Introduction of Two-Dose Mumps-Containing Vaccine into Routine Immunization Schedule in Quzhou, China, Using Cox-Proportional Hazard Model

Mumps is a vaccine-preventable disease caused by the mumps virus, but the incidence of mumps has increased among the children who were vaccinated with one-dose measles-mumps-rubella (MMR) in recent years. In this study, we analyzed the influence of different doses of mumps-containing vaccine (MuCV) against mumps using Cox-proportional hazard model. We collected 909 mumps cases of children who were born from 2006 to 2010 and vaccinated with different doses of MuCV in Quzhou during 2006-2018, which were all clinically diagnosed. Kaplan-Meier survival methods and Cox-proportional hazard model were used to estimate the hazard probabilities. Kaplan–Meier curves showed that the cumulative hazard of male and female has no difference; lower hazards were detected among those who were vaccinated with two-dose MuCV, born in 2006, and infected after supplementary immunization activities (SIA). Cox-proportional hazard regression suggested that onset after SIA, born in 2006, and vaccinated with two-dose MuCV were protective factors against infection even after adjusting for potential confounding effects. Our study showed that it was necessary to revise the diagnostic criteria of mumps and identify RT-PCR as the standard for mumps diagnosis in China. We suggested that routine immunization schedule should introduce two doses of MMR and prevaccination screening should be performed before booster immunization in vaccinated populations.

Assessing Vaccine Coverage and Timeliness in Bamako, Mali after the Introduction of Rotavirus Vaccine: A Modified Immunization Cluster Survey

Vaccine coverage and timeliness are critical metrics for evaluating the performance of immunization programs. Following the introduction of rotavirus vaccine in Bamako, Mali, we conducted two cluster surveys spaced approximately 1 year apart to evaluate these metrics among children 9 to 20 months of age. Using the child’s immunization card or the medical record at the center of administration, each selected child’s immunization status was determined at 9 and 12 months of age. Deviations from the WHO-recommended immunization schedule were described by the median delay and fraction of children receiving doses outside of recommended age ranges. Overall, 1,002 children were enrolled in the two surveys combined; 80.1% of children born 7 to 12 months after introduction (survey 1) received three doses of pentavalent rotavirus vaccine (ROTA3) by 9 months of age, which increased to 86.1% among children born 17 to 26 months after introduction (survey 2). Concomitantly, coverage with the third dose of diphtheria-pertussis-tetanus-containing vaccine (DPT3) by age 9 months was 86.5% (survey 1) and 88.9% (survey 2); by age 12 months, 61.3% and 72.4% of children, respectively, had received all scheduled immunizations. The median delay in ROTA3 and DPT3 administration were similar at about 3.4 weeks. Within 3 years of introduction, coverage of rotavirus vaccine among Bamako infants achieved coverage similar to DPT3 and is approaching the Global Vaccine Action Plan goal of 90% coverage by 2020. However, timeliness of coverage remains a concern.

Meningococcal Vaccines of New Generations – the First 20 Years of Use

Relevance. Meningococcal vaccine refers to any of the vaccines used to prevent infection by Neisseria meningitidis. Therefore, there is a great scientific and practical interest in the existing and developed menicococcal vaccines.Aims the review is to provide an analysis: literature data on the effectiveness of meningococcal vaccines of new generations - conjugated polysaccharide serogroups A, C, W and Y and protein serogroup B.Conclusions. With regard to conjugated vaccines, there are a large number of reliable observations confirming the high immunological and epidemiological effectiveness of these vaccine preparations, including the prevention of bacterial carriage and the development of herd immunity. These vaccines are weakly reactogenic, and in many countries, they are introduced into national immunization programs and in some countries are used as mandatory (UK) or in connection with the existing epidemic indications. The protein «vesicle» vaccine based on serogroup B meningococcal outer membrane proteins, showed high efficacy only in those cases when the protein composition of the strain that caused the morbidity corresponded to the composition (mainly in terms of the PorA subtype antigen) of the vaccine. Genetic-engineered vaccines containing only a few serogroup B meningococcal protein antigens with or without the addition of «vesicle» proteins are difficult to evaluate due to the small number of observations associated with low serogroup В prevalence, but in Great Britain, such vaccine was also introduced as mandatory in the national immunization schedule for babies. At the same time, new vaccines of serogroup B induce immune protection against some strains of meningococcus of other serogroups C, W, and Y, and even against other species of Neisseria, in particular - gonococcus. This circumstance gives rise to hope for the development of protein meningococcal vaccines with a wider spectrum of specificity than the group, and even than the species.

