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Background: Effective vaccination governance in conflict-affected regions poses unique challenges. This study evaluates the governance of vaccination programs in northwest Syria, focusing on effectiveness, efficiency, inclusiveness, data availability, vision, transparency, accountability, and sustainability. Methods: Using a mixed-methods approach, and adapting Siddiqi's framework for health governance, data were collected through 14 key informant interviews (KIIs), a validating workshop, and ethnographic observations. Findings were triangulated to provide a comprehensive understanding of vaccination governance. Results: The study highlights innovative approaches used to navigate the complex health governance landscape to deliver vaccination interventions, which strengthened sub-national vaccination structures such as The Syria Immunisation Group (SIG). The analysis revealed several key themes. Effectiveness and efficiency were demonstrated through cold-chain reliability and extensive outreach activities, though formal reports lacked detailed analysis of vaccine losses and linkage between disease outbreak data and coverage statistics. Key informants and workshop participants rated the vaccination strategy positively but identified inefficiencies due to irregular funding and bureaucracy. Inclusiveness and data availability were prioritised, with outreach activities targeting vulnerable groups. However, significant gaps in demographic data and reliance on paper-based systems hindered comprehensive coverage analysis. Digitalisation efforts were noted but require further support. The SIG demonstrated a clear strategic vision supported by international organizations such as the World Health Organization, yet limited partner participation in strategic planning raised concerns about broader ownership and engagement. While the SIG was perceived as approachable, the lack of public documentation and financial disclosure limited transparency. Internal information sharing was prevalent, but public communication strategies were insufficient. Accountability and sustainability faced challenges due to a decentralized structure and reliance on diverse donors. Despite stabilizing factors such as decentralization and financial continuity, fragmented oversight and reliance on donor funding remained significant concerns. Discussion: The study highlights the complexities of vaccination governance in conflict-affected areas. Comparisons with other conflict zones underscore the importance of local organisations and international support. The SIG's role is pivotal, but its legitimacy, transparency, and inclusivity require improvement. The potential transition to early recovery in Syria poses additional challenges to SIG's sustainability and integration into national programs. Conclusion: The governance of vaccination in northwest Syria is multifaceted, involving multiple stakeholders and lacking a legitimate government. Enhancing transparency, local ownership, and participatory decision-making are crucial for improving governance. The role of international bodies is essential, emphasising the need for structured feedback mechanisms and transparent monitoring processes to ensure the program's success and sustainability. Key message: • A hybrid governance model that combines top-down and bottom-up approaches effectively improves immunisation programs in conflict settings and promotes local ownership. • In conflict settings, immunisation programmes require strong and direct intervention from the WHO with central management and coordination of the vaccine activities. • In conflict areas, when the government is a party to the conflict or has limited access to some areas, United Nations institutions must intervene to manage or support vaccine activities in partnership with local entities, regardless of notions of national sovereignty. • In Syria, the reluctance of United Nations institutions to fill the void left by the state in areas outside its control and provide vaccines led to the emergence of many diseases, including polio in 2013 and measles in 2017. [ABSTRACT FROM AUTHOR]

Background: Respiratory syncytial virus (RSV) is associated with substantial morbidity among infants. This study modelled the potential public health and economic impact of nirsevimab, a long-acting monoclonal antibody, as an immunoprophylactic strategy for all infants in Spain in their first RSV season. Methods: A static decision-analytic model of the Spanish birth cohort during its first RSV season was developed to estimate the impact of nirsevimab on RSV-related health events and costs versus the standard of practice (SoP). Spain-specific costs and epidemiological data were used as model inputs. Modelled outcomes included RSV-related outpatient visits, emerging room (ER) visits, hospitalisations – including pediatric intensive care unit (PICU) admission, mechanical ventilation, and inpatient mortality. Results: Under the current SoP, RSV caused 151,741 primary care visits, 38,798 ER visits, 12,889 hospitalisations, 1,412 PICU admissions, and 16 deaths over a single season, representing a cost of €71.8 million from a healthcare payer perspective. Universal immunisation of all infants with nirsevimab was expected to prevent 97,157 primary care visits (64.0% reduction), 24,789 ER visits (63.9%), 8,185 hospitalisations (63.5%), 869 PICU admissions (61.5%), and 9 inpatient deaths (52.6%), saving €47.8 million (62.4%) in healthcare costs. Conclusions: These results suggest that immunisation with nirsevimab of all infants experiencing their first RSV season in Spain is likely to prevent thousands of RSV-related health events and save considerable costs versus the current SoP. [ABSTRACT FROM AUTHOR]

The national influenza vaccination programme of the United Kingdom is highly successful, changeable and progressive and can feel relentless in its delivery. When the national flu immunisation programme plan for 2024 to 2025 (as known as ‘the annual letter’) was published on 12th March 2024, initially it seemed that this year would have very few changes to the programme, when compared to those of the last few years (UK Health Security Agency [UKHSA], 2024). However, since then there have been two versions of a statement of amendment, the second due to loss of a valuable vaccine type (UKHSA, 2024), and a pertinent letter from NHS England concerning the start dates for the programme (NHS England, 2024). These changes should not be a surprise to any immuniser, especially those who have been involved in the flu vaccination programmes in previous years. Changes often happen in the lead up to, and even after, the start of the programme. Our national immunisation programmes (NIPs) are never static for long. They are changeable due to such things as changing epidemiology, differing vaccine types or supply, new evidence, national advice or recommendations being implemented and shared with the field regularly. [ABSTRACT FROM AUTHOR]

Background: Community pharmacists have become flu vaccine immunisers in several countries to increase vaccine uptake. Aim: This study aimed to perform a scoping review to evaluate the pharmacist's role and contribution to flu immunisation coverage, satisfaction and promotion as vaccine providers. Design: The framework proposed by Arksey and O'Malley and the PRISMA Extension for Scoping Reviews (PRISMA‐ScR) were considered for this analysis. Two electronic databases (PubMed and Cochrane Library) were used to search for relevant peer‐reviewed quantitative, qualitative and mixed‐method studies published between 1990 and 2022. Results: A total of 37 studies were included. These studies suggested that, over time, there was an increase in the rate of vaccine administration within community pharmacies across the various countries examined. Moreover, patients have consistently expressed their satisfaction with the convenience and accessibility of pharmacy‐based vaccine services, with some expressing a preference for pharmacies over traditional visits to their general practitioner′s office. Conclusion: Several initiatives aimed at promoting flu vaccination have been rolled out in pharmacy settings, and a number of these initiatives have demonstrated positive outcomes. The flu vaccination service provided by pharmacists has proven to be an asset in public health by improving accessibility to immunisation services. Pharmacists should continue to take part in yearly flu vaccination programs as flu vaccine providers as they contribute to an increased uptake of immunisations by the population. Extending these services to other vaccines should be further considered. [ABSTRACT FROM AUTHOR]

Background: Immunocompromised hosts (ICH) experience more breakthrough infections and worse clinical outcomes following infection with COVID-19 than immunocompetent people. Prophylactic monoclonal antibody therapies can be challenging to access, and escape variants emerge rapidly. Immunity conferred through vaccination remains a central prevention strategy for COVID-19. COVID-19 vaccines do not elicit optimal immunity in ICH but boosting, through additional doses of vaccine improves humoral and cellular immune responses. This trial aims to assess the immunogenicity and safety of different COVID-19 vaccine booster strategies against SARS-CoV-2 for ICH in Australia. Methods: Bringing optimised COVID-19 vaccine schedules to immunocompromised populations (BOOST-IC) is an adaptive randomised trial of one or two additional doses of COVID-19 vaccines 3 months apart in people living with HIV, solid organ transplant (SOT) recipients, or those who have haematological malignancies (chronic lymphocytic leukaemia, non-Hodgkin lymphoma or multiple myeloma). Key eligibility criteria include having received 3 to 7 doses of Australian Therapeutic Goods Administration (TGA)-approved COVID-19 vaccines at least 3 months earlier, and having not received SARS-CoV-2-specific monoclonal antibodies in the 3 months prior to receiving the study vaccine. The primary outcome is the geometric mean concentration of anti-spike SARS-CoV-2 immunoglobulin G (IgG) 28 days after the final dose of the study vaccine. Key secondary outcomes include anti-spike SARS-CoV-2 IgG titres and the proportion of people seroconverting 6 and 12 months after study vaccines, local and systemic reactions in the 7 days after vaccination, adverse events of special interest, COVID-19 infection, mortality and quality of life. Discussion: This study will enhance the understanding of COVID-19 vaccine responses in ICH, and enable the development of safe, and optimised vaccine schedules in people with HIV, SOT, or haematological malignancy. Trial registration: ClinicalTrials.gov NCT05556720. Registered on 23rd August 2022. [ABSTRACT FROM AUTHOR]

