Vaccine: X

Declines in routine influenza vaccination rates have become a cause for concern as influenza vaccine coverage rates have declined among Black, Non-Hispanic children compared to an increase in coverage among White, Non-Hispanic children ages 6 months to 17 years old. Influenza season years analyzed were 2012-2022 using data provided by the US Center for Disease Controls FluVaxView database. Data for this database is sourced from the National Immunization Survey-Flu (NIS-Flu) and the Behavioral Risk Factor Surveillance System (BRFSS) survey. White, Non-Hispanic children saw an increase in vaccination coverage from 55.8% to 60.3%, whereas Black, Non-Hispanic children decreased from 58.2% to 52.9% coverage. Chi-squared tests with Yates correlation were performed to find statistical significance. Vaccination coverage rate changes for both demographics were found to be statistically significant at p < 0.00001. 70% influenza vaccination coverage rate remains the US Department of Healths HealthyPeople 2030 initiatives goal for all demographics and may be achieved by utilizing interventional tools such as motivational interviewing, provider-patient dialogue, community-based vaccination clinics, or home visits. Evidence-based interventional provider-patient dialogue has had success in increasing vaccination rates among other vaccines. Continued research into the cause of influenza vaccination rate decline among vulnerable and medically underserved populations is needed to best implement vaccine-based interventions.

New maternal vaccines have the potential to reduce morbidity and mortality for infants from common illnesses that pose the greatest risk in the earliest phase of their life. Respiratory syncytial virus (RSV) is a leading cause of acute lower respiratory infections among infants under six months of age. With the recent approval of a maternal vaccine for RSV, this study aimed to understand decision-making factors among pregnant and lactating women for receiving a newly licensed vaccine during pregnancy. Pregnant and lactating women from two counties in Kenya, Nakuru and Mombasa, were recruited to complete a cross-sectional survey in August-September 2022. The survey explored topics of trust in various types of sources for information about new maternal vaccines, the importance of a healthcare providers recommendation of a new maternal vaccine, and concerns about new maternal vaccines. We surveyed 400 pregnant and lactating women. In both counties, information about the new vaccine was most trusted when coming from healthcare providers, and least trusted when coming from social media. Womens intention to receive a new maternal vaccine was heavily influenced by a positive recommendation from a healthcare provider. The greatest concerns about a new vaccine were side effects and the vaccines ingredients. The information and recommendation from a healthcare provider are important influences on decision-making for new maternal vaccines. As a new maternal immunization for RSV becomes more available, healthcare providers should be engaged early to reduce vaccine hesitancy amongst providers and equip providers with appropriate information tailored to pregnant women about the RSV maternal vaccine.

AbstractO_ST_ABSBackgroundC_ST_ABSCytomegalovirus is a leading cause of congenital disease and multiple strains enable congenital CMV (cCMV) from both primary and non-primary infection. A cross-strain protective cCMV vaccine is a high priority. The guinea pig is the only small animal model for cCMV and guinea pig cytomegalovirus (GPCMV) encodes functional homolog proteins including cell entry gB glycoprotein and non-structural immediate early 1 protein (IE1), essential for lytic infection. A gB vaccine antibody response fails to provide horizontal protection against highly cell-associated clinical GPCMV strain TAMYC compared to prototype strain 22122. Previously, a recombinant defective adenovirus (Ad) vaccine encoding IE1, a T-cell antigen, provided high-level cCMV protection. In this study, we hypothesized that a combined Ad-based strategy encoding trimeric gB complex and IE1 (AdgB+AdIE1) could improve cross-strain protection against cCMV compared to a gB vaccine (AdgB). MethodsA preconception vaccine study evaluated the immune response and ability of vaccines to provide cross-strain protection against cCMV. Seronegative female animals were assigned into three vaccine groups: Group 1 (AdgB); Group 2 (AdgB+AdIE1); Group 3 (no vaccine). Animals were vaccinated following a previously defined protocol and antibody ELISAs were used to evaluate gB immune response (AD1, prefusion gB and wild type gB). Additionally, an IFN{gamma}-ELISPOT assay evaluated IE1 T-cell response. During second trimester dams were challenged with GPCMV (22122 and TAMYC) and pregnancy went to term where viral loads in pup target organs and placentas were evaluated. ResultsVaccinated dams elicited a higher neutralizing antibody response to gB than natural convalescent immunity and antibodies recognized homolog AD1 gB domain as well as prefusion gB with response surpassing natural immunity. Group 2 animals additionally elicited a T-cell response to IE1. Evaluation of viral load in pups demonstrated that AdgB+AdIE1 vaccine reduced GPCMV transmission to below detectable limits compared to 91.7% in unvaccinated group. In contrast, AdgB reduced cCMV transmission to 12% in pups. ConclusionComplete cross-strain cCMV protection is a significant milestone in this model and achieved by inclusion of an antibody response to trimeric gB and T-cell response to IE1. Importantly, gB and IE1 responses can synergize and increase protection against cCMV unlike prior approaches.

