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1.
Vaccine ; 42(6): 1200-1210, 2024 Feb 27.
Artículo en Inglés | MEDLINE | ID: mdl-38302338

RESUMEN

Vaccines to protect against human papillomavirus (HPV) infection are recommended for all adolescents by the World Health Organization (WHO) and are primarily delivered in school-based settings. This systematic review aims to summarize the available evidence on the cost of HPV vaccine delivery in low- and middle-income countries (LMICs). This updated evidence is eminent given recent global efforts to revitalize HPV vaccine delivery following the COVID-19 pandemic and can be used to inform planning for program sustainability. We carried out a systematic review of published literature reporting the costs of HPV vaccine delivery in LMICs published between 2005 and 2023. Eligibility criteria were developed using the Population, Intervention, Comparator, Outcome (PICO) framework, and studies that reported primary costing data and unit costs of HPV vaccine delivery were included. From the included studies, we extracted data such as phase of HPV vaccine implementation when costing was done, delivery strategy, and unit costs. Unit costs were converted into 2022 US$ for comparability. All included studies underwent critical appraisal using an adapted framework including Consolidated Health Economics Evaluation Reporting Standards criteria, the WHO-led consensus statement on vaccine delivery costing, and other frameworks. Our research identified 226 records, of which 15 met our inclusion criteria. Most studies (64 %) were carried out in African countries and during HPV vaccine pilots or demonstrations (60 %). Vaccine delivery cost ranged from $0.31 to $24.07 per dose for financial costs and $1.48 to $48.70 per dose for economic costs. The critical appraisal showed that most studies did not describe the uncertainty of reported delivery cost. Our systematic review evidence suggests that HPV vaccine delivery costs vary widely depending on country and stage of implementation when costing was done. Areas for further research include costing when programs are beyond the introduction phase and in LMICs outside of Africa.


Asunto(s)
Infecciones por Papillomavirus , Vacunas contra Papillomavirus , Adolescente , Humanos , Países en Desarrollo , Pandemias , Programas de Inmunización , Organización Mundial de la Salud , Infecciones por Papillomavirus/epidemiología , Análisis Costo-Beneficio
2.
Hum Vaccin Immunother ; 20(1): 2315711, 2024 Dec 31.
Artículo en Inglés | MEDLINE | ID: mdl-38359841

RESUMEN

This is a response to Marchand & Masoud's response letter regarding my criticism "Response to Dr. Somovilla del Saz's letter to the editor regarding "Risk of all-cause and cardiac-related mortality after vaccination against COVID-19: A meta-analysis of self-controlled case series studies."" The response is a defense of the initial criticism to the paper regarding the validity of the inclusion of Ladapo´s paper.


Asunto(s)
COVID-19 , Humanos , COVID-19/prevención & control , Vacunación
3.
Lupus ; 33(4): 375-386, 2024 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-38315894

RESUMEN

OBJECTIVE: Vaccination against SARS-CoV-2 reduced morbidity and mortality rates due to COVID-19 worldwide. However, several adverse effects have been documented and of great interest such as Systemic Lupus Erythematosus (SLE). The aim of the present study was to perform a systematic review of case reports and case series describing the development of SLE following COVID-19 against vaccination. METHODS: Case report and case series studies were included. Systematic reviews, narratives, letters to the editor, correspondence, etc. were excluded. A selective bibliographic search was performed in the PubMed, Scopus, and EMBASE databases. In addition, the Web of Science platform was consulted. The Joanna Brigs Institute (JBI) tool was used to assess the risk of bias and quality of the studies. The Statistical Package for the Social Sciences (SPSS) 23.0 was used for the formal analysis of the descriptive data. RESULTS: 12 studies met the eligibility criteria and reported a total of 16 patients. The mean age was 42.4 ± 18.69 years. A slight predominance of post-vaccination SLE was observed in females (females (n = 9) and males (n = 7). A higher association was found with Pfizer-BioNTech-162b2 vaccine (75%), followed by Sinopharm (12.5%), Moderna (6.25%). and AstraZeneca (6.25%) vaccines. Most cases were associated with the first dose (56.25%), followed by the second dose (37.5%) and only one case associated with the third dose. The number of days elapsed from vaccine administration to the appearance of the first clinical manifestations was between 1 and 30 days. Mainly there was involvement of the musculoskeletal and cutaneous system. All patients responded well to treatment with good evolution and there was no case of death. CONCLUSION: Cases of SLE associated with COVID-19 vaccination against are infrequent. However, clinical monitoring is recommended for persons receiving the SARS-CoV-2 vaccine, mainly those receiving the first dose and the Pfizer-BioNTech-162b2 vaccine.


