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Kumar SS, Hartner AM, Chandran A, Gaythorpe KAM, Li X. Evaluating effective measles vaccine coverage in the Malaysian population accounting for between-dose correlation and vaccine efficacy. BMC Public Health 2023; 23:2351. [PMID: 38017415 PMCID: PMC10683193 DOI: 10.1186/s12889-023-17082-9] [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: 07/07/2023] [Accepted: 10/27/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Malaysia introduced the two dose measles-mumps-rubella (MMR) vaccine in 2004 as part of its measles elimination strategy. However, despite high historical coverage of MCV1 and MCV2, Malaysia continues to report high measles incidence. This study suggests a novel indicator for investigating population immunity against measles in the Malaysian population. METHODS We define effective vaccine coverage (EVC) of measles as the proportion of a population vaccinated with measles-containing vaccine (MCV) and effectively protected against measles infection. A quantitative evaluation of EVC throughout the life course of Malaysian birth cohorts was conducted accounting for both vaccine efficacy (VE) and between-dose correlation (BdC). Measles vaccination coverage was sourced from WHO-UNICEF estimates of Malaysia's routine immunisation coverage and supplementary immunisation activities (SIAs). United Nations World population estimates and projections (UNWPP) provided birth cohort sizes stratified by age and year. A step wise joint Bernoulli distribution was used to proportionate the Malaysian population born between 1982, the first year of Malaysia's measles vaccination programme, and 2021, into individuals who received zero dose, one dose and multiple doses of MCV. VE estimates by age and doses received are then adopted to derive EVC. A sensitivity analysis was conducted using 1000 random combinations of BdC and VE parameters. RESULTS This study suggests that no birth cohort in the Malaysian population has achieved > 95% population immunity (EVC) conferred through measles vaccination since the measles immunisation programme began in Malaysia. CONCLUSION The persistence of measles in Malaysia is due to pockets of insufficient vaccination coverage against measles in the population. Monitoring BdC through immunisation surveillance systems may allow for the identification of susceptible subpopulations (primarily zero-dose MCV individuals) and increase the coverage of individuals who are vaccinated with multiple doses of MCV. This study provides a tool for assessment of national-level population immunity of measles conferred through vaccination and does not consider subnational heterogeneity or vaccine waning. This tool can be readily applied to other regions and vaccine-preventable diseases.
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Affiliation(s)
- Shurendar Selva Kumar
- MRC Centre for Global Infectious Disease Analysis, Jameel Institute, School of Public Health, Imperial College London, London, W2 1NY, UK.
| | - Anna-Maria Hartner
- MRC Centre for Global Infectious Disease Analysis, Jameel Institute, School of Public Health, Imperial College London, London, W2 1NY, UK
- Centre for Artificial Intelligence in Public Health Research, Robert Koch Institute, Wildau, Germany
| | | | - Katy A M Gaythorpe
- MRC Centre for Global Infectious Disease Analysis, Jameel Institute, School of Public Health, Imperial College London, London, W2 1NY, UK
| | - Xiang Li
- MRC Centre for Global Infectious Disease Analysis, Jameel Institute, School of Public Health, Imperial College London, London, W2 1NY, UK.
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Sáfadi MAP. The importance of immunization as a public health instrument. J Pediatr (Rio J) 2023; 99 Suppl 1:S1-S3. [PMID: 36581310 PMCID: PMC10066437 DOI: 10.1016/j.jped.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- Marco Aurélio Palazzi Sáfadi
- Departamento de Pediatria, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil; Associate Editor of the Jornal de Pediatria, Sociedade Brasileira de Pediatria, Rio de Janeiro, RJ, Brazil.
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Ferreira LS, Darcie Marquitti FM, Paixão da Silva RL, Borges ME, Ferreira da Costa Gomes M, Cruz OG, Kraenkel RA, Coutinho RM, Prado PI, Bastos LS. Estimating the impact of implementation and timing of the COVID-19 vaccination programme in Brazil: a counterfactual analysis. LANCET REGIONAL HEALTH. AMERICAS 2023; 17:100397. [PMID: 36439909 PMCID: PMC9676113 DOI: 10.1016/j.lana.2022.100397] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 09/30/2022] [Accepted: 10/27/2022] [Indexed: 11/22/2022]
Abstract
Background Vaccines developed between 2020 and 2021 against the SARS-CoV-2 virus were designed to diminish the severity and prevent deaths due to COVID-19. However, estimates of the effectiveness of vaccination campaigns in achieving these goals remain a methodological challenge. In this work, we developed a Bayesian statistical model to estimate the number of deaths and hospitalisations averted by vaccination of older adults (above 60 years old) in Brazil. Methods We fit a linear model to predict the number of deaths and hospitalisations of older adults as a function of vaccination coverage in this group and casualties in younger adults. We used this model in a counterfactual analysis, simulating alternative scenarios without vaccination or with faster vaccination roll-out. We estimated the direct effects of COVID-19 vaccination by computing the difference between hypothetical and realised scenarios. Findings We estimated that more than 165,000 individuals above 60 years of age were not hospitalised due to COVID-19 in the first seven months of the vaccination campaign. An additional contingent of 104,000 hospitalisations could have been averted if vaccination had started earlier. We also estimated that more than 58 thousand lives were saved by vaccinations in the period analysed for the same age group and that an additional 47 thousand lives could have been saved had the Brazilian government started the vaccination programme earlier. Interpretation Our estimates provided a lower bound for vaccination impacts in Brazil, demonstrating the importance of preventing the suffering and loss of older Brazilian adults. Once vaccines were approved, an early vaccination roll-out could have saved many more lives, especially when facing a pandemic. Funding The Coordenação de Aperfeiçoamento de Pessoal de Nível Superior-Brazil (Finance Code 001 to F.M.D.M. and L.S.F.), Conselho Nacional de Desenvolvimento Científico e Tecnológico - Brazil (grant number: 315854/2020-0 to M.E.B., 141698/2018-7 to R.L.P.d.S., 313055/2020-3 to P.I.P., 311832/2017-2 to R.A.K.), Fundação de Amparo à Pesquisa do Estado de São Paulo - Brazil (contract number: 2016/01343-7 to R.A.K.), Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro - Brazil (grant number: E-26/201.277/2021 to L.S.B.) and Inova Fiocruz/Fundação Oswaldo Cruz - Brazil (grant number: 48401485034116) to L.S.B., O.G.C. and M.G.d.F.C. The funding agencies had no role in the conceptualization of the study.
