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Braun MR, Flitter BA, Sun W, Tucker SN. An easy pill to swallow: oral recombinant vaccines for the 21st century. Curr Opin Immunol 2023; 84:102374. [PMID: 37562075 DOI: 10.1016/j.coi.2023.102374] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/06/2023] [Accepted: 07/07/2023] [Indexed: 08/12/2023]
Abstract
Oral vaccines have a distinctive advantage of stimulating immune responses in the mucosa, where numerous pathogens gain entry and cause disease. Although various efforts have been attempted to create recombinant mucosal vaccines that provoke strong immunogenicity, the outcomes in clinical trials have been weak or inconsistent. Therefore, next-generation mucosal vaccines are needed that are more immunogenic. Here, we discuss oral vaccines with an emphasis on a next-generation mucosal vaccine that utilizes a nonreplicating human recombinant adenovirus type-5 (rAd5) vector. Numerous positive clinical results investigating oral rAd5 vaccines are reviewed, with a summary of the immunogenicity and efficacy results for specific vaccine indications of influenza, norovirus, and SARS-CoV-2. The determination of correlates of protection for oral vaccination and the potential impact this novel vaccine formulation may have on disease transmission are also discussed. In summary, successful oral vaccination can be accomplished and would have major public health benefits if approved.
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Affiliation(s)
- Molly R Braun
- Vaxart, Inc., 170 Harbor Way STE 300, South San Francisco, CA 94080, USA
| | - Becca A Flitter
- Vaxart, Inc., 170 Harbor Way STE 300, South San Francisco, CA 94080, USA
| | - William Sun
- Vaxart, Inc., 170 Harbor Way STE 300, South San Francisco, CA 94080, USA
| | - Sean N Tucker
- Vaxart, Inc., 170 Harbor Way STE 300, South San Francisco, CA 94080, USA.
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2
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Cho BH, Athar HM, Bates LG, Yarnoff BO, Harris LQ, Washington ML, Jones-Jack NH, Pike JJ. Patient flow time data of COVID-19 vaccination clinics in 23 sites, United States, April and May 2021. Vaccine 2023; 41:750-755. [PMID: 36526502 PMCID: PMC9742208 DOI: 10.1016/j.vaccine.2022.12.013] [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: 08/03/2022] [Revised: 11/10/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Public health department (PHD) led COVID-19 vaccination clinics can be a critical component of pandemic response as they facilitate high volume of vaccination. However, few patient-time analyses examining patient throughput at mass vaccination clinics with unique COVID-19 vaccination challenges have been published. METHODS During April and May of 2021, 521 patients in 23 COVID-19 vaccination sites counties of 6 states were followed to measure the time spent from entry to vaccination. The total time was summarized and tabulated by clinic characteristics. A multivariate linear regression analysis was conducted to evaluate the association between vaccination clinic settings and patient waiting times in the clinic. RESULTS The average time a patient spent in the clinic from entry to vaccination was 9 min 5 s (range: 02:00-23:39). Longer patient flow times were observed in clinics with higher numbers of doses administered, 6 or fewer vaccinators, walk-in patients accepted, dedicated services for people with disabilities, and drive-through clinics. The multivariate linear regression showed that longer patient waiting times were significantly associated with the number of vaccine doses administered, dedicated services for people with disabilities, the availability of more than one brand of vaccine, and rurality. CONCLUSIONS Given the standardized procedures outlined by immunization guidelines, reducing the wait time is critical in lowering the patient flow time by relieving the bottleneck effect in the clinic. Our study suggests enhancing the efficiency of PHD-led vaccination clinics by preparing vaccinators to provide vaccines with proper and timely support such as training or delivering necessary supplies and paperwork to the vaccinators. In addition, patient wait time can be spent answering questions about vaccination or reviewing educational materials on other public health services.
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Affiliation(s)
- Bo-Hyun Cho
- Centers for Disease Control and Prevention, Atlanta, GA, United States.