Asunto(s)
COVID-19 , Lupus Eritematoso Sistémico , Femenino , Masculino , Humanos , Adulto Joven , Adulto , Persona de Mediana Edad , Vacunas contra la COVID-19/efectos adversos , COVID-19/epidemiología , COVID-19/prevención & control , SARS-CoV-2 , Vacunación/efectos adversos
4.
Int J Infect Dis ; 142: 106963, 2024 May.
Artículo en Inglés | MEDLINE | ID: mdl-38354849

RESUMEN

OBJECTIVES: The COVID-19 pandemic changed the adult vaccination landscape, possibly permanently. This review attempts to quantitate the magnitude of those changes. METHODS: PubMed was searched for studies on adult / life-course vaccination between 1 January 2020 until 8 November 2022. RESULTS: Twenty-one articles were identified and observations summarised as positive developments/impediments to life-course immunisation, and areas needing policy and structural reform. Unprecedented funding, international co-operation and technical advances led to COVID-19 vaccines authorised in record time. Investments in infrastructure and an expanded healthcare workforce streamlined vaccine delivery to adults. Constant media coverage and targeted messaging have improved health literacy. Conversely, the speed of vaccine development was perceived as a safety risk, and an 'infodemic' of misinformation propagated through social media negatively influenced vaccine uptake. Vaccine access and affordability remains inequitable among older adults and minority groups. CONCLUSIONS: The COVID pandemic led to an opportunity to permanently change policies, attitudes, and systems for vaccine delivery to adults to establish a global life-course approach to immunisation. This is a call for action to sustain the momentum triggered by the COVID-19 pandemic. Addressing inequalities, improving health literacy and optimally using social media are critical to sustain adult vaccinations in post-COVID-19 era.


Asunto(s)
Vacunas contra la COVID-19 , COVID-19 , Humanos , Anciano , Pandemias/prevención & control , COVID-19/epidemiología , COVID-19/prevención & control , Vacunación , Inmunización
5.
ESC Heart Fail ; 11(3): 1795-1801, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38344896

RESUMEN

AIMS: Takotsubo syndrome (TTS) is a rare complication of vaccination. In this study, we sought to provide insight into the characteristics of reported TTS induced by vaccination. METHODS AND RESULTS: We did a systematic review, searching PubMed, Embase, Web of Science, Ovid MEDLINE, Journals@Ovid, and Scopus databases up to 26 April 2023 to identify case reports or case series of vaccine-induced TTS. We then extracted and summarized the data from these reports. Eighteen reports were identified, with a total of 19 patients with TTS associated with vaccinations. Of the 19 included patients, the majority were female (n = 13, 68.4%) with a mean age of 56.6 ± 21.9 years. Seventeen patients developed TTS after coronavirus disease 2019 vaccination, 14 of whom received an mRNA vaccination. Two cases of TTS occurred after influenza vaccination. Among the 19 patients, 17 (89.5%) completed transthoracic echocardiography and 16 (84.2%) underwent angiography procedures. Seven patients (36.8%) completed cardiac magnetic resonance imaging. The median time to symptom onset was 2 (inter-quartile range, 1-4) days. The most common symptoms were chest pain (68.4%), dyspnoea (57.9%), and digestive symptoms (31.6%). A total of 57.9% of patients developed nonspecific symptoms such as fatigue, myalgia, diaphoresis, and fever. Among the 16 reported cases of TTS, 15 patients (93.8%) exhibited elevated cardiac troponin levels, while among the nine reported cases, eight patients (88.9%) had elevated natriuretic peptide levels. All patients had electrocardiographic changes: ST-segment change (47.1%), T-wave inversion (58.8%), and prolonged corrected QT interval (35.3%). The most common TTS type was apical ballooning (88.2%). Treatment during hospitalization typically included beta-blockers (44.4%), angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (33.3%), and diuretics (22.2%). After treatment, 81.3% of patients were discharged with improved symptoms. Among this group, nine patients (56.3%) were reported to have recovered ventricular wall motion during follow-up. Two patients (12.5%) died following vaccination without resuscitation attempts. CONCLUSIONS: TTS is a rare but potentially life-threatening complication of vaccination. Typical TTS symptoms such as chest pain and dyspnoea should be considered alarming symptoms, though nonspecific symptoms are common. The risks of such rare adverse events should be balanced against the risks of infection.


Asunto(s)
Vacunas contra la COVID-19 , COVID-19 , Cardiomiopatía de Takotsubo , Humanos , Cardiomiopatía de Takotsubo/etiología , Cardiomiopatía de Takotsubo/diagnóstico , Vacunas contra la COVID-19/efectos adversos , Vacunas contra la COVID-19/administración & dosificación , COVID-19/complicaciones , COVID-19/epidemiología , COVID-19/prevención & control , Vacunación/efectos adversos , Vacunación/métodos , SARS-CoV-2 , Ecocardiografía
6.
Front Public Health ; 12: 1323195, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38347924

