Identifying factors that can be used to assess a country's readiness to deploy a new vaccine or improve uptake of an underutilised vaccine: a scoping review.

OBJECTIVES: Identifying whether a country is ready to deploy a new vaccine or improve uptake of an existing vaccine requires knowledge of a diverse range of interdependent, context-specific factors. This scoping review aims to identify common themes that emerge across articles, which include tools or guidance that can be used to establish whether a country is ready to deploy a new vaccine or increase uptake of an underutilised vaccine. DESIGN: Scoping review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews guidelines. DATA SOURCES: Embase, CINAHL, Cochrane Library, Google Scholar, MEDLINE, PsycINFO and Web of Science were searched for articles published until 9 September 2023. Relevant articles were also identified through expert opinion. ELIGIBILITY CRITERIA: Articles published in any year or language that included tools or guidance to identify factors that influence a country's readiness to deploy a new or underutilised vaccine. DATA EXTRACTION AND SYNTHESIS: Two independent reviewers screened records and performed data extraction. Findings were synthesised by conducting a thematic analysis. RESULTS: 38 articles met our inclusion criteria; these documents were created using methodologies including expert review panels and Delphi surveys and varied in terms of content and context-of-use. 12 common themes were identified relevant to a country's readiness to deploy a new or underutilised vaccine. These themes were as follows: (1) legal, political and professional consensus; (2) sociocultural factors and communication; (3) policy, guidelines and regulations; (4) financing; (5) vaccine characteristics and supply logistics; (6) programme planning; (7) programme monitoring and evaluation; (8) sustainable and integrated healthcare provision; (9) safety surveillance and reporting; (10) disease burden and characteristics; (11) vaccination equity and (12) human resources and training of professionals. CONCLUSIONS: This information has the potential to form the basis of a globally applicable evidence-based vaccine readiness assessment tool that can inform policy and immunisation programme decision-makers.

Public health impact and return on investment of the pediatric immunization program in Poland.

BACKGROUND: This study aims to evaluate the epidemiological impact and return on investment of the pediatric immunization program (PIP) in Poland from the healthcare-sector and societal perspectives. RESEARCH DESIGN AND METHODS: A health-economic model was developed focusing on the nine vaccines, targeting 11 pathogens, recommended by the public health authorities for children aged 0-6 years in Poland. The 2019 birth cohort (388,178) was followed over their lifetime, with the model estimating discounted health outcomes, life-years gained, quality-adjusted life-years, and direct and indirect costs with and without the PIP based on current and pre-vaccine - era disease incidence estimates, respectively. RESULTS: Across 11 targeted pathogens, the Polish PIP prevented more than 452,300 cases of disease, 1,600 deaths, 37,900 life-years lost, and 38,800 quality-adjusted life-years lost. The PIP was associated with vaccination costs of €54 million. Pediatric immunization averted €65 million from a healthcare-sector perspective (benefit-cost ratio [BCR], 2.2) and averted €358 million from a societal perspective (BCR, 7.6). The BCRs from both perspectives remained >1.0 in scenario analyses. CONCLUSIONS: The Polish PIP, which has not previously been systematically assessed, brings large-scale prevention of disease-related morbidity, premature mortality, and associated costs. This analysis highlights the value of continued investment in pediatric immunization in Poland.

Intersection of policy and Immunization Information Systems (IIS).

BACKGROUND: Immunization information systems (IIS) are confidential, population-based computerized databases that record vaccination doses administered to persons residing within a given geopolitical area. We sought to highlight the evolution of IIS policy over the last two decades, as IIS play a pivotal role in achieving equitable and high vaccine uptake. METHODS: Legal epidemiological research methods were used to assess relevant IIS statutes and administrative codes across all 50 states, the District of Columbia, Philadelphia, and New York City. Where relevant, laws were cross-checked or supplemented with state and local health department resources. Comparisons to previous legal studies enabled evaluation of trends in IIS laws over time. RESULTS: The compilation of current laws provides an updated overview of the diverse interstate and intrastate policies within the US that govern the capabilities and implementation of IIS. The findings of this study show the progress that has been made in the past decade in improving policies that enable IIS to be utilized across the life-course. Conversely, gaps in IIS data collection, limited interoperability with local and national health information systems, and inconsistent access to view or utilize IIS records due to existing policies, continue to limit the full potential of IIS. CONCLUSIONS: In the United States (US), IIS are implemented and managed at the state and local level, creating variability in IIS policies and implementation. Findings from this study serve as a comprehensive benchmark of current IIS laws that may aid policy stakeholders who are exploring amendments to jurisdictional IIS laws.