Objective: This study aims to conduct a detailed bibliometric and visual analysis of acute kidney injury (AKI) and immune-related research conducted over the past two decades, focusing on identifying emerging trends and key areas of interest. Methods: The Web of Science Core Collection (WoSCC) was utilised for the meticulous examination of various parameters including publication volume, authorship, geographic distribution, institutional contributions, journal sources, prevalent keywords and citation frequencies. Data were intricately visualised and interpreted using VOSviewer, CiteSpace and Excel 365 software. Results: Analysis of the WoSCC database revealed 3,537 articles on AKI and immunisation, originating from 94 countries and regions, involving 3,552 institutions and authored by 18,243 individuals. Notably, the top five countries contributing to this field were the United States, China, Germany, Italy and the United Kingdom, with the United States leading with 35.76% of total publications. Among the 3,552 contributing institutions, those in the United States were predominant, with Harvard University leading with 134 papers and 3,906 citations. Key journals driving productivity included Frontiers in Immunology, Kidney International, Journal of the American Society of Nephrology and International Journal of Molecular Sciences, with Kidney International being the most cited, followed by Journal of the American Society of Nephrology and New England Journal of Medicine. Prominent authors in the field included Ronco Claudio, Okusa Mark D and Anders, Hans-Joachim. Co-citation clustering and timeline analysis highlighted recent research foci such as COVID-19, immune checkpoint inhibitors, regulated necrosis, cirrhosis and AKI. Keyword analysis identified "inflammation," "ischaemia-reperfusion injury," "sepsis," "covid-19," and "oxidative stress" as prevalent terms. Conclusion: This study provides the first bibliometric analysis of AKI and immune research, offering a comprehensive overview of research hotspots and evolving trends within the field. [ABSTRACT FROM AUTHOR]

Issue Addressed: Childcare educator knowledge gaps in infection control practices and outbreak management. This can contribute to the well‐reported issue of transmission of infectious diseases in childcare centres and the associated health and economic costs. Methods: A health promotion program in the form of an educational slideshow presentation with interactive question/answer component was developed and offered to all childcare centre staff in the Wide Bay region, Queensland. Results: Childcare educators who participated in the education sessions reported a significant increase in their knowledge and confidence in outbreak management on pre‐ and post‐intervention self‐assessment. Conclusions: Simple educational programs can significantly improve the self‐assessed knowledge and confidence of childcare educators in managing infectious diseases. So What?: Improving knowledge and confidence of childcare centre staff in managing basic infectious diseases can help reduce the health and economic impacts of these infections. Simple educational health promotion programs could be introduced as part of an orientation program for new staff, or refreshers for existing staff. [ABSTRACT FROM AUTHOR]

Background: The aim of this review was to investigate the impact of short message service (SMS)-based interventions on childhood and adolescent vaccine coverage and timeliness. Methods: A pre-defined search strategy was used to identify all relevant publications up until July 2022 from electronic databases. Reports of randomised trials written in English and involving children and adolescents less than 18 years old were included. The review was conducted in accordance with PRISMA guidelines. Results: Thirty randomised trials were identified. Most trials were conducted in high-income countries. There was marked heterogeneity between studies. SMS-based interventions were associated with small to moderate improvements in vaccine coverage and timeliness compared to no SMS reminder. Reminders with embedded education or which were combined with monetary incentives performed better than simple reminders in some settings. Conclusion: Some SMS-based interventions appear effective for improving child vaccine coverage and timeliness in some settings. Future studies should focus on identifying which features of SMS-based strategies, including the message content and timing, are determinants of effectiveness. [ABSTRACT FROM AUTHOR]

Background Hybrid SARS-CoV-2 immunity may provide longer duration protection against severe SARS-CoV-2 infection and hospitalisation than purely vaccine-derived immunity. Older adults represent a high-risk group for severe disease, yet available data is skewed towards younger adults. Methods A prospective longitudinal study at a large London long-term care facility (LTCF) was conducted from March 2020 to April 2022 to assess the effect of hybrid versus vaccine-only immunity on SARS-CoV-2 infection in older adults during Omicron variant dominance. Hybrid immunity was assessed by a combination of SARS-CoV-2 polymerase chain reaction testing weekly (asymptomatic screening) and as required (symptomatic testing), as well as serial SARS-CoV-2 serology. Results 280 participants (median age 82 yrs, IQR 76–88 yrs; 95.4% male) were followed up. 168/280 (60%) had evidence of hybrid immunity prior to the Omicron variant wave. Participants with hybrid immunity had substantially lower odds of acquiring COVID-19 infection during the Omicron wave compared to those with vaccine-only immunity (unadjusted odds ratio 0.26, 95% CI 0.14–0.47, chi-squared P  < .0001). Participants with hybrid immunity had an odds ratio of 0.40 (0.19–0.79) for asymptomatic infection and 0.15 (0.06–0.34) for symptomatic infection (Likelihood ratio test, P  < .0001). Discussion Our data highlight potential opportunities to target ongoing booster vaccination campaigns for those most at risk of severe infection. Reporting of data in older adults will be of particular value to examine the effect of hybrid immunity as new variants continue to emerge and vaccination strategies evolve. [ABSTRACT FROM AUTHOR]

Aim: Immunisation is a global health priority, but methods of non‐pharmacological pain relief are not widely used in routine clinical practice. In this study, we set out to investigate the effects of maternal singing during the routine vaccination of infants. Methods: We recruited 67 mother–infant pairs at Health Centres in the Aosta Region of Italy. Infants aged 2–4 months were randomly allocated to a singing intervention group or to a control group whose injections were administered following standard practice. Pre‐ and post‐immunisation pain was blindly assessed using the Modified Behavioural Pain Scale, and mother–infant proximity indexes were assigned based on muted video‐tracks. Results: When assessed for pain, the infants in the maternal singing group were assigned significantly lower movement indexes (p = 0.032) and marginally significantly lower cry indexes (p = 0.076). A higher frequency of mother‐to‐infant gaze (p < 0.005) was observed in the singing group dyads. Finally, the intervention group mothers' self‐perceived ease in singing was correlated with their previous singing experience and with lower anxiety following the vaccination procedure (p < 0.05). Conclusion: Maternal singing during immunisation procedures benefits both mothers and babies. The practice of singing is a biologically rooted and adaptive form of intuitive parental communication that should be encouraged, especially in at‐risk populations. [ABSTRACT FROM AUTHOR]

Abstract Background Effective vaccination governance in conflict-affected regions poses unique challenges. This study evaluates the governance of vaccination programs in northwest Syria, focusing on effectiveness, efficiency, inclusiveness, data availability, vision, transparency, accountability, and sustainability. Methods Using a mixed-methods approach, and adapting Siddiqi’s framework for health governance, data were collected through 14 key informant interviews (KIIs), a validating workshop, and ethnographic observations. Findings were triangulated to provide a comprehensive understanding of vaccination governance. Results The study highlights innovative approaches used to navigate the complex health governance landscape to deliver vaccination interventions, which strengthened sub-national vaccination structures such as The Syria Immunisation Group (SIG). The analysis revealed several key themes. Effectiveness and efficiency were demonstrated through cold-chain reliability and extensive outreach activities, though formal reports lacked detailed analysis of vaccine losses and linkage between disease outbreak data and coverage statistics. Key informants and workshop participants rated the vaccination strategy positively but identified inefficiencies due to irregular funding and bureaucracy. Inclusiveness and data availability were prioritised, with outreach activities targeting vulnerable groups. However, significant gaps in demographic data and reliance on paper-based systems hindered comprehensive coverage analysis. Digitalisation efforts were noted but require further support. The SIG demonstrated a clear strategic vision supported by international organizations such as the World Health Organization, yet limited partner participation in strategic planning raised concerns about broader ownership and engagement. While the SIG was perceived as approachable, the lack of public documentation and financial disclosure limited transparency. Internal information sharing was prevalent, but public communication strategies were insufficient. Accountability and sustainability faced challenges due to a decentralized structure and reliance on diverse donors. Despite stabilizing factors such as decentralization and financial continuity, fragmented oversight and reliance on donor funding remained significant concerns. Discussion The study highlights the complexities of vaccination governance in conflict-affected areas. Comparisons with other conflict zones underscore the importance of local organisations and international support. The SIG’s role is pivotal, but its legitimacy, transparency, and inclusivity require improvement. The potential transition to early recovery in Syria poses additional challenges to SIG’s sustainability and integration into national programs. Conclusion The governance of vaccination in northwest Syria is multifaceted, involving multiple stakeholders and lacking a legitimate government. Enhancing transparency, local ownership, and participatory decision-making are crucial for improving governance. The role of international bodies is essential, emphasising the need for structured feedback mechanisms and transparent monitoring processes to ensure the program’s success and sustainability.

Abstract Background Respiratory syncytial virus (RSV) is associated with substantial morbidity among infants. This study modelled the potential public health and economic impact of nirsevimab, a long-acting monoclonal antibody, as an immunoprophylactic strategy for all infants in Spain in their first RSV season. Methods A static decision-analytic model of the Spanish birth cohort during its first RSV season was developed to estimate the impact of nirsevimab on RSV-related health events and costs versus the standard of practice (SoP). Spain-specific costs and epidemiological data were used as model inputs. Modelled outcomes included RSV-related outpatient visits, emerging room (ER) visits, hospitalisations – including pediatric intensive care unit (PICU) admission, mechanical ventilation, and inpatient mortality. Results Under the current SoP, RSV caused 151,741 primary care visits, 38,798 ER visits, 12,889 hospitalisations, 1,412 PICU admissions, and 16 deaths over a single season, representing a cost of €71.8 million from a healthcare payer perspective. Universal immunisation of all infants with nirsevimab was expected to prevent 97,157 primary care visits (64.0% reduction), 24,789 ER visits (63.9%), 8,185 hospitalisations (63.5%), 869 PICU admissions (61.5%), and 9 inpatient deaths (52.6%), saving €47.8 million (62.4%) in healthcare costs. Conclusions These results suggest that immunisation with nirsevimab of all infants experiencing their first RSV season in Spain is likely to prevent thousands of RSV-related health events and save considerable costs versus the current SoP.

