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Adams K, Diallo D, Tadount F, Mouajou V, Quach C. Evaluation of the decision-making process underlying the initial off-label use of vaccines: A scoping review. Vaccine 2024; 42:126246. [PMID: 39191181 DOI: 10.1016/j.vaccine.2024.126246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 08/15/2024] [Accepted: 08/16/2024] [Indexed: 08/29/2024]
Abstract
BACKGROUND This scoping review aimed to assess the non-standardized decision-making process of National or International Immunization Technical Advisory Groups (NITAG) in developing novel off-label recommendations by examining the supportive evidence. METHODS We used the Joanna Briggs Institute framework. A search strategy was developed with a librarian to identify recommendations and evidence from peer-reviewed and gray literature until January 2022, using PubMed, Medline, EMBASE, clinicaltrials.gov, the International Clinical trials registry, governmental agency and pharmaceutical websites, the Global NITAG Network center website, and Google Scholar. Recommendations involving one of 26 pre-identified vaccine-preventable diseases, human use, and the introduction of a novel change across time and countries, were included. Evidence regarding efficacy/effectiveness, safety, or immunogenicity were included. Recommendations for fast-track approval, unlabeled or individual level off-label use, passive immunization, booster doses or provincial strategies were excluded. Only English and French documents were included. Two reviewers reviewed title/abstracts and full-text documents, and three performed data extraction. The primary outcome was the presence and elements of the evidence. FINDINGS Out of 4023 documents, 12 were included, and 116 were found through manual search. Over the 40-year span captured (1982-2018), most recommendations were from the last two decades and included evidence, except three from the 1990s. Most included safety (69.2%) and immunogenicity (65.4%) studies and randomized controlled trials (57.7%). Indication-based recommendations included RCTs more often (84.6%) than posology-based recommendations (30.8%). There was evidence involving populations or vaccines different from those in the recommendation. INTERPRETATION Critical outcomes evidence is not systematically included in off-label recommendations, nor must it involve the exact population or vaccine(s) of concern. However, in recent years, more off-label recommendations include critical outcome evidence, mainly RCTs.
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Affiliation(s)
- Kelsey Adams
- Centre de Recherche, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
| | - Dieynaba Diallo
- Centre de Recherche, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada; Institut national de santé publique du Québec, Montréal, Québec, Canada
| | - Fazia Tadount
- Centre de Recherche, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
| | - Verinsa Mouajou
- Centre de Recherche, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
| | - Caroline Quach
- Centre de Recherche, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada; Department of Microbiology, Infectious Diseases, and Immunology, University of Montreal Faculty of Medicine, Montreal, Quebec, Canada.
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Huang Y, Song Y, Li J, Wang Y, Zeng X, Ma C, Yin Z. Survey on Immunization Services for Children with Medical Conditions - China, 2022. China CDC Wkly 2023; 5:419-423. [PMID: 37275266 PMCID: PMC10235818 DOI: 10.46234/ccdcw2023.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 04/24/2023] [Indexed: 06/07/2023] Open
Abstract
What is already known about this topic? Children with medical conditions frequently experience under-immunization. Ensuring high-quality immunization services is crucial for enhancing vaccination coverage levels; nevertheless, the state of immunization service provision for children with medical conditions in China remains unclear. What is added by this report? Immunization support for children with medical conditions in China demonstrates considerable variability and may be inadequate. Primary obstacles to the provision of immunization services include an absence of comprehensive vaccination recommendations and assessment guidelines for specific medical conditions, as well as inconsistencies among vaccine recommendations, package inserts, and expert consensus statements pertaining to the vaccination of children with medical conditions. What are the implications for public health practice? The examination of provincial practices in providing immunization services for children with medical conditions, as well as understanding the barriers faced by National Immunization Program providers in administering vaccinations, can contribute to the improvement of immunization services for this population in China.