The impact of the COVID-19 pandemic on vaccination uptake in the United States and strategies to recover and improve vaccination rates: A review.

The COVID-19 pandemic disrupted routine healthcare delivery, causing declines in CDC-recommended vaccination rates across the life-course in the United States (US). Ensuring protection against disease outbreaks and associated morbidity and mortality depends on improving vaccine coverage rates (VCRs) and uptake. The authors conducted a targeted literature review to assess the pandemic's effects on routine vaccination rates across different populations, evaluating VCR recovery and improvement efforts. The review highlights articles published with data measuring or evaluating VCR decline across the US during the COVID-19 pandemic from January 2020 to April 2022, associated health impacts, and policy and programmatic strategies to recover routine VCRs. While vaccination rates stagnated or declined across some populations pre-pandemic, the review indicated there were further VCR declines in 2020 and 2021 compared to 2019 across numerous CDC-recommended vaccines, ages, and geographies, with some vaccines and sub-populations disproportionally impacted. The review additionally identified declines in patient healthcare visit frequency and increases in morbidity and mortality associated with vaccine-preventable disease (VPD) complications. Reviewed publications highlighted multifaceted strategies that could aid in recovering VCRs. Overall, findings demonstrate a significant reduction in VCRs across all age groups and highlight promising solutions to inform vaccine uptake efforts and ensure broader protection against VPDs.

Understanding Diversity of Policies, Functionalities, and Operationalization of Immunization Information Systems and Their Impact: A Targeted Review of the Literature.

The COVID-19 pandemic has focused attention on the use of immunization information systems (IIS) to record and consolidate immunization records from a variety of sources to generate comprehensive patient immunization histories. Operationalization of IIS in the United States is decentralized, and as such, there are over 60 different IIS with wide variations in enabling policies and functionalities. As such, the policies that inform the development and operation of those sub-national IIS exist at the state and sometimes city levels. A targeted literature review was conducted to identify IIS policies and functionalities and assess their impact. The authors identified articles published from 2012 to 2022 that discussed or evaluated IIS policies and functionalities and screened titles, abstracts, and full text for inclusion. When selected for inclusion, authors extracted IIS policy/functionality characteristics and qualitative or quantitative outcomes of their implementation, where applicable. The search terms yielded 86 articles, of which 39 were included in the analysis. The articles were heterogeneous with respect to study design, interventions, outcomes, and effect measures. Out of the 17 IIS policies and functional components identified in the targeted literature review, the most commonly evaluated were provider-based patient reminder/recall, IIS-based centralized reminder/recall, and clinical decision support. Patient reminder/recall had the most published research and was associated with increased vaccination rates and vaccine knowledge. Despite the lack of quantitative evidence, there is a consensus that immunization data interoperability is critical to supporting IIS data quality, access, and exchange. Significant evidence gaps remain about the effectiveness of IIS functionalities and policies. Future research should evaluate the impact of policies and functionalities to guide improved utilization of IIS, increase national interoperability and standardization, and ultimately improve vaccination coverage and population health.

Changes in vaccine administration trends across the life-course during the COVID-19 pandemic in the United States: a claims database study.

BACKGROUND: This study provides an updated and expanded analysis of the impact of the COVID-19 pandemic on routine vaccinations across the life-course in the United States. RESEARCH DESIGN AND METHODS: Routine wellness visits and vaccination rates were calculated using structured claims data for each month during the impact period (January 2020 to August 2022) and compared to the respective baseline period (January 2018 to December 2019). Monthly rates were aggregated as annual accumulated and cumulative percent changes. RESULTS: The complete monthly rate interactive dataset can be viewed at https://vaccinationtrends.com. The greatest decrease in annual accumulated administration rates in the 0-2 and 4-6 years age groups was for the measles, mumps, and rubella vaccine; for adolescents and older adults, it was for human papillomavirus and pneumococcal vaccines, respectively. Routine in-person wellness visit rates recovered faster and more completely than vaccination rates in all age groups, indicating potential missed opportunities to administer vaccines during visits. CONCLUSIONS: This updated analysis reveals that the negative impact of the COVID-19 pandemic on routine vaccination continued through 2021 and into 2022. Proactive efforts to reverse this decline are needed to increase individual- and population-level vaccination coverage and avoid the associated preventable morbidity, mortality, and health care costs.

A review of factors influencing vaccination policies and programs for older adults globally.

