Economic impact of switching from partially combined vaccine “Pentaxim® and hepatitis B” to fully combined vaccine “Hexaxim®” in the Malaysian National Immunization Program

Background The decision to implement new vaccines should be supported by public health and economic evaluations. Therefore, this study was primarily designed to evaluate the economic impact of switching from partially combined vaccine (Pentaxim® plus hepatitis B) to fully combined vaccine (Hexaxim®) in the Malaysian National Immunization Program (NIP) and to investigate healthcare professionals (HCPs)’ and parents’/caregivers’ perceptions. Methods In this economic evaluation study, 22 primary healthcare centers were randomly selected in Malaysia between December 2019 and July 2020. The baseline immunization schedule includes switching from Pentaxim® (four doses) and hepatitis B (three doses) to Hexaxim® (four doses), whereas the alternative scheme includes switching from Pentaxim® (four doses) and hepatitis B (three doses) to Hexaxim® (four doses) and hepatitis B (one dose) administered at birth. Direct medical costs were extracted using a costing questionnaire and an observational time and motion chart. Direct non-medical (cost for transportation) and indirect costs (loss of productivity) were derived from parents’/caregivers’ questionnaire. Also, HCPs’ and parent’s/caregivers’ perceptions were investigated using structured questionnaires. Results The cost per dose of Pentaxim® plus hepatitis B vs. Hexaxim® for the baseline scheme was Malaysian ringgit (RM) 31.90 (7.7 United States dollar [USD]) vs. 17.10 (4.1 USD) for direct medical cost, RM 54.40 (13.1 USD) vs. RM 27.20 (6.6 USD) for direct non-medical cost, RM 221.33 (53.3 USD) vs. RM 110.66 (26.7 USD) for indirect cost, and RM 307.63 (74.2 USD) vs. RM 155.00 (37.4 USD) for societal (total) cost. A similar trend was observed for the alternative scheme. Compared with Pentaxim® plus hepatitis B, total cost savings per dose of Hexaxim® were RM 137.20 (33.1 USD) and RM 104.70 (25.2 USD) in the baseline and alternative scheme, respectively. Eighty-four percent of physicians and 95% of nurses supported the use of Hexaxim® in the NIP. The majority of parents/caregivers had a positive perception regarding Hexaxim® vaccine in various aspects. Conclusions Incorporation of Hexaxim® within Malaysian NIP is highly recommended because the use of Hexaxim® has demonstrated substantial direct and indirect cost savings for healthcare providers and parents/caregivers with a high percentage of positive perceptions, compared with Pentaxim® plus hepatitis B. Trial registration Not applicable.

Comparison of social inequality in HPV vaccination among teenagers with parental reports and healthcare providers’ records in the 2019 National Immunization Survey-Teen.

Background: Relatively little is known and inconclusive about social inequality in human papillomavirus (HPV) vaccination among teenagers in the United States. This study aims to investigate whether there is a social disparity in HPV vaccination among teenagers and if so, whether it can differ by the source of teen vaccination information (parental reports and provider records). Methods: We used the data from the 2019 National Immunization Survey-Teen (NIS-Teen; 42,668 teenagers, aged 13-17) including parental reported vaccination status. Among them, 18,877 teenagers had adequate provider reported vaccination records. Two socioeconomic status (SES) measures were used: mother’s education and annual family income. Multivariate logistic analyses were conducted. Results: False negatives of parental reports against provider records were more than two times higher (p < 0.001) in low SES teens than in high SES teens. In both SES measures, the proportion of HPV unvaccinated teenagers were lowest in the highest SES level in analyses with parental reports. However, it was the opposite in analyses with provider records. Interestingly, regardless of vaccination information source, the HPV unvaccinated rate was highest in the middle SES teens (>12 years, non-college graduates; and above poverty level, but not > $75K). Conclusion: A significant social inequality in HPV vaccination among teenagers exists in the United States. The pattern of social inequality in HPV vaccination can be distorted when only parent reported vaccination information is used.

Estimating the impact of implementation and timing of COVID-19 vaccination program in Brazil: a counterfactual analysis

The vaccines developed in 2020-2021 against the SARS-CoV-2 virus were designed to prevent severity and deaths due to COVID-19. However, how effective this vaccination campaign was at saving lives remains a methodological challenge. In this work, we developed a Bayesian statistical model to estimate the number of deaths and hospitalizations in individuals above 60 years old in Brazil. Using the actual number of hospitalized and deaths from the Brazilian database, and also the coverage of second dose according to the National Immunization Program, we rebuilt the realized scenario as well as the hypothetical scenario without vaccination in Brazil in order to perform a counterfactual analysis. By computing the difference between the hypothetical and realized scenarios, we were able to estimate the direct effect of COVID-19 vaccination in Brazil. We also evaluated two other hypothetical, but not impossible, scenarios considering earlier vaccination roll-outs. We estimated that more than 165 thousand of 60+ years old individuals were not hospitalized due to COVID-19 until August 28, 2021, and other approximately 100 thousand individuals could not have been hospitalized if the immunization started as soon it was approved in Brazil. We also estimate that more than 75 thousand lives were saved in the period analysed for the same age group, and additional 48 thousand lives could have been saved if the Brazilian Government started the immunization 8 weeks earlier.