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Affiliation(s)
- Yong Huang
- Guangzhou Municipal Center for Disease Control and Prevention, Guangzhou City, Guangdong Province, China
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yudan Song
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Junhong Li
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yamin Wang
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xiang Zeng
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
- Chinese Field Epidemiology Training Program, Chinese Center for Disease Control and Prevention, Beijing, China
- Zhuhai Municipal Center for Disease Control and Prevention, Zhuhai City, Guangdong Province, China
| | - Chao Ma
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zundong Yin
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
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Kazma J, Araji T, Khilnani A, van den Anker J, Ahmadzia HK. Knowledge, Attitude, and Beliefs of Medication Use in Pregnancy in an Urban Tertiary Care Center. J Clin Pharmacol 2022; 62 Suppl 1:S30-S35. [PMID: 36106780 DOI: 10.1002/jcph.2116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 06/13/2022] [Indexed: 11/06/2022]
Abstract
Medication use in pregnancy is common. However, there is a gap in the literature assessing the knowledge of pregnant individuals about medication use in pregnancy. The aim of our study is to assess the knowledge, attitudes, and beliefs of pregnant people on medication use in pregnancy. We conducted a cross-sectional survey questionnaire that was completed by pregnant patients from December 2021 to January 2022. The survey included questions regarding knowledge, attitude, and sources for obtaining information about medication use in pregnancy and general statements from the Beliefs about Medicines Questionnaire (BMQ). A total of 150 participants completed the survey. Most patients reported that a person should know that medication use for chronic diseases must be modified during pregnancy and that medications can be used in any trimester of pregnancy. Most reported that medication use can lead to fetal growth restriction and maternal bleeding. The mean scores (SDs) on the BMQ-General for the overuse, harm, and benefit statements were 8.7 (2.4), 8.2 (3.1), and 15.7 (2.8). Even though medication use in pregnancy is common, it is an area of concern to pregnant patients. More research on identifying the risks of different medicines used in pregnancy is thus needed.
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Affiliation(s)
- Jamil Kazma
- Department of Obstetrics and Gynecology, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Tarek Araji
- Department of Obstetrics and Gynecology, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Aneka Khilnani
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - John van den Anker
- Division of Clinical Pharmacology, Children's National Hospital, Washington, DC, USA.,Division of Pediatric Pharmacology and Pharmacometrics, University Children's Hospital Basel, University of Basel, Basel, Switzerland
| | - Homa K Ahmadzia
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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Affiliation(s)
- H Cody Meissner
- From the Department of Pediatrics, Tufts Children's Hospital, Tufts Medical Center, Boston
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Diallo D, Quach C. Evaluation of the decision-making process underlying the initial off-label use of vaccines: a scoping review protocol. BMJ Open 2021; 11:e042748. [PMID: 33664073 PMCID: PMC7934726 DOI: 10.1136/bmjopen-2020-042748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 10/31/2020] [Accepted: 02/09/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Vaccination has become a central part of public health prevention. Vaccines are introduced after licensure by national regulatory authorities, whereas recommendations for use of licensed vaccines are made by national or international advisory committees and may include off-label use. The methodological and decision-making processes that are used to assess novel initial off-label vaccine use are unclear. This review aims to examine the off-label assessment processes to map evidence and concepts used in the decision-making process and present a common approach between all recommendations and specifics of each decision. METHODS AND ANALYSIS The methodological framework described at the Joanna Briggs Institute will be applied to this scoping review. A search strategy was developed, in collaboration with an experienced senior health research librarian, by combining Mesgarpour's highly sensitive search strategies. Peer-reviewed and grey literature will be systematically identified using PubMed, Medline and EMBASE; governmental agency and pharmaceutical websites; and search engines, such as Google Scholar. Reports and studies on off-label vaccine use in public health will be included. Screening will be independently undertaken by two reviewers. Data will be extracted using a standard form. Results will be narratively summarised to highlight relevant findings and guide the development of an analytical framework for off-label vaccination recommendations. ETHICS AND DISSEMINATION This research does not require ethical approval. This scoping review will provide decision-making elements and a synthesis of knowledge on vaccines off-label use. Findings will be relevant to decision-makers/advisory committees and public health. These will be disseminated through peer-reviewed articles and conferences.
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Affiliation(s)
- Dieynaba Diallo
- Centre de Recherche, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
- Microbiology, Infectious Diseases, and Immunology, University of Montreal Faculty of Medicine, Montreal, Quebec, Canada
| | - Caroline Quach
- Centre de Recherche, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
- Microbiology, Infectious Diseases, and Immunology, University of Montreal Faculty of Medicine, Montreal, Quebec, Canada
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Abstract
Vaccines are one of the greatest public health achievements, protecting children and adults against numerous infectious diseases; however, the complex, rigorous process of vaccine development is unknown to many. A candidate vaccine undergoes extensive evaluation of safety and efficacy to meet licensure requirements before recommendations for use become policy. This time-consuming process involves an intricate collaboration among academia, public and private organizations, and federal agencies to ensure that safety is prioritized in every step. Vaccine safety continues to be monitored after licensure through a robust system. Yet, vaccine hesitancy remains a major challenge, especially now with the coronavirus disease 2019 (COVID-19) pandemic and concerns about the speed with which candidate vaccines are being developed. This article reviews the vaccine development process and the systems in place to ensure safety and effectiveness. A better understanding of these topics is necessary to address concerns and improve public acceptance of all vaccines, particularly COVID-19 vaccines. [Pediatr Ann. 2020;49(12):e509-e515.].
