The contribution of vaccination to global health, from the past to the present: mandatory or social duty?

Vaccines have saved millions of lives and reduced the severity of many infections, but today the reduction in vaccine coverage has been reflected in the resurgence of epidemics of mumps, whooping cough, measles and chickenpox. This has happened because many people do not recognize the effectiveness of vaccination and fear the side effects, in other words, the main concern is the safety of the vaccines. As a consequence, the greater responsibility of the individual and respect for his will can lead authorities to less vigorously promote the “duty of vaccination”, which is also a social duty. Unfortunately, however, the attitude of individuals is guided by their beliefs about health, which are often supported by an erroneous perception of risk arising from false news.

Covishield Vaccine Coverage and its adverse effects among the Staffs of Nepalgunj Medical College Banke

Introduction: The corona virus disease-19 pandemic is an ongoing global health crisis and the greatest challenge we have been facing right now in the most peculiar ways. It has caused huge loss of lives and has severely affected the global economy and financial markets. Vaccines are a new critical tool to fight this voracious battle. They have been released in several parts of the world. Although the safety and efficacy of these vaccines have been discussed, we know very little about the post-vaccination experience outside clinical trial situations. Adequate information about the effects of the vaccine can aware the public remove misconceptions and increase vaccine acceptability. Aims: To know the percentage of Covishield vaccine coverage and its adverse effects among the staffs of Nepalgunj Medical College. Methods: A descriptive cross-sectional study was conducted among the vaccinated 91 out of 116 staff members of Nepalgunj Medical College (NGMC), Baijanath Rural Municipality-1, Banke. Results: Out of 91 persons, 15.4%(14) developed headache, 20%(18) developed fever, and 8.7%(17) developed body aches. Of those who developed post-vaccination side effects 47%(16) of the persons were from age group 36-55years,17%(1) of them between age group 55-65 years, and none above 65 years developed fever. 20%(13) of total male and 35%(5) of total female developed fever within 96 hours after receiving first dose of Covishield AstraZeneca vaccine. Conclusion: Most of the study subjects reported milder side effects which lasted for less than 5 days. No casualties were reported. Local pain and swelling at the injection site, headache and fever were the most common side effects. The side effects were more common in younger individuals and women.

Childhood Immunisation Coverage during the COVID-19 Epidemic in Italy

The COVID-19 pandemic has affected national healthcare systems worldwide, with around 282 million cumulative confirmed cases reported in over 220 countries and territories as of the end of 2021. The Italian National Health System was heavily affected, with detrimental impacts on preventive service delivery. Routine vaccination services were disrupted across the country during the first months of the pandemic, and both access to and demand for vaccines have decreased during the pandemic. In many cases, parents preferred to postpone scheduled appointments for routine paediatric vaccinations because of stay-at-home orders or fear of COVID-19 infection when accessing care. The objective of the current study was to assess the routine childhood vaccine coverage (VC) rates during the COVID-19 epidemic in Italy. We compared 2020 and 2019 VC by age group and vaccine type. The Italian Ministry of Health collected anonymised and aggregated immunisation national data through the local health authorities (LHAs). Results were considered statistically significant at a two-tailed p-value ≤ 0.05. VC rates for mandatory vaccinations decreased in 2020 compared to 2019 (range of VC rate decrease: −1% to −2.7%), while chicken pox increased (+2.2%) in 7-year-old children. Recommended vaccinations were moderately affected (range of VC rate decrease in 2020 vs. 2019: −1.4% to −8.5%), with the exception of anti-HPV in males, Men ACWY, and anti-rotavirus vaccination (VC increase 2020 vs. 2019: +1.8%, +4.7% and +9.4%, respectively). In the COVID-19 era, the implementation of coherent, transparent, and effective communication campaigns and educational programs on safe childhood vaccinations, together with the increase in the number of healthcare staff employed, is essential to support strategies to reinforce vaccination confidence and behaviour, thus avoiding health threats due to VPD during and beyond COVID-19 times.