Trial design and protocol of randomized controlled trial comparing the efficacy of oral mefenamic acid, paracetamol and placebo for analgesic prophylaxis in childhood vaccination (MAP VaC trial)

<p class="abstract"><strong>Background:</strong> Needle related pain has been one of the most important concerns for parents of children receiving vaccination. Non-steroidal anti-inflammatory drugs (NSAIDs) like paracetamol and mefenamic acid have been commonly used as analgesics in pediatric population. However, prophylactic administration of these drugs for analgesia during vaccination has not been studied. The main objective of this study is to compare the efficacy of prophylactic paracetamol, mefenamic acid and placebo on needle pain associated with vaccination.</p><p class="abstract"><strong>Methods:</strong> This is a three-arm parallel, triple blind, randomized controlled trial. Children aged 6 weeks to 7 years who need immunization as per national immunization schedule and reporting to pediatric outpatient department (OPD) at tertiary level hospital, AIIMS Mangalagiri, Andhra Pradesh, will be included. All participants will be randomly allotted to any of the three groups by computer based block randomization. Each participant will be given any one of the three drugs as per their allocation. Vaccination will be done as per national immunization schedule after 30 minutes of drug administration. Face, legs, activity, cry, consolability (FLACC) scoring will be done immediately after vaccine administration and repeated at 15 minutes and 30 minutes. All personnel involved in randomization, drug and vaccine administration, FLACC scoring and statistical analysis will be blinded along with parents and children enrolled in the study.</p><p class="abstract"><strong>Conclusions: </strong>If this intervention study shows evidence of a difference between drug and placebo signifying reduction in vaccine related pain with these drugs, this will have a huge impact on National Immunization programme by improving compliance, vaccine coverage and by reducing vaccine hesitancy.</p><p class="abstract"><strong>Trial registration:</strong> Clinical trials registration number is CTRI/2021/01/030239.</p>

Immunological effectiveness of hepatitis B vaccination in deviation from vaccination schedule in healthy children and children with chronic diseases

Introduction. Vaccination is the primary method of preventing hepatitis B (HBV). Immunization performed according to the standard schedule often provides protective level of antibodies against HBV. However, the frequency deviation of the immunization schedule in children due to unjustified medical contraindication is the current problem in Russia. At the same time, there is currently no clear strategy for patients with significant deviations of the vaccination schedule, especially regarding extending the interval between the first and third administration of the HBV vaccine. The aim is to evaluate the immunological effects of vaccination against hepatitis B in the vaccination schedule deviation in healthy children and children with chronic diseases. Materials and methods. Eighty-one 0.7-11.7 year child with a disrupted schedule of vaccination against HBV was observed. The children were divided into two groups: children vaccinated within 12-35 months (group 1, n = 48) and children immunized more than 36 months after the first vaccination (group 2, n = 33). Children with chronic forms of pathology were included in both study groups. Blood tests for HBV antibodies after vaccination were performed 1-3 months after the third vaccination. Results. The average concentration of antibodies in the range of 10-1000 mMEd/ml in children of group 1 was significantly higher than in children of group 2 (p = 0.037). In addition, children with chronic diseases were significantly more likely to have an anti-HBs titer higher than 1000 mMEd/ml after the third vaccination than healthy children (p = 0.012). Conclusion. An increase in the interval between the first and third administration of the hepatitis B vaccine leads to a rise in the number of children who are not immune to hepatitis B. Chronic diseases fail to affect the immune response due to the introduction of the hepatitis B vaccine, even if the immunization schedule is disrupted.