RESUMEN

Background: Despite the elevated risks of infection transmission, people in prisons frequently encounter significant barriers in accessing essential healthcare services in many countries. The present scoping review aimed to evaluate the state of availability and model of delivery of vaccination services within correctional facilities across the globe. Methods: Following the methodological framework for scoping reviews and adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews criteria, we conducted a systematic search across four peer-reviewed literature databases (Medline via PubMed, Web of Science, the Cochrane Library, Science Direct, and EBSCO), as well as 14 sources of grey literature. Two researchers meticulously examined the identified papers independently to extract pertinent data published between 2012 and 2022. The quality of the selected publications was assessed using established quality assessment tools. Results: Of the 11,281 identified papers 52 met the inclusion criteria. With the exception of one, all the included publications presented data from high-income countries, predominantly originating from the United States. Across the world, the most prevalent vaccines available in prison settings were COVID-19 and HBV vaccines, typically distributed in response to health crises such as pandemics, epidemics, and local outbreaks. Vaccine coverage and uptake rates within correctional facilities displayed noteworthy disparities among various countries and regions. Besides, individual and organizational barriers and facilitating factors of vaccination in prison settings emerged and discussed in the text. Discussion: The lack of vaccination services combined with low rates of vaccination coverage and uptake among people living and working in correctional facilities represents a cause for concern. Prisons are not isolated from the broader community, therefore, efforts to increase vaccine uptake among people who live and work in prisons will yield broader public health benefits.


Asunto(s)
COVID-19 , Enfermedades Transmisibles Emergentes , Vacunas , Humanos , Enfermedades Transmisibles Emergentes/epidemiología , Enfermedades Transmisibles Emergentes/prevención & control , Vacunación , Pandemias/prevención & control
7.
Neonatology ; 121(3): 271-282, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38286126

RESUMEN

INTRODUCTION: Severe respiratory syncytial virus (RSV) disease is most prevalent during infancy, particularly in those born prematurely, who benefit least from maternal antibody transfers. Maternal immunization is an attractive prevention leading to vaccine clinical trials. This meta-analysis aimed to evaluate recent maternal RSV vaccine trials. METHODS: Following PRISMA-P guidelines for systematic reviews and registered at https://www.crd.york.ac.uk/prospero, this study shortlisted six randomized clinical trials of suitable quality from four databases. Meta-analysis evaluated vaccine safety, immunogenicity, and efficacy in infants and their mothers. RESULTS: From random-effects and fixed-effects meta-analysis between trial and control arms, the maternal post-vaccination geometric antibody (Ab) titers showed pooled standard mean differences (SMDs [95% CI]) at delivery of (4.14 [2.91-5.37]), (3.95 [2.79-5.11]), and (12.20 [7.76, 16.64]) for RSV neutralizing Ab A, B, and F IgG, respectively. Vaccine administration was more likely than placebo to cause local pain, erythema, swelling, and systemic myalgia. Furthermore, the Ab levels in infants at birth showed pooled SMDs of each RSV A (3.9 [2.81-4.99]), RSV B (1.86 [1.09-2.62]), and RSV F IgG (2.24 [1.24-3.23]). The overall reduction of RSV-related lower respiratory tract infections and hospitalizations in the first 6 months of life was 52% and 48%, respectively. CONCLUSIONS: Not only does antenatal RSV vaccination look safe and immunogenic in vaccinated mothers, but it also reliably provides effective antibody levels in infants and diminishes RSV-related severe disease in infants under 6 months of age.


Asunto(s)
Infecciones por Virus Sincitial Respiratorio , Vacunas contra Virus Sincitial Respiratorio , Vacunación , Humanos , Infecciones por Virus Sincitial Respiratorio/prevención & control , Infecciones por Virus Sincitial Respiratorio/inmunología , Vacunas contra Virus Sincitial Respiratorio/inmunología , Vacunas contra Virus Sincitial Respiratorio/efectos adversos , Vacunas contra Virus Sincitial Respiratorio/administración & dosificación , Lactante , Femenino , Inmunidad Materno-Adquirida , Virus Sincitial Respiratorio Humano/inmunología , Recién Nacido , Anticuerpos Antivirales/sangre , Ensayos Clínicos Controlados Aleatorios como Asunto , Embarazo , Inmunogenicidad Vacunal
8.
Eur J Med Res ; 29(1): 55, 2024 Jan 17.
Artículo en Inglés | MEDLINE | ID: mdl-38229141

RESUMEN

BACKGROUND: Patients with autoimmune and immune-mediated diseases (AI-IMD) are at greater risk of COVID-19 infection; therefore, they should be prioritized in vaccination programs. However, there are concerns regarding the safety of COVID-19 vaccines in terms of disease relapse, flare, or exacerbation. In this study, we aimed to provide a more precise and reliable vision using systematic review and meta-analysis. METHODS: PubMed-MEDLINE, Embase, and Web of Science were searched for original articles reporting the relapse/flare in adult patients with AI-IMD between June 1, 2020 and September 25, 2022. Subgroup analysis and sensitivity analysis were conducted to investigate the sources of heterogeneity. Statistical analysis was performed using R software. RESULTS: A total of 134 observations of various AI-IMDs across 74 studies assessed the rate of relapse, flare, or exacerbation in AI-IMD patients. Accordingly, the crude overall prevalence of relapse, flare, or exacerbation was 6.28% (95% CI [4.78%; 7.95%], I2 = 97.6%), changing from 6.28% (I2 = 97.6%) to 6.24% (I2 = 65.1%) after removing the outliers. AI-IMD patients administering mRNA, vector-based, and inactive vaccines showed 8.13% ([5.6%; 11.03%], I2 = 98.1%), 0.32% ([0.0%; 4.03%], I2 = 93.5%), and 3.07% ([1.09%; 5.9%], I2 = 96.2%) relapse, flare, or exacerbation, respectively (p-value = 0.0086). In terms of disease category, nephrologic (26.66%) and hematologic (14.12%) disorders had the highest and dermatologic (4.81%) and neurologic (2.62%) disorders exhibited to have the lowest crude prevalence of relapse, flare, or exacerbation (p-value < 0.0001). CONCLUSION: The risk of flare/relapse/exacerbation in AI-IMD patients is found to be minimal, especially with vector-based vaccines. Vaccination against COVID-19 is recommended in this population.