SARS-CoV-2 infection and COVID-19 vaccination rates in pregnant women in Scotland

Population-level data on COVID-19 vaccine uptake in pregnancy and SARS-CoV-2 infection outcomes are lacking. We describe COVID-19 vaccine uptake and SARS-CoV-2 infection in pregnant women in Scotland, using whole-population data from a national, prospective cohort. Between the start of a COVID-19 vaccine program in Scotland, on 8 December 2020 and 31 October 2021, 25,917 COVID-19 vaccinations were given to 18,457 pregnant women. Vaccine coverage was substantially lower in pregnant women than in the general female population of 18−44 years; 32.3% of women giving birth in October 2021 had two doses of vaccine compared to 77.4% in all women. The extended perinatal mortality rate for women who gave birth within 28 d of a COVID-19 diagnosis was 22.6 per 1,000 births (95% CI 12.9−38.5; pandemic background rate 5.6 per 1,000 births; 452 out of 80,456; 95% CI 5.1−6.2). Overall, 77.4% (3,833 out of 4,950; 95% CI 76.2−78.6) of SARS-CoV-2 infections, 90.9% (748 out of 823; 95% CI 88.7−92.7) of SARS-CoV-2 associated with hospital admission and 98% (102 out of 104; 95% CI 92.5−99.7) of SARS-CoV-2 associated with critical care admission, as well as all baby deaths, occurred in pregnant women who were unvaccinated at the time of COVID-19 diagnosis. Addressing low vaccine uptake rates in pregnant women is imperative to protect the health of women and babies in the ongoing pandemic.

How Large Fraction of A Population Must be Vaccinated before A Disease is Controlled?

The ongoing Covid-19 pandemic has already caused more than 5 million casualties despite hard restrictions and relatively high vaccine coverage in many countries. The crucial question is therefore, how large vaccination rate and how severe restrictions are required to terminate the spread of the decease, assuming that the vaccine efficiency and the basic reproduction ratio (R0) are known? To answer this question, a mathematical equation was applied to visualize the required vaccination level as function of vaccine efficiency, restriction efficiency and basic reproduction ratio (R0). In addition to the modelling study, Covid-19 data from Europe was collected during 19/11-26/11 (2021) to assess the relation between vaccination rate and incidence. The analysis indicates that a vaccination rate of ~92% (2 doses) is required to stop Delta (B.1.617.2) without severe restrictions, under conditions like those in Europe late November 2021. A third vaccine dose, improved vaccines, higher vaccination rates and/or stronger restrictions will be required to force Omicron (B.1.1.529) to expire without infecting a large fraction of the population.

Vaccine Administration in Children’s Hospitals

OBJECTIVES: To examine inpatient vaccine delivery across a national sample of children’s hospitals. METHODS: We conducted a retrospective cohort study examining vaccine administration at 49 children’s hospitals in the Pediatric Health Information System database. Children <18 years old admitted between July 1, 2017, and June 30, 2019, and age eligible for vaccinations were included. We determined the proportion of hospitalizations with ≥1 dose of any vaccine type administered overall and by hospital, the type of vaccines administered, and the demographic characteristics of children who received vaccines. We calculated adjusted hospital-level rates for each vaccine type by hospital. We used logistic and linear regression models to examine characteristics associated with vaccine administration. RESULTS: There were 1 185 667 children and 1 536 340 hospitalizations included. The mean age was 5.5 years; 18% were non-Hispanic Black, and 55% had public insurance. There were ≥1 vaccine doses administered in 12.9% (95% confidence interval: 12.8–12.9) of hospitalizations, ranging from 1% to 45% across hospitals. The most common vaccines administered were hepatitis B and influenza. Vaccine doses other than the hepatitis B birth dose and influenza were administered in 1.9% of hospitalizations. Children had higher odds of receiving a vaccine dose other than the hepatitis B birth dose or influenza if they were <2 months old, had public insurance, were non-Hispanic Black race, were medically complex, or had a length of stay ≥3 days. CONCLUSIONS: In this national study, few hospitalizations involved vaccine administration with substantial variability across US children's hospitals. Efforts to standardize inpatient vaccine administration may represent an opportunity to increase childhood vaccine coverage.