BackgroundVaccine hesitancy has been a serious public health concern. Pregnant women are at higher risk of developing complications related to COVID-19 infections and other infectious diseases. These complications can lead to poor outcomes for infants. This study assessed the level of hesitancy of COVID-19 vaccination among pregnant women in Nigeria. MethodA hospital-based cross-sectional study was conducted among 104 pregnant women at the Plateau State Specialist Hospital antenatal clinic. A semi-structured data collection tool of 15 items was used to assess participants COVID-19 vaccine hesitancy, with scores below the mean indicating hesitancy. Data were collected and managed using the Research Electronic Data Capture (REDCap). Descriptive analyses and binary logistic regression were done using Stata MP 18, and a significant p-value was set at <0.05. ResultsThe mean age of the participants was 30.3 (SD 6.3) years, with less than half (49%) falling within the 25-34 age group. Majority (96.2%) of the participants were married, resided in the urban area (84.6%) and were employed (64.4%). More than half of the participants had more than one child (72.1%), were healthy (55.8%) and had no family members or friends who had taken the COVID-19 vaccine (70.2%). About 71% of the participants had a positive perception of the COVID-19 vaccine. The overall mean score for vaccine hesitancy among participants was 3.0 (S.D 1.6), with 57.7% hesitating to the COVID-19 vaccine. Participants with more than one child (aOR = 3.31, 95%CI=1.17-9.42), in healthy condition (aOR = 3.95, 95%CI=1.55-10.07), had family and friends who had received COVID-19 vaccine (aOR = 3.27, 95%CI=1.07-10.00) and Negative perception on COVID-19 vaccine (aOR = 4.16, 95%CI=1.05-16.57) had more likelihood to the hesitancy of COVID-19 vaccine. ConclusionNearly three out of five pregnant women in our study expressed COVID-19 vaccine hesitancy. Pregnant women were more likely to be hesitant to COVD-19 vaccines if the felt their health was good and had a family member that had received a COVID-19 shot. Public health efforts and education campaigns for pregnant women are needed to change their perception patterns in promoting vaccination uptake and inclusion in vaccine trials.

BackgroundSince 2019, Hong Kong has implemented a routine nonavalent human papillomavirus (HPV) vaccination program for schoolgirls aged 10-12 years with two-dose uptake of over 85%. However, the impacts of gender-neutral vaccination (GNV) with a single-dose schedule have not been studied. ObjectiveTo evaluate the cost-effectiveness of expanding the two-dose female-only vaccination (2dFOV) to GNV and reducing the schedule to one dose. MethodsWe modeled the impacts of HPV vaccination on the burden of HPV-related cancers in both genders at various vaccine uptake among schoolboys. We estimated the changes in the associated costs and health benefits across the lifetime of all cohorts of both genders over a time horizon of 100 years with a 3% annual discount rate. We calculated the incremental cost-effectiveness ratio (ICER) of expanding 2dFOV to GNV, using a two-dose or one-dose schedule compared to a threshold of one gross domestic product per capita (US$48,757). Sensitivity analyses were performed to assess the uncertainty of the findings. ResultsAssuming base case vaccination cost and 85% uptake for both genders, two-dose GNV (2F2M) has an ICER of US$109,375 (90% prediction interval: (US$63,824, US$264,980)) compared to 2dFOV and is not cost-effective. Compared to 2dFOV under the same assumptions, giving one dose to both genders (1F1M) always results in QALY gains if one-dose schedule provides 30-year protection; this strategy is cost-effective (and may be cost-saving). If the one-dose schedule gives only 20-year protection, 1F1M incurs QALY gains in 91% and 67% of simulations if boys uptake is 85% and 50%, respectively. Compared to 2dFOV, if 85% of boys are vaccinated and one-dose schedule provides at least 20 years of protection, adding one dose for boys (2F1M) is cost-effective in 47% of simulations at the base case vaccination cost. Conclusions1F1M is more effective than 2dFOV if it protects for at least 20-30 years with boys uptake of 50% or above. The findings highlight the potential of implementing GNV with a single-dose schedule for better resource allocation and optimizing the impacts of the vaccination program.