Abstract Background The newborn and infant continuum of care such as essential newborn care, early initiation and exclusive breastfeeding, and immunisation are highly recommended for improving the quality of life and survival of infants. However, newborn and infant mortality remains high across Sub-Saharan African countries. While unintended pregnancies are associated with adverse newborn and infant health outcomes, there is inconclusive evidence on whether pregnancy intention influences newborn and infant continuum of care completion. Therefore, this review aimed to pool findings reported in the literature on the association between pregnancy intention and newborn and infant health care across the continuum of care in Sub-Saharan Africa. Methods We searched MEDLINE Complete, EMBASE, CINAHL Complete, and Global Health databases for studies potentially eligible for this systematic review and meta-analysis. Two researchers independently screened the identified articles by abstract and title, and then full-text using Covidence. We used the Newcastle–Ottawa Scale to assess the quality of the included studies. The Cochran’s Q test and I2 were executed to detect and quantify the presence of statistical heterogeneity in the studies. Meta-analysis was done for each outcome when more than one original study reported relevant data, using Stata statistical software version 18. Results Eleven studies were included from a total of 235 articles identified by the search. The odds of completing essential newborn care (pooled odds ratio: 3.04, 95% CI: 1.56, 5.90), early initiation of breastfeeding (pooled odds ratio: 1.30, 95% CI: 1.13, 1.52), exclusive breastfeeding (pooled odds ratio: 2.21, 95% CI: 1.68, 2.89), and being fully immunised (pooled odds ratio: 2.73, 95% CI: 1.16, 6.40) were higher among infants born to women with intended pregnancies as compared to women with unintended pregnancies. Conclusion Intended pregnancy was positively associated with essential newborn care completion, early initiation and exclusive breastfeeding, and full immunisation of infants in SSA countries. Thus, policy-makers and stakeholders should strengthen the provision of quality family planning services to prevent unintended pregnancy. Furthermore, follow-up of women with unintended pregnancies is needed to increase women’s opportunity to access essential newborn health care services that further reduce the risk of newborn and infant morbidity and mortality. Systematic review registration PROSPERO registration number CRD42023409148.

Objectives: To determine clients’ satisfaction with immunisation services in the urban and rural primary health centres of a South-eastern state in Nigeria Methods: A three-stage sampling method was used to select 800 clients who presented with their children/wards to 18 of the 440 primary health centres. Exit interviews were conducted using an adapted, semi-structured questionnaire. A composite index of satisfaction with immunisation services, denoted as true satisfaction, was assessed as the proportion of clients who reported being satisfied with the immunisation services received on the day of data collection, who were ready to use the health centre again for immunisation services, and who were willing to recommend the health centre to others for the same services. Findings: The mean age of the clients was 28.9±4.5 and 26.7±5.1 years old in the urban and rural areas, respectively. The main reasons why the clients chose the primary health centres for immunisation services were because of their proximity to the health centres in the urban area (34.3%) and the availability of vaccines in the rural area (35.3%). The majority of clients in the urban (84.5%) and rural areas (94.3%) were truly satisfied with the immunisation services. A long waiting time and uncomfortable waiting areas were the major sources of dissatisfaction among the clients. Factors that were associated with the clients’ true satisfaction with immunisation services included being a client in an urban area (adjusted odds ratio (AOR)=0.2, 95% confidence interval (CI): 0.1-0.4), being married, (AOR=33.5, 95% CI: 12.7-88.1), being of the Igbo ethnic nationality (AOR=14.9, 95% CI: 3.9- 7.4), being a Christian (AOR=21.1, 95% CI: 2.9-154.6), and being in close proximity to the health centres (AOR=2.6, 95% CI: 1.5-4.4). Conclusion: The waiting time needs to be reduced and the physical conditions of the waiting area need to be improved to reduce the clients’ dissatisfaction with the services, particularly in urban areas.

Background: Vaccine- preventable-diseases are major contributors to child mortality in Africa. In Nigeria, apart from the routine childhood vaccines that are provided free by the government, there are additional lifesaving non-routine vaccines like Rotavirus, Pneumococcal Conjugate (PCV), Varicella, Cerebrospinal meningitis, and Measles, Mumps, Rubella (MMR) vaccines. Until 2015 when PCV was included in the routine childhood immunisation, these five vaccines were optional and parents paid to immunize their children with them. Objective: To assess the level of knowledge and utilization of nonroutine immunisations among mothers. Methodology: A descriptive, cross -sectional study conducted in three infant welfare clinics purposively selected in Ibadan North Local Government Area, Oyo State, Nigeria. Participants were 110 mothers of children aged 6-24 months. A structured questionnaire was used for data collection and analysis done using SPSS version 20.0. Descriptive statistics were computed and Chi-square test was used for investigating association between categorical variables at 0.05 level of significance. Results: The findings revealed that 62 (56.4%) of the 110 mothers were aware of non-routine immunisation of which 23 (20.9%) had good knowledge about it. Only 23 (20.9%) of their children were immunized with all the nonroutine vaccines. High income, higher level of education and good knowledge level about non-routine immunisation of mothers were associated with the utilization of all non-routine immunisation among their children (p

Abstract Background Immunocompromised hosts (ICH) experience more breakthrough infections and worse clinical outcomes following infection with COVID-19 than immunocompetent people. Prophylactic monoclonal antibody therapies can be challenging to access, and escape variants emerge rapidly. Immunity conferred through vaccination remains a central prevention strategy for COVID-19. COVID-19 vaccines do not elicit optimal immunity in ICH but boosting, through additional doses of vaccine improves humoral and cellular immune responses. This trial aims to assess the immunogenicity and safety of different COVID-19 vaccine booster strategies against SARS-CoV-2 for ICH in Australia. Methods Bringing optimised COVID-19 vaccine schedules to immunocompromised populations (BOOST-IC) is an adaptive randomised trial of one or two additional doses of COVID-19 vaccines 3 months apart in people living with HIV, solid organ transplant (SOT) recipients, or those who have haematological malignancies (chronic lymphocytic leukaemia, non-Hodgkin lymphoma or multiple myeloma). Key eligibility criteria include having received 3 to 7 doses of Australian Therapeutic Goods Administration (TGA)-approved COVID-19 vaccines at least 3 months earlier, and having not received SARS-CoV-2-specific monoclonal antibodies in the 3 months prior to receiving the study vaccine. The primary outcome is the geometric mean concentration of anti-spike SARS-CoV-2 immunoglobulin G (IgG) 28 days after the final dose of the study vaccine. Key secondary outcomes include anti-spike SARS-CoV-2 IgG titres and the proportion of people seroconverting 6 and 12 months after study vaccines, local and systemic reactions in the 7 days after vaccination, adverse events of special interest, COVID-19 infection, mortality and quality of life. Discussion This study will enhance the understanding of COVID-19 vaccine responses in ICH, and enable the development of safe, and optimised vaccine schedules in people with HIV, SOT, or haematological malignancy. Trial registration ClinicalTrials.gov NCT05556720. Registered on 23rd August 2022.

Abstract Background The aim of this review was to investigate the impact of short message service (SMS)-based interventions on childhood and adolescent vaccine coverage and timeliness. Methods A pre-defined search strategy was used to identify all relevant publications up until July 2022 from electronic databases. Reports of randomised trials written in English and involving children and adolescents less than 18 years old were included. The review was conducted in accordance with PRISMA guidelines. Results Thirty randomised trials were identified. Most trials were conducted in high-income countries. There was marked heterogeneity between studies. SMS-based interventions were associated with small to moderate improvements in vaccine coverage and timeliness compared to no SMS reminder. Reminders with embedded education or which were combined with monetary incentives performed better than simple reminders in some settings. Conclusion Some SMS-based interventions appear effective for improving child vaccine coverage and timeliness in some settings. Future studies should focus on identifying which features of SMS-based strategies, including the message content and timing, are determinants of effectiveness.

Acute Disseminated Encephalomyelitis (ADEM) is a neurological disorder characterised by demyelination, where the immune system targets the Central Nervous System (CNS). This condition typically develops rapidly, with neurological symptoms appearing within days to weeks following viral infections or immunisations. Before the onset of neurological manifestations, patients often experience systemic symptoms such as fever, headache, malaise, and myalgias. The transition from the febrile phase of illness to neurological symptoms generally occurs with a latency period of 7 to 14 days. ADEM is commonly referred to as “post-infectious,” “para-infectious,” “post-exanthematous,” or “post-vaccinal” encephalomyelitis. Recognised as a potential cause of permanent neurological disability, ADEM frequently affects individuals early in life, underscoring the significance of understanding this disease entity, particularly in the context of routine immunisation practices. Herein, the authors present the case of a 28-year-old female, who presented with quadriparesis in a drowsy state following a febrile illness. Upon further evaluation, she was diagnosed with a co-infection of Influenza B and leptospirosis, confirmed by positive serological tests. Magnetic Resonance Imaging (MRI) of the brain revealed hyperintensities suggestive of ADEM in multiple areas of the brainstem and thalamus, while Cerebrospinal Fluid (CSF) examination showed an albumin-cytological dissociative picture, further supporting the diagnosis. Treatment comprised a pulse steroid regimen followed by oral steroid tapering. Subsequently, the patient demonstrated clinical improvement over the course of a week, with progressive enhancements observed during follow-up assessments. The present case highlights the importance of prompt recognition and management of ADEM, emphasising the role of corticosteroid therapy in achieving favourable patient outcomes.