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Affiliation(s)
- Leonardo Souto Ferreira
- Instituto de Física Teórica, Universidade Estadual Paulista, São Paulo, Brazil,Observatório COVID-19 BR, Brazil
| | - Flavia Maria Darcie Marquitti
- Observatório COVID-19 BR, Brazil,Instituto de Física ‘Gleb Wataghin’ and Instituto de Biologia, Universidade Estadual de Campinas, Campinas, Brazil,Corresponding author. Instituto de Física ‘Gleb Wataghin’, Rua Sérgio Buarque de Holanda, 777 - Cidade Universitária, Universidade Estadual de Campinas, Campinas, Brazil Zip-code: 13083-859
| | - Rafael Lopes Paixão da Silva
- Instituto de Física Teórica, Universidade Estadual Paulista, São Paulo, Brazil,Observatório COVID-19 BR, Brazil
| | | | | | - Oswaldo Gonçalves Cruz
- Observatório COVID-19 BR, Brazil,Fundação Oswaldo Cruz, Programa de Computação Científica, Rio de Janeiro, Brazil
| | - Roberto André Kraenkel
- Instituto de Física Teórica, Universidade Estadual Paulista, São Paulo, Brazil,Observatório COVID-19 BR, Brazil
| | - Renato Mendes Coutinho
- Observatório COVID-19 BR, Brazil,Centro de Matemática, Computação e Cognição, Universidade Federal do ABC, Santo André, Brazil
| | - Paulo Inácio Prado
- Observatório COVID-19 BR, Brazil,Instituto de Biociências, Universidade de São Paulo, São Paulo, Brazil
| | - Leonardo Soares Bastos
- Observatório COVID-19 BR, Brazil,Fundação Oswaldo Cruz, Programa de Computação Científica, Rio de Janeiro, Brazil
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Mahdiabadi S, Rezaei N. Anaphylaxis and allergic reactions to COVID‐19 vaccines: A narrative review of characteristics and potential obstacles on achieving herd immunity. Health Sci Rep 2022; 5:e787. [PMID: 36032518 PMCID: PMC9401640 DOI: 10.1002/hsr2.787] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/29/2022] [Accepted: 08/01/2022] [Indexed: 12/24/2022] Open
Abstract
Background and Aims Methods Results Conclusion
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Affiliation(s)
- Sara Mahdiabadi
- School of Medicine Tehran University of Medical Sciences Tehran Iran
- Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Children's Medical Center Tehran Iran
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center Tehran University of Medical Sciences Tehran Iran
| | - Nima Rezaei
- Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Children's Medical Center Tehran Iran
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center Tehran University of Medical Sciences Tehran Iran
- Department of Immunology, School of Medicine Tehran University of Medical Sciences Tehran Iran
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Review of Over 15 Years Postmarketing Safety Surveillance Spontaneous Data for the Human Rotavirus Vaccine (Rotarix) on Intussusception. Drug Saf 2022; 45:155-168. [PMID: 35015268 PMCID: PMC8894299 DOI: 10.1007/s40264-021-01141-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2021] [Indexed: 01/16/2023]
Abstract
Introduction Rotavirus (RV) is the most common cause of acute gastroenteritis in children <5 years of age worldwide, and vaccination reduces the disease burden. Evidence from postmarketing surveillance studies suggested an increased risk of intussusception (IS) in infants post-RV vaccination. An overall positive benefit–risk balance for the human RV vaccine (HRV) Rotarix (GlaxoSmithKline [GSK], Belgium) has been established and recent findings indicate an indirect effect of reduced IS over the long term. Objective The aim of this study was to discuss spontaneous data from the GSK worldwide safety database on IS post-Rotarix administration. Methods The database was reviewed for all spontaneous IS cases from 2004 to 2020. Additionally, an observed versus expected (O/E) analysis was done for adverse events attributed to IS. Data were reviewed as overall worldwide and stratified by region (Europe/USA/Japan) and dose. Results A male predominance of IS patients was observed, consistent with earlier reports. The most frequently reported events in confirmed IS cases (Brighton Collaboration Working Group [BCWG] level 1) with time to onset ≤ 30 days post-vaccination were vomiting (55.8%), haematochezia (47.2%), and crying (21.1%). The observations from the IS spontaneous cases review and results of the O/E analysis are consistent with the known IS safety profile of RV vaccines: a transient increased incidence of IS post-vaccination (primarily in Europe/Japan/worldwide), mostly within 7 days postdose 1. Conclusion Since the outcomes of early IS management are favourable over delayed management, healthcare professionals should inform parents about the importance of seeking immediate medical advice in case of unusual behaviour of the vaccinated infant. GSK continues to monitor the IS risk post-Rotarix administration through routine pharmacovigilance activities. Graphic abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1007/s40264-021-01141-4. Rotavirus (RV) is the most common cause of acute gastroenteritis and a major cause of death in young children worldwide. Vaccination has been instrumental in reducing the impact of RV disease. Real-world evidence suggests an increased risk of intussusception (an infrequent type of bowel obstruction) in infants following RV vaccination. We reviewed IS cases reported spontaneously worldwide in children following a two-dose vaccination with the human RV vaccine (Rotarix, GlaxoSmithKline [GSK]) since its launch in 2004. We observed that (1) IS occurred more frequently 7 days after the first dose and, to a lesser extent, after the second dose; (2) boys were more frequently affected than girls (56.3%); (3) of 862 confirmed reported cases, 557 required hospitalisation; and (4) surgical intervention was required for 294 of 557 hospitalised cases. We used statistical analysis to assess whether the number of cases observed would be higher or lower than the natural occurrence of IS (irrespective of vaccination). These results were in line with the known RV vaccine safety profile. It is important to constantly monitor the real-world safety profile of RV vaccines in the postmarketing setting. Since the outcomes of early management of IS are favourable compared with delayed management, healthcare professionals should inform parents to seek immediate medical advice if they observe unusual behaviour in their vaccinated child. In conclusion, our analyses on data of a large patient pool for this rare event reinforce the favourable safety profile of human RV vaccine and the benefits of vaccination in young children.
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Thompson KM, Badizadegan K. Health economic analyses of secondary vaccine effects: a systematic review and policy insights. Expert Rev Vaccines 2021; 21:297-312. [PMID: 34927511 DOI: 10.1080/14760584.2022.2017287] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
INTRODUCTION : Numerous analyses demonstrate substantial health economic impacts of primary vaccine effects (preventing or mitigating clinical manifestations of the diseases they target), but vaccines may also be associated with secondary effects, previously known as non-specific, heterologous, or off-target effects. AREAS COVERED : We define key concepts to distinguish primary and secondary vaccine effects for health economic analyses, summarized terminology used in different fields, and perform a systematic review of health economic analyses focused on secondary vaccine effects (SVEs). EXPERT OPINION : Health economists integrate evidence from multiple fields, which often use incomplete or inconsistent definitions. Like regulators and policy makers, health economists require high-quality evidence of specific effects. Consistent with the limited evidence on mechanisms of action for SVEs, the associated health economic literature remains highly limited, with 4 studies identified by our systematic review. The lack of specific and well-controlled evidence that supports quantification of specific SVEs limits the consideration of these effects in vaccine research, development, regulatory, and recommendation decisions and health economic analyses.
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Chiang V, Leung ASY, Au EYL, Ho MHK, Lee TH, Wu AYY, Wong GWK, Li PH. Consensus Statements on the Approach to COVID-19 Vaccine Allergy Safety in Hong Kong. FRONTIERS IN ALLERGY 2021; 2:690837. [PMID: 35387010 PMCID: PMC8974694 DOI: 10.3389/falgy.2021.690837] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 06/15/2021] [Indexed: 12/30/2022] Open
Abstract
Background: Mass coronavirus disease 2019 (COVID-19) vaccination to achieve herd immunity is an effective means to mitigate the current COVID-19 pandemic. Reports of COVID-19 vaccine-associated allergic reactions and lack of clear local guidance are contributing factors leading to a low vaccine acceptance rate in the community. A task force of experts from the Hong Kong Institute of Allergy (HKIA) has been formed to address current needs. Objective: To formulate a set of consensus statements (CS) on COVID-19 vaccine allergy safety (VAS) in Hong Kong. Methods: A nominated task force of experts managing patients with drug and vaccine allergies in Hong Kong formulated the CS by the Delphi method. An agreement was a priori defined as ≥80% consensus. Results: A total of 11 statements met the criteria for consensus with good overall agreement among task force members, including seven statements on pre-vaccination recommendations and four statements on vaccination and post-vaccination guidance. Individuals with a history of suspected allergic reaction to prior COVID-19 vaccination should not receive further COVID-19 vaccination, and other groups at risk of COVID-19 vaccine-associated allergic reactions have been identified. The importance of pre-vaccination and post-vaccination assessment by frontline healthcare workers and evaluation by allergists are highlighted. Conclusion: The CS provides pragmatic and timely guidance for local frontline healthcare providers on decisions regarding COVID-19 VAS.
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Affiliation(s)
- Valerie Chiang
- Division of Clinical Immunology, Department of Pathology, Queen Mary Hospital, Hong Kong, China
| | - Agnes S. Y. Leung
- Department of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Elaine Y. L. Au
- Division of Clinical Immunology, Department of Pathology, Queen Mary Hospital, Hong Kong, China
| | - Marco H. K. Ho
- Department of Paediatrics & Adolescent Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Tak Hong Lee
- Allergy Centre, Hong Kong Sanatorium and Hospital, Hong Kong, China
| | | | - Gary W. K. Wong
- Department of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Philip H. Li
- Division of Rheumatology & Clinical Immunology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
- *Correspondence: Philip H. Li
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Klimek L, Jutel M, Akdis CA, Bousquet J, Akdis M, Torres MJ, Agache I, Canonica GW, Del Giacco S, O'Mahony L, Shamji MH, Schwarze J, Untersmayr E, Ring J, Bedbrook A, Worm M, Zuberbier T, Knol E, Hoffmann‐Sommergruber K, Chivato T. ARIA-EAACI statement on severe allergic reactions to COVID-19 vaccines - An EAACI-ARIA Position Paper. Allergy 2021; 76:1624-1628. [PMID: 33378789 DOI: 10.1111/all.14726] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 12/28/2020] [Indexed: 12/01/2022]
Abstract
Further to the approval of the Coronavirus disease 2019 (COVID-19) vaccine BNT162b2, several severe anaphylaxis cases occured within the first few days of public vaccination. An investigation is taking place to understand the cases and their triggers. The vaccine will be administered to a large number of individuals worldwide and there are raising concerns that severe adverse events might occur. With the current information, the European Academy of Allergy and Clinical Immunology (EAACI) states its position for the following preliminary recommendations that are to be revised as soon as more data emerge. To minimize the risk of severe allergic reactions in vaccinated individuals, it is urgently required to understand the specific nature of the reported severe allergic reactions, including the background medical history of the individuals affected and the mechanisms involved. To achieve this goal, all clinical and laboratory information should be collected and reported. Mild and moderate allergic patients should not be excluded from the vaccine as this could have a significant impact on reaching the goal of population immunity. Healthcare practitioners vaccinating against COVID-19 are required to be sufficiently prepared to recognize and treat anaphylaxis properly with the ability to administer adrenaline. Further to vaccine administration, a mandatory observation period of at least 15 minutes should be followed for all individuals. The current data have not shown any higher risk for patients suffering from allergic rhinitis or asthma, and this message should be clearly stated by physicians to enable our patients to trust the vaccine. More than 30% of the population suffers from allergic diseases and the benefit of the vaccination clearly outweighs the risk of severe COVID-19 development.