Policies and programs to increase vaccine coverage rates among adults 50 years of age or older are limited and vaccine uptake is often suboptimal. Our review evaluated evidence on the effectiveness and success of adult-targeted vaccination interventions and identified literature gaps. Literature was retrieved (2021) from PubMed, Embase, and Google Scholar databases. Outcomes assessed included data on an intervention's effectiveness and impact on vaccine uptake. Interventions were characterized thematically: affordability (n = 9), awareness (n = 25), and vaccination access (n = 6); and included influenza, pneumococcal, tetanus-containing, and herpes zoster vaccines. Interactive interventions directed toward patients, including provider-led educational initiatives and provider recommendations showed more positive associations than less interactive interventions, such as posters and reminder-recall letters. Provider interventions, including awareness campaigns, incentives, affordability efforts, or vaccination site expansion generally showed positive associations. Combining interventions was found to be successful across several studies. Barriers and interventions varied for population subgroups, therefore, tailoring programs is critical.

Drivers of and barriers to routine adult vaccination: A systematic literature review.

We performed a systematic literature review in PubMed and Embase (2016-2021) to investigate the drivers of and barriers to routine vaccination in adults aged 50 and older globally. A thematic assessment identified three categories across 61 publications: sociodemographic, health-related, and attitudinal. The most common sociodemographic determinants (factors identified in studies; n = 47) associated with vaccination uptake were economic status, age, education, and household composition, which had mixed effects on vaccine uptake. For health-related determinants (n = 27), individuals with comorbidities and health care consumption were the most common factors, both increased vaccine uptake. The most common attitudinal factors (n = 42) were self-efficacy, provider or other's recommendations, and vaccine-preventable disease awareness; across studies, all attitude factors had a positive effect, unlike the sociodemographic and health status categories. Findings suggest that patient and provider awareness and education campaigns are effective ways to increase uptake of routine vaccinations in older adults.

Attitudes and Beliefs around the Value of Vaccination in the United States.

Despite the benefits of immunization, differences in attitudes persist toward vaccines. We captured individuals' perceptions of vaccines and vaccination across the United States (US) to inform vaccine-related policy development. A survey was completed by 5000 respondents from 10 states. Respondents were screened for inclusion, which included individuals ≥ 18 years of age that had received a vaccine or were unvaccinated but indicated a favorable or neutral attitude towards vaccinations. Participants were excluded if they indicated they did not support the idea of vaccinations. Questions explored perceptions of vaccines for all age groups. Among unvaccinated individuals, the most common concerns were about safety (38%). Most respondents (95%) highlighted the importance of state immunization programs for disease prevention. Access to health and immunization records and immunization information systems were important to 96% and 88% of respondents, respectively, for future health planning. Doctors and healthcare professionals (HCPs) were considered trusted sources for vaccine information (95%). Overall, respondents recognized the importance of vaccination, but documented concerns among the unvaccinated indicated a need for greater promotion regarding vaccine safety. Doctors and HCPs, as trusted information sources, should continue to and increasingly advocate for the importance of immunization to increase vaccine uptake.

Residents Attitudes and Home Sanitation Predict Presence of German Cockroaches (Blattodea: Ectobiidae) in Apartments for Low-Income Senior Residents.

The German cockroach, Blattella germanica (L.), is a common pest found in apartment buildings. Prevalence of cockroach infestations is affected by both environmental conditions and building occupant behavior, but their relationships are not well studied. The objective of this study was to analyze the presence of German cockroaches in relation to environmental conditions, resident demographics, and residents' tolerance of cockroaches. We conducted resident interviews, placed sticky traps to detect the presence of German cockroaches, and assessed apartment conditions. A total of 388 apartments from seven low-income apartment buildings, occupied by senior citizens in New Jersey, United States, were included. Among the 344 apartments where trap count data were obtained, 30% had German cockroaches. Among interviewed residents whose apartments had existing cockroach infestations, 36% were unaware of the presence of cockroaches. The odds of having cockroaches in apartments with a 'poor' sanitation rating in kitchens and bathrooms was 2.7 times greater than that in apartments with better sanitation conditions. Residents' tolerance to cockroaches is significantly associated with presence of cockroaches and cockroach population size. The median cockroach count when residents were bothered by cockroaches was ≥3, based on deployment of 4 sticky traps per apartment, over a 2-wk period. Assessing and reducing cockroach tolerance thresholds and improving housekeeping through resident education and assistance from community and housing management should be incorporated in future cockroach management programs in order to reduce high cockroach infestation rates found in similar communities.

Efficacy of three different steamers for control of bed bugs (Cimex lectularius L.).