SCIENTIFIC RELEVANCE. Inconsistent terminology for vaccine safety may create challenges for healthcare professionals in identifying, interpreting, and assessing adverse events following vaccination in clinical practice.AIM. The authors aimed to review Russian and international terminology for adverse events following vaccination. DISCUSSION. This review covers the terminology used in Russian, EAEU, WHO, and ICH documents. The term “adverse event” is used in most Russian and international pharmacovigilance regulations and guidelines; this term universally defines undesirable consequences associated with medicinal products regardless of their therapeutic class. Russian regulations and guidelines use various terms to describe adverse events following vaccination, including “adverse events”, “side effects of vaccines”, and “post-vaccination complications”. In 2019, the Ministry of Health of Russia approved the Guidelines for the Detection, Investigation, and Prevention of Side Effects Following Immunisation. However, the term “side effects following immunisation” cannot unambiguously characterise the safety of vaccines, as this term can refer to negative, neutral, or positive events following vaccination. The term “post-vaccination complications” is defined in Russian legislation as a list of pathological conditions. The list is not exhaustive and does not fully reflect the definition of post-vaccination complications as severe and/or persistent health issues following vaccination. The term “adverse events following immunisation”, which is recommended by most international guidelines, describes the negative consequences of vaccination more accurately. At the same time, the term “post-vaccination complications” can be reformulated as “serious adverse events following vaccination” with clearly defined and categorised criteria.CONCLUSIONS. In addition to aiding in detecting, classifying, and evaluating adverse events following immunisation, the unification of terminology for vaccine safety in Russian regulations and guidelines will also facilitate risk mitigation in both individual and mass vaccination campaigns in general.

Issue Addressed Methods Results Conclusions So What? Increasing and maintaining vaccination uptake is crucial for preventing and managing infectious diseases. In the context of the post‐coronavirus disease 2019 (COVID‐19) pandemic landscape, this paper examines the perceptions of immunisation implementers and policymakers to uncover the challenges and evidence gaps in routine immunisation efforts.We conducted an online two‐round modified Delphi survey with immunisation experts, senior public servants, policymakers, policy advisory groups, and representatives from peak bodies from across Australia. We asked respondents to outline what they see as the greatest challenges to increasing and maintaining uptake of recommended vaccines in Australia; the most difficult aspects of their work in vaccination; the largest evidence gaps in vaccine uptake; and the kinds of social and behavioural research they would like to see prioritised.The two most important challenges for increasing and maintaining vaccine uptake were effectively communicating the benefits of vaccines to parents and the public and ensuring accessible and affordable vaccination services. Participants strongly agreed that ‘communication about the importance of vaccination’ was the most difficult aspect of their work. Consistently important was the need to better engage specific population groups, such as culturally and linguistically diverse people, pregnant people, at risk cohorts, and health care providers. Social and behavioural research about ‘how to effectively address hesitancy’ was ranked highly among participants.Findings from this project help provide an understanding of the behavioural, social, ethical, and policy knowledge needs for immunisation policy and implementation in Australia. To respond to vaccine challenges, increase coverage and build public trust in vaccination, policymakers and governments should incorporate social research into vaccination programmes.Australia is preparing to launch a Centre for Disease Control. This study demonstrates the importance of integrating social, behavioural, ethical, and policy research into the fabric of this new enterprise. It underlines the need to capacity‐build a workforce able to deliver high‐quality research in these areas, address the needs of immunisation implementers and policymakers, and achieve good outcomes for Australians. [ABSTRACT FROM AUTHOR]

Acute Disseminated Encephalomyelitis (ADEM) is a neurological disorder characterised by demyelination, where the immune system targets the Central Nervous System (CNS). This condition typically develops rapidly, with neurological symptoms appearing within days to weeks following viral infections or immunisations. Before the onset of neurological manifestations, patients often experience systemic symptoms such as fever, headache, malaise, and myalgias. The transition from the febrile phase of illness to neurological symptoms generally occurs with a latency period of 7 to 14 days. ADEM is commonly referred to as "post-infectious," "para-infectious," "post-exanthematous," or "post-vaccinal" encephalomyelitis. Recognised as a potential cause of permanent neurological disability, ADEM frequently affects individuals early in life, underscoring the significance of understanding this disease entity, particularly in the context of routine immunisation practices. Herein, the authors present the case of a 28-year-old female, who presented with quadriparesis in a drowsy state following a febrile illness. Upon further evaluation, she was diagnosed with a co-infection of Influenza B and leptospirosis, confirmed by positive serological tests. Magnetic Resonance Imaging (MRI) of the brain revealed hyperintensities suggestive of ADEM in multiple areas of the brainstem and thalamus, while Cerebrospinal Fluid (CSF) examination showed an albumincytological dissociative picture, further supporting the diagnosis. Treatment comprised a pulse steroid regimen followed by oral steroid tapering. Subsequently, the patient demonstrated clinical improvement over the course of a week, with progressive enhancements observed during follow-up assessments. The present case highlights the importance of prompt recognition and management of ADEM, emphasising the role of corticosteroid therapy in achieving favourable patient outcomes. [ABSTRACT FROM AUTHOR]

In September 2023, France was one of the first countries that started a national immunisation campaign with nirsevimab, a new monoclonal antibody against respiratory syncytial virus (RSV). Using data from a network of paediatric intensive care units (PICUs), we aimed to estimate nirsevimab effectiveness against severe cases of RSV bronchiolitis in France. We conducted a case–control study based on the test‐negative design and included 288 infants reported by 20 PICUs. We estimated nirsevimab effectiveness at 75.9% (48.5–88.7) in the main analysis and 80.6% (61.6–90.3) and 80.4% (61.7–89.9) in two sensitivity analyses. These real‐world estimates confirmed the efficacy observed in clinical studies. [ABSTRACT FROM AUTHOR]

Aim: A long-acting monoclonal antibody against RSV (nirsevimab), given as an injection shortly after birth, is currently being rolled out globally. Carer acceptance of intra- muscular (IM) vitamin K, another injection given shortly after birth, could serve to indicate the acceptability of nirsevimab. Methods: We analysed a national dataset of postnatal health visitor visits in Scotland; individual-level data on gestation were not available. The primary outcome measure was the modality of administration of vitamin K; potential explanatory variables were maternal age, infant ethnicity, English as a first language, and measures of socioeconomic deprivation. We examined associations between IM vitamin K administration or oral/no vitamin K and each explanatory variable. Results: From 2019 to 2021, questionnaires were available for 142 857 infants; data was missing for 2.7%. IM Vitamin K uptake was high: 95.5% of carers consented, with 1.1% requesting oral vitamin K and 0.9% refusing vitamin K altogether. Infant ethnicity, use of English as a first language, socio-economic status and maternal age were not associated with reduced uptake of IM vitamin K. Conclusion: If IM Vitamin K administration is a valid proxy measure for nirsevimab acceptance, we did not identify groups that might require increased engagement prior to nirsevimab roll- out. [ABSTRACT FROM AUTHOR]

This article was sponsored by CSL Seqirus. CSL Seqirus had no involvement in the writing or editorial process of this article. Since the flu pandemic of 2009 (with exception of the two pandemic years), our flu seasons tended to have followed a low and late pattern. Influenza starts circulating around January with type A strains first then followed by type B leading into April and May. The pattern of influenza was different in 2023/24. Reported positivity rates were considerably lower than 2022/23 (and compared to 2017/18 onwards). Rates peaked in January but as of week 18, remain higher than 2022/23 and follow that low late pattern. This article discusses the learnings from recent flu seasons and how nurses can most effectively use the annual immunisation drive. [ABSTRACT FROM AUTHOR]

Population has increased drastically over the years and new diseases compete with the population. Immunisation is a preventive measure, which makes the person resistant or immune to the disease. Vaccination stimulates our own immune system against infection or diseases. Vaccines are available for more than twenty life-threatening diseases and it saves millions of lives throughout the world. In the 70th World Assembly conducted in the year 2017, around 194 countries participated and took the oath to strengthen vaccination thereby achieving goals of Global Vaccine Action Plan (GVAP). In spite of remarkable immunisation progress, approximately 20 million infants are not exposed to vaccination every year. The immunisation progress has stalled or even reversed in some countries, and there is a real risk that complacency will undermine past achievements. This paper considered the database of vaccine consumption rate from many countries issued by WHO to analyse the reason for poor access to vaccine with respect to the morality and poverty levels. For this analysis, the relation between vaccine consumption by children below five years, the children's death rate record issued by the United Nations Children's Education Fund (UNICEF), poverty index issued by the United Nations are considered. Multivariate linear regression algorithm is used to identify the correlation between datasets. The result shows that an increase in vaccination coverage results in reduction on mortality rate in most of the countries. A correlation coefficient of 0.7 was found between IMR and the vaccine dosages. Sub-Sahara countries' poverty index has direct impact on the declined view of vaccination coverage. [ABSTRACT FROM AUTHOR]