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Affiliation(s)
- Ludger Klimek
- Center for Rhinology and Allergology Wiesbaden Germany
| | - Marek Jutel
- Department of Clinical Immunology Wrocław Medical University Wrocław Poland
| | - Cezmi A. Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF University of Zurich Davos Switzerland
| | - Jean Bousquet
- Department of Dermatology and Allergy Comprehensive Allergy Center Humboldt‐Universität zu Berlin, and Berlin Institute of Health Charité, Universitätsmedizin Berlin Berlin Germany
- University Hospital Montpellier Montpellier France
- MACVIA‐France Montpellier France
| | - Mübeccel Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF University of Zurich Davos Switzerland
| | - Maria J Torres
- Allergy Unit Hospital Regional Universitario de Málaga‐UMA‐ARADyAL Málaga Spain
| | | | - G. Walter Canonica
- Personalized Medicine Clinic Asthma & Allergy Humanitas Research Hospital‐IRCCS Milan Italy
- Department of Biomedical Sciences Humanitas University Milan Italy
| | - Stefano Del Giacco
- Department of Medical Sciences and Public Health and Unit of Allergy and Clinical Immunology University Hospital "Duilio Casula" University of Cagliari Cagliari Italy
| | - Liam O'Mahony
- Department of Medicine and Microbiology APC Microbiome Ireland University College Cork Cork Ireland
| | - Mohamed H. Shamji
- Immunomodulation and Tolerance Group, Allergy and Clinical Immunology Inflammation, Repair and Development National Heart and Lung Institute Imperial College London London UK
- Asthma UK Centre in Allergic Mechanisms of Asthma London UK
| | - Jürgen Schwarze
- Child Life and Health and Centre for Inflammation Research, Queen's Medical Research Institute The University of Edinburgh Edinburgh UK
| | - Eva Untersmayr
- Institute of Pathophysiology and Allergy Research Center for Pathophysiology, Infectiology and Immunology Medical University of Vienna Vienna Austria
| | - Johannes Ring
- Department of Dermatology and Allergy TUM Munich Germany
| | | | - Margitta Worm
- Department of Dermatology and Allergy Comprehensive Allergy Center Humboldt‐Universität zu Berlin, and Berlin Institute of Health Charité, Universitätsmedizin Berlin Berlin Germany
| | - Torsten Zuberbier
- Department of Dermatology and Allergy Comprehensive Allergy Center Humboldt‐Universität zu Berlin, and Berlin Institute of Health Charité, Universitätsmedizin Berlin Berlin Germany
| | - Edward Knol
- Departments of Immuno and Dermatology/Allergology University Medical Center Utrecht Netherlands
| | - Karin Hoffmann‐Sommergruber
- Institute of Pathophysiology and Allergy Research Center for Pathophysiology, Infectiology and Immunology Medical University of Vienna Vienna Austria
| | - Tomás Chivato
- School of medicine. University CEU San Pablo Madrid Spain
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Malik TM, Mohammed-Awel J, Gumel AB, Elbasha EH. Mathematical assessment of the impact of cohort vaccination on pneumococcal carriage and serotype replacement. JOURNAL OF BIOLOGICAL DYNAMICS 2021; 15:S214-S247. [PMID: 33594952 DOI: 10.1080/17513758.2021.1884760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 01/20/2021] [Indexed: 06/12/2023]
Abstract
Although pneumococcal vaccines are quite effective in reducing disease burden, factors such as imperfect vaccine efficacy and serotype replacement present an important challenge against realizing direct and herd protection benefits of the vaccines. In this study, a novel mathematical model is designed and used to describe the dynamics of two Streptococcus pneumoniae (SP) serotypes, in response to the introduction of a cohort vaccination program which targets one of the two serotypes. The model is fitted to a pediatric SP carriage prevalence data from Atlanta, GA. The model, which is rigorously analysed to investigate the existence and asymptotic stability properties of the associated equilibria (in addition to exploring conditions for competitive exclusion), is simulated to assess the impact of vaccination under different levels of serotype-specific competition and illustrate the phenomenon of serotype replacement. The calibrated model is used to forecast the carriage prevalence in the pediatric cohort over 30 years.
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Affiliation(s)
- Tufail M Malik
- Merck & Co. Inc., 2000 Galloping Hill Road, Kenilworth, NJ, USA
| | | | - Abba B Gumel
- School of Mathematical and Statistical Sciences, Arizona State University, Tempe, AZ, USA
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Constrained Optimization for Pneumococcal Vaccination in Brazil. Value Health Reg Issues 2021; 26:40-49. [PMID: 33848895 DOI: 10.1016/j.vhri.2020.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 10/02/2020] [Accepted: 11/12/2020] [Indexed: 01/17/2023]
Abstract
OBJECTIVES To identify the most cost-efficient combination of pneumococcal vaccines in infants and aging adults for a 10-year period in Brazil. METHODS Constrained optimization (CO) prioritized 9 pneumococcal vaccine regimens according to their gain in quality-adjusted life-years (QALYs) and their related costs over a prespecified time horizon with defined constraints for 2 age groups, infants and aging adults. The analysis starts from the current universal infant vaccination of pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV), 2 primary and 1 booster dose at 2, 4, and 12 months, respectively. Key constraints are the fixed annual vaccine budget increase and the relative return on investment (ROIR) per regimen, which must be > 1, the reference intervention being the current vaccination strategy in infants and the most cost-efficient one in aging adults. RESULTS The CO analysis including all the constraints indicates that over 10 years the maximum extra health gain is 126 194 QALYs for an extra budget of $974 million Brazilian reals (ROIR = 1.15). Results could be improved with a higher proportion of the at-risk population in aging adults, less herd effect, and better QALY scores. CONCLUSION The study shows that with 4 constraints on budget, time horizon, vaccine coverage, and cost efficiency, a CO analysis could identify the most cost-efficient overall pneumococcal vaccination strategy for Brazil, allowing for limited vaccine budget increase while obtaining appropriate health gain.
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Schwere allergische Reaktionen nach COVID-19-Impfung mit dem Impfstoff von Pfizer/BioNTech in Großbritannien und USA. ALLERGO JOURNAL 2021; 30:24-29. [PMID: 33785990 PMCID: PMC7994061 DOI: 10.1007/s15007-021-4762-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Zwei Mitarbeiter des National Health Service (NHS) in England entwickelten nach der Verabreichung des BNT162b2-Impfstoffs von BionNTech gegen COVID-19 schwere allergische Reaktionen. Die britische Fachinformation für den BNT162b2-Impfstoff enthält bereits Hinweise auf eine Kontraindikation zur Anwendung bei Personen, die allergisch auf den Impfstoff oder einen seiner Bestandteile reagiert haben. Als Vorsichtsmaßnahme hat die englische Regulationsbehörde für Arzneimittel und Gesundheitsprodukte (MHRA) eine vorläufige Anleitung herausgegeben, "Patienten mit schweren Allergien" grundsätzlich nicht zu impfen. Allergische Reaktionen auf Impfstoffe sind sehr selten, aber Impfstoffkomponenten verursachen bekanntermaßen allergische Reaktionen. BNT162b2 ist ein Impfstoff, der auf einer in Lipidnanopartikel eingebetteten mRNA basiert und mit weiteren Substanzen angereichert wird, um den Transport in die Zellen zu ermöglichen. In der zentralen klinischen Phase-III-Studie wurde der BNT162b2-Impfstoff im Allgemeinen gut vertragen. Impfstoffe gelten als eine der wirksamsten Maßnahmen im Bereich der öffentlichen Gesundheit. Schwere allergische Reaktionen auf Impfstoffe sind selten, können jedoch lebensbedrohlich sein. Es ist ratsam, die Impfteams auf diese Gefahr aufmerksam zu machen und angemessene Vorsichtsmaßnahmen zu treffen, während mehr Erfahrungen mit dem neuen Impfstoff gesammelt werden.