BackgroundTo assist decision making on the introduction of rotavirus vaccine (RVV), pneumococcal conjugate vaccine (PCV) and human papillomavirus vaccine (HPVV), cost-effectiveness and budget impact evaluations were undertaken in Samoa, Tonga, Tuvalu and Vanuatu. MethodsA proportionate outcomes model was used to evaluate vaccine introduction in each country from a health systems perspective, using country-specific data supplemented with regional and global estimates. A 10-year vaccination program was modelled from 2021, with costs and outcomes (disability-adjusted life years; DALYs) summed over a life-time horizon and discounted at 3%. Vaccine dose costs were based on Pan American Health Organization (PAHO) Revolving Fund prices, with lower priced products also explored. FindingsIntroduction of all three vaccines in all countries could prevent over 1,000 deaths over the lifetimes of the vaccinated cohorts. The cost per DALY averted at PAHO Revolving Fund prices ranged from 43% - 73% of the per capita gross domestic product (GDP) in each country, and 15% - 58% for lower-priced vaccines. The budget impact ranged from 359% (Samoa) to 1,368% (Vanuatu) of the 2019 vaccine budgets, and 149% (Samoa) to 775% (Vanuatu) for lower-priced vaccines. Cost-effectiveness results were most sensitive to disease burden, discount rate, vaccine efficacy, and program costs. InterpretationDevelopment partner-supported introduction of HPVV, PCV and RVV may represent good value for money in Samoa, Tonga, Tuvalu and Vanuatu, depending on willingness to pay thresholds, but will place considerable burden on immunisation budgets. Financial sustainability requires increases in immunisation budgets and negotiation of affordable vaccine prices. FundingAsian Development Bank.

The emergence of SARS-CoV-2 variants continues to be a major obstacle for controlling the global pandemic. Despite the currently authorized SARS-CoV-2 vaccines ability to reduce severe disease and hospitalization, new immunization strategies are needed that enhance mucosal immune responses, inhibit community transmission, and provide protection against emerging variants. We have developed a mucosally delivered, non-replicating recombinant adenovirus vector (rAd5) vaccine, that has proven efficacy in the clinic against other respiratory viruses [1]. Here we evaluated the immunogenicity of three candidate SARS-CoV-2 vaccines in cynomolgus macaques that contained spike (S) and/or nucleocapsid (N) from either the Wuhan or the beta variant to select a candidate for future clinical development. Mucosal immunization with the Wuhan specific S vaccine (ED90) induced significant cross-reactive serum IgG responses against to Wuhan, beta, gamma and delta lineages, and generated substantial serum neutralizing activity. In nasal samples, ED90 immunization induced 1000-fold increases in IgA to all variants of concern tested and had neutralizing activity against Wuhan and delta. While immunization with the beta specific vaccine (ED94) enhanced IgG and IgA responses to homologous beta variant S and RBD, this approach resulted in less cross-reactive responses to other variants in the serum and nasal passages compared to ED90. As ED90 immunization induced the most robust cross-reactive systemic and mucosal antibody responses, this candidate was chosen for future clinical development.

Group B streptococcus (GBS) is a leading cause of neonatal and infant sepsis, pneumonia, and meningitis and is also associated with preterm birth, stillbirth, and other negative pregnancy outcomes. Infants born to mothers colonized with GBS bacteria are at greatest risk of the disease, and more than 95% of GBS disease occurs in sub-Saharan Africa. Screening and intrapartum antibiotic prophylaxis are important but insufficient prevention strategies, and their implementation is inconsistent or absent in many low- and middle-income settings. Maternal GBS vaccines are now in clinical trials, aiming to confer protection to newborns through maternal antibody transfer. Strengthening community uptake of these vaccines, once available, will hinge on strong delivery systems to reach pregnant persons, including providers who can provide appropriate and effective information and recommendations to their patients. We conducted a mixed-methods study to describe providers knowledge, attitudes, and beliefs related to GBS and maternal vaccination in Nakuru and Mombasa Counties, Kenya. Based on a cross-sectional survey of 100 providers and 12 in-depth interviews, we found that provider lack of awareness of GBS disease and its burden in the community is a substantial barrier to future GBS vaccine decision-making and demand; perceived community awareness of GBS was also limited. Actual and perceived provider knowledge of GBS varies, emphasizing the need for preemptive education and training in advance of a GBS vaccine introduction. Providers are trusted sources of information for their patients and are very likely to recommend a maternal vaccine that is recommended by the Ministry of Health. With licensed GBS vaccines on the horizon, there is an important opportunity to build provider awareness and knowledge of GBS risk, help strengthen provider and community trust in maternal vaccination and prevent serious GBS disease.