In January 2021, Australia initiated a national COVID-19 vaccine rollout strategy but faced setbacks, leading to negative press and media controversy, which may have diminished vaccine confidence. This study aimed to assess the factors influencing vaccine confidence in Australian adults (≥18 years of age) following the administration of a COVID-19 vaccine. Conducted at Blacktown Hospital, Sydney, a cross-sectional survey with 1053 respondents gauged vaccine confidence and influencing factors. The results showed overall high confidence (mean score 33/40). Trusted sources included the Australian Department of Health (77.8%), NSW Health (76.7%), and general practitioners (53.7%), while social media was distrusted (5.9%). The motivations for vaccination varied: university-educated individuals prioritised personal health (X2 = 17.81; p < 0.001), while religious and/or older respondents (≥50 years of age) emphasised community (X2 = 11.69; p < 0.001) and family protection (X2 = 17.314; p < 0.001). Multivariate logistic regression revealed use of the Australian Department of Health website as a trusted source of COVID-19 information as the strongest predictor of high confidence (>30; OR 1.43; p = 0.041), while exposure to fake news decreased confidence (OR 0.71; p = 0.025). The study underscores the importance of reliable health information sources in bolstering vaccine confidence and highlights the detrimental effects of misinformation. Promoting awareness of trustworthy health channels is crucial to combat vaccine hesitancy in Australia. [ABSTRACT FROM AUTHOR]

Kidney transplant recipients are at an increased risk of hospitalisation and death from SARS-CoV-2 infection, and standard two-dose vaccination schedules are typically inadequate to generate protective immunity. Gut dysbiosis, which is common among kidney transplant recipients and known to effect systemic immunity, may be a contributing factor to a lack of vaccine immunogenicity in this at-risk cohort. The gut microbiota modulates vaccine responses, with the production of immunomodulatory short-chain fatty acids by bacteria such as Bifidobacterium associated with heightened vaccine responses in both observational and experimental studies. As SCFA-producing populations in the gut microbiota are enhanced by diets rich in non-digestible fibre, dietary supplementation with prebiotic fibre emerges as a potential adjuvant strategy to correct dysbiosis and improve vaccine-induced immunity. In a randomised, double-bind, placebo-controlled trial of 72 kidney transplant recipients, we found dietary supplementation with prebiotic inulin for 4 weeks before and after a third SARS-CoV2 mRNA vaccine to be feasible, tolerable, and safe. Inulin supplementation resulted in an increase in gut Bifidobacterium, as determined by 16S RNA sequencing, but did not increase in vitro neutralisation of live SARS-CoV-2 virus at 4 weeks following a third vaccination. Dietary fibre supplementation is a feasible strategy with the potential to enhance vaccine-induced immunity and warrants further investigation. [ABSTRACT FROM AUTHOR]

(1) The Russian invasion of Ukraine forced many people to leave their country and seek asylum in various European countries, with serious consequences from a health perspective. In this context, we describe the health measures undertaken by AcToVax4NAM Consortium Countries (Cyprus–Germany–Greece–Italy–Malta–Poland–Romania–Spain) to prevent Vaccine-Preventable Disease (VPD) outbreaks in the context of mass movements of populations that resulted from the crisis in Ukraine. (2) We collected information on the vaccinations offered to Ukrainians in the Consortium Countries. (3) All these countries have provided Temporary Protection (TP) status to refugees from Ukraine and have followed the recommendations of European and International Agencies to offer them vaccinations according to the National Immunisation Programmes. The COVID-19 vaccination is offered in all countries with regard to the general population. Most countries provide information on TP and access to health/vaccination services in the Ukrainian language. (4) The information collected shows a common effort to ensure the adequate planning of health and vaccination services for refugees from Ukraine and, very often, to include them in the national vaccination offer. It is important that this initial response towards people who have fled Ukraine will be continued following the emergency but, more importantly, that it serves as a best practice towards all migrants and refugees entering the EU. [ABSTRACT FROM AUTHOR]

The cost effectiveness of childhood varicella vaccination is uncertain, as evidenced by variation in national health policies. Within the European Economic Area (EEA), only 10 of 30 countries offer universally funded childhood varicella vaccination. This study estimates the cost effectiveness of universal childhood varicella vaccination for one EEA country (Ireland), highlighting the difference in cost effectiveness between alternative vaccination strategies. An age-structured dynamic transmission model, simulating varicella zoster virus transmission, was developed to analyse the impact of three vaccination strategies; one-dose at 12 months old, two-dose at 12 and 15 months old (short-interval), and two-dose at 12 months and five years old (long-interval). The analysis adopted an 80-year time horizon and considered payer and societal perspectives. Clinical effectiveness was based on cases of varicella and subsequently herpes zoster and post-herpetic neuralgia avoided, and outcomes were expressed in quality-adjusted life-years (QALYs). Costs were presented in 2022 Irish Euro and cost effectiveness was interpreted with reference to a willingness-to-pay threshold of €20,000 per QALY gained. From the payer perspective, the incremental cost-effectiveness ratio (ICER) for a one-dose strategy, compared with no vaccination, was estimated at €8,712 per QALY gained. The ICER for the next least expensive strategy, two-dose long-interval, compared with one-dose, was estimated at €45,090 per QALY gained. From a societal perspective, all three strategies were cost-saving compared with no vaccination; the two-dose short-interval strategy dominated, yielding the largest cost savings and health benefits. Results were stable across a range of sensitivity and scenario analyses. A one-dose strategy was highly cost effective from the payer perspective, driven by a reduction in hospitalisations. Two-dose strategies were cost saving from the societal perspective. These results should be considered alongside other factors such as acceptability of a new vaccine within the overall childhood immunisation schedule, programme objectives and budget impact. [ABSTRACT FROM AUTHOR]

Immunisation against herpes zoster is recommended for adults aged ≥ 50 years. Two vaccines, a live attenuated (ZVL, Zostavax®) and an adjuvant recombinant subunit (HZ/su, Shingrix®), are available in Australia. Immunisation guidelines are shifting their recommendations towards HZ/su because of higher efficacy in preventing herpes zoster and associated complications. However, there are limited post-marketing data comparing the safety profiles of these vaccines. Data from SmartVax, an active surveillance system for monitoring adverse events following immunisation (AEFIs) utilised by > 450 clinics throughout Australia, were analysed. Data from patients aged ≥ 50 years, who received ZVL or HZ/su, from 1 June 2021 to 31 May 2022, at clinics that utilised SmartVax were included. The proportion of records where patients who reported any, local, and systemic AEFIs after receiving ZVL or HZ/su were compared using multivariable logistic regression models. Data from 10,392 immunisation records (n = 8341 ZVL; n = 2051 HZ/su) were included. The proportion of AEFIs reported was higher with HZ/su (41.9 % [any], 33.8 % [local], 25.2 % [systemic]) than with ZVL (8.7 % [any], 6.2 % [local], 3.5 % [systemic]). After controlling for demographic variables, HZ/su presented a 6-fold increase in the odds (OR 6.44; 95 %CI: 5.57–7.46) of a reported AEFI compared to ZVL. Only 59 (0.6 %) of vaccinations lead to medical attention being sought due to an AEFI. While rates of AEFIs was higher with HZ/su than ZVL, most AEFIs were mild and did not require medical attention. Our findings support the change in vaccine recommendations and the use of HZ/su in immunisation programs. [ABSTRACT FROM AUTHOR]

Background: Migrants in the UK and Europe face vulnerability to vaccine-preventable diseases (VPDs) due to missed childhood vaccines and doses and marginalisation from health systems. Ensuring migrants receive catch-up vaccinations, including MMR, Td/IPV, MenACWY, and HPV, is essential to align them with UK and European vaccination schedules and ultimately reduce morbidity and mortality. However, recent evidence highlights poor awareness and implementation of catch-up vaccination guidelines by UK primary care staff, requiring novel approaches to strengthen the primary care pathway. Methods: The 'Vacc on Track' study (May 2021–September 2022) aimed to measure under-vaccination rates among migrants in UK primary care and establish new referral pathways for catch-up vaccination. Participants included migrants aged 16 or older, born outside of Western Europe, North America, Australia, or New Zealand, in two London boroughs. Quantitative data on vaccination history, referral, uptake, and sociodemographic factors were collected, with practice nurses prompted to deliver catch-up vaccinations following UK guidelines. Focus group discussions and in-depth interviews with staff and migrants explored views on delivering catch-up vaccination, including barriers, facilitators, and opportunities. Data were analysed using STATA12 and NVivo 12. Results: Results from 57 migrants presenting to study sites from 18 countries (mean age 41 [SD 7.2] years; 62% female; mean 11.3 [SD 9.1] years in UK) over a minimum of 6 months of follow-up revealed significant catch-up vaccination needs, particularly for MMR (49 [86%] required catch-up vaccination) and Td/IPV (50 [88%]). Fifty-three (93%) participants were referred for any catch-up vaccination, but completion of courses was low (6 [12%] for Td/IPV and 33 [64%] for MMR), suggesting individual and systemic barriers. Qualitative in-depth interviews (n = 39) with adult migrants highlighted the lack of systems currently in place in the UK to offer catch-up vaccination to migrants on arrival and the need for health-care provider skills and knowledge of catch-up vaccination to be improved. Focus group discussions and interviews with practice staff (n = 32) identified limited appointment/follow-up time, staff knowledge gaps, inadequate engagement routes, and low incentivisation as challenges that will need to be addressed. However, they underscored the potential of staff champions, trust-building mechanisms, and community-based approaches to strengthen catch-up vaccination uptake among migrants. Conclusions: Given the significant catch-up vaccination needs of migrants in our sample, and the current barriers to driving uptake identified, our findings suggest it will be important to explore this public health issue further, potentially through a larger study or trial. Strengthening existing pathways, staff capacity and knowledge in primary care, alongside implementing new strategies centred on cultural competence and building trust with migrant communities will be important focus areas. [ABSTRACT FROM AUTHOR]

