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Lambach P, Orenstein W, Silal S, Sbarra AN, Koh M, Aggarwal R, Hasan Farooqui H, Flasche S, Hogan A, Kim SY, Leask J, Luz PM, Lyimo DC, Moss WJ, Pitzer VE, Wang XY, Wu J. Report from the World Health Organization's immunization and vaccines related implementation research advisory committee (IVIR-AC) meeting, Geneva, 11-13 September 2023. Vaccine 2024; 42:1424-1434. [PMID: 38326131 PMCID: PMC10953699 DOI: 10.1016/j.vaccine.2024.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 02/02/2024] [Indexed: 02/09/2024]
Abstract
Evaluating vaccine-related research is critical to maximize the potential of vaccination programmes. The WHO Immunization and Vaccine-related Implementation Research Advisory Committee (IVIR-AC) provides an independent review of research that estimates the performance, impact and value of vaccines, with a particular focus on transmission and economic modelling. On 11-13 September 2023, IVIR-AC was convened for a bi-annual meeting where the committee reviewed research and presentations across eight different sessions. This report summarizes the background information, proceedings and recommendations from that meeting. Sessions ranged in topic from timing of measles supplementary immunization activities, analyses of conditions necessary to meet measles elimination in the South-East Asia region, translating modelled evidence into policy, a risk-benefit analysis of dengue vaccine, COVID-19 scenario modelling in the African region, therapeutic vaccination against human papilloma virus, the Vaccine Impact Modelling Consortium, and the Immunization Agenda 2030 vaccine impact estimates.
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Affiliation(s)
- Philipp Lambach
- Immunizations, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | | | - Sheetal Silal
- Modelling and Simulation Hub, Africa, University of Cape Town, Cape Town, South Africa; Centre for Global Health, Nuffield Department of Medicine, Oxford University, Oxford, United Kingdom
| | - Alyssa N Sbarra
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom.
| | - Mitsuki Koh
- Immunizations, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Rakesh Aggarwal
- Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India
| | | | - Stefan Flasche
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | | | - Julie Leask
- School of Public Health, University of Sydney Sydney, Australia
| | - Paula M Luz
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | | | - William J Moss
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | | | - Xian-Yi Wang
- Institutes of Biomedical Sciences, Fudan University, Shanghai, China
| | - Joseph Wu
- School of Public Health, The University of Hong Kong, Hong Kong
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Halsey N, Evans S, Santosham M, Hacker A, Edwards KM, Chandler RE, Dudley MZ, Dekker CL, Al-Abri S, Arora N, Buttery J, Dodoo A, Eskola J, Heininger U, Jee Y, Khuri N, Obaro S, Orenstein W, Pitisuttithum P, Safadi M, Whitney CG, Black S. Considerations for unblinding individual study participants during vaccine trials. Vaccine 2023; 41:3399-3402. [PMID: 37121805 DOI: 10.1016/j.vaccine.2023.04.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 03/26/2023] [Accepted: 04/11/2023] [Indexed: 05/02/2023]
Abstract
Premature unblinding of individual participants is rarely reported in publications, but such unblinding can disrupt vaccine trials by causing worry and drop-out of other participants or "pseudo unblinding," in which participants or investigators over-interpret certain symptoms as being related to receiving an investigational product. This review summarizes appropriate reasons for unblinding in vaccine trials. Regulatory guidance could be improved by distinguishing guidance for vaccine trials from drug trials, with the recognition that unblinding individual participants in vaccine studies is rarely needed for management of adverse events following immunization.
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Affiliation(s)
- Neal Halsey
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States.
| | - Stephen Evans
- London School of Hygiene and Tropical Medicine, United Kingdom
| | - Mathuram Santosham
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States
| | - Adam Hacker
- Coalition for Epidemic Preparedness Innovations, Norway
| | | | | | - Matthew Z Dudley
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States
| | | | - Seif Al-Abri
- Directorate General for Disease Surveillance and Control, Muscat, Oman
| | - Narendra Arora
- Executive Director of The INCLEN Trust International, India
| | | | | | - Juhani Eskola
- National Institute for Health and Wellfare, Helsinki, Finland
| | | | | | | | - Stephen Obaro
- University of Nebraska Medical Center, United States
| | | | | | | | | | - Steve Black
- Global Vaccine Data Network, Auckland, New Zealand
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Affiliation(s)
- John F Modlin
- Departments of Pediatrics and Medicine, Geisel School of Medicine, Hanover, New Hampshire, USA
| | - William Schaffner
- Department of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Walt Orenstein
- Medicine, Pediatrics, Global Health, and Epidemiology, Emory University School of Medicine, Atlanta, Georgia, USA
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Anderson EJ, Kamidani S, Orenstein W, Campbell JD. COVID-19 Vaccines Have Moved Out of Neutral, but Still Gearing Up in Children. Clin Infect Dis 2021; 74:169-170. [PMID: 33949653 PMCID: PMC8135996 DOI: 10.1093/cid/ciab400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
| | - Satoshi Kamidani
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA.,Center for Childhood Infections and Vaccines (CCIV), Children's Healthcare of Atlanta, Atlanta, GA
| | - Walt Orenstein
- Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - James D Campbell
- Department of Pediatrics and Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD
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Shen AK, Hughes Iv R, DeWald E, Rosenbaum S, Pisani A, Orenstein W. Ensuring Equitable Access To COVID-19 Vaccines In The US: Current System Challenges And Opportunities. Health Aff (Millwood) 2020; 40:62-69. [PMID: 33211542 DOI: 10.1377/hlthaff.2020.01554] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
There has been a worldwide effort to accelerate the development of safe and effective vaccines for severe acute respiratory syndrome coronavirus-2. When vaccines become licensed and available broadly to the public, the final hurdle is equitable distribution and access for all who are recommended for vaccination. Frameworks and existing systems for allocation, distribution, vaccination, and monitoring for safety and effectiveness are assets of the current immunization delivery system that should be leveraged to ensure the equitable distribution and broad uptake of licensed vaccines. The system should be strengthened to address gaps in access to immunization services and to modernize the public health infrastructure. We offer five recommendations as guideposts to ensure that policies and practices at the federal, state, local, and tribal levels support equity, transparency, accountability, availability, and access to coronavirus disease 2019 vaccines.