BackgroundAt the time of this survey, September 1st, there were roughly 6 million COVID-19 cases and 176,771 deaths in the United States and no federally approved vaccine. The objective of this study was to explore the willingness to accept a COVID-19 vaccine in the United States and describe variability in this acceptability by key racial, ethnic and socio-demographic characteristics. MethodsThis was a cross-sectional digital survey that sampled participants from a nationally-representative panel maintained by a third party, Dynata. Dynata randomly sampled their database and emailed web-based surveys to United States residents ensuring the sample was matched to US Census estimates for age, race, gender, income, and Census region. Participants were asked how willing or unwilling they would be to: 1) receive a COVID-19 vaccine as soon as it was made publicly available, and 2) receive the influenza vaccine for the upcoming influenza season. Participants could respond with extremely willing, willing, unwilling, or extremely unwilling. For those who reported being unwilling to receive a COVID-19 vaccine, reasons for this hesitancy were captured. All participants were asked about where they obtain vaccine-related information, and which sources they trust most. Univariable and multivariable logistic regressions were conducted to examine the association of all demographic characteristics with willingness to receive COVID-19 vaccine. FindingsFrom September 1st to September 7, 2020, 1592 respondents completed the online survey. Overall, weighted analyses found that only 58.9% of the sample population were either willing or extremely willing to receive a COVID-19 vaccine as soon as it was made publicly available. In comparison, 67.7% of the respondents were willing or extremely willing to take the influenza vaccine. By gender, 66.1% of males and 51.5% of females were willing to receive a COVID-19 vaccine. Males were significantly more willing to receive a COVID-19 vaccine (adjusted odds ratio (OR)=1.98, 95% CI: 1.56, 2.53; p<0.001) than females. Blacks were the least willing racial/ethnic group (48.8%) Blacks, (aOR=0.59, 95%CI: 0.43, 0.80; p<0.001) were significantly less willing, than whites, to receive a COVID-19 vaccine. There were numerous reasons provided for being unwilling to receive a COVID-19 vaccine. The most common reason was concern about the vaccines safety (36.9%), followed by concerns over its efficacy (19.1%). InterpretationIn conclusion, we found that a substantial proportion (41%) of United States residents are unwilling to receive a COVID-19 vaccine as soon as one is made publicly available. We found that vaccine acceptance differs by sub-populations. In addition to sub-group differences in willingness to receive the vaccine, respondents provided a variety of reasons for being unwilling to receive the vaccine, driven by various sources of vaccine information (and misinformation). This compounds the challenge of delivering a safe and efficacious COVID-19 vaccine at a population level to achieve herd immunity. A multi-pronged and targeted communications and outreach effort is likely needed to achieve a high level of immunization coverage.

BackgroundThe use of chorioallantoic membranes (CAM) route for the propagation of fowlpox virus (FPV) is the method applied in the production of potent and effective fowlpox vaccine at the National Veterinary Research Institute (NVRI), Vom. However, production insufficiency has led to inadequate supply of vaccine to meet farmers demands. This has left large number of susceptible and unvaccinated flocks with outbreaks of the disease being reported in Nigerian. AimThis study adapted FPV to Chicken embryo fibroblast (CEF) cell culture and assessed its immunogenicity and safety of the resulting vaccine in comparison to a locally produced CAM-based FPV vaccine. MethodsThe FPV were propagated on CAM and CEF of 9 to 12 day old developing chicken embryos. The vaccine harvests were subjected to quality checks, titrated, and used in vaccinating experimental birds via the wing web to monitor for takes, seroconversion, and safety. ResultsThe FPV was successful adapted to CEF as demonstrated by the attainment of 80 to 90% cytopathic effect within 71 to 115 hours in the different passages. Both the CEF and CAM-adapted vaccine harvests were highly replicative producing titres of above 106.0/ml TCID50, but higher titres of 108.25/ml TCID50 was recorded in the CEF-adapted vaccines. Experimentally vaccinated birds showed 100% takes within 3 to 4 days post-vaccination, with no adverse effects recorded. ConclusionThis research reported successful development and adaptation of FPV to CEF that was safe and immunogenic, with the potential for its use in the production of self-sufficiency vaccine for fowlpox prevention and control in poultry.