The Impact of Haemophilus Influenzae and Streptococcus Pneumoniae Vaccination in Bacterial Meningitis in a Pediatric Referral Hospital in Mexico

Objective The study aimed to compare the epidemiology of bacterial meningitis (BM) before and after vaccination, and identify possible risk factors associated with mortality. Methods The medical and microbiologic records of children (1 month–18 years) with a discharge diagnosis of BM in a third level children's hospital in Mexico from 1990 to 2018 were reviewed. The epidemiology, pathogens, and outcomes were compared before and after introducing Haemophilus influenzae type b (Hib) and pneumococcal conjugate vaccines to the Mexican immunization schedule. Risk factors associated with mortality were determined. Results In the 28-year period, 226 cases with BM were included 55.8% (1990–1999), 27.4% (2000–2008), and 16.8% (2009–2018) (p = 0.0001). The most frequent pathogen was Hib, documented in 39% of cases. There was a reduction in neurological complications after introducing the Hib conjugate vaccine (59 vs. 39%; p = 0.003) and sequelae after the Streptococcus pneumoniae conjugate vaccine (43 vs. 35%; p = 0.05). Independent risk factors associated with mortality were coma (odds ratio [OR]: 15 [2.9–78]), intracerebral bleeding (OR: 3.5 [1.4–12]), and pneumococcal meningitis (OR: 9.4 [2.2–39]). Conclusion Since the introduction of Hib and pneumococcal conjugate vaccines to the national immunization schedule, there was a reduction in BM cases, mainly associated with the Hib vaccine, with the consequent reduction of neurological complications and sequelae.

Immunization and Immunization Coverage According to National Immunization Schedule for Children Population: Cross-Sectional Multi-Centre Study

Background. Monitoring of documented vaccination is one of the indicators of the epidemiological supervision quality of preventive vaccination. It is crucial for epidemical situation prevention. Objective. The aim of the study is to estimate immunization and immunization coverage levels according to National Immunization Schedule (NIS) for children population in Russia. Methods. Immunization rates were estimated according to preventive vaccination cards (form №063/y) and children development cards (form №112/y) among children aged from 6 months to 15 years in 8 towns of Russia. Immunization was determined by the ratio of people who has fully performed all the vaccines from NIS (version of the year 2014), while immunization coverage – by the ratio people who has received at least one dose of corresponding vaccine. Results. The study has included data from 2,687 vaccinated children. The highest levels of immunization and immunization coverage were against tuberculosis (98.1% each), hepatitis B (85.9% and 96.5%), measles, mumps and rubella (84.4% and 93.9%). Immunization against diphtheria, pertussis and tetanus significantly differed from their immunization coverage (60.5% and 94.9%), as well as for poliomyelitis (65.0% and 94.9%). Relatively low immunization and immunization coverage levels were observed for pneumococcal infection (27.6% and 47.1%) and influenza (5.8% and 30.5%). The increase in the immunization level with age was observed for all vaccines, except pneumococcal vaccine. Conclusion. Immunization and immunization coverage against infections included in NIS vary significantly. The highest immunization and immunization coverage levels for all age groups were revealed for tuberculosis vaccine, and the lowest — for influenza vaccine.

Evidence of Circulation of Several HAV Genetic Variants and Emergence of Potential Antigenic Variants in an Endemo-Epidemic Country before Vaccine Introduction

Similar to several other countries in the world, the epidemiology of hepatitis A virus changed from high to intermediate endemicity level in Tunisia, which led to the occurrence of outbreaks. This study aimed to determine the genetic and antigenic variability of HAV strains circulating in Tunisia during the last few years. Genotyping using complete VP1 gene and VP1-2A junction confirmed the predominance of genotype IA, with co-circulation of several genetic and antigenic variants. Phylogenetic analysis including Tunisian and strains from other regions of the world showed the presence of at least two IA-variants within IA subgenotype. Amino-acid analysis showed several mutations in or close to epitope regions in the VP1-region. This study provides a baseline on the genetic and antigenic variability of HAV circulating strains before the introduction of vaccination into the national immunization schedule.