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Affiliation(s)
- Angela K Shen
- Angela K. Shen is a visiting scientist at the Vaccine Education Center, Children's Hospital of Philadelphia, in Philadelphia, Pennsylvania, and a public health consultant at the Immunization Action Coalition, in St. Paul, Minnesota
| | - Richard Hughes Iv
- Richard Hughes IV was managing director and vaccines leader at Avalere Health, in Washington, D.C., at the time of writing this article. He is now vice president of public policy at Moderna, in Washington, D.C
| | - Erica DeWald
- Erica DeWald is director of advocacy at Vaccinate Your Family, in Washington, D.C
| | - Sara Rosenbaum
- Sara Rosenbaum is the Harold and Jane Hirsh Professor of Health Law and Policy and founding chair of the Department of Health Policy, George Washington University School of Public Health and Health Services, in Washington, D.C
| | - Amy Pisani
- Amy Pisani is executive director of Vaccinate Your Family
| | - Walt Orenstein
- Walt Orenstein is a professor in the School of Medicine at Emory University, in Atlanta, Georgia
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Abstract
Policies to remove parents' ability to opt-out from school immunization requirements on the basis of religious or personal beliefs (ie, nonmedical exemptions) may be a useful strategy to increase immunization rates and prevent outbreaks of vaccine-preventable disease. However, there is uncertainty about the effectiveness of this strategy and the range of possible outcomes. We advocate for a more deliberative process through which a broad range of outcomes is scrutinized and the balance of values underlying the policy decision to eliminate nonmedical exemptions is clearly articulated. We identify 3 outcomes that require particular consideration before policies to eliminate nonmedical exemptions are implemented widely and outline a process for making the values underlying such policies more explicit.
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Affiliation(s)
- Douglas J Opel
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, Washington.,Department of Pediatrics, University of Washington School of Medicine, Seattle
| | - Jason L Schwartz
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
| | - Saad B Omer
- Departments of Epidemiology and Global Health, Emory University School of Public Health, Atlanta, Georgia.,Emory Vaccine Center, Atlanta, Georgia
| | - Ross Silverman
- Department of Health Policy and Management, Indiana University Fairbanks School of Public Health, Indianapolis.,Indiana University McKinney School of Law, Indianapolis
| | - Jeff Duchin
- Public Health-Seattle and King County, Seattle, Washington.,Department of Epidemiology, University of Washington School of Public Health, Seattle.,Department of Medicine, University of Washington School of Medicine, Seattle
| | - Eric Kodish
- Pediatric Institute and Department of Bioethics, Cleveland Clinic, Cleveland, Ohio
| | - Douglas S Diekema
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, Washington.,Department of Pediatrics, University of Washington School of Medicine, Seattle
| | - Edgar K Marcuse
- Department of Pediatrics, University of Washington School of Medicine, Seattle
| | - Walt Orenstein
- Emory Vaccine Center, Atlanta, Georgia.,Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
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Abstract
In 2013, the World Health Assembly endorsed a plan that calls for the ultimate withdrawal of oral polio vaccines (OPV) from all immunization programs globally. The withdrawal would begin in a phased manner with removal of the type 2 component of OPV in 2016 through a global switch from trivalent OPV to bivalent OPV (containing only types 1 and 3). To mitigate risks associated with immunity gaps after OPV type 2 withdrawal, the WHO Strategic Advisory Group of Experts has recommended that all 126 OPV-only using countries introduce at least one dose of inactivated polio vaccine into routine immunization programs by end-2015, before the trivalent OPV-bivalent OPV switch. The introduction of inactivated polio vaccine would reduce risks of reintroduction of type 2 poliovirus by providing some level of seroprotection, facilitating interruption of transmission if outbreaks occur, and accelerating eradication by boosting immunity to types 1 and 3 polioviruses.