BACKGROUND: Bed bugs, Cimex lectularius L., have become one of the most difficult urban pests to control. Steam treatment is reported to be an effective method to kill bed bugs and is considered to be an important component of bed bug integrated pest management (IPM). We evaluated and compared the efficacies of two affordable consumer-grade commercial steamers and a commonly used professional-grade steamer for killing bed bugs. RESULTS: In laboratory experiments, the consumer-grade steamers at affordable prices achieved the same high control efficacy as the professional-grade steamer for treating bed bugs exposed on mattresses (100% bed bug mortality for all steamers), located beneath a fabric cover (>89% bed bug mortality for all steamers), or hiding in cracks (100% bed bug mortality for all steamers). Bed bugs located behind a leather cover did not suffer significant mortality from steam treatment regardless of the type of steamers used and the treatment duration. CONCLUSION: Proper use of steamers can kill all life stages of bed bugs. Affordable consumer-grade steamers are as effective as professional-grade steam machines for eliminating bed bugs resting on mattresses and hiding behind fabric materials or in cracks. © 2018 Society of Chemical Industry.

Pest Prevalence and Evaluation of Community-Wide Integrated Pest Management for Reducing Cockroach Infestations and Indoor Insecticide Residues.

Pest infestations in residential buildings are common, but community-wide pest survey data are lacking. Frequent insecticide applications for controlling indoor pests leave insecticide residues and pose potential health risks to residents. In this study, a community-wide pest survey was carried out in a housing complex consisting of 258 units in 40 buildings in New Brunswick, New Jersey. It was immediately followed by implementation of an integrated pest management (IPM) program in all the cockroach-infested apartments and two bed bug apartments with the goal of eliminating pest infestations, reducing pyrethroid residues, and increasing resident satisfaction with pest control services. The IPM-treated apartments were revisited and treated biweekly or monthly for 7 mo. Initial inspection found the top three pests and their infestation rates to be as follows: German cockroaches (Blattella germanica L. [Blattodea: Blattellidae]), 28%; rodents, 11%; and bed bugs (Cimex lectularius L. [Hemiptera: Cimicidae]), 8%. Floor wipe samples were collected in the kitchens and bedrooms of 20 apartments for pyrethroid residue analysis before the IPM implementation; 17 of the 20 apartments were resampled again at 7 mo. The IPM program reduced cockroach counts per apartment by 88% at 7 wk after initial treatment. At 7 mo, 85% of the cockroach infestations found in the initial survey were eliminated. The average number of pyrethroids detected decreased significantly from 6 ± 1 (mean ± SEM) and 5 ± 1 to 2 ± 1 and 3 ± 1 in the kitchens and bedrooms, respectively. The average concentrations of targeted pyrethroids residue also decreased significantly in the kitchens and bedrooms.

Effect of Feeding History and Time Elapsed From Field Collection on the Movement Behavior and Response to Stimulation in Cimex lectularius (Hemiptera: Cimicidae).

The common bed bug (Cimex lectularius L.) (Hemiptera: Cimicidae) is an obligate blood-sucking insect that has been resurging in many countries. Researching this pest's behavior will help design more effective control methods. In this study, we evaluated the effect of feeding history and time elapsed from field collection on bed bug movement behavior and response to chemical lure or carbon dioxide stimulation in the laboratory. After CO2 was released, bed bugs unfed for 3 d began to return to harborages; in contrast, the ones unfed for 2 and 4 wk spent significantly more time outside their harborages during the first 1 h after than the 1 h before CO2 release. After CO2 release, there was an increase in activity (time spent moving outside harborage) in all bed bugs with different feeding history or time elapsed from field collection. During the 8-h observation period when CO2 was present, bed bug males unfed for 4 wk spent significantly more time exploring outside harborages than the ones unfed for 3 d, 1 wk, and 2 wk. Nymphs collected 1-2 wk and 1 yr ago spent significantly more time exploring outside harborages than the ones collected 43 yr ago. Bed bug's exploratory activity (the total percentage of bed bugs trapped in both baited and unbaited interceptors) was significantly affected by their time elapsed from field collection and their exploratory activity level was 1-2 wk > 6 mo > 5 and 43 yr. Both feeding history and time elapsed from field collection significantly affected bed bug movement, whereas bed bug's response to chemical lure or CO2 (the percentage of bed bugs trapped in the baited interceptor, summarized as the number of bed bugs trapped in the baited interceptor divided by the total number of trapped bed bugs in both baited and unbaited interceptors) was unaffected by the time elapsed from field collection.

Effect of Mating Status and Age on the Male Mate Choice and Mating Competency in the Common Bed Bug, Cimex lectularius (Hemiptera: Cimicidae).