The Government of Bangladesh has offered COVID-19 vaccines at no cost; however, sustaining this free vaccination program for a large population poses significant challenges. Assessing willingness to pay (WTP) is essential for understanding potential pricing strategies, subsidy requirements, and vaccine demand. This study aimed to estimate the prevalence of WTP for COVID-19 vaccines and identify its influencing factors to support program sustainability. Using a cross-sectional design, data were collected from 1,497 respondents through online, and face-to-face interviews and multiple logistic regression was employed to analyze the correlates of WTP. Results showed that 50.9% of participants were willing to pay, with an average WTP of 754.55 BDT (US$8.93) and a median of 300 BDT (US$3.55). WTP was significantly higher among individuals with graduate (aOR=2.2, P=0.007) or Masters & MPhil/PhD education (aOR=2, P=0.030), higher family income (aOR=1, P=0.039), and those with more excellent knowledge about the vaccine (aOR=1.1, P=0.003), positive behavioral practices (aOR=1.1, P<0.001), stronger subjective norms (aOR=1.2, P=0.009), higher anticipated regret (aOR=1.2, P=0.005), and perceived benefits (aOR=1.1, P=0.029). Conversely, WTP was lower among participants with negative attitudes toward vaccines (aOR=0.9, P<0.001) and high behavioral control (aOR=0.9, P=0.006). With nearly half of respondents unwilling to pay, the study highlights the need to improve vaccine-related knowledge, promote positive behaviors, reduce vaccine hesitancy, and enhance income-based affordability to increase WTP. Health promotion efforts should focus on disseminating vaccine knowledge and addressing negative perceptions. Additionally, a subsidized program for low-income groups could help mitigate financial barriers and promote equitable vaccine access.

Background: In Burkina Faso, typhoid fever remains a major public health concern, with a high incidence among children younger than 15 years of age. To address this burden, the country introduced typhoid conjugate vaccine in January 2025 through a national vaccination campaign reaching children aged 9 months to 14 years. This study aimed to estimate the cost of typhoid conjugate vaccine delivery during the national campaign and to identify the main cost drivers across different administrative levels. Methods: We conducted a cross-sectional, retrospective costing study using a microcosting approach from the government perspective. We collected data from fifty health facilities, eight health districts, five health regions, and the national level. Financial and economic costs were estimated for each level, excluding vaccine and syringe costs. All costs were converted to 2024 USD using the official exchange rate. Findings: Vaccinators administered a total of 10.5 million typhoid conjugate vaccine doses. The average financial cost per dose was $0.47 (95% CI: $0.39-$0.51), and the economic cost was $2.16 (95% CI: $1.71-$2.56). Human resources and per diem payments were the main contributors to costs. Costs varied by geography, delivery strategy, and security context, with higher costs observed in rural and conflict-affected areas. The mobile-temporary posts strategy had the highest economic cost per dose ($2.02; 95% CI: $1.64-$2.40), while the fixed strategy had the highest financial cost per dose ($0.41; 95% CI: ($0.32-$0.49). Conclusion: The financial cost per dose remained within Gavi, the Vaccine Alliance's operational support range. The observed cost variations highlight the need for targeted funding and enhanced logistical support to ensure equitable access, particularly in rural and insecure areas. This study provides evidence to inform future vaccination campaigns and supports decision-making for typhoid conjugate vaccine introduction in other countries in the region.

Respiratory syncytial virus (RSV) is a highly infectious virus, and infants and young children are particularly vulnerable to its progression to severe lower respiratory tract illness (LRTI). Nirsevimab, an extended half-life monoclonal antibody, was recently approved in Canada as a passive immunization intervention for the prevention of RSV LRTI. A static decision tree model was utilized to determine the cost-effectiveness of nirsevimab in Canadian infants compared to current standard of care (palivizumab for infants born preterm, and with specific chronic conditions) and generate an optimal price per dose (PPD) at accepted willingness-to-pay (WTP) thresholds. Various health outcomes (including hospitalization, ICU, and mechanical ventilation) and healthcare costs were calculated over one RSV season, with any necessary follow-up prophylaxis in the second season for three infant categories (palivizumab-eligible, preterm, and term). All health-related parameters and costs were tailored to the Canadian environment. Compared to scenarios where only at-risk segments of the infant population received nirsevimab, the base case (administering nirsevimab to all infants in their first RSV season) was the most cost-effective versus standard care: the PPD was $692 at a $40,000/QALY WTP threshold, using average costing data assumptions across all scenarios. Compared to standard care, the base case scenario could avoid 18,249 RSV-related health outcomes (reduction of 9.96%). Variations in discount rate, distribution of monthly RSV infections, nirsevimab coverage rate for infants born at term, and palivizumab cost had the most significant model impact. Passive immunization of all infants with nirsevimab can significantly reduce RSV-related health and economic burden across Canada.