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Klimek L, Novak N, Hamelmann E, Werfel T, Wagenmann M, Taube C, Bauer A, Merk H, Rabe U, Jung K, Schlenter W, Ring J, Chaker A, Wehrmann W, Becker S, Mülleneisen N, Nemat K, Czech W, Wrede H, Brehler R, Fuchs T, Jakob T, Ankermann T, Schmidt SM, Gerstlauer M, Vogelberg C, Zuberbier T, Hartmann K, Worm M. Severe allergic reactions after COVID-19 vaccination with the Pfizer/BioNTech vaccine in Great Britain and USA: Position statement of the German Allergy Societies: Medical Association of German Allergologists (AeDA), German Society for Allergology and Clinical Immunology (DGAKI) and Society for Pediatric Allergology and Environmental Medicine (GPA). ACTA ACUST UNITED AC 2021; 30:51-55. [PMID: 33643776 PMCID: PMC7903024 DOI: 10.1007/s40629-020-00160-4] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2020] [Indexed: 11/27/2022]
Abstract
Two employees of the National Health Service (NHS) in England developed severe allergic reactions following administration of BNT162b2 vaccine against COVID-19 (coronavirus disease 2019). The British SmPC for the BNT162b2 vaccine already includes reference to a contraindication for use in individuals who have had an allergic reaction to the vaccine or any of its components. As a precautionary measure, the Medicines and Healthcare products Regulatory Agency (MHRA) has issued interim guidance to the NHS not to vaccinate in principle in "patients with severe allergies". Allergic reactions to vaccines are very rare, but vaccine components are known to cause allergic reactions. BNT162b2 is a vaccine based on an mRNA embedded in lipid nanoparticles and blended with other substances to enable its transport into the cells. In the pivotal phase III clinical trial, the BNT162b2 vaccine was generally well tolerated, but this large clinical trial, used to support vaccine approval by the MHRA and US Food and Drug Administration, excluded individuals with a "history of a severe adverse reaction related to the vaccine and/or a severe allergic reaction (e.g., anaphylaxis) to a component of the study medication". Vaccines are recognized as one of the most effective public health interventions. This repeated administration of a foreign protein (antigen) necessitates a careful allergological history before each application and diagnostic clarification and a risk-benefit assessment before each injection. Severe allergic reactions to vaccines are rare but can be life-threatening, and it is prudent to raise awareness of this hazard among vaccination teams and to take adequate precautions while more experience is gained with this new vaccine.
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Affiliation(s)
- Ludger Klimek
- Center for Rhinology and Allergology Wiesbaden, Wiesbaden, Germany
| | - Natalija Novak
- Clinic and Polyclinic for Dermatology and Allergology, University Hospital Bonn, Bonn, Germany
| | - Eckard Hamelmann
- Pediatric and Adolescent Medicine, Children's Center Bethel, University Hospital OWL of Bielefeld University, Bielefeld, Germany
| | - Thomas Werfel
- Department of Dermatology, Allergology and Venereology, Hannover Medical School, Hannover, Germany
| | - Martin Wagenmann
- Department of Ear, Nose and Throat Medicine, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Christian Taube
- Clinic for Pneumology, University Medicine Essen-Ruhrlandklinik, West German Lung Center, Essen, Germany
| | - Andrea Bauer
- Clinic and Polyclinic for Dermatology, University Allergy Center, University Clinic Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Hans Merk
- Department of Dermatology and Allergology, RWTH Aachen, Aachen, Germany
| | - Uta Rabe
- Clinic for Allergology, Johanniter Hospital in Fläming Treuenbrietzen GmbH, Treuenbrietzen, Germany
| | - Kirsten Jung
- Practice for Dermatology, Immunology and Allergology, Erfurt, Germany
| | | | | | - Adam Chaker
- Ear, Nose and Throat Clinic, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,Center for Allergy and Environment (ZAUM), Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | | | - Sven Becker
- Ear, Nose and Throat Clinic, University of Tübingen, Tübingen, Germany
| | | | - Katja Nemat
- Practice for Pediatric Pneumology/Allergology at the Children's Center Dresden (Kid), Dresden, Germany
| | - Wolfgang Czech
- Practice and Clinic for Allergology/Dermatology Schwarzwald-Baar Clinic, Villingen-Schwenningen, Germany
| | - Holger Wrede
- Ear, Nose and Throat Specialist, Herford, Germany
| | - Randolf Brehler
- Department of Skin Diseases, Outpatient Clinic for Allergology, Occupational Dermatology and Environmental Medicine, Münster University Hospital, Münster, Germany
| | - Thomas Fuchs
- Department of Dermatology, Venereology and Allergology, University Medical Center, Georg-August University, Göttingen, Germany
| | - Thilo Jakob
- Department of Dermatology and Allergology, University Hospital Gießen, UKGM Justus Liebig University Gießen, Gießen, Germany
| | - Tobias Ankermann
- Clinic for Pediatric and Adolescent Medicine, Pneumology, Allergology, Neonatology, Intensive Care Medicine, Infectiology, Schleswig-Holstein University Medical Center, Kiel, Germany
| | - Sebastian M Schmidt
- Center for Pediatric and Adolescent Medicine, Clinic and Polyclinic for Pediatric and Adolescent Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Michael Gerstlauer
- Pediatric Pneumology/Pediatric Allergology, 2nd Clinic for Children and Adolescents, University Hospital Augsburg, Augsburg, Germany
| | - Christian Vogelberg
- Department of Pediatric Pneumology/Allergology, Clinic and Polyclinic for Pediatric and Adolescent Medicine, Carl Gustav Carus University Hospital, Dresden, Germany
| | - Thomas Zuberbier
- Clinic for Dermatology, Venereology and Allergology, Charité-University Medicine Berlin, Berlin, Germany
| | - Karin Hartmann
- Clinic for Dermatology and Allergology, University Hospital Basel, Basel, Switzerland
| | - Margitta Worm
- Allergologie und Immunologie, Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
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13
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Tregoning JS, Brown ES, Cheeseman HM, Flight KE, Higham SL, Lemm N, Pierce BF, Stirling DC, Wang Z, Pollock KM. Vaccines for COVID-19. Clin Exp Immunol 2020; 202:162-192. [PMID: 32935331 PMCID: PMC7597597 DOI: 10.1111/cei.13517] [Citation(s) in RCA: 145] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 09/04/2020] [Accepted: 09/04/2020] [Indexed: 12/13/2022] Open
Abstract
Since the emergence of COVID-19, caused by the SARS-CoV-2 virus at the end of 2019, there has been an explosion of vaccine development. By 24 September 2020, a staggering number of vaccines (more than 200) had started preclinical development, of which 43 had entered clinical trials, including some approaches that have not previously been licensed for human vaccines. Vaccines have been widely considered as part of the exit strategy to enable the return to previous patterns of working, schooling and socializing. Importantly, to effectively control the COVID-19 pandemic, production needs to be scaled-up from a small number of preclinical doses to enough filled vials to immunize the world's population, which requires close engagement with manufacturers and regulators. It will require a global effort to control the virus, necessitating equitable access for all countries to effective vaccines. This review explores the immune responses required to protect against SARS-CoV-2 and the potential for vaccine-induced immunopathology. We describe the profile of the different platforms and the advantages and disadvantages of each approach. The review also addresses the critical steps between promising preclinical leads and manufacturing at scale. The issues faced during this pandemic and the platforms being developed to address it will be invaluable for future outbreak control. Nine months after the outbreak began we are at a point where preclinical and early clinical data are being generated for the vaccines; an overview of this important area will help our understanding of the next phases.
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Affiliation(s)
- J. S. Tregoning
- Department of Infectious DiseaseSt Mary’s CampusImperial College LondonLondonUK
| | - E. S. Brown
- Department of Infectious DiseaseSt Mary’s CampusImperial College LondonLondonUK
| | - H. M. Cheeseman
- Department of Infectious DiseaseSt Mary’s CampusImperial College LondonLondonUK
| | - K. E. Flight
- Department of Infectious DiseaseSt Mary’s CampusImperial College LondonLondonUK
| | - S. L. Higham
- Department of Infectious DiseaseSt Mary’s CampusImperial College LondonLondonUK
| | - N.‐M. Lemm
- Department of Infectious DiseaseSt Mary’s CampusImperial College LondonLondonUK
| | - B. F. Pierce
- Department of Infectious DiseaseSt Mary’s CampusImperial College LondonLondonUK
| | - D. C. Stirling
- Department of Infectious DiseaseSt Mary’s CampusImperial College LondonLondonUK
| | - Z. Wang
- Department of Infectious DiseaseSt Mary’s CampusImperial College LondonLondonUK
| | - K. M. Pollock
- Department of Infectious DiseaseSt Mary’s CampusImperial College LondonLondonUK
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14
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Hakim H, Bettinger JA, Chambers CT, Driedger SM, Dubé E, Gavaruzzi T, Giguere AMC, Kavanagh É, Leask J, MacDonald SE, Orji R, Parent E, Paquette JS, Roberge J, Sander B, Scherer AM, Tremblay-Breault M, Wilson K, Reinharz D, Witteman HO. A Web Application About Herd Immunity Using Personalized Avatars: Development Study. J Med Internet Res 2020; 22:e20113. [PMID: 33124994 PMCID: PMC7665952 DOI: 10.2196/20113] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/03/2020] [Accepted: 07/26/2020] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Herd immunity or community immunity refers to the reduced risk of infection among susceptible individuals in a population through the presence and proximity of immune individuals. Recent studies suggest that improving the understanding of community immunity may increase intentions to get vaccinated. OBJECTIVE This study aims to design a web application about community immunity and optimize it based on users' cognitive and emotional responses. METHODS Our multidisciplinary team developed a web application about community immunity to communicate epidemiological evidence in a personalized way. In our application, people build their own community by creating an avatar representing themselves and 8 other avatars representing people around them, for example, their family or coworkers. The application integrates these avatars in a 2-min visualization showing how different parameters (eg, vaccine coverage, and contact within communities) influence community immunity. We predefined communication goals, created prototype visualizations, and tested four iterative versions of our visualization in a university-based human-computer interaction laboratory and community-based settings (a cafeteria, two shopping malls, and a public library). Data included psychophysiological measures (eye tracking, galvanic skin response, facial emotion recognition, and electroencephalogram) to assess participants' cognitive and affective responses to the visualization and verbal feedback to assess their interpretations of the visualization's content and messaging. RESULTS Among 110 participants across all four cycles, 68 (61.8%) were women and 38 (34.5%) were men (4/110, 3.6%; not reported), with a mean age of 38 (SD 17) years. More than half (65/110, 59.0%) of participants reported having a university-level education. Iterative changes across the cycles included adding the ability for users to create their own avatars, specific signals about who was represented by the different avatars, using color and movement to indicate protection or lack of protection from infectious disease, and changes to terminology to ensure clarity for people with varying educational backgrounds. Overall, we observed 3 generalizable findings. First, visualization does indeed appear to be a promising medium for conveying what community immunity is and how it works. Second, by involving multiple users in an iterative design process, it is possible to create a short and simple visualization that clearly conveys a complex topic. Finally, evaluating users' emotional responses during the design process, in addition to their cognitive responses, offers insights that help inform the final design of an intervention. CONCLUSIONS Visualization with personalized avatars may help people understand their individual roles in population health. Our app showed promise as a method of communicating the relationship between individual behavior and community health. The next steps will include assessing the effects of the application on risk perception, knowledge, and vaccination intentions in a randomized controlled trial. This study offers a potential road map for designing health communication materials for complex topics such as community immunity.