• Coverage of measles and pertussis childhood vaccines in Norway vary by parental immigrant background. • East-European background was often associated with relatively low and recently declining coverage of both vaccines. • Somali background was associated with relatively low coverage of measles vaccine, but not of pertussis vaccine. • Mother's length of residency was positively associated with coverage among children of East-European or Vietnamese background. The Norwegian Childhood Immunization Program maintains a high national coverage of 95–97% in the most recent years. Whether there are subgroups with lower uptake is less studied. This study examines pertussis and measles vaccination coverage among six immigrant groups in Norway. These vaccines are normally administered as part of different combination vaccines and their coverage rate indicate the national vaccination coverage against a range of additional infections. Data from the Norwegian National Population Register were linked at individual level with vaccination data from the Norwegian Immunisation Registry. The final sample consisted of 53,052 children born during 2000–2018 in Norway to parents who were born in Iraq, Lithuania, Pakistan, Poland, Somalia, or Vietnam. Vaccination coverage was measured at 2-years of age. Multivariate linear regression was utilized to estimate the relationship between vaccinations status, year of birth, gender, mother's length of residency in Norway, and area of residence. At two years of age, the majority of the children were vaccinated. Coverage among the groups varied at, above, and below the national average for the two vaccines. For most of the years examined, children born by parents from Lithuania, Poland, and Somalia had lower coverage for the measles vaccine (range 81–84% in 2020) than the national level (97% in 2020). Children born by parents from the Eastern-European countries also had lower coverage than the national level for the pertussis vaccine (range 87–89% in 2020). This study illustrates how subgroups with lower vaccination coverage may exists within a well-established vaccination program with high national coverages. Differences in coverage were found for both vaccines, but the differences were more pronounced for the measles vaccine. The high vaccination coverage in Norway provides indirect protection through herd immunity for unvaccinated individuals, however, the lower vaccination coverage in some immigrant groups is a concern. [ABSTRACT FROM AUTHOR]

• Past vaccination experiences influenced participants' vaccine uptake decisions. • Settlement support services promote vaccine uptake and trust in health care providers (HCPs). • Participants called for clear, dialogic vaccination information from HCPs. • Without HCP information, participants relied on community members for information. • At times community members contributed to vaccine hesitancy and distrust in HCPs. Research on immigrant and refugee vaccination uptake in Canada shows that immunization decisions vary by vaccine type, location, age and migration status. Despite their diversity, these studies often treat immigrant and refugee populations as a single group relative to other Canadians. In this comparative study, we explored how previous risk communication and immunization experiences influence immunization decisions by immigrant and refugee women from three communities across Canada. Participants included women from the Punjabi immigrant community located in Surrey and Abbotsford, British Columbia (n = 36), the Nigerian immigrant community located in Winnipeg, Manitoba (n = 43), and the Congolese refugee community in Edmonton, Alberta (n = 18). Using focus groups guided by focused ethnography methodology, we sought to understand immunization experiences in Canada and before arrival, and what information sources influenced the immunization decision-making process by the women in the three communities. Participants had differing past experiences in Canada and before their arrival that influenced how they used information in their vaccination decisions. Clear vaccination communications and dialogue with Canadian health care providers increased trust in Canadian health care and the likelihood of vaccine uptake. By contrast, weak vaccine recommendations and antivaccination information in the community prompted participants to decline future vaccines. Given our participants' different communication preferences and needs, we argue that a one-size-fits-all communication approach is inappropriate for immigrant and refugee populations. Instead, multi-pronged communication strategies are required to reach participants and respond to previous experiences and information that may lead to vaccination hesitancy. [ABSTRACT FROM AUTHOR]

• Specialist immunisation clinics facilitate safe childhood vaccination practises. • The majority of post review adverse events are non serious. • Prior serious adverse events are unlikely to recur. • Underlying neurological conditions predispose to post vaccination seizures. • Family history of adverse event is not associated with adverse event occurrence. Prior experience of an adverse event following immunisation is a known barrier to vaccination. Limited Australian data evaluating adverse event recurrence among children exists to inform clinical decisions. We aimed to assess adverse event following immunisation recurrence among children with prior adverse events and to evaluate if family history increased adverse event risk. A prospective cohort study was conducted from March 3rd until August 18th, 2023. Children ≤ 16 years with prior adverse events following immunisation in themselves or family were recruited from specialist immunisation clinics at two quaternary paediatric hospitals. Adverse event outcomes were collected via surveys administered at presentation, three, and eight days post vaccination, and analysed by key characteristics and potential risk factors. Forty three of forty nine (43/49, 87.8 %) children enrolled received further vaccines. Of those who completed the follow up surveys, 50.0 % (16/32) reported an adverse event. Recurrence of prior adverse events occurred for 23.3 % (10/43, 95 % CI: 11.8 % – 38.6 %) of the cohort. Two of twelve (2/12, 16.7 %) participants with prior serious adverse events who received further vaccines reported a serious adverse event recurrence. No post review serious adverse events were observed in children with prior non serious adverse events. Neurological conditions were a risk factor for prior (neurological condition 3/3 versus no neurological condition 2/40, p < 0.001) and post review (neurological condition 2/3 versus no neurological condition 0/28, p = 0.006) post vaccination seizures. Family history had no relationship to post review adverse events (family history 5/8 versus no family history 11/23, p = 0.685). Revaccination is safe for the majority of children with a personal or family history of adverse event following immunisation. [ABSTRACT FROM AUTHOR]

Aim: The pneumococcal conjugate vaccine, which covered seven serotypes of Streptococcus pneumoniae (PCV7), was introduced in Stockholm, Sweden, in 2007. It was replaced by a 13‐valent vaccine (PCV13) in 2011. We previously reported a decreased incidence of pneumonia and sinusitis among young children 4 years after the introduction of the PCV7. This study followed the incidence of pneumonia, sinusitis, mastoiditis and meningitis for four more years. Methods: We studied validated hospital registry data covering children up to 17 years of age, who were hospitalised in the Stockholm region from 2003 to 2016, when the child population peaked at 485 687. All 11 115 cases diagnosed with pneumonia, coded as bacterial pneumonia, sinusitis, mastoiditis, bacterial meningitis or empyema, were identified. The controls had viral pneumonia or pyelonephritis. Results: The incidence rates for children under 2 years of age hospitalised for sinusitis, mastoiditis and meningitis decreased significantly by 61%–79% during the eight‐year post‐vaccination period. Hospitalisations for bacterial pneumonia decreased by 19%–25% in the same age group. These changes were probably due to both the vaccines and changes in diagnosis routines. Conclusion: The effect of vaccination on children under 2 years of age was sustained 8 years after the introduction of the pneumococcal conjugate vaccines. [ABSTRACT FROM AUTHOR]

Background and Aims We sought to determine whether six commonly used immunosuppressive regimens were associated with lower antibody responses after seasonal influenza vaccination in patients with inflammatory bowel disease [IBD]. Methods We conducted a prospective study including 213 IBD patients and 53 healthy controls: 165 who had received seasonal influenza vaccine and 101 who had not. IBD medications included infliximab, thiopurines, infliximab and thiopurine combination therapy, ustekinumab, vedolizumab, or tofacitinib. The primary outcome was antibody responses against influenza/A H3N2 and A/H1N1, compared to controls, adjusting for age, prior vaccination, and interval between vaccination and sampling. Results Lower antibody responses against influenza A/H3N2 were observed in patients on infliximab (geometric mean ratio 0.35 [95% confidence interval 0.20–0.60], p  = 0.0002), combination of infliximab and thiopurine therapy (0.46 [0.27–0.79], p  = 0.0050), and tofacitinib (0.28 [0.14–0.57], p  = 0.0005) compared to controls. Lower antibody responses against A/H1N1 were observed in patients on infliximab (0.29 [0.15–0.56], p  = 0.0003), combination of infliximab and thiopurine therapy (0.34 [0.17–0.66], p  = 0.0016), thiopurine monotherapy (0.46 [0.24–0.87], p  = 0.017), and tofacitinib (0.23 [0.10–0.56], p  = 0.0013). Ustekinumab and vedolizumab were not associated with reduced antibody responses against A/H3N2 or A/H1N1. Vaccination in the previous year was associated with higher antibody responses to A/H3N2. Vaccine-induced anti-SARS-CoV-2 antibody concentration weakly correlated with antibodies against H3N2 [ r  = 0.27; p  = 0.0004] and H1N1 [ r  = 0.33; p  < 0.0001]. Conclusions Vaccination in both the 2020–2021 and 2021–2022 seasons was associated with significantly higher antibody responses to influenza/A than no vaccination or vaccination in 2021–2022 alone. Infliximab and tofacitinib are associated with lower binding antibody responses to influenza/A, similar to COVID-19 vaccine-induced antibody responses. [ABSTRACT FROM AUTHOR]