We investigated male mate choice and mating competency in the common bed bug, Cimex lectularius L., using video tracking for 10 min per experiment. In the male mate choice experiment, when a male was placed with two females of different mating status, males preferred to initiate copulation with the virgin female more quickly than with the mated female, and the mean total copulation duration with virgin females (38.0 ± 3.0 s) was significantly longer than with mated females (14.6 ± 3.0 s). When a male was placed with two females of different age, males initiated copulation more quickly with the old virgin female (29-34 d adult emergence) than with the young virgin one (<7 d adult emergence), and the mean total copulation duration with old virgin females (38.4 ± 4.0 s) was significantly longer than with young virgin females (24.0 ± 3.0 s). In the male mating competency experiment where a female was placed with two males of different mating status or age, the virgin males were more eager to mate than the mated males, and the old virgin males (29-34 d adult emergence) were more eager than the young virgin males (<7 d adult emergence), with eagerness measured by the percentage of first mate selected (first copulation occurred) and the total copulation duration by each group of males. Male mating competency is related to postmating duration (PMD); males mated 1 d earlier were significantly less likely to mate than virgin males. However, males mated 7 d earlier showed no significant difference in mating competency compared to virgin males. In conclusion, mate choice in C. lectularius is associated with both male and female mating status, age, and PMD.

Avoidance Behavior to Essential Oils by Anopheles minimus, a Malaria Vector in Thailand.

Essential oils extracted from 4 different plant species--citronella (Cymbopogon nardus), hairy basil (Ocimum americanum), sweet basil (Ocimum basilicum), and vetiver (Vetiveria zizanioides)-were investigated for their irritant and repellent activities against Anopheles minimus, using an excito-repellency test system. Pure essential oils were used in absolute ethanol at the concentrations of 0.5%, 1%, 2.5%, and 5% (v/v) compared with deet. At the lowest concentration of 0.5%, hairy basil displayed the best irritant and repellent effects against An. minimus. Citronella and vetiver at 1-5% showed strong irritant effects with>80% escape, while repellent effects of both oils were observed at 1% and 2.5% citronella (73-89% escape) and at 5% vetiver (83.9% escape). Sweet basil had only moderate irritant action at 5% concentration (69.6% escape) and slightly repellent on test mosquitoes (<50% escape). The results found that hairy basil, citronella, and vetiver are promising potential mosquito repellent products for protection against An. minimus.

Establishing the discriminating concentration for permethrin and fipronil resistance in Rhipicephalus sanguineus (Latreille) (Acari: Ixodidae), the brown dog tick.

BACKGROUND: Rhipicephalus sanguineus (Latreille), the brown dog tick, is a veterinary canine and urban pest. These ticks have been found to develop resistance and tolerance to the two commonly used acaricides permethrin and fipronil respectively. We have developed a discriminating concentration that can be used for rapid detection of permethrin and fipronil resistance in brown dog tick populations. The availability of a discriminating concentration for the brown dog tick provides an inexpensive and rapid resistance diagnostic technique that can be used to guide tick management plans for companion animals and aid in the selection of environmental treatment options. RESULTS: Establishing the discriminating concentration for permethrin and fipronil in brown dog ticks enables a resistant:susceptible screening. For permethrin the discriminating concentration was set at 0.19%, and for fipronil at 0.15%. Three additional diagnostic concentrations were chosen to evaluate resistance levels when larval tick numbers were available for screening. CONCLUSION: Future tick submissions from residences and kennel facilities can be subjected to a single chemical concentration to diagnose resistance, which minimizes time, costs and tick rearing requirements and guides effective control plans. With the standardized use of larval ticks, a client-submission quantity of ideally five engorged females would provide sufficient larval numbers to utilize this technique. © 2015 Society of Chemical Industry.

Detection of Permethrin Resistance and Fipronil Tolerance in Rhipicephalus sanguineus (Acari: Ixodidae) in the United States.

Permethrin is a commonly used acaricide for tick control on domestic animals and in residential environments, while fipronil use is restricted to on-animal treatment. Following widespread reports of permethrin and fipronil application failures to control indoor infestations of Rhipicephalus sanguineus (Latreille), the brown dog tick, 31 tick populations were obtained from Florida and Texas for acaricide resistance screening. These field-collected ticks from kennels and residential facilities were challenged with technical grade permethrin and fipronil to create dose response curves that were compared with an acaricide-susceptible strain. Permethrin resistance was successfully screened in nine populations, all of which were resistant or highly resistant. Tick susceptibility to fipronil was conducted on four populations, which were found to be tolerant, with resistance ratios below 10. This is the first documentation of R. sanguineus permethrin resistance and fipronil tolerance in the United States. Potential causes of resistance development and recommendations on future brown dog tick control management plans are discussed.