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Affiliation(s)
- Hina Hakim
- Department of Family and Emergency Medicine, Laval University, Quebec City, QC, Canada
| | - Julie A Bettinger
- Vaccine Evaluation Center, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Christine T Chambers
- Department of Psychology and Neuroscience and Pediatrics, Dalhousie University, Halifax, NS, Canada
| | - S Michelle Driedger
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada, Winnipeg, MB, Canada
| | - Eve Dubé
- Institut national de santé publique du Québec, Institut national de santé publique du Québec, Quebec City, QC, Canada
| | - Teresa Gavaruzzi
- Department of Developmental Psychology and Socialization, University of Padova, Italy, Padova, Italy
| | - Anik M C Giguere
- Department of Family and Emergency Medicine, Laval University, Quebec City, QC, Canada
| | - Éric Kavanagh
- École de design, Édifice La Fabrique, Laval University, Quebec City, QC, Canada
| | - Julie Leask
- Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, University of Sydney, Sydney, Australia
| | | | - Rita Orji
- Faculty of Computer Science, Dalhousie University, Halifax, NS, Canada
| | - Elizabeth Parent
- Department of Family and Emergency Medicine, Laval University, Quebec City, QC, Canada
| | | | - Jacynthe Roberge
- École de design, Édifice La Fabrique, Laval University, Quebec City, QC, Canada
| | - Beate Sander
- University Health Network, Toronto General Hospital, Eaton Building, Toronto, ON, Canada
| | - Aaron M Scherer
- Department of Internal Medicine, University of Iowa, Iowa, IA, United States
| | | | - Kumanan Wilson
- Department of Medicine, Bruyere Research Institute and Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Daniel Reinharz
- Department of Social and Preventive Medicine, Laval University, Quebec City, QC, Canada
| | - Holly O Witteman
- Department of Family and Emergency Medicine, Laval University, Quebec City, QC, Canada
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15
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Toth DJA, Keegan LT, Samore MH, Khader K, O'Hagan JJ, Yu H, Quintana A, Swerdlow DL. Modeling the potential impact of administering vaccines against Clostridioides difficile infection to individuals in healthcare facilities. Vaccine 2020; 38:5927-5932. [PMID: 32703744 DOI: 10.1016/j.vaccine.2020.06.081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 06/25/2020] [Accepted: 06/30/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND A vaccine against Clostridioides difficile infection (CDI) is in development. While the vaccine has potential to both directly protect those vaccinated and mitigate transmission by reducing environmental contamination, the impact of the vaccine on C. difficile colonization remains unclear. Consequently, the transmission-reduction effect of the vaccine depends on the contribution of symptomatic CDI to overall transmission of C. difficile. METHODS We designed a simulation model of CDI among patients in a network of 10 hospitals and nursing homes and calibrated the model using estimates of transmissibility from whole genome sequencing studies that estimated the fraction of CDI attributable to transmission from other CDI patients. We assumed the vaccine reduced the rate of progression to CDI among carriers by 25-95% after completion of a 3-dose vaccine course administered to randomly chosen patients at facility discharge. We simulated the administration of this vaccination campaign and tallied effects over 5 years. RESULTS We estimated 30 times higher infectivity of CDI patients compared to other carriers. Simulations of the vaccination campaign produced an average reduction of 3-16 CDI cases per 1000 vaccinated patients, with 2-11 of those cases prevented among those vaccinated and 1-5 prevented among unvaccinated patients. CONCLUSIONS Our findings demonstrate potential for a vaccine against CDI to reduce transmissions in healthcare facilities, even with no direct effect on carriage susceptibility. The vaccine's population impact will increase if received by individuals at risk for CDI onset in high-transmission settings.
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Affiliation(s)
- Damon J A Toth
- Department of Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, USA; Department of Internal Medicine (Epidemiology), University of Utah, Salt Lake City, UT, USA.
| | - Lindsay T Keegan
- Department of Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, USA; Department of Internal Medicine (Epidemiology), University of Utah, Salt Lake City, UT, USA
| | - Matthew H Samore
- Department of Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, USA; Department of Internal Medicine (Epidemiology), University of Utah, Salt Lake City, UT, USA.
| | - Karim Khader
- Department of Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, USA; Department of Internal Medicine (Epidemiology), University of Utah, Salt Lake City, UT, USA
| | - Justin J O'Hagan
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
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16
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Abstract
During the 20th century, the discovery of modern vaccines and ensuing mass vaccination dramatically decreased the incidence of many infectious diseases and in some cases eliminated them. Despite this, we are now witnessing a decrease in vaccine confidence that threatens to reverse the progress made. Considering the different extents of low vaccine confidence in different countries of the world, both developed and developing, we aim to contribute to the discussion of the reasons for this, and to propose some viable scientific solutions to build or help restore vaccine confidence worldwide.
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Affiliation(s)
- Selim Badur
- EM, Vaccines Scientific Affairs and Public Health, GSK, Istanbul, Turkey
| | - Martin Ota
- EM, Vaccines Scientific Affairs and Public Health, GSK, Wavre, Belgium
| | | | - Richard Adegbola
- Immunisation & Global Health Consulting, RAMBICON, Lagos, Nigeria
| | - Anil Dutta
- Vaccines R&D Medical, GSK, Wavre, Belgium
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17
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Kotsopoulos N, Haitsma G, Connolly MP, Standaert B. Estimating the money flow in the economy attributed to rotavirus disease and vaccination in the Netherlands using a Social Accounting Matrix (SAM) framework. Expert Rev Pharmacoecon Outcomes Res 2019; 20:603-612. [PMID: 31755345 DOI: 10.1080/14737167.2020.1693269] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background: The economics of rotavirus gastroenteritis in infants <5 years old is well-known within healthcare. The financial consequences for families, employers and authorities are not so well explored. The present study evaluates how vaccine prevention changes money flows among those involved in the management of disease, and its consequences. Methods: A Social Accounting Matrix (SAM) framework has been developed reflecting the distribution of income and spending at equilibrium affected by rotavirus disease among all those concerned for 1 year. The data came from official sources and published literature. A comparison of the financial equilibrium between with and without a national rotavirus immunization program has been conducted, along with sensitivity analysis for the results. Results: The total financial cost difference at equilibrium between presence and absence of rotavirus vaccination was +€26.758 million over one year as a net economic surplus. The payment of vaccination (€19.194 million) by the government was offset by the increase in tax revenue (€14.561 million) and by the lower spending in treatment care (€7.998 million). Conclusion: Studying the financial flows between different transacting agents can demonstrate the financial burden of a disease and the benefits of its prevention on agents' income and spending.