| | - Heba M. Athar
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Laurel G. Bates
- RTI International, Research Triangle Park, NC, United States
| | | | | | | | | | - Jamison J. Pike
- Centers for Disease Control and Prevention, Atlanta, GA, United States
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Allocation of scarce resources in a pandemic: rapid systematic review update of strategies for policymakers. J Clin Epidemiol 2021; 139:255-263. [PMID: 34048911 PMCID: PMC8642033 DOI: 10.1016/j.jclinepi.2021.04.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 03/29/2021] [Accepted: 04/08/2021] [Indexed: 01/07/2023]
Abstract
OBJECTIVE In pandemics like COVID-19, the need for medical resources quickly outpaces available supply. policymakers need strategies to inform decisions about allocating scarce resources. STUDY DESIGN AND SETTING We updated a systematic review on evidence-based approaches and searched databases through May 2020 for evaluation of strategies for policymakers. RESULTS The 201 identified studies evaluated reducing demand for healthcare, optimizing existing resources, augmenting resources, and adopting crisis standards of care. Most research exists to reduce demand (n = 149); 39 higher quality studies reported benefits of contact tracing, school closures, travel restrictions, and mass vaccination. Of 28 strategies to augment resources, 6 higher quality studies reported effectiveness of establishing temporary facilities, use of volunteers, and decision support software. Of 23 strategies to optimize existing resources, 12 higher quality studies reported successful scope of work expansions and building on existing interagency agreements. Of 15 COVID-19 studies, 5 higher quality studies reported on combinations of policies and benefits of community-wide mask policies. CONCLUSION Despite the volume, the evidence base is limited; few strategies were empirically tested in robust study designs. The review provides a comprehensive overview of the effects of strategies to allocate resources and provides critical appraisal to identify the best available evidence.
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Perry IA, Noe RS, Stewart A. Use of Medical Countermeasures in Small-Scale Emergency Responses. Am J Public Health 2019; 108:S196-S201. [PMID: 30192656 DOI: 10.2105/ajph.2018.304491] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
It is well documented that long-standing focus on public health emergency preparedness medical countermeasures (MCMs) distribution and mass dispensing capabilities for mitigation of bioterrorism incidents and a lack of real-world opportunities to test national preparedness for large-scale emergencies has hindered development of a body of evidence-based practices in the United States. To encourage jurisdictions seeking innovative opportunities for continuous improvement, we describe instances when the MCM capabilities were used to address smaller-scale, more-frequent public health emergencies such as disease outbreaks, natural disasters, or routine influenza vaccination. We argue that small-scale events represent a critical opportunity that state, local, tribal, and territorial entities can utilize for greater gains in MCM operational readiness than through exercises or planned reviews. By using and evaluating MCM capabilities during a real response, jurisdictions can advance preparedness science and support the translation of research into practice, thereby increasing their capacity to scale up for larger, rarer, higher-consequence emergencies.
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Affiliation(s)
- Ijeoma A Perry
- All of the authors are with Centers for Disease Control and Prevention, Office of Public Health Preparedness and Response, Atlanta, GA
| | - Rebecca S Noe
- All of the authors are with Centers for Disease Control and Prevention, Office of Public Health Preparedness and Response, Atlanta, GA
| | - Amy Stewart
- All of the authors are with Centers for Disease Control and Prevention, Office of Public Health Preparedness and Response, Atlanta, GA
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Kiser M, Lovelace K. A National Network of Public Health and Faith-Based Organizations to Increase Influenza Prevention Among Hard-to-Reach Populations. Am J Public Health 2019; 109:371-377. [PMID: 30676795 PMCID: PMC6366510 DOI: 10.2105/ajph.2018.304826] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2018] [Indexed: 11/04/2022]
Abstract
We studied a national collaboration to prevent the spread of 2009 H1N1 and seasonal influenza, and highlighted how a partnership among the Interfaith Health Program (IHP) at Emory University, the Department of Health and Human Services Partnership Center, the Centers for Disease Control and Prevention, and the Association of State and Territorial Health Officials (ASTHO) leveraged the distinctive capabilities of local public health, health care, and faith-based organizations in 10 communities around the country. From 2009 to 2016, IHP, ASTHO, and the Partnership Center worked as intermediaries with these partnerships, aligning and amplifying their capacity to extend influenza prevention services for hard-to-reach vulnerable populations. We suggested that intermediary organizations enabled information sharing, co-learning, and dissemination of best practices through horizontal and vertical channels. We recommended practices for these partnerships to engage local networks that share commitments to eliminate health disparities, to use a frame of strengths and assets, and to provide a supportive multilocal, multilevel learning community.