In view of the increasing occurrence of anthelmintic-resistant strains of gastrointestinal nematodes in ruminants, various alternative control strategies have been investigated, such as those based on the induction of protective immune responses by immunisation with parasite antigens. In this study, the protective activity of somatic antigens from adult worms of Teladorsagia circumcincta purified by affinity chromatography on thiol-sepharose was analysed in goats. After challenge, the enriched products induced a slight reduction in the cumulative faecal egg counts (21%) and in the number of worms (23.3%), with a greater effect on female worms, which also showed a reduction in parameters related to their fertility. These parasitological findings were associated with a Th2 immune response, with a prominent local humoral response and an eosinophilic infiltrate in the gastric mucosa (negatively associated with the fertility of female worms and the number of worms, respectively), as well as an infiltration of MCHII+, CD4+, IgG+ and IgA+ cells. However, several analyses showed an increase in CD8+ cells in the mucosa, as well as IL-2 expression in the gastric lymph nodes, which may have been associated with inhibition of protective responses or with the development of mixed Th1/Th2 responses, a finding that should be analysed in future studies. [ABSTRACT FROM AUTHOR]

Objective: To support immunisation providers through a cold chain management audit. Methods: An electronic audit survey using the National Vaccine Storage Guidelines as a gold standard was developed for general practice (GP) and community pharmacy. It included automated feedback, with individualised support from a clinical nurse specialist as required. Responses were analysed to determine the proportion of providers meeting criteria in four categories: procedures, refrigerators and equipment, temperature monitoring and emergency storage. Results: Of 818 providers invited, 420 GPs (89.6%) and 276 pharmacies (82%) responded. Over 70% met all procedural and emergency storage criteria. Although most providers (98.1% GPs, 97.0% pharmacies) used a data logger, the proportion measuring at 5-minute intervals, reviewing data logger printouts weekly and manually recording minimum and maximum temperatures was lower. In total, 58% of providers required follow-up by the clinical nurse specialist, most regarding the need for equipment. Conclusion: An electronic audit enabled public health to engage with a large number of immunisation providers. Most reported high compliance with the national guidelines although opportunities for education were identified and actioned. Implications for Public Health: Electronic solutions can support public health units to engage with providers to ensure vaccines remain effective and wastage is limited.

Background: In India, the Expanded Programme on Immunization was introduced in 1978 and renamed the Universal Immunization Programme in 1985 with the intention of immunising at least 85% of newborns. To improve infant mortality and health outcomes in India and other low and middle income countries, it is critical to understand the local immunisation barriers. Methodology: A community based cross sectional study was conducted amongst the Khatik population of North East Delhi. All childbearing women were included in the study, and data from 387 mothers was collected. Results: The illiteracy rate amongst women (18.3%) was found to be higher compared to that amongst men (7.1%). A high proportion of the children were immunised (98.7%). The results of the chisquare test revealed that the influence of socio demographic variables was not statistically associated, with the immunisation status of the children (P > 0.05). Conclusion: However, it was also evaluated that both mothers and fathers with high and intermediate school levels of education were more likely to immunise their child compared to those who were illiterate, and with primary and middle levels of education. Increasing mothers' knowledge could help to reduce the number of children who are not immunised.

Background Under-utilisation of immunisation services remains a public health challenge. Pharmacists act as facilitators and increasingly as immunisers, yet relatively little robust evidence exists of the impact elicited on patient health outcome and vaccination uptake. Objective To evaluate the influence of pharmacist interventions on public vaccination rate. Methods SCOPUS, PubMed, and Web of Science were searched from inception to April 2023 to retrieve non- and randomised controlled clinical trials (RCTs). Studies were excluded if no comparator group to pharmacist involvement was reported. Data extraction, risk of bias assessments, and meta-analyses using random-effect models, were performed. Results Four RCTs and 15 non-RCTs, encompassing influenza, pneumococcal, herpes zoster, and tetanus-diphtheria and pertussis vaccine types, and administered in diverse settings including community pharmacies, were included. Pooled effect sizes revealed that, as compared to usual care, pharmacists, regardless of their intervention, improved the overall immunisation uptake by up to 51% [RR 1.51 (1.28, 1.77)] while immunisation frequency doubled when pharmacists acted specifically as advocators [RR 2.09 (1.42, 3.07)]. Conclusion While the evidence for pharmacist immunisers was mixed, their contribution to immunisation programmes boosted public vaccination rate. Pharmacists demonstrated leadership and acquired indispensable advocator roles in the community and hospital settings. Future research could explore the depth of engagement and hence the extent of influence on immunisation uptake.

In 2013, shingles vaccination was introduced in Wales as a routine immunisation programme for older adults. Invitation for this vaccination has historically been recommended but not mandated by vaccination policy. We surveyed general practices to investigate if invitations and reminders are associated with higher uptake of shingles vaccine. Using data from general practices, we calculated practice-level shingles vaccine uptake between 01/07/2021 and 31/06/2022 for registered patients aged 70–84 years. We distributed an online survey via email to all general practices in Wales on their use of vaccination invitations and reminders, method of invitations, and characteristics of their vaccination delivery. We used linear regression to calculate coefficients and 95 %CI to measure associations between invitations and vaccine uptake, adjusting for key demographics, with a multi-level component to account for similarities between general practices within the same health board. Survey response rate was 37 % (143/384). Median vaccine uptake for responding general practices was 57 % (IQR 50–68 %) compared to 58 % (IQR 48–68 %) nationally. General practices inviting all eligible patients (n = 95) had a 9 % (95 %CI 6–13 %) higher vaccination uptake compared to those inviting none or some (n = 48, p < 0.001). Of practices sending invitations, those who reminded all patients (n = 42) had a 6 % (95 %CI 1–11 %, p = 0.02) higher uptake compared to those that reminded none (n = 30). Practice size was associated with higher uptake, with small practices (n = 11, p = 0.02) having coverage 9 % (95 %CI 2–16 %) higher compared to the reference population (medium-sized practices, n = 78). General practices inviting and reminding all eligible patients for shingles vaccination have a higher uptake compared to those inviting and reminding only some or none. From September 2023, shingles vaccination policy in Wales has been updated to explicitly mandate effective universal call and recall mechanisms in general practices. [ABSTRACT FROM AUTHOR]

Influenza vaccination is recommended and provided free-of-charge to Danish citizens aged ≥65 years and to individuals with acquired immunodeficiency. We aimed to estimate influenza vaccination coverage and investigate predictors of influenza non-vaccination in Danish cancer patients. A nationwide cohort study of all Danish citizens aged ≥18 years with an incident cancer diagnosis between 2002 and 2017. Using national registries, we assessed information on influenza vaccination and potential predictors of influenza non-vaccination. We estimated adjusted prevalence ratios (aPR) of influenza non-vaccination for patients aged <65 years and ≥65 years. We observed 269,863 patients during 840,876 influenza vaccination seasons. The influenza vaccination coverage was 14 % for cancer patients <65 years and 51 % for those ≥65 years. No influenza vaccination in the previous season was associated with non-vaccination in the current season (<65 years: aPR = 2.75, 95 %CI = 2.71–2.80; ≥65 years: aPR = 5.15, 95 %CI = 5.10–5.21). Haematological cancer patients receiving chemotherapy had lower vaccination prevalence compared with those not receiving chemotherapy. The influenza vaccination coverage was low among cancer patients. Influenza non-vaccination in the previous season was the strongest predictor of not receiving influenza vaccination in the current season. Haematological cancer patients on current chemotherapy had lower vaccination prevalence than those not currently receiving chemotherapy. [ABSTRACT FROM AUTHOR]

Background: Achieving universal health coverage includes ensuring that children have access to vaccines that are of high quality, safe, efficacious, and affordable. The Immunisation Agenda 2030 aims to expand services to zero-dose and incompletely vaccinated children and reduce immunisation rate disparities as a contribution to vaccination equity. This study explored the factors influencing full vaccination status among children aged 12 – 23 months in a rural district of the Upper East Region of Ghana. Methods: A population-based cross-sectional study was conducted among carers of children aged 12 -23 months in the Kassena Nankana West district. A multistage sampling technique was used to select 360 carers. Information regarding the vaccination status of children was gathered through a combination of children's health record books and carers' recollections. Information on potential determinants was also systematically collected for analysis in Stata version 15.0. Results: The results showed that 76.9% (95% CI: 72.3 – 81.0) of children had full vaccinations per the national schedule. All children received at least one vaccination. A higher percentage of carers with incompletely vaccinated children reported that they had travelled with their children as the primary reason for missing certain vaccine doses. Full vaccination status was significantly associated with secondary (aOR = 2.60; 95% CI: 1.20—5.63) and tertiary (aOR = 3.98, 95% CI: 1.34—11.84) maternal educational level, being in a partnership relationship (aOR = 2.09, 95% CI: 1.03—4.25), and residing in close proximity to healthcare facilities (aOR = 0.41, 95% CI: 0.21—0.80). Conclusions: Our study found that nearly one-quarter of children aged 12—23 months in the study setting are underserved with vaccination services for a variety of reasons. Effectively reaching these children will require strengthening health systems, including eliminating vaccine shortages, addressing the unique challenges faced by unmarried women with children aged 12–23 months, and improving accessibility to vaccination services. [ABSTRACT FROM AUTHOR]