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Affiliation(s)
- Nikolaos Kotsopoulos
- Health Economics, Global Market Access Solutions Sarl , St-Prex, Switzerland.,Department of Economics, University of Athens , Athens, Greece
| | - Gertruud Haitsma
- Health Economics, Global Market Access Solutions Sarl , St-Prex, Switzerland
| | - Mark P Connolly
- Health Economics, Global Market Access Solutions Sarl , St-Prex, Switzerland.,Unit of Pharmacoepidemiology & Pharmacoeconomics, Department of Pharmacy, University of Groningen , Groningen, The Netherlands
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18
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Vaccine-associated hypersensitivity. J Allergy Clin Immunol 2019; 141:463-472. [PMID: 29413255 DOI: 10.1016/j.jaci.2017.12.971] [Citation(s) in RCA: 168] [Impact Index Per Article: 33.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 12/13/2017] [Accepted: 12/14/2017] [Indexed: 12/21/2022]
Abstract
Vaccine-associated hypersensitivity reactions are not infrequent; however, serious acute-onset, presumably IgE-mediated or IgG and complement-mediated anaphylactic or serious delayed-onset T cell-mediated systemic reactions are considered extremely rare. Hypersensitivity can occur because of either the active vaccine component (antigen) or one of the other components. Postvaccination acute-onset hypersensitivity reactions include self-limited localized adverse events and, rarely, systemic reactions ranging from urticaria/angioedema to full-blown anaphylaxis with multisystem involvement. Risk of anaphylaxis after all vaccines is estimated to be 1.31 (95% CI, 0.90-1.84) per million vaccine doses, respectively. Serious hypersensitivity reactions after influenza vaccines are particularly important because of the large number of persons vaccinated annually. Influenza vaccines are unique in requiring annual changes in the vaccines' antigenic composition to match the predicted circulating influenza strains. Recently, novel influenza vaccine types were introduced in the United States (recombinant vaccines, some with higher antigen content and a new adjuvanted vaccine). Providers should be aware of changing recommendations on the basis of recent published evidence for persons with a history of egg allergy to receive annual influenza vaccination. Further research is needed to elucidate the pathophysiology and risk factors for reported vaccine-associated adverse events. Further research is also needed to determine whether repeated annual inactivated influenza vaccination, the number of vaccine antigens administered at the same time, and the current timing of routine infant vaccinations are optimal for overall population well-being.
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19
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Pietsch C, Liebert U. Rotavirus vaccine effectiveness in preventing hospitalizations due to gastroenteritis: a descriptive epidemiological study from Germany. Clin Microbiol Infect 2019; 25:102-106. [DOI: 10.1016/j.cmi.2018.03.046] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 03/26/2018] [Accepted: 03/30/2018] [Indexed: 10/17/2022]
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20
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Hakim H, Provencher T, Chambers CT, Driedger SM, Dube E, Gavaruzzi T, Giguere AMC, Ivers NM, MacDonald S, Paquette JS, Wilson K, Reinharz D, Witteman HO. Interventions to help people understand community immunity: A systematic review. Vaccine 2018; 37:235-247. [PMID: 30528593 DOI: 10.1016/j.vaccine.2018.11.016] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 10/05/2018] [Accepted: 11/01/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Herd immunity, or community immunity, occurs when susceptible people in a population are indirectly protected from infection thanks to the pervasiveness of immunity within the population. In this study, we aimed to systematically review interventions designed to communicate what community immunity is and how community immunity works to members of the general public. METHODS We searched PubMed, EMBASE, CINAHL, the Cochrane Central Register of Controlled Trials and Web of Science for peer-reviewed articles describing interventions with or without evaluations. We then conducted web searches with Google to identify interventions lacking associated publications. We extracted data about the target population of the interventions, the interventions themselves (e.g., did they describe what community immunity is, and how it works), any effects of evaluated interventions, and synthesized data narratively. RESULTS We identified 32 interventions: 11 interventions described in peer-reviewed articles and 21 interventions without associated articles. Of the 32 interventions, 5 described what community immunity is, 6 described the mechanisms of how community immunity occurs and 21 described both. Fourteen of the 32 addressed infectious diseases in general while the other 13 addressed one or more specific diseases. Twelve of the 32 interventions used videos, 7 used interactive simulations and 6 used questionnaires. Ten of the 11 peer-reviewed articles described studies evaluating at least one effect of the interventions. Within these 10, 4/4 reported increased knowledge, 3/5 reported shifts of attitudes in favour of vaccination, 2/5 reported increased intentions to vaccinate. Of 3 studies evaluating interventions specifically about community immunity, 2 reported increased intentions to vaccinate. CONCLUSIONS A compelling benefit of vaccination exists at the population level in the form of community immunity. Identifying ways to optimally communicate about this benefit may be important, because some evidence suggests that effective communication about community immunity can increase vaccination intentions.
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Affiliation(s)
- Hina Hakim
- Department of Family and Emergency Medicine, Laval University, 1050 avenue de la Médecine, Pavillon Ferdinand-Vandry, Quebec City, QC G1V 0A6, Canada.
| | | | - Christine T Chambers
- Department of Pediatrics and Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada.
| | - S Michelle Driedger
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
| | - Eve Dube
- Institut national de santé publique du Québec, Quebec City, QC, Canada.
| | - Teresa Gavaruzzi
- Department of Developmental Psychology and Socialization, University of Padova, Italy.
| | - Anik M C Giguere
- Department of Family and Emergency Medicine, Laval University, 1050 avenue de la Médecine, Pavillon Ferdinand-Vandry, Quebec City, QC G1V 0A6, Canada.
| | - Noah M Ivers
- Department of Family and Community Medicine, Women's College Hospital - University of Toronto, Toronto, ON, Canada.
| | | | - Jean-Sebastien Paquette
- Department of Family and Emergency Medicine, Laval University, 1050 avenue de la Médecine, Pavillon Ferdinand-Vandry, Quebec City, QC G1V 0A6, Canada.
| | - Kumanan Wilson
- Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
| | - Daniel Reinharz
- Department of Social and Preventive Medicine, Laval University, Quebec City, QC, Canada.
| | - Holly O Witteman
- Department of Family and Emergency Medicine, Laval University, 1050 avenue de la Médecine, Pavillon Ferdinand-Vandry, Quebec City, QC G1V 0A6, Canada.
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21
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Pirçon JY, Talarico CA, Bollaerts K, Hausdorff WP, Clarke CJ. The choice of analytical methodology can alter conclusions regarding herd effects of paediatric pneumococcal vaccination programmes. Vaccine 2018; 36:6933-6943. [DOI: 10.1016/j.vaccine.2018.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 09/25/2018] [Accepted: 10/02/2018] [Indexed: 10/28/2022]
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22
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Lopez Bernal JA, Andrews N, Amirthalingam G. The Use of Quasi-experimental Designs for Vaccine Evaluation. Clin Infect Dis 2018; 68:1769-1776. [DOI: 10.1093/cid/ciy906] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 10/18/2018] [Indexed: 02/07/2023] Open
Affiliation(s)
- James A Lopez Bernal
- Immunisation, Hepatitis and Blood Safety Department, Public Health England, London, United Kingdom
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Nick Andrews
- Statistics, Modelling and Economics Department, Public Health England, London, United Kingdom
| | - Gayatri Amirthalingam
- Immunisation, Hepatitis and Blood Safety Department, Public Health England, London, United Kingdom
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23
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DeAntonio R, Amador S, Bunge EM, Eeuwijk J, Prado-Cohrs D, Nieto Guevara J, Rubio MDP, Ortega-Barria E. Vaccination herd effect experience in Latin America: a systematic literature review. Hum Vaccin Immunother 2018; 15:49-71. [PMID: 30230953 PMCID: PMC6363147 DOI: 10.1080/21645515.2018.1514225] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: National pediatric vaccination programs have been introduced in Latin America (LatAm) to reduce the burden of diseases due to pathogens such as rotavirus, Haemophilus influenzae type b (Hib) and pneumococcus. Vaccination health benefits may extend to unvaccinated populations by reducing pathogen transmission. Understanding herd effect is important for implementation and assessment of vaccination programs. The objective was to conduct a systematic review of published epidemiological evidence of herd effect with Hib, rotavirus and pneumococcal conjugate vaccines (PCV) in LatAm. Methods: Searches were conducted in PubMed, Virtual Health Library (VHL), SciELO and SCOPUS databases, for studies reporting data on herd effect from Hib, rotavirus and PCV vaccination in LatAm, without age restriction. Searches were limited to articles published in English, Spanish or Portuguese (1990–2016). After screening and full-text review, articles meeting the selection criteria were included to be critically appraised following criteria for observational and interventional studies. The presence of a herd effect was defined as a significant decrease in incidence of disease, hospitalization, or mortality. Results: 3,465 unique articles were identified, and 23 were included (Hib vaccine n = 5, PCV n = 8, rotavirus vaccine n = 10). Most studies included children and/or adolescents (age range varied between studies). Studies in adults, including older adults (aged > 65 years), were limited. Few studies reported statistically significant reductions in disease incidence in age groups not targeted for vaccination. Hib-confirmed meningitis hospitalization decreased in children but herd effect could not be quantified. Some evidence of herd effect was identified for PCV and rotavirus vaccine in unvaccinated children. Evidence for herd effects due to PCV in adults was limited. Conclusion: After introduction of Hib, PCV and rotavirus vaccination in LatAm, reductions in morbidity/mortality have been reported in children not targeted for vaccination. However, due to methodological limitations (e.g. short post-vaccination periods and age range studied), there is currently insufficient evidence to quantify the herd effect in adult populations. More research and higher quality surveillance is needed to characterize herd effect of these vaccines in LatAm.