Asunto(s)
Enfermedades Autoinmunes , COVID-19 , Adulto , Humanos , Vacunas contra la COVID-19/efectos adversos , SARS-CoV-2 , COVID-19/epidemiología , COVID-19/prevención & control , Vacunación , Enfermedad Crónica
9.
PLoS Med ; 21(1): e1004333, 2024 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-38181066

RESUMEN

BACKGROUND: Historically, lack of data on cost-effectiveness of influenza vaccination has been identified as a barrier to vaccine use in low- and middle-income countries. We conducted a systematic review of economic evaluations describing (1) costs of influenza illness; (2) costs of influenza vaccination programs; and (3) vaccination cost-effectiveness from low- and middle-income countries to assess if gaps persist that could hinder global implementation of influenza vaccination programs. METHODS AND FINDINGS: We performed a systematic search in Medline, Embase, Cochrane Library, CINAHL, and Scopus in January 2022 and October 2023 using a combination of the following key words: "influenza" AND "cost" OR "economic." The search included studies with publication years 2012 through 2022. Studies were eligible if they (1) presented original, peer-reviewed findings on cost of illness, cost of vaccination program, or cost-effectiveness of vaccination for seasonal influenza; and (2) included data for at least 1 low- or middle-income country. We abstracted general study characteristics and data specific to each of the 3 study types. Of 54 included studies, 26 presented data on cost-effectiveness, 24 on cost-of-illness, and 5 on program costs. Represented countries were classified as upper-middle income (UMIC; n = 12), lower-middle income (LMIC; n = 7), and low-income (LIC; n = 3). The most evaluated target groups were children (n = 26 studies), older adults (n = 17), and persons with chronic medical conditions (n = 12); fewer studies evaluated pregnant persons (n = 9), healthcare workers (n = 5), and persons in congregate living settings (n = 1). Costs-of-illness were generally higher in UMICs than in LMICs/LICs; however, the highest national economic burden, as a percent of gross domestic product and national health expenditure, was reported from an LIC. Among studies that evaluated the cost-effectiveness of influenza vaccine introduction, most (88%) interpreted at least 1 scenario per target group as either cost-effective or cost-saving, based on thresholds designated in the study. Key limitations of this work included (1) heterogeneity across included studies; (2) restrictiveness of the inclusion criteria used; and (3) potential for missed influenza burden from use of sentinel surveillance systems. CONCLUSIONS: The 54 studies identified in this review suggest an increased momentum to generate economic evidence about influenza illness and vaccination from low- and middle-income countries during 2012 to 2022. However, given that we observed substantial heterogeneity, continued evaluation of the economic burden of influenza illness and costs/cost-effectiveness of influenza vaccination, particularly in LICs and among underrepresented target groups (e.g., healthcare workers and pregnant persons), is needed. Use of standardized methodology could facilitate pooling across settings and knowledge sharing to strengthen global influenza vaccination programs.


Asunto(s)
Vacunas contra la Influenza , Gripe Humana , Embarazo , Femenino , Niño , Humanos , Anciano , Gripe Humana/epidemiología , Vacunas contra la Influenza/uso terapéutico , Países en Desarrollo , Análisis Costo-Beneficio , Vacunación
10.
Immun Inflamm Dis ; 12(1): e1136, 2024 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-38270314

RESUMEN

OBJECTIVE: The current study aims to evaluate the impact of COVID-19 infection and vaccination on ovarian reserve by detecting the anti-Mullerian hormone (AMH) level. METHOD: PubMed, Embase, Web of Science, and Scopus has been searched for studies assessing the effect of COVID-19 infection and/or vaccination on AMH levels up to February 27, 2023. Based on PRISMA 2020 statement criteria, a systematic review and meta-analysis of included studies were performed. The studies' quality was assessed by the National Institute of Health (NIH) quality assessment tool. The standardized mean difference (MD) of the AMH level was used and the quantitative values of each study were pooled separately by using a random effect model. RESULTS: Out of 246 studies screened, 18 were included in the systematic review and 14 in the meta-analysis. Included studies were published between 2021 and 2022 and were conducted in different countries, including the USA (n = 3), China (n = 2), Russia (n = 2), Turkey (n = 5), Israel (n = 3), Czech (n = 2), and Spain (n = 1). Eight studies investigated the effect of SARS-CoV-2 infection on AMH levels, and ten studies investigated the possible effect of COVID-19 vaccination on AMH levels. The pooled analysis showed a statistically significant decrease in AMH levels after COVID-19 infection (SMD: -0.24; 95% CI: -0.36 to -0.11; I2 = 0%; p = .0003). Vaccination analysis showed a nonstatistically significant change in AMH levels after COVID-19 vaccination (SMD: -0.11; 95% CI: -0.25 to 0.04; I2 = 35%; p = .14). CONCLUSION: COVID-19 infection can result in ovarian reserve injury by reducing the AMH level but getting vaccinated against COVID-19 has no impact on the AMH level.