BackgroundIndia rolled out COVID-19 vaccinations for adults in January 2021 and children aged 12-18 in early 2022. A 2021 survey indicated that 63% of Indian parents were willing to vaccinate their children against COVID-19, with few studies examining vaccine hesitancy and acceptability. The the Behavioral and Social Drivers of Vaccination (BeSD) framework helps demonstrate which factors may affect vaccination uptake. Our study examined parents intentions-to-vaccinate their children below 18 years of age against COVID-19 in Mysore, India and their decision-making process using the BeSD framework. MethodsFrom November 2021 to May 2022, 506 parents/guardians of children below 18 years of age living in Mysore district, India were consented and interviewed by phone or face-to-face. We assessed their own COVID-19 vaccination status, vaccine confidence (Vaccine Confidence Index), intention-to-vaccinate their child against COVID-19, and other factors affecting vaccination such as demographic variables. Multivariable ordinal logistic regression was conducted to examine the association of influencing factors based on the literature and BeSD framework using Stata version 16.1. Intention-to-vaccinate was presented as odds ratios (OR) with associated 95% confidence intervals (95%CI). ResultsThe majority (91.3%) of the 503 participants fully trusted COVID-19 vaccines for their children. The same number (91.3%) had been fully vaccinated themselves, and 78.3% reported being (very) likely to vaccinate their children against COVID-19. Vaccine-hesitant and vaccine-confident groups were not significantly different socio-demographically. As parental age increased, parents had higher odds to express intention-to-vaccinate their child (OR: 1.04, 95%CI: 1.01-1.08). Parents from urban Mysore had lower odds to vaccinate their child compared to those from rural areas (OR: 0.53, 95%CI: 0.35-0.82). ConclusionMost parents expressed vaccine confidence and intention-to-vaccinate their child against COVID-19. Exploring decision-making processes among parents is a crucial strategy to ensure effective implementation of vaccination programs.

IntroductionVaccination is critical in controlling the coronavirus disease 19 (COVID-19) pandemic. However, vaccine perception and acceptance among pregnant and lactating women is unknown in Singapore. We aimed to determine the acceptance of COVID-19 vaccination among these two groups of women in Singapore, and factors associated with vaccine acceptance. MethodsWe conducted an anonymous, online survey on the perception and acceptance of the COVID-19 vaccine in pregnant and lactating women at a tertiary hospital in Singapore from 1st March to 31st May 2021. Information on demographics and knowledge were collected, and these factors were assessed for their relationship with vaccine acceptance. ResultsA total of 201 pregnant and 207 lactating women participated. Vaccine acceptance rates in pregnant and lactating women were 30.3% and 16.9% respectively. Pregnant women who were unsure or unwilling to take the vaccine cited concerns about safety of the vaccine during pregnancy (92.9%), while lactating women were concerned about potential long-term negative effects on the breastfeeding child (75.6%). Other factors significantly associated with vaccine acceptance included a lower monthly household income or education level, appropriate knowledge regarding vaccine mechanism and higher perceived maternal risk of COVID-19. Most pregnant (70.0%) and lactating women (83.7%) were willing to take the vaccine only when more safety data during pregnancy and breastfeeding were available. ConclusionsCOVID-19 vaccine acceptance was low among pregnant and lactating women in Singapore. Addressing safety concerns when more data is available and education on mechanism of vaccine action will likely improve acceptance among these women.