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Affiliation(s)
- Rodrigo DeAntonio
- a Centro de Vacunación Internacional S A CEVAXIN , Panama City , Panama
| | | | - Eveline M Bunge
- c Pallas Health Research and Consultancy BV , Rotterdam , the Netherlands
| | - Jennifer Eeuwijk
- c Pallas Health Research and Consultancy BV , Rotterdam , the Netherlands
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Smith C, Ding L, Gorbach PM, Franco EL, Kahn JA. Who's Not Protected in the Herd? Factors Associated with Vaccine-Type HPV in Unvaccinated Women. J Pediatr Adolesc Gynecol 2018; 31:89-93. [PMID: 28943220 PMCID: PMC5862729 DOI: 10.1016/j.jpag.2017.09.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Revised: 09/11/2017] [Accepted: 09/17/2017] [Indexed: 10/18/2022]
Abstract
STUDY OBJECTIVE Evidence suggests that vaccine-type human papillomavirus (HPV) prevalence may decrease in unvaccinated women after HPV vaccine introduction, indicating herd protection. The aim of this study was to determine factors associated with vaccine-type HPV (i.e. absence of herd protection) after vaccine introduction. DESIGN We conducted three cross-sectional studies from 2006-2014 (n = 1180): wave 1 (2006-2007), wave 2 (2009-2010), and wave 3 (2013-2014). SETTING Participants were recruited from a hospital-based teen health center and a community health department. PARTICIPANTS We recruited 13-26 year-old young women; those included in this analysis had not received an HPV vaccine. INTERVENTIONS AND MAIN OUTCOME MEASURES The outcome measure was infection with at least one vaccine-type HPV (HPV6, 11, 16, 18). RESULTS Multivariable logistic regression demonstrated that in wave 1 (before vaccine introduction), history of anal intercourse (OR = 1.8, 95% CI = 1.1-3.0), age 18-21 vs 13-17 years (OR = 2.1, CI = 1.2-3.6), and Black/multiracial vs White race (OR = 1.8, CI = 1.1-3.0) were associated with vaccine-type HPV in unvaccinated women. In wave 2, no variables were associated with HPV. In wave 3, sexually transmitted infection history (OR = 3.6, CI = 1.3-9.7) was associated with HPV. CONCLUSION We did not identify a consistent set of modifiable risk factors associated with vaccine-type HPV after vaccine introduction across the three study waves, underscoring the urgency of vaccination for primary HPV prevention and the limitations of relying on herd protection.
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Affiliation(s)
- C Smith
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - L Ding
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - P M Gorbach
- University of California, Los Angeles, Los Angeles, California
| | - E L Franco
- McGill University, Montreal, Quebec, Canada
| | - J A Kahn
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; University of Cincinnati College of Medicine, Cincinnati, Ohio.
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Lehtinen M, Söderlund-Strand A, Vänskä S, Luostarinen T, Eriksson T, Natunen K, Apter D, Baussano I, Harjula K, Hokkanen M, Kuortti M, Palmroth J, Petäjä T, Pukkala E, Rekonen S, Siitari-Mattila M, Surcel HM, Tuomivaara L, Paavonen J, Dillner J, Dubin G, Garnett G. Impact of gender-neutral or girls-only vaccination against human papillomavirus-Results of a community-randomized clinical trial (I). Int J Cancer 2018; 142:949-958. [PMID: 29055031 DOI: 10.1002/ijc.31119] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 09/08/2017] [Accepted: 09/25/2017] [Indexed: 01/03/2023]
Abstract
Human papillomavirus (HPV) vaccine is efficacious but the real-life effectiveness of gender-neutral and girls-only vaccination strategies is unknown. We report a community-randomized trial on the protective effectiveness [(PE) = vaccine efficacy (VE) + herd effect (HE)] of the two strategies among females in virtually HPV vaccination naïve population. We randomized 33 Finnish communities into Arm A) gender-neutral vaccination with AS04-adjuvanted HPV16/18 vaccine (11 communities), Arm B) HPV vaccination of girls and hepatitis B-virus (HBV) vaccination of boys (11 communities) or Arm C) gender-neutral HBV vaccination (11 communities). All resident 39,420 females and 40,852 males born 1992-95 were invited in 2007-09. Virtually all (99%) 12- to 15-year-old participating males (11,662) and females (20,513) received three doses resulting in uniform 20-30% male and 50% female vaccination coverage by birth cohort. Four years later (2010-14) 11,396 cervicovaginal samples obtained from 18.5 year-old women were tested for HPV DNA, and prevalence of cervical HPV infections by trial arm and birth cohort was the main outcome measure. VEs against HPV16/18 varied between 89.2% and 95.2% across birth cohorts in arms A and B. The VEs against non-vaccine types consistent with cross-protection were highest in those born 1994-95 for HPV45 (VEA 82.8%; VEB 86.1%) and for HPV31 (VEA 77.6%, VEB 84.6%). The HEs in the non HPV-vaccinated were statistically significant in those born 1994-95 for HPV18 (HEA 51.0%; 95% CI 8.3-73.8, HEB 47.2%; 6.5-70.2) and for HPV31/33 in arm A (HEA 53.7%; 22.1-72.5). For HPV16 and 45 no significant herd effects were detected. PE estimates against HPV16/18 were similar by both strategies (PEA 58.1%; 45.1-69.4; PEB 55.7%; 42.9-66.6). PE estimates against HPV31/33 were higher by the gender-neutral vaccination (PEA 60.5%; 43.6-73.4; PEB 44.5%; 24.9-60.6). In conclusion, while gender-neutral strategy enhanced the effectiveness of HPV vaccination for cross-protected HPV types with low to moderate coverage, high coverage in males appears to be key to providing a substantial public health benefit also to unvaccinated females. Trial registration www.clinicaltrials.gov.com NCT000534638.
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Affiliation(s)
- Matti Lehtinen
- Department of Laboratory Medicine, Karolinska Institute, Huddinge, Sweden
| | | | | | - Tapio Luostarinen
- Department of Laboratory Medicine, Karolinska Institute, Huddinge, Sweden
| | - Tiina Eriksson
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | - Kari Natunen
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | | | - Iacopo Baussano
- Department of Infections and Cancer, International Agency for Research on Cancer, Lyon, France
| | - Katja Harjula
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | - Mari Hokkanen
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | - Marjo Kuortti
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | - Johanna Palmroth
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | - Tiina Petäjä
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | - Eero Pukkala
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | - Sirpa Rekonen
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | | | | | - Leena Tuomivaara
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | - Jorma Paavonen
- Department of Obstetrics and Gynecology, University of Helsinki, Finland
| | - Joakim Dillner
- Department of Laboratory Medicine, Karolinska Institute, Huddinge, Sweden
| | - Gary Dubin
- Takeda Pharmaceuticals International, Switzerland
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Ortiz JR, Hickling J, Jones R, Donabedian A, Engelhardt OG, Katz JM, Madhi SA, Neuzil KM, Rimmelzwaan GF, Southern J, Spiro DJ, Hombach J. Report on eighth WHO meeting on development of influenza vaccines that induce broadly protective and long-lasting immune responses: Chicago, USA, 23-24 August 2016. Vaccine 2017; 36:932-938. [PMID: 29221895 DOI: 10.1016/j.vaccine.2017.11.061] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 11/17/2017] [Indexed: 12/26/2022]
Abstract
In August 2016, the World Health Organization (WHO) convened the "Eighth meeting on development of influenza vaccines that induce broadly protective and long-lasting immune responses" to discuss the regulatory requirements and pathways for licensure of next-generation influenza vaccines, and to identify areas where WHO can promote the development of such vaccines. Participants included approximately 120 representatives of academia, the vaccine industry, research and development funders, and regulatory and public health agencies. They reviewed the draft WHO preferred product characteristics (PPCs) of vaccines that could address prioritized unmet public health needs and discussed the challenges facing the development of such vaccines, especially for low- and middle-income countries (LMIC). They defined the data desired by public-health decision makers globally and explored how to support the progression of promising candidates into late-stage clinical trials and for all countries. This report highlights the major discussions of the meeting.
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Affiliation(s)
- Justin R Ortiz
- Initiative for Vaccine Research, World Health Organization (WHO), Geneva, Switzerland.
| | - Julian Hickling
- Working in Tandem Ltd, Cambridge, Northern Ireland, United Kingdom.
| | - Rebecca Jones
- Working in Tandem Ltd, Cambridge, Northern Ireland, United Kingdom.
| | - Armen Donabedian
- Biomedical Advanced Research and Development Authority, United States Department of Health and Human Services, Washington DC, United States.
| | - Othmar G Engelhardt
- Division of Virology, National Institute for Biological Standards and Control, A Centre of the Medicines and Healthcare products Regulatory Agency, Potters Bar, Hertfordshire, United Kingdom.
| | - Jacqueline M Katz
- Influenza Division, Centers for Disease Control and Prevention (CDC), Atlanta, United States.
| | - Shabir A Madhi
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Kathleen M Neuzil
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, United States.
| | - Guus F Rimmelzwaan
- Erasmus Medical Center, Department of Viroscience, Rotterdam, The Netherlands.
| | - James Southern
- Advisor to Medicines Control Council, Simon's Town, South Africa.
| | - David J Spiro
- National Institutes of Health, Bethesda, United States.
| | - Joachim Hombach
- Initiative for Vaccine Research, World Health Organization (WHO), Geneva, Switzerland.
