitions for adverse events of special interest. However, stitching these all together and using them effectively requires investment and collaboration. This paper provides a high-level overview of some of the facets of modern vaccine safety assessment and how they are, or can be, applied to COVID-19 vaccines.
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Ateudjieu J, Stoll B, Bisseck AC, Tembei AM, Genton B. Safety profile of the meningococcal conjugate vaccine (Menafrivac™) in clinical trials and vaccination campaigns: a review of published studies. Hum Vaccin Immunother 2020; 16:1245-1259. [PMID: 31403358 DOI: 10.1080/21645515.2019.1652041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
The study aimed to assess the capacity of AEFI surveillance during vaccination campaigns with the new conjugate meningitis vaccine (MenAfrivac). A systematic review of studies on MenAfrivac™ published in English during 2001-2016 was done.AEFIs incidence (I) was estimated and compared between MenAfrivac™ clinical trials and immunization campaigns using incidence difference (Id). Nine studies were included with an overall local AEFI I of 11,496/100,000 doses administered per week in clinical trials and 0.72/100,000 doses in immunization campaigns. An Id of 11,497.92 [11,497.91-11,497.93] and 17,243.20 [17,241.80-17,245.90] per 100,000 doses administered per week for overall local and systemic AEFI, respectively, were observed with highest from clinical trials. The incidence of AEFIs after MenAfrivac™ vaccination was far lower in campaigns than in clinical trial studies. Current capacity of AEFI surveillance during vaccination campaigns requires extensive re-assessment of its structure and capacity.
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Affiliation(s)
- Jerome Ateudjieu
- Department of Biomedical Sciences, Faculty of Sciences, University of Dschang , Dschang, Cameroon.,Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute , Basel, Switzerland.,Division of Health Operations Research, Ministry of Public Health , Nonthaburi, Cameroon
| | - Beat Stoll
- Institute of Social and Preventive Medicine, Faculty of Medicine, University of Geneva , Geneva, Switzerland
| | - Anne Cecile Bisseck
- Division of Health Operations Research, Ministry of Public Health , Nonthaburi, Cameroon.,Faculty of Medicine, University of Yaounde 1 , Yaounde, Cameroon
| | - Ayok M Tembei
- Department of Research and Training, M.A. SANTE (Meileur Accès aux soins de santé) , Yaounde, Cameroon
| | - Blaise Genton
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute , Basel, Switzerland.,Department of Ambulatory Care and Community Medicine-Infectious Disease Service, University Hospital , Lausanne, Switzerland
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Farmacovigilancia de vacunas y su aplicación en Chile. REVISTA MÉDICA CLÍNICA LAS CONDES 2020. [DOI: 10.1016/j.rmclc.2020.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Izurieta HS, Moro PL, Chen RT. Hospital-based collaboration for epidemiological investigation of vaccine safety: A potential solution for low and middle-income countries? Vaccine 2018; 36:345-346. [PMID: 29033065 DOI: 10.1016/j.vaccine.2017.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Hector S Izurieta
- Center for Biologics Evaluation and Research (CBER), Food and Drug Administration, MD, USA.
| | - Pedro L Moro
- Immunization Safety Office (ISO), Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Robert T Chen
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
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