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Affiliation(s)
- Manish Patel
- Task Force for Global Health, 325 Swanton Way, Atlanta, GA 30330, USA
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Gershon AA, Gardner P, Peter G, Nichols K, Orenstein W. Quality standards for immunization. Guidelines from the Infectious Diseases Society of America. Clin Infect Dis 1997; 25:782-6. [PMID: 9356789 DOI: 10.1086/515544] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
This is the third in a series of guidelines commissioned by the Infectious Diseases Society of America through its Practice Guidelines Committee. It is presented as a standard of care rather than a practice guideline because the case for following these recommendations is very strong and it should be followed with rare exceptions. The purpose of this guideline is to provide assistance to clinicians when making decisions on providing immunizations to healthy infants, children, and adults. The document is a summary of guidelines already developed by national organizations. The targeted providers are pediatricians, family practitioners, internists, and other physicians who provide immunizations. The IDSA provided the funding. Panel members represent experts in adult and pediatric infectious diseases. The guidelines are evidence-based. A standard ranking system is used for the strength of the recommendations and the quality of the evidence cited in the literature reviewed. The document has been subjected to external review by peer reviewers as well as by the Practice Guidelines Committee and was approved by the IDSA Council. An executive summary and tables highlight the major recommendations. Indicators for measuring compliance with the standards are included.
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Affiliation(s)
- A A Gershon
- Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, New York 10032, USA
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McLaughlin M, Thomas P, Onorato I, Rubinstein A, Oleske J, Nicholas S, Krasinski K, Guigli P, Orenstein W. Live virus vaccines in human immunodeficiency virus-infected children: a retrospective survey. Pediatrics 1988; 82:229-33. [PMID: 3399296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Live virus vaccines can cause serious adverse reactions when administered to immunocompromised patients. Because children infected with human immunodeficiency virus (HIV) may be immunosuppressed, immunization of these children with live virus vaccines is a potential problem. A retrospective survey was conducted by the New York City Department of Health, with consultation from the Centers for Disease Control, to evaluate the frequency of serious adverse events following receipt of live vaccines among children with HIV infection receiving pediatric care in New York City and New Jersey. Outpatient records of 319 children being cared for by 16 participating physicians were reviewed. Of the 319 charts, 221 (69%) contained vaccination histories. Perinatal transmission of HIV infection was suspected for 208 (94%) of the 221 cases and infection via transfusion for the remaining 13 (6%). Of the 221 for whom immunization histories were available, 180 (81%) had received at least one dose of live oral polio vaccine and 70 (32%) had received measles, mumps, and rubella vaccine. There were 120 children for whom a temporal relationship between immunization and onset of symptoms of immunodeficiency could be seen; 46/120 had received at least one dose of oral polio vaccine and 23/45 had received measles, mumps, and rubella vaccine after onset of symptoms. Although follow-up of this population has been limited, there were no reports of serious adverse events such as typical or atypical measles, paralytic poliomyelitis, or aseptic meningitis in the month following vaccination.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- M McLaughlin
- New York City Department of Health, Division of Medical Affairs, NY 10013
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Abstract
From February 5 through April 23, 1982, 110 cases of mumps were reported among 357 students in a middle school in Ashtabula County, Ohio, an overall attack rate of 31%. Vaccine efficacy was calculated using a variety of case definitions, case surveillance systems, and vaccination-status ascertainment methods to evaluate their effects on the estimated vaccine efficacy. From data collected at the school for case ascertainment and vaccination status, clinical vaccine efficacy was initially estimated at 37%. By means of a uniform case definition (parotitis lasting two days or more) and only cases and vaccination status ascertained from parental questionnaires, estimated vaccine efficacy increased to 70%. From secondary attack rates in household members with provider-verified vaccination status, the vaccine efficacy further increased to 85%. This outbreak investigation confirms that the methods used to ascertain cases and determine vaccination status greatly affect estimates of vaccine efficacy. Studies relying solely on school records for case finding and determination of immunization status may provide misleadingly low estimates of vaccine efficacy for mumps vaccine as well as for other vaccines. Appropriate methods demonstrate that mumps vaccine is highly effective and support recommendations for its continued use.
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Fraser DW, Tsai TR, Orenstein W, Parkin WE, Beecham HJ, Sharrar RG, Harris J, Mallison GF, Martin SM, McDade JE, Shepard CC, Brachman PS. Legionnaires' disease: description of an epidemic of pneumonia. N Engl J Med 1977; 297:1189-97. [PMID: 335244 DOI: 10.1056/nejm197712012972201] [Citation(s) in RCA: 1030] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
An explosive, common-source outbreak of pneumonia caused by a previously unrecognized bacterium affected primarily persons attending an American Legion convention in Philadelphia in July, 1976. Twenty-nine of 182 cases were fatal. Spread of the bacterium appeared to be air borne. The source of the bacterium was not found, but epidemiologic analysis suggested that exposure may have occurred in the lobby of the headquarters hotel or in the area immediately surrounding the hotel. Person-to-person spread seemed not to have occurred. Many hotel employees appeared to be immune, suggesting that the agent may have been present in the vicinity, perhaps intermittently, for two or more years.
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Mills J, Orenstein W, Cohen SN. Enteritis associated with pneumococci. Am J Dis Child 1973; 126:244-5. [PMID: 4146756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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