Improving vaccination rates in older adults and at-risk groups: focus on pertussis

Despite the implementation of effective paediatric vaccination programmes, pertussis remains a global health problem. Disease epidemiology has changed over time, shifting towards the adolescent and adult populations. In adults, the true burden of pertussis is greatly underestimated and pertussis vaccine coverage rates are suboptimal, including individuals with chronic conditions. Here, we report the outcomes of a virtual international scientific workshop to assess the evidence on the burden of pertussis in older adults and identify potential solutions to improve uptake of pertussis vaccines. In adults, pertussis is underdiagnosed in part due to atypical or milder clinical presentation and the lack of testing and case confirmation. However, contemporary epidemiological data denoted an increase in the burden of pertussis among adolescents and adults. This might be related to a variety of reasons including the waning of immunity over time, the lack of booster vaccination, and the improved diagnostic methods that led to increased recognition of the disease in adults. Pertussis sequelae can be severe in older adults, particularly those with existing chronic medical conditions, and the vulnerability of these groups is further enhanced by low pertussis vaccine coverage. Possible measures to increase vaccine uptake include strengthening and harmonisation of immunisation guidelines, healthcare professionals taking a more active role in recommending pertussis vaccination, involvement of vaccination centres and pharmacies in the vaccination process, and improving knowledge of pertussis burden and vaccine efficacy among the general population.

Prevalence and evolution of clinical cases of Yellow Fever in Brazil between the years 2007 to 2016

Yellow Fever (YF) is a non-contagious infectious disease of variable symptoms that occurs mainly in tropical forests regions of the Americas and Africa and is caused by a Flavivirus belonging to the Flaviviridae family. Its vectors are mosquitoes of the genus Haemagogus, Sabethes and Aedes, and these have non-human primates as the main source of infection. In Brazil, there has been no record of urban AF since 1942, although the increase in cases of the wild form combined with low vaccination coverage contribute to the risk of re-urbanization of the disease Material and methods: For the study, epidemiological data were obtained from confirmed cases of Yellow Fever reported in the Notification System for Health Disorders (SINAN) available at the Informatics Department of the Unified Health System (DATASUS). Results and discussion: A total of 177 cases of were reported in Brazil, the year with the highest notification was in 2016 (52). The region with the highest occurrence of cases were the Southeast (95). Regarding the clinical evolution, of the 177 cases, 68 affected patients were cured, while 89 died from the reported injury, evidencing a high rate of lethality (50.2%). Conclusion: YF remains a public health problem, over the years there was a decrease in cases, this was due to immunization campaigns in the country, however, there was a significant increase in notifications in 2016, this whole panorama reinforces the need intensifying surveillance and expanding vaccine coverage.

How Large Fraction of A Population Must be Vaccinated before A Disease is Controlled?

The ongoing Covid-19 pandemic has already caused more than 5 million casualties despite hard restrictions and relatively high vaccine coverage in many countries. The crucial question is therefore, how large vaccination rate and how severe restrictions are required to terminate the spread of the decease, assuming that the vaccine efficiency and the basic reproduction ratio (R0) are known? To answer this question, a simple mathematical equation was developed to visualize the required vaccination level as function of vaccine efficiency, restriction efficiency and basic reproduction ratio (R0). In addition to the modelling study, Covid-19 data from Europe was collected during 19/11-26/11 (2021) to assess the relation between vaccination rate and incidence. The analysis indicates that a vaccination rate of ~92% (2 doses) is currently required to stop Delta (B.1.617.2) without severe restrictions, using the vaccines that are most common in Europe today. A third vaccine dose, improved vaccines, higher vaccination rates and/or stronger restrictions will be required to force Omicron (B.1.1.529) to expire without infecting a large fraction of the population.