Determination of diphtheria risk indicators based on the study of antidiphtheria immunity in the population of Dnipropetrovsk region

Background. Vaccination is the most effective part of primary prevention. Serological monitoring of infectious diseases covered by national immunization programs is very important as it provides up-to-date information on the burden of the infection and the immunological status of the population. The study was aimed to present an analysis of epidemiological monitoring of the protection against diphtheria of the population, to show the generalized epidemiological situation regarding diphtheria, and to determine the risk of diphtheria among the population of Dnipropetrovsk region. Materials and methods. Epidemiological analysis of diphtheria immunity (2017–2019) was performed based on the results of enzyme-linked immunosorbent assay of IgG antibodies levels against diphtheria toxin in 271 residents of Dnipropetrovsk region. Results. Analysis of the results revealed that only 30.6 % (n = 83) of the population have levels of antitoxic antibodies of 1.0 IU/ml or more, which provides sufficient protection against diphtheria in the next 5–7 years of life. At that time, the majority of the population (69.4 %) needs immediate one-time booster vaccination (n = 134; 49.5 %) or immediate basic vaccination (n = 54; 19.9 %) due to low levels of antitoxic diphtheria antibodies. In the age group 8–15 years, 65.9 % (n = 62) of patients require immediate basic or booster vaccination, which indicates that children of this age do not have basic immunological protection due to violations of the vaccination schedule or its absence. In the group aged 27 years and older, 79.1 % (n = 72) of the subjects do not have protective levels of anti-diphtheria antibodies, which indicates a lack of actual protection against diphtheria. Conclusions. The results indicate insufficient protection of the population against diphtheria. In this regard, the development of strategic measures for mass immunoprophylaxis of diphtheria both in children and adults is relevant. The country should conduct regular epidemiological monitoring, which would study the population’s immunity against diphtheria and other controlled infections, and draw up a long-term strategic and tactical plan to address shortcomings in the work of mass immunoprophylaxis of the population.

Side Effects After Vaccination Using the Pfizer-Biontech (Bnt162b2) Against Sars-Cov-2 in the Young Adults

Background: In order to limit the spread of the SARS-CoV-2 virus, national immunization programs have started in many countries. Vaccinations are effective in preventing infection and severe clinical form of COVID-19, which affects 15% of patients. Despite the high efficacy of The Pfizer-BioNTech (BNT162b2) vaccine, the characterization of side effects in age-stratified populations is still not exhaustive in the literature.Aim: The aim of our study is to determine what side effects affect the population of young adults following vaccination with the Pfizer-BioNTech vaccine (BNT162b2).Material and methods: An anonymous survey was conducted. People vaccinated with two doses of the SARS-CoV-2 vaccine (BNT162b2) were qualified for the study. The Paired Wilcoxon and Fisher's exact tests were used for statistical analysis.Results: The main side effects after the first dose were increased pain, pain and swelling at the injection site. After the 2nd dose, the dominant side effects were weakness, fever and headache. In the case of the 2nd dose, no difference in side effects was observed between those who suffered of COVID-19 and those who had no symptoms of COVID-19 in their past medical history.

Study the Distribution of Rotavirus Genotypes in Vaccinated and non Vaccinated Children in Babylon Province

Rotaviruses, a major cause of gastroenteritis in children worldwide accounts for around half a million deaths annually. Vaccine against the virus has been recommended by the WHO to be involved in the national immunization program.To evaluate the genetic characterization of rotavirus among children with acute gastroenteritis in Babylon province is warranted. Children complained of diarrhea with rotavirus infection detected in their stool were involved in the study. The age range was 10 months to 60 months and with retrogradechecking of rotavirus vaccine history. Rotavirus genotypes were detected by reverse transcription-polymerase chain reaction (RT-PCR).A total number of 40 children with rotavirus gastroenteritis were used to examine the rotavirus genotyping distribution. The prevalent genotypes were found to be G1, G9, and G2. No significant difference in the distribution of the length of diarrhea according to genotype. Vaccinated children exhibited significantly higher percentage of G2 while G1 and G9 were presented more considerably in not vaccinated children.We detected a variety of rotavirus strains includingthe major global genotypes.Obviously, rotavirus strains are continuing to vary in Iraq. The vaccination changes the genotype prevalence and this situation may create challenges to the effectiveness of rotavirus vaccines and planning for future polices. Keywords: Rotavirus, Vaccine, Genotype.

Population Optimally Immunized after Accounting for Type-Specific COVID-19 Vaccine Waning Intervals: State-Level Prevalence and Trends

BACKGROUND: COVID-19 vaccines exhibit real-world waning effectiveness against SARS-CoV-2 infection within the first 3-6 months after a completed series. Consequently, the main metric tracked by the CDC (percent "fully vaccinated," with no adjustment for booster status) has become insufficiently informative. METHODS: We analyzed CDC daily vaccination data to quantify COVID-19 immunization status for 4 mutually-exclusive groups: (1) not immunized; (2) partially immunized (people who received the 1st dose of a 2-dose series); (3) immunized with waning immunity (previously immunized people whose booster dose is overdue); and (4) optimally immunized (people who: (a) received the Janssen vaccine <2 months ago or completed an mRNA vaccine series <6 months ago, or (b) received the Janssen vaccine >2 months ago or completed an mRNA vaccine series >6 months ago and received a booster dose.) RESULTS: The proportion of the total US population who were optimally immunized against COVID-19 fell from a high of 45.3% on July 17 to 29.4% on November 30. During November, the majority of states experienced a worsening trend in the percent of the total population who were overdue for a booster dose, including the 4 largest states, with percentage point increases of 3.5 in New York, 3.4 in California, 2.3 in Texas and 1.7 in Florida. CONCLUSIONS: Our proposed classification scheme accounts for type-specific vaccine waning intervals, provides an accurate assessment of progress toward national immunization goals, and reveals the urgent need for additional public health mitigation strategies to successfully combat the COVID-19 pandemic in the United States.