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Affiliation(s)
- Mimi Kiser
- Mimi Kiser is with the Rollins School of Public Health, Emory University, Atlanta, GA. Kay Lovelace is with the Department of Public Health Education, University of North Carolina, Greensboro
| | - Kay Lovelace
- Mimi Kiser is with the Rollins School of Public Health, Emory University, Atlanta, GA. Kay Lovelace is with the Department of Public Health Education, University of North Carolina, Greensboro
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Kearney A, Pettit C. Introduction to Biological Agents and Pandemics. CIOTTONE'S DISASTER MEDICINE 2016. [PMCID: PMC7152235 DOI: 10.1016/b978-0-323-28665-7.00123-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Liebowitz D, Lindbloom JD, Brandl JR, Garg SJ, Tucker SN. High titre neutralising antibodies to influenza after oral tablet immunisation: a phase 1, randomised, placebo-controlled trial. THE LANCET. INFECTIOUS DISEASES 2015; 15:1041-1048. [DOI: 10.1016/s1473-3099(15)00266-2] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 03/21/2015] [Accepted: 04/01/2015] [Indexed: 12/12/2022]
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O'Hagan JJ, Wong KK, Campbell AP, Patel A, Swerdlow DL, Fry AM, Koonin LM, Meltzer MI. Estimating the United States demand for influenza antivirals and the effect on severe influenza disease during a potential pandemic. Clin Infect Dis 2015; 60 Suppl 1:S30-41. [PMID: 25878299 DOI: 10.1093/cid/civ084] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Following the detection of a novel influenza strain A(H7N9), we modeled the use of antiviral treatment in the United States to mitigate severe disease across a range of hypothetical pandemic scenarios. Our outcomes were total demand for antiviral (neuraminidase inhibitor) treatment and the number of hospitalizations and deaths averted. The model included estimates of attack rate, healthcare-seeking behavior, prescription rates, adherence, disease severity, and the potential effect of antivirals on the risks of hospitalization and death. Based on these inputs, the total antiviral regimens estimated to be available in the United States (as of April 2013) were sufficient to meet treatment needs for the scenarios considered. However, distribution logistics were not examined and should be addressed in future work. Treatment was estimated to avert many severe outcomes (5200-248,000 deaths; 4800-504,000 hospitalizations); however, large numbers remained (25,000-425,000 deaths; 580,000-3,700,000 hospitalizations), suggesting that the impact of combinations of interventions should be examined.
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Affiliation(s)
- Justin J O'Hagan
- National Center for Immunization and Respiratory Diseases (NCIRD), Centers for Disease Control and Prevention (CDC) IHRC Inc
| | - Karen K Wong
- Epidemic Intelligence Service assigned to Influenza Division
| | | | | | - David L Swerdlow
- National Center for Immunization and Respiratory Diseases (NCIRD), Centers for Disease Control and Prevention (CDC) Modeling Unit and Office of the Director, NCIRD
| | - Alicia M Fry
- Epidemiology and Prevention Branch, Influenza Division, NCIRD
| | - Lisa M Koonin
- Influenza Coordination Unit, Office of Infectious Diseases
| | - Martin I Meltzer
- Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, Georgia
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Rebmann T, Loux TM, Swick Z, Dolgin H, Reddick D, Wakefield M. Are US jurisdictions prepared to dispense medical countermeasures through open points of dispensing? Findings from a national study. Health Secur 2015; 13:96-105. [PMID: 25813973 DOI: 10.1089/hs.2014.0080] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Communities will rely on open points of dispensing (PODs) for mass dispensing of medical countermeasures following a bioterrorism attack or a pandemic. US Cities Readiness Initiative (CRI) open POD preparedness is assessed using the Technical Assistance Review (TAR) but focuses on oral prophylaxis dispensing; mass vaccination readiness is not well measured. Non-CRI preparedness had not been studied. In 2013 an online questionnaire was sent to all 456 CRIs and a random sample of 500 non-CRIs to measure open POD preparedness and exercise participation. Hierarchical linear regression was used to describe factors associated with higher POD preparedness and exercise participation scores. In total, 257 subjects participated, for a 41% response rate. Almost all open PODs have existing written plans and/or a layout for each site (93.4%, n=240, and 87.0%, n=220). Only half (46.7%, n=120) have an alternative dispensing modality in place, and even fewer (42.6%, n=104) report having adequate staffing. Determinants of open POD preparedness were perceived preparedness, participation in more POD exercises, and more closed POD coverage. Most jurisdictions conducted a full-scale exercise and a staff notification drill (83.7%, n=215 for both). Fewer than half (40.5%, n=104) have conducted a vaccination clinic exercise. Determinants of increased POD exercises were perceived preparedness, years of work experience, community type (nontribal), and larger population. Because successful open POD deployment is critical, jurisdictions need to plan for mass vaccination, use of alternative dispensing modalities, and recruitment strategies to increase POD staffing.
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