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Standaert B, Rappuoli R. Towards a more comprehensive approach for a total economic assessment of vaccines?: 1. The building blocks for a health economic assessment of vaccination. JOURNAL OF MARKET ACCESS & HEALTH POLICY 2017; 5:1335162. [PMID: 29785251 PMCID: PMC5956291 DOI: 10.1080/20016689.2017.1335162] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 05/22/2017] [Indexed: 05/08/2023]
Abstract
Since we were born, we all take preventative actions to avoid unpredictable adverse conditions. Some actions are done automatically. Others require a conscious choice , either for personal or social benefit. A distinction can therefore be drawn between non-active and active prevention, and between individual and social prevention. Active prevention requires making a choice in time, effort, and cost. We call it an economic choice. Vaccines belong to the group of active and social prevention. Because a vaccination program is an economic social choice, how should it be valued, and what cost should we pay for? To date, the economic evaluations developed for treatment have been applied to vaccines. However, over 25 different characteristics differentiate vaccines from treatment. For example, the benefit of vaccination is measured at the population level not at the individual level, the main effect of prevention is societal and not an individual-based gain only, and the biggest hurdle to implement a new vaccine is the initial budget investment and not so much its estimated 'value for money'. This makes the current application of incremental cost-utility analysis difficult for vaccines for a comprehensive evaluation. New approaches may be needed to capture the full economic benefit of vaccines..
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Geographic variation in pneumococcal vaccine efficacy estimated from dynamic modeling of epidemiological data post-PCV7. Sci Rep 2017; 7:3049. [PMID: 28607461 PMCID: PMC5468270 DOI: 10.1038/s41598-017-02955-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 04/28/2017] [Indexed: 11/09/2022] Open
Abstract
Although mean efficacy of multivalent pneumococcus vaccines has been intensively studied, variance in vaccine efficacy (VE) has been overlooked. Different net individual protection across settings can be driven by environmental conditions, local serotype and clonal composition, as well as by socio-demographic and genetic host factors. Understanding efficacy variation has implications for population-level effectiveness and other eco-evolutionary feedbacks. Here I show that realized VE can vary across epidemiological settings, by applying a multi-site-one-model approach to data post-vaccination. I analyse serotype prevalence dynamics following PCV7, in asymptomatic carriage in children attending day care in Portugal, Norway, France, Greece, Hungary and Hong-Kong. Model fitting to each dataset provides site-specific estimates for vaccine efficacy against acquisition, and pneumococcal transmission parameters. According to this model, variable serotype replacement across sites can be explained through variable PCV7 efficacy, ranging from 40% in Norway to 10% in Hong-Kong. While the details of how this effect is achieved remain to be determined, here I report three factors negatively associated with the VE readout, including initial prevalence of serotype 19F, daily mean temperature, and the Gini index. The study warrants more attention on local modulators of vaccine performance and calls for predictive frameworks within and across populations.
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Nicoli F, Appay V. Immunological considerations regarding parental concerns on pediatric immunizations. Vaccine 2017; 35:3012-3019. [PMID: 28465096 DOI: 10.1016/j.vaccine.2017.04.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 03/31/2017] [Accepted: 04/12/2017] [Indexed: 01/10/2023]
Abstract
Despite the fundamental role of vaccines in the decline of infant mortality, parents may decide to decline vaccination for their own children. Many factors may influence this decision, such as the belief that the infant immune system is weakened by vaccines, and concerns have been raised about the number of vaccines and the early age at which they are administered. Studies focused on the infant immune system and its reaction to immunizations, summarized in this review, show that vaccines can overcome those suboptimal features of infant immune system that render them more at risk of infections and of their severe manifestations. In addition, many vaccines have been shown to improve heterologous innate and adaptive immunity resulting in lower mortality rates for fully vaccinated children. Thus, multiple vaccinations are necessary and not dangerous, as infants can respond to several antigens as well as when responding to single stimuli. Current immunization schedules have been developed and tested to avoid vaccine interference, improve benefits and reduce side effects compared to single administrations. The infant immune system is therefore capable, early after birth, of managing several antigenic challenges and exploits them to prompt its development.
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Affiliation(s)
- Francesco Nicoli
- Sorbonne Universités, UPMC Univ Paris 06, DHU FAST, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), F-75013 Paris, France; INSERM, U1135, CIMI-Paris, F-75013 Paris, France.
| | - Victor Appay
- Sorbonne Universités, UPMC Univ Paris 06, DHU FAST, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), F-75013 Paris, France; INSERM, U1135, CIMI-Paris, F-75013 Paris, France; International Research Center of Medical Sciences (IRCMS), Kumamoto University, Kumamoto 860-0811, Japan
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Standaert B, Rappuoli R. 2. How is the economic assessment of vaccines performed today? JOURNAL OF MARKET ACCESS & HEALTH POLICY 2017; 5:1335163. [PMID: 29785252 PMCID: PMC5956288 DOI: 10.1080/20016689.2017.1335163] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 05/22/2017] [Indexed: 05/06/2023]
Abstract
This paper describes how the economic assessment of vaccines is performed today. It discusses why it may be incomplete and explores potential approaches to adjust the analysis to be more comprehensive. Besides helping protect against serious disease, vaccines also help avoid mild disease episodes that may not receive medical attention but which have important societal consequences. They also benefit unvaccinated individuals by reducing disease transmission. Wider societal benefits may extend beyond a decrease in disease incidence, as lower transmission rates reduce the risk of epidemics, which in turn reduces the pressure on healthcare providers, and may improve the quality of care for patients with unrelated diseases. Vaccines also lower the use of antibiotics leading to less pressure on anti-microbial resistance. Conventional ICUA focuses on individual health benefits, like increased survival. Therefore, this approach may not adequately capture the wider vaccination benefits. We discuss differences between treatment and vaccine prevention in the economic assessment, and how ICUA has been adapted to cope with the inconsistencies. Although such adaptations may fulfil the demand of one specific stakeholder, they may not meet the needs of other stakeholders who operate at the societal level, such as ministries other than healthcare, employers, caregivers, and insurers.
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Affiliation(s)
- Baudouin Standaert
- Health Economics, GSK, Wavre, Belgium
- CONTACT Baudouin Standaert GSK, Avenue Fleming 20, 1300Wavre, Belgium
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Doherty M, Buchy P, Standaert B, Giaquinto C, Prado- Cohrs D. Vaccine impact: Benefits for human health. Vaccine 2016; 34:6707-6714. [DOI: 10.1016/j.vaccine.2016.10.025] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 09/21/2016] [Accepted: 10/11/2016] [Indexed: 12/28/2022]
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Vaccine strategies: Optimising outcomes. Vaccine 2016; 34:6691-6699. [PMID: 27887796 DOI: 10.1016/j.vaccine.2016.10.078] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 10/12/2016] [Accepted: 10/31/2016] [Indexed: 11/22/2022]
Abstract
Successful immunisation programmes generally result from high vaccine effectiveness and adequate uptake of vaccines. In the development of new vaccination strategies, the structure and strength of the local healthcare system is a key consideration. In high income countries, existing infrastructures are usually used, while in less developed countries, the capacity for introducing new vaccines may need to be strengthened, particularly for vaccines administered beyond early childhood, such as the measles or human papillomavirus (HPV) vaccine. Reliable immunisation service funding is another important factor and low income countries often need external supplementary sources of finance. Many regions also obtain support in generating an evidence base for vaccination via initiatives created by organisations including World Health Organization (WHO), the Pan American Health Organization (PAHO), the Agence de Médecine Préventive and the Sabin Vaccine Institute. Strong monitoring and surveillance mechanisms are also required. An example is the efficient and low-cost approaches for measuring the impact of the hepatitis B control initiative and evaluating achievement of goals that have been established in the WHO Western Pacific region. A review of implementation strategies reveals differing degrees of success. For example, in the Americas, PAHO advanced a measles-mumps-rubella vaccine strategy, targeting different population groups in mass, catch-up and follow-up vaccination campaigns. This has had much success but coverage data from some parts of the region suggest that children are still not receiving all appropriate vaccines, highlighting problems with local service infrastructures. Stark differences in coverage levels are also observed among high income countries, as is the case with HPV vaccine implementation in the USA versus the UK and Australia, reflecting differences in delivery settings. Experience and research have shown which vaccine strategies work well and the factors that encourage success, which often include strong support from government and healthcare organisations, as well as tailored, culturally-appropriate local approaches to optimise outcomes.
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Ben-Shimol S, Givon-Lavi N, Leibovitz E, Raiz S, Greenberg D, Dagan R. Impact of Widespread Introduction of Pneumococcal Conjugate Vaccines on Pneumococcal and Nonpneumococcal Otitis Media. Clin Infect Dis 2016; 63:611-8. [DOI: 10.1093/cid/ciw347] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 05/17/2016] [Indexed: 11/13/2022] Open
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