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Jacobson RM, St Sauver JL, Griffin JM, MacLaughlin KL, Finney Rutten LJ. How health care providers should address vaccine hesitancy in the clinical setting: Evidence for presumptive language in making a strong recommendation. Hum Vaccin Immunother 2020; 16:2131-2135. [PMID: 32242766 PMCID: PMC7553710 DOI: 10.1080/21645515.2020.1735226] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Vaccine hesitancy occurs throughout the world and can result in poor vaccine uptake and vaccine-preventable disease-outbreaks. Vaccine hesitancy dates back to the days of Edward Jenner and the smallpox vaccine. It persists despite the preponderance of evidence supporting vaccine safety and effectiveness. Studies show even among parents of well-vaccinated children that 15–35% of those parents are vaccine-hesitant. Studies have failed to show the efficacy of educational interventions, and, indeed, a number of studies of educational interventions show a contrarian effect leaving the vaccine-hesitant more entrenched in their views. Still dozens of studies support health care provider recommendation as a major factor in achieving high rates of vaccine uptake. Furthermore, studies find those recommendations perceived as stronger are more effective than those perceived as weaker. What makes for a stronger recommendation? Several observational studies indicate that presumptive, announcement language as contrasted with participatory, conversational language makes for a stronger more effective recommendation. Several trials now demonstrate that health care providers and practices can implement this language and obtain higher vaccination uptake. The authors recommend the practice be adopted as a routine practice in the clinical setting for all vaccinations
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Affiliation(s)
- Robert M Jacobson
- Department of Pediatric and Adolescent Medicine, Mayo Clinic , Rochester, MN, USA.,Department of Health Sciences Research, Mayo Clinic , Rochester, MN, USA
| | | | - Joan M Griffin
- Department of Health Sciences Research, Mayo Clinic , Rochester, MN, USA
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Pickering LK, Meissner HC, Orenstein WA, Cohn AC. Principles of Vaccine Licensure, Approval, and Recommendations for Use. Mayo Clin Proc 2020; 95:600-608. [PMID: 32063358 DOI: 10.1016/j.mayocp.2019.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 10/30/2019] [Accepted: 11/11/2019] [Indexed: 11/30/2022]
Abstract
The licensure and recommendation processes for vaccines are complex. In the United States, vaccines are licensed for the civilian and military populations on the basis of review of Biologics License Applications submitted to the Food and Drug Administration (FDA) by vaccine manufacturers. For FDA-licensed vaccines, the product label includes indications, contraindications, and precautions for each vaccine. Package inserts do not include recommendations for vaccine use from the Advisory Committee on Immunization Practices (ACIP). The ACIP is chartered as a federal advisory committee to provide expert external advice and guidance to the director of the Centers for Disease Control and Prevention on the use of vaccines and related agents for control of vaccine preventable diseases in the civilian and military populations of the United States. As an external advisory committee to the Centers for Disease Control and Prevention, the ACIP has no regulatory authority but the committee does have responsibility for approving vaccines to be covered under the Vaccines for Children program. To implement ACIP vaccine recommendations in the public and private sectors, a collaboration of federal, state, and local governments as well as private organizations dealing with public health, vaccine supply, vaccine administration, vaccine finance, outcomes monitoring, public perception, and public trust and support must work together. Issues including vaccine misinformation, declining community immunity (herd protection), and need for risk communication add stress to this complex and fragile system. This study describes the functions of and interactions between FDA and ACIP.
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Affiliation(s)
- Larry K Pickering
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA.
| | - H Cody Meissner
- Department of Pediatrics, Tufts Medical Center, Tufts University School of Medicine, Boston, MA
| | - Walter A Orenstein
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA; Emory Vaccine Center, Emory University, Atlanta, GA
| | - Amanda C Cohn
- Immunization Services, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
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Meissner HC, Nair N, Plotkin SA. The National Vaccine Injury Compensation Program: Striking a Balance Between Individual Rights and Community Benefit. JAMA 2019; 321:343-344. [PMID: 30608524 DOI: 10.1001/jama.2018.20421] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- H Cody Meissner
- Tufts Medical Center, Department of Pediatrics, Tufts University School of Medicine, Boston, Massachusetts
| | - Narayan Nair
- Division of Injury Compensation Program, Department of Health and Human Services, Rockville, Maryland
| | - Stanley A Plotkin
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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