Asunto(s)
Hormona Antimülleriana , COVID-19 , Humanos , COVID-19/prevención & control , Vacunas contra la COVID-19 , SARS-CoV-2 , Vacunación , Factor de Crecimiento Transformador beta
11.
Syst Rev ; 13(1): 30, 2024 01 16.
Artículo en Inglés | MEDLINE | ID: mdl-38229123

RESUMEN

BACKGROUND: The interaction between modelers and policymakers is becoming more common due to the increase in computing speed seen in recent decades. The recent pandemic caused by the SARS-CoV-2 virus was no exception. Thus, this study aims to identify and assess epidemiological mathematical models of SARS-CoV-2 applied to real-world data, including immunization for coronavirus 2019 (COVID-19). METHODOLOGY: PubMed, JSTOR, medRxiv, LILACS, EconLit, and other databases were searched for studies employing epidemiological mathematical models of SARS-CoV-2 applied to real-world data. We summarized the information qualitatively, and each article included was assessed for bias risk using the Joanna Briggs Institute (JBI) and PROBAST checklist tool. The PROSPERO registration number is CRD42022344542. FINDINGS: In total, 5646 articles were retrieved, of which 411 were included. Most of the information was published in 2021. The countries with the highest number of studies were the United States, Canada, China, and the United Kingdom; no studies were found in low-income countries. The SEIR model (susceptible, exposed, infectious, and recovered) was the most frequently used approach, followed by agent-based modeling. Moreover, the most commonly used software were R, Matlab, and Python, with the most recurring health outcomes being death and recovery. According to the JBI assessment, 61.4% of articles were considered to have a low risk of bias. INTERPRETATION: The utilization of mathematical models increased following the onset of the SARS-CoV-2 pandemic. Stakeholders have begun to incorporate these analytical tools more extensively into public policy, enabling the construction of various scenarios for public health. This contribution adds value to informed decision-making. Therefore, understanding their advancements, strengths, and limitations is essential.


Asunto(s)
COVID-19 , SARS-CoV-2 , Humanos , Estados Unidos , COVID-19/epidemiología , COVID-19/prevención & control , Pandemias/prevención & control , Vacunación , Evaluación de Resultado en la Atención de Salud
12.
Vaccine ; 42(5): 1034-1041, 2024 Feb 15.
Artículo en Inglés | MEDLINE | ID: mdl-38267331

RESUMEN

BACKGROUND: The effects of seasonal influenza vaccination on cardiovascular disease (CVD) outcomes, including among individuals with established CVD, are uncertain. METHODS: To evaluate the efficacy and safety of influenza vaccines compared to no vaccines or placebo for preventing all-cause/CVD mortality or all-cause/CVD hospitalization in the general population and in populations with pre-existing CVD, we conducted a living systematic review (LSR) and prospective meta-analysis (PMA). Published randomized controlled trials (RCT) and observational studies between 1994 and 2023 were searched. PRISMA guidelines were followed in the extraction of study details, and risk of bias was assessed using the Cochrane tools. Analyses were stratified by study design and CVD history. Study quality was evaluated using GRADE system. Meta analyses based on random-effects models were performed between July and October 2022. Pooled risk ratios (RRs) for all-cause/CVD mortality and all-cause/CVD hospitalization were main outcomes. RESULTS: Six published RCTs comprising 12,662 participants (mean age, 62 years; 45 % women; 8,797 with pre-existing CVD) and 37 observational studies comprising 6,311,703 participants (mean age, 49 years; 50 % women; 1,189,955 with pre-existing CVD) were included. Only those RCTs judged to be low risk were included in the analyses, and observational studies at anything greater than moderate risk of bias were excluded. In RCTs, influenza vaccine was not significantly associated with lower all-cause mortality (RR, 0.85; 95 %CI, 0.61-1.17), cardiovascular death (RR, 0.80; 95 %CI, 0.60-1.07), or CVD hospitalization (RR, 0.69; 95 %CI, 0.47-1.02). A statistically significant reduction in all-cause hospitalization (RR, 0.86; 95 %CI, 0.76-0.97) was observed. The evidence level was assessed as moderate for all-cause hospitalization, and low for other outcomes. Overall, observational studies suggested a stronger protective association between influenza vaccination and outcomes, except for CVD hospitalization. Based on RCTs, there was no difference in the effects of influenza vaccination on all-cause mortality among the general population compared to those with pre-existing CVD, although the summary point estimate favored benefits only in those with pre-existing CVD. CONCLUSIONS: While observational studies suggest that influenza vaccination may be associated with lower all-cause and CVD mortality and all-cause hospitalization, RCTs reported to date suggest a reduction in the risk of all-cause hospitalization but do not provide clear evidence to support preventive effects on mortality (all-cause or CVD) or CVD hospitalization.