BackgroundThe health care workers (HCWs) were one of the vulnerable populations prioritized during the Covid-19 vaccination (COVISHIELD and COVAXIN) campaign. They are also the first point of contact for vaccine-related information and therefore, play a crucial role in shaping peoples vaccine seeking behaviour. Objectives(i) To estimate the proportion of Covid-19 vaccine hesitancy among HCWs in urban primary health care centres (UPHC) across Hyderabad; and (ii) To explore factors influencing vaccine hesitancy and vaccine acceptance in this population. MethodsA cross-sectional study was conducted among 238 HCWs from 21 urban health centres in Hyderabad between June and July 2021. The prevalence of vaccine hesitancy was assessed using the questions adapted from the UNICEF Guyana Covid-19 Vaccination Hesitancy Survey. We used the SAGE determinants of vaccine hesitancy to determine factors underlying vaccine hesitancy and acceptance. ResultsThe prevalence of vaccine hesitancy among HCWs was 17% (12.3% - 22.2%) during the 6 months following emergency vaccine approval. Self-protection, Vaccine-confidence, and Responsibility towards the general population were some of the reasons in favour of Covid-19 vaccination. Whereas Vaccine-safety has emerged as the primary determinant of vaccine-hesitancy in this population. HCWs were susceptible to misinformation in the social media and in their communities, which might have shaped their opinion about the vaccines for the Covid-19. ConclusionAlthough the COVID-19 vaccines (COVISHIELD and COVAXIN) were approved for administration by the Drugs Controller General of India, one in every six HCWs working in the UPHCs in Hyderabad, India had either refused or delayed vaccinations mainly due to limited information on vaccine-safety. This highlights a critical need to address the vaccine-hesitancy among HCWs (especially during the initial phases of novel vaccine introduction), as similar behaviour of the HCWs towards novel vaccines could affect the uptake of these vaccines among the general population (which they serve).

Childhood vaccination is vital for disease prevention intervention, yet some Northern Saskatchewan First Nations communities have immunization coverage below the 95% target. We aimed to explore community perspectives on the barriers and facilitators of childhood immunization uptake in First Nations communities in Northern Saskatchewan. We used a qualitative design informed by Indigenous methodologies and community-based participatory approaches to engage three First Nations communities and conducted sharing circles to gather rich, culturally grounded perspectives on childhood immunization. We purposefully recruited parents, caregivers, an Elder, and a community leader. We audio-recorded and transcribed one sharing circle (5 participants) discussion, then analyzed data thematically with Indigenous research principles, ensuring community collaboration and ethical stewardship throughout the study. The results were validated through a community feedback session. Participants described several structural and social factors that limited access to immunization, including transportation barriers, limited clinic hours, geographic isolation, and reduced services during the COVID-19 pandemic. Caregiver mental health issues, substance use, and unstable home environments were identified as barriers to immunization uptake. Language barriers, lack of health literacy, and historical trauma also shaped vaccine hesitancy. Key enablers identified included establishining trusting relationships with local healthcare providers, use of mobile clinics, peer support, tailored communication strategies, community events that incorporated immunization programs rooted in cultural practices, and involvement of Elders and local leadership in planning and delivery. Our findings show that vaccine uptake in Northern Saskatchewan First Nations communities reflects a complex set of contextual factors, shaped by structural conditions and historical experiences. We recommend policy and practice approaches that support culturally safe, community-led immunization programming. Strengthening trust, expanding flexible service models, and integrating First Nations knowledge systems into public health planning can help improve childhood vaccination coverage and contribute to health equity in northern and remote settings.

BackgroundThe major challenges of vaccination programs are notably coverage in the target population, vaccine hesitancy, and cost-effectiveness. A vaccination strategy with fractional doses is a dose-saving strategy to address current vaccine shortages. Herein, we aimed to review the literature on administering fractional vaccine doses in Africa. MethodsA methodical search of PubMed was conducted to identify articles published up till March 31, 2023. Peer-reviewed studies were selected for inclusion if they focused on studies that described the use of fractional doses of vaccines and were conducted in any of the 54 African countries. ResultsFindings from eleven eligible studies were analyzed. Studies were from the Democratic Republic of the Congo, Gambia, Ghana, Kenya, South Africa, and Uganda. They covered five vaccines including the yellow fever vaccine (n=3; 27.3%), inactivated poliovirus vaccine (n=3; 27.3%), meningococcal A/C/Y/W135 vaccine (n=2; 18.2%), Haemophilus influenzae type b vaccine (n=2; 18.2%), and malaria vaccine (n=1; 9.1%). Fractionated doses used most often consist of one-fifth of the standard dose (n=8; 72.7%). Regarding immunogenicity/efficacity, eight of ten studies that addressed immunogenicity suggest that immune responses to the fractional dose vaccines were comparable to that of the standard dose vaccines and resulted in higher antibody titers. Regarding safety, all of the eight studies that addressed the safety of fractional doses in Africa, suggest that safety and tolerability data of fractional dosing were favorable compared to full dose regimen. ConclusionFractional dosing may be considered to address the availability and acceptability of certain vaccines while maintaining protection. This strategy also has the potential advantage of reducing the cost of vaccination programs, vaccine antigen overload, and vaccine side effects.