Countries in Europe and around the world have taken varying approaches to their policies on COVID-19 vaccination for children. The low risk of severe illness from COVID-19 means that even small risks from vaccination warrant careful consideration. Vaccination appears to result in a decreased risk of severe illness including the paediatric multi-system inflammatory syndrome known to be associated with COVID-19. These risks have already decreased significantly with the emergence of the Omicron variant and its subvariants, and due to widespread population immunity through previous infection. There is a relatively high risk of myocarditis following second doses of mRNA vaccines in adolescent males, although the general course of this condition appears mild. Conclusion: COVID-19 vaccination only provides a transient reduction in transmission. Currently, insufficient evidence exists to determine the impact of vaccination on post-acute COVID syndromes in children, which are uncommon. What is Known: • Vaccines against COVID-19 have significantly reduced morbidity and mortality around the world. • Whilst countries have universally recommended vaccines for adults and continue to recommend them for vulnerable populations, there has been more variability in recommendations for children. What is New: • In the setting of near universal existing immunity from infection, the majority of the initial benefit in protecting against severe illness has been eroded. • The risks of myocarditis following mRNA vaccination for children is low, but an important consideration given the modest benefits. [ABSTRACT FROM AUTHOR]

The United Kingdom (UK) has a comprehensive national immunisation programme which comprises both routine and selective immunisation schedules (UK Health Security Agency [UKHSA], 2023). The routine programme includes those vaccines offered to the population, with eligibility predicated on age. For the last few years, vaccine coverage has been falling in the majority of children’s and young people’s immunisation programmes (UKHSA, 2022; UKHSA 2023a; UKHSA 2023b; UKHSA 2023c). The decline in coverage has been made worse by the Covid-19 pandemic and consequent lockdowns, illness among recipients, and confusion and hesitancy about vaccines in general. This article discusses the drop in coverage of the adolescent immunisation programmes in England, and the role that general practice nurses (GPNs) and primary care immunisers can play in ensuring that young people are offered missing vaccines. The benefit of this catch-up activity is seen in reduced risk of morbidity and mortality from vaccine preventable illness in both individuals and those around them. [ABSTRACT FROM AUTHOR]

Background: A COVID-19 vaccination training program was designed for Aboriginal and Torres Strait Islander (First Nations) health workers and practitioners in Queensland to expand their scope of practice to include COVID-19 immunisation. In the setting of a global pandemic, the project aimed to improve vaccination levels and show how First Nations staff are central to community-led responses to effectively address their community's health needs. Methods: The program, consisting of an online module and face to face workshop, is described and then evaluated with the RE–AIM framework via mixed methods of participant training surveys and qualitative feedback. Results: The program reached 738 online and 329 workshop participants with the majority identifying as First Nations. The 52 workshops were attended by participants from 12 different hospital and health services in Queensland and 13 Aboriginal Community Controlled Health Organisations (ACCHOs). Feedback was positive, with participants rating the training highly. Of the First Nations Health Workers and Practitioners who responded to the workshop follow up survey, the majority (34/40) implemented their new skills in practice helping minimise the impact of COVID-19 outbreaks in their community. Most respondents (38/40) considered vaccination should be permanently in their scope of practice. Conclusions: The successful implementation of the vaccination training project was an example of First Nations led health care. Improving scope of practice for First Nations health staff can improve not just career retention and progression but also the delivery of primary care to a community that continues to bear the inequity of poorer health outcomes. First Nations health professionals remain underrepresented in the workforce. This program aimed to maximise community COVID-19 vaccination coverage by placing First Nations staff central to their own community's response to the pandemic. Evaluation shows these new skills were valuable in helping protect First Nations communities against the pandemic. Improving scope of practice for First Nations health staff can improve the delivery of primary health care to a community that continues to bear the inequity of poorer health outcomes. [ABSTRACT FROM AUTHOR]

Objectives: Some expert groups recommend that cats should be vaccinated with non-adjuvanted feline leukaemia virus (FeLV) and rabies vector vaccines, which, in the European Union, are currently not licensed for concurrent use and have to be administered at least 14 days apart (different from the USA) and thus at separate visits, which is associated with more stress for cats and owners. The aim of this study was to assess the anti-rabies antibody response in cats after vaccination against rabies and FeLV at concurrent vs separate (4 weeks apart) visits using two canarypox-vectored vaccines (Purevax Rabies and Purevax FeLV; Boehringer Ingelheim) and to evaluate the occurrence of vaccine-associated adverse events (VAAEs). Methods: Healthy FeLV antigen-negative client-owned kittens (n = 106) were prospectively included in this randomised study. All kittens received primary vaccinations against rabies (week 0) and FeLV (weeks 4 and 8). After 1 year, the study group (n = 52) received booster vaccinations against rabies and FeLV concurrently at the same visit (weeks 50–52). The control group (n = 54) received booster vaccinations against rabies (weeks 50–52) and FeLV (weeks 54–56) separately. Anti-rabies virus antibodies (anti-RAV Ab) were determined by fluorescent antibody virus neutralisation assay at weeks 4, 50–52 and 54–56, and compared between both groups using a Mann–Whitney U-test. Results: Four weeks after the first rabies vaccination, 87/106 (82.1%) kittens had a titre ⩾0.5 IU/ml and 19/106 (17.9%) had a titre <0.5 IU/ml. Four weeks after the 1-year rabies booster, all cats had adequate anti-RAV Ab according to the World Organisation for Animal Health (⩾0.5 IU/ml), and the titres of the study group (median = 14.30 IU/ml) and the control group (median = 21.39 IU/ml) did not differ significantly (P = 0.141). VAAEs were observed in 7/106 (6.6%) cats. Conclusions and relevance: Concurrent administration of Purevax FeLV and Purevax Rabies vector vaccines at the 1-year booster does not interfere with the development of anti-RAV Ab or cause more adverse effects and thus represents a better option than separate vaccination visits for cats and owners. [ABSTRACT FROM AUTHOR]

Background: Final-year nursing students are actively involved in the delivery of public immunisation programmes as part of workplace-based learning, and require adequate knowledge, clinical skills, and attitudes regarding vaccines. This study investigated the knowledge, attitudes and perceptions regarding vaccines of final year nursing students at a South African University. Methods: This cross-sectional study, through the use of an online survey questionnaire, assessed the knowledge, attitudes and perceptions regarding vaccines and the Expanded Programme of Immunization of final-year nursing students registered at a South African University during the 2021-2022 academic year. Results: There were 68 participants enrolled in the study (85% response rate). Participants displayed good knowledge regarding vaccines (average score of 52.54/70 ± 5.01 standard deviation [s.d.]), and overall positive perceptions of their training on vaccines and its safety. Knowledge gaps were identified in the mechanisms through which vaccines confer immunity in the human body and the cold chain requirements for the storage of vaccines. Of concern was the prevalent misconception among 78% of participants that vaccines are not effective. Conclusion: The findings of this study indicate that final year nursing students at the University of KwaZulu-Natal, South Africa have good knowledge regarding vaccines. However, an improved understanding of the mechanism of vaccines will aid nursing students to confront and address misperceptions by clients thereby reducing improving vaccine uptake. Curriculum planners should also consider the inclusion of communication strategies to address vaccine hesitancy. Contribution: The study contributes to data on nurse education regarding vaccines in the African context, and identifies areas to improve vaccine uptake. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic has disrupted health systems globally, affecting various services, including immunization programs. This study evaluates the impact of COVID-19 on immunization program financing and service delivery in Zambia, a lower-middle-income country, to understand how such disruptions could reshape future healthcare priorities and funding. Methods: The study employed a mixed-methods approach, integrating both qualitative and quantitative data collection. Data were gathered at national and subnational levels, including in-depth interviews with 36 healthcare workers and an online survey completed by 44 staff members. The evaluation focused on the changes in government funding, the effect on static and outreach immunization activities, vaccine supply distribution, and the impact on human resources within the Expanded Programme on Immunisation (EPI). Results: Findings indicated that while regular disbursements to districts improved in 2020, there was heightened competition for limited resources due to COVID-19, leading to a redirection of funds from routine immunization to pandemic-related activities. The study revealed a significant decline in immunization coverage, attributed to reduced health facility visits and outreach sessions. Additionally, financial constraints heightened by the pandemic made it challenging for districts to accommodate the extra costs associated with implementing COVID-19- compliant immunization services. Human resources for immunization were also impacted, with staff being reallocated to COVID-19 response activities, thus increasing workload and stress levels among remaining personnel. Conclusion: COVID-19 has substantially affected the funding, delivery, and human resource components of Zambia's immunization program. Despite an increase in regular funding disbursements, the redirection of funds to COVID-19 activities has strained routine immunization services. The pandemic has highlighted the need for robust health systems that can withstand global health crises without compromising essential services like immunization. Recommendations include closer monitoring of immunization service delivery impacts, assessment of COVID-19's financial implications on immunization, development of clear protocols for service delivery under pandemic conditions, and a re-investment in community engagement and education post-pandemic. [ABSTRACT FROM AUTHOR]