Asunto(s)
Enfermedades Cardiovasculares , Vacunas contra la Influenza , Gripe Humana , Femenino , Humanos , Persona de Mediana Edad , Masculino , Enfermedades Cardiovasculares/prevención & control , Vacunación , Hospitalización
13.
Vaccine ; 42(5): 1022-1033, 2024 Feb 15.
Artículo en Inglés | MEDLINE | ID: mdl-38281897

RESUMEN

INTRODUCTION: The rapid development of COVID-19 vaccines is a cornerstone in the global effort to combat the pandemic. Healthcare workers (HCWs), being at the forefront of the pandemic response, have been the focus of vaccine mandate policies. This review aims to evaluate the impacts of COVID-19 vaccine mandates among HCWs, a critical step in understanding the broader implications of such policies in healthcare settings. OBJECTIVE: The review seeks to synthesize available literature to contribute to greater understanding of the outcomes associated with COVID-19 vaccine mandates for HCWs including vaccine uptake, infection rates, and staffing. METHODS: A systematic search of relevant literature published from March 2020 to September 2023 was conducted. The Newcastle-Ottawa scale was employed for quality assessment of the included articles. A total of 4,779 publications were identified, with 15 studies meeting the inclusion criteria for the review. A narrative synthesis approach was used to analyze these studies. RESULTS: COVID-19 vaccine mandates for HCWs were broadly successful in increasing vaccine uptake in most settings. Although the penalties imposed on unvaccinated HCWs did not lead to major disruption of health services, less well-resourced areas may have been more impacted. Furthermore, there is insufficient literature on the impact of the vaccine mandate on reducing SARS-CoV-2 infection among HCWs. CONCLUSION: COVID-19 vaccine mandates for HCWs have significant implications for public health policy and healthcare management. The findings underscore the need for tailored approaches in mandate policies, considering the specific contexts of healthcare settings and the diverse populations of HCWs. While mandates have shown potential in increasing vaccine uptake with minimal impacts to staffing, more work is needed to investigate the impacts of mandates across various contexts. In addition to these impacts, future research should focus on long-term effects and implications on broader public health strategies.


Asunto(s)
Vacunas contra la COVID-19 , COVID-19 , Humanos , COVID-19/prevención & control , SARS-CoV-2 , Vacunación , Personal de Salud
14.
Nat Commun ; 15(1): 921, 2024 Jan 31.
Artículo en Inglés | MEDLINE | ID: mdl-38297003

RESUMEN

A key goal of pertussis control is to protect infants too young to be vaccinated, the age group most vulnerable to this highly contagious respiratory infection. In the last decade, maternal immunization has been deployed in many countries, successfully reducing pertussis in this age group. Because of immunological blunting, however, this strategy may erode the effectiveness of primary vaccination at later ages. Here, we systematically reviewed the literature on the relative risk (RR) of pertussis after primary immunization of infants born to vaccinated vs. unvaccinated mothers. The four studies identified had ≤6 years of follow-up and large statistical uncertainty (meta-analysis weighted mean RR: 0.71, 95% CI: 0.38-1.32). To interpret this evidence, we designed a new mathematical model with explicit blunting mechanisms and evaluated maternal immunization's short- and long-term impact on pertussis transmission dynamics. We show that transient dynamics can mask blunting for at least a decade after rolling out maternal immunization. Hence, the current epidemiological evidence may be insufficient to rule out modest reductions in the effectiveness of primary vaccination. Irrespective of this potential collateral cost, we predict that maternal immunization will remain effective at protecting unvaccinated newborns, supporting current public health recommendations.


Asunto(s)
Infecciones del Sistema Respiratorio , Vacunas , Tos Ferina , Lactante , Embarazo , Femenino , Recién Nacido , Humanos , Tos Ferina/epidemiología , Tos Ferina/prevención & control , Vacunación , Parto , Inmunización
15.
PLoS Negl Trop Dis ; 18(1): e0011889, 2024 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-38190394

RESUMEN

BACKGROUND: Currently, vaccination of livestock with attenuated strains of Brucella remains an essential measure for controlling brucellosis, although these vaccines may be dangerous to humans. The aim of this study was to review the risk posed to humans by occupational exposure to vaccine strains and the measures that should be implemented to minimize this risk. METHODS: This article reviewed the scientific literature indexed in PubMed up to September 30, 2023, following "the PRISMA guidelines". Special emphasis was placed on the vaccine strain used and the route of exposure. Non-occupational exposure to vaccine strains, intentional human inoculation, publications on exposure to wild strains, and secondary scientific sources were excluded from the study. RESULTS: Nineteen primary reports were found and classified in three subgroups: safety accidents in vaccine factories that led to an outbreak (n = 2), survellaince studies on vaccine manufacturing workers with a serologic diagnosis of Brucella infection (n = 3), and publications of infection by vaccine strains during their administration, including case reports, records of occupational accidents and investigations of outbreaks in vaccination campaigns (n = 14). Although accidental exposure during vaccine manufacturing were uncommon, they could provoke large outbreaks through airborne spread with risk of spread to the neighboring population. Besides, despite strict protection measures, a percentage of vaccine manufacturing workers developed positive Brucella serology without clinical infection. The most frequent type of exposure with symptomatic infection was needle injury during vaccine administration. Prolonged contact with the pathogen, lack of information and a low adherence to personal protective equipment (PPE) use in the work environment were commonly associated with infection. CONCLUSIONS: Brucella vaccines pose occupational risk of contagion to humans from their production to their administration to livestock, although morbidity is low and deaths were not reported. Recommended protective measures and active surveillance of exposed workers appeared to reduce this risk. It would be advisable to carry out observational studies and/or systematic registries using solid diagnostic criteria.