Cameroons Expanded Program on Immunization (EPI) introduced the HPV vaccine into the routine immunization schedule in Cameroon in October 2020. However, HPV vaccine coverage has remained low, reaching only 20% by December 2022. In response, a gender-neutral vaccination (GNV) approach was adopted and implemented from January 2023 to increase acceptance, reduce stigma, and improve vaccine coverage. This study aimed to assess the perceptions of key immunization stakeholders in Cameroon on the GNV approach to HPV vaccination. A cross-sectional study was conducted from June to September 2024 using an in-depth and semi-structured interviews to explore the perspectives of key stakeholders (policymakers, community leaders, and parents of girls aged 9-13 years) across three regions (South-West, North, and Centre) and the central level. Data was analyzed using traditional content analysis, via manual and NVivo coding to identify key themes. The research team ensured reliability through consensus discussions, and key quotes illustrating central findings were identified. A total of 51 participants were interviewed. Participants observed that the inclusion of boys in the HPV vaccination program contributed to a positive shift in community perceptions, dispelled misconceptions, and enhanced overall vaccine acceptance. However, challenges related to limited resources, lingering misinformation, and hesitancy from parents, religious leaders, and healthcare workers hindered the effective implementation of the GNV approach. Participants emphasized the need for improved partnerships, sensitization strategies, integration with existing health programs, and sustained funding to enhance community understanding and increase vaccination uptake. Overall, stakeholders viewed the GNV approach as effective for improving HPV vaccine acceptability and promoting equity, but emphasized the need for continuous investments and stronger community engagement to address challenges like limited resources, misinformation, and hesitancy.

IntroductionCOVID-19 vaccine acceptance research has mostly originated from high-income countries and reasons why youth may not get vaccinated may differ in low-income settings. Understanding vaccination coverage across different population groups and the sociocultural influences in healthcare delivery is important to inform targeted vaccination campaigns. MethodsA population-based survey was conducted in 24 communities across three provinces (Harare, Bulawayo and Mashonaland East) in Zimbabwe between October 2021 and June 2022. Youth aged 18 - 24 years were recruited using random sampling. Data on sociodemographic information and COVID-19 vaccination uptake and reasons for non-uptake were collected. ResultsA total of 17,682 youth were recruited (n=10,743, 60.8% female). The median age of survey participants was 20 (IQR: 19 - 22) years. Almost two thirds (n=10,651, 60.2%) of participants reported receiving at least one dose of COVID-19 vaccine. A higher proportion of men than women had been vaccinated (68.9% vs 54.7%), and vaccination prevalence increased with age (<19 years: 57.5%, 20-22: 61.5%, >23: 62.2%). Lack of time to get vaccinated, belief that the vaccine was unsafe and anxiety about side effects (particularly infertility) were the main reasons for not getting vaccinated. Factors associated with vaccination were male sex (OR=1.69, 95%CI:1.58-1.80), increasing age (>22 years: OR=1.12, 95%CI:1.04-1.21), education level (post-secondary: OR=4.34, 95%CI:3.27-5.76), and socioeconomic status (least poor: OR=1.32, 95%CI:1.20-1.47). ConclusionThis study found vaccine inequity across age, sex, educational attainment and socioeconomic status among youth. Strategies should address these inequities by understanding concerns and tailoring vaccine campaigns to specific groups. What is already known on this topicMany countries have faced challenges when rolling out COVID-19 vaccines. Infrastructure, logistics, misinformation and vaccine hesitancy have been barriers to vaccine access and uptake globally. Vaccine nationalism by high-income countries has particularly affected countries in Africa and Asia, resulting in inequity between countries and regions. What this study addsVaccine uptake among youth in Zimbabwe was more than 50% across all age-groups. Men, those with more education and those living under less socially deprived socioeconomic conditions were more like to be vaccinated. Fear of side effects and myths circulating on social media were barriers. Religion was less of a barrier than other studies reported, likely due to religious institutions collaborations in COVID-19 vaccination efforts. How this study might affect research, practice or policyVaccination campaigns should actively address specific concerns of communities, especially concerns around fertility and early death, and provide vaccines in easy-access and convenient locations. Involving community leaders in both education and vaccination efforts is pivotal given the trust and influence they have.