Asunto(s)
Vacuna contra la Brucelosis , Brucella , Brucelosis , Exposición Profesional , Animales , Humanos , Brucelosis/epidemiología , Brucelosis/prevención & control , Vacunación , Ganado , Vacunas Atenuadas
16.
Lancet Glob Health ; 12(3): e445-e456, 2024 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-38272044

RESUMEN

BACKGROUND: Long-term immunity following yellow fever vaccination remains controversial. We aimed to summarise the literature regarding the long-term protection (≥10 years) conveyed by a single dose of yellow fever vaccination. METHODS: In this systematic review and meta-analysis, we searched 11 databases from database inception to Aug 24, 2023. We included cohort and cross-sectional studies reporting immunogenicity outcomes for children or adults who received a single dose of yellow fever vaccination 10 or more years ago. Case series and single case reports were excluded. Participants who received more than one dose of yellow fever vaccination before measurement of the outcome were excluded. Identified records were reviewed by two independent reviewers. The primary outcome of the meta-analysis was the pooled seroprotection rate. Risk of bias was assessed with the Risk Of Bias In Non-randomized Studies of Interventions tool, and the Joanna Briggs Institute tool for analytical cross-sectional studies. Studies of moderate or good quality that reported seroprotection were included for random-effects meta-analysis and stratified by endemicity and specific risk groups. The study was registered with PROSPERO, CRD42023384087. FINDINGS: Of the 7363 articles identified by our search, 39 were eligible for inclusion for systematic review. These studies comprised 2895 individuals vaccinated 10-60 years ago. 20 studies were included in the meta-analysis. Pooled seroprotection rates were 94% (95% CI 86-99) among healthy adults in a non-endemic setting (mostly travellers) and 76% (65-85) in an endemic setting (all Brazilian studies). The pooled seroprotection rate was 47% (35-60) in children (aged 9-23 months at time of vaccination) and 61% (38-82) in people living with HIV. Reported criteria for seroprotection were highly heterogeneous. INTERPRETATION: The gathered evidence suggests that a single dose of yellow fever vaccination provides lifelong protection in travellers. However, in people living with HIV and children (younger than 2 years), booster doses might still be required because lower proportions of vaccinees were seroprotected 10 or more years post-vaccination. Lower observed seroprotection rates among residents of endemic areas were partly explained by the use of a higher cutoff for seroprotection that was applied in Brazil. Studies from sub-Saharan Africa were scarce and of low quality; thus no conclusions could be drawn for this region. FUNDING: None.


Asunto(s)
Infecciones por VIH , Fiebre Amarilla , Niño , Adulto , Humanos , Fiebre Amarilla/prevención & control , Estudios Transversales , Vacunación , Factores de Tiempo
18.
J Med Virol ; 96(1): e29343, 2024 01.
Artículo en Inglés | MEDLINE | ID: mdl-38163281

RESUMEN

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes COVID-19 and has brought a huge burden in terms of human lives. Strict social distance and influenza vaccination have been recommended to avoid co-infections between influenza viruses and SARS-CoV-2. Scattered reports suggested a protective effect of influenza vaccine on COVID-19 development and severity. We analyzed 51 studies on the capacity of influenza vaccination to affect infection with SARS-CoV-2, hospitalization, admission to Intensive Care Units (ICU), and mortality. All subjects taken into consideration did not receive any anti-SARS-CoV-2 vaccine, although their status with respect to previous infections with SARS-CoV-2 is not known. Comparison between vaccinated and not-vaccinated subjects for each of the four endpoints was expressed as odds ratio (OR), with 95% confidence intervals (CIs); all analyses were performed by DerSimonian and Laird model, and Hartung-Knapp model when studies were less than 10. In a total of 61 029 936 subjects from 33 studies, influenza vaccination reduced frequency of SARS-CoV-2 infection [OR plus 95% CI = 0.70 (0.65-0.77)]. The effect was significant in all studies together, in health care workers and in the general population; distance from influenza vaccination and the type of vaccine were also of importance. In 98 174 subjects from 11 studies, frequency of ICU admission was reduced with influenza vaccination [OR (95% CI) = 0.71 (0.54-0.94)]; the effect was significant in all studies together, in pregnant women and in hospitalized subjects. In contrast, in 4 737 328 subjects from 14 studies hospitalization was not modified [OR (95% CI) = 1.05 (0.82-1.35)], and in 4 139 660 subjects from 19 studies, mortality was not modified [OR (95% CI) = 0.76 (0.26-2.20)]. Our study emphasizes the importance of influenza vaccination in the protection against SARS-CoV-2 infection.


Asunto(s)
COVID-19 , Vacunas contra la Influenza , Femenino , Humanos , Embarazo , COVID-19/epidemiología , COVID-19/mortalidad , Hospitalización , Vacunas contra la Influenza/administración & dosificación , Gripe Humana/epidemiología , Gripe Humana/prevención & control , SARS-CoV-2 , Vacunación
19.
Vaccine ; 42(4): 819-827, 2024 Feb 06.
Artículo en Inglés | MEDLINE | ID: mdl-38218668

RESUMEN

Delays in achieving polio eradication have led to ongoing risks of poliovirus importations that may cause outbreaks in polio-free countries. Because of the low, but non-zero risk of paralysis with oral poliovirus vaccines (OPVs), countries that achieve and maintain high national routine immunization coverage have increasingly shifted to exclusive use of inactivated poliovirus vaccine (IPV) for all preventive immunizations. However, immunization coverage within countries varies, with under-vaccinated subpopulations potentially able to sustain transmission of imported polioviruses and experience local outbreaks. Due to its cost, ease-of-use, and ability to induce mucosal immunity, using OPV as an outbreak control measure offers a more cost-effective option in countries in which OPV remains in use. However, recent polio outbreaks in IPV-only countries raise questions about whether and when IPV use for outbreak response may fail to stop poliovirus transmission and what consequences may follow from using OPV for outbreak response in these countries. We systematically reviewed the literature to identify modeling studies that explored the use of IPV for outbreak response in IPV-only countries. In addition, applying a model of the 2022 type 2 poliovirus outbreak in New York, we characterized the implications of using different OPV formulations for outbreak response instead of IPV. We also explored the hypothetical scenario of the same outbreak except for type 1 poliovirus instead of type 2. We find that using IPV for outbreak response will likely only stop outbreaks for polioviruses of relatively low transmission potential in countries with very high overall immunization coverage, seasonal transmission dynamics, and only if IPV immunization interventions reach some unvaccinated individuals. Using OPV for outbreak response in IPV-only countries poses substantial risks and challenges that require careful consideration, but may represent an option to consider for some outbreaks in some populations depending on the properties of the available vaccines and coverage attainable.


Asunto(s)
Poliomielitis , Poliovirus , Humanos , Estados Unidos/epidemiología , Vacuna Antipolio de Virus Inactivados , Vacuna Antipolio Oral , Poliomielitis/epidemiología , Poliomielitis/prevención & control , Brotes de Enfermedades/prevención & control , Vacunación , New York
20.
Syst Rev ; 13(1): 14, 2024 01 05.
Artículo en Inglés | MEDLINE | ID: mdl-38178265

RESUMEN

INTRODUCTION: The HPV vaccine is characterized by its significant effectiveness in preventing the occurrence of cervical cancer. However, the South Asian countries face multiple challenges in implementing the human papillomavirus vaccine (HPV) at scale. Implementation of human papillomavirus vaccination for eliminating cervical cancer necessitates investigating the factors that impact the health system of these nations. Hence, this review will map the evidence on factors influencing the scaling up of human papillomavirus vaccination in South Asia. METHODS: The proposed scoping review will follow the steps given by Arksey and O'Malley and Levac et al. The search approach will follow McGowan et al. (14) evidence-based manual for Peer Analysis of Electronic Search Strategies (PRESS 2015) for systematic searches. Using a comprehensive search, the literature from 2006 onward will be identified from PubMed, CINAHL, EMBASE, Web of Science, and Scopus. The search strategy will include terms relating to the HPV vaccine and implementation. A predefined criterion for the inclusion and exclusion of studies will be adopted by three review authors independently to determine the eligible studies. The results will be narratively synthesized and examined in addition to being quantitatively presented to provide an outline. The review will be presented per the "Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for scoping review (PRISMA-ScR)" guidelines. CONCLUSIONS/DISCUSSION: The evaluation is anticipated to map the barriers and enablers influencing the rollout of the human papillomavirus vaccine. Lessons learned from the South Asian countries, where the vaccine has been implemented, may contribute to aiding the implementation of the vaccine in countries with similar health systems in an effective manner. SYSTEMATIC REVIEW REGISTRATION: The protocol was prospectively registered on the "open science framework". The registration DOI is https://doi.org/10.17605/OSF.IO/T5SW9 .


Asunto(s)
Infecciones por Papillomavirus , Vacunas contra Papillomavirus , Neoplasias del Cuello Uterino , Femenino , Humanos , Sur de Asia , Infecciones por Papillomavirus/prevención & control , Proyectos de Investigación , Literatura de Revisión como Asunto , Revisiones Sistemáticas como Asunto/métodos , Neoplasias del Cuello Uterino/prevención & control , Vacunación
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