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Domingues CMAS, Safadi MAP, Espinal C, Trejo Varon R, Becerra-Posada F, Ospina-Henao S. Strategies for expanding childhood vaccination in the Americas following the COVID-19 pandemic. Rev Panam Salud Publica 2024; 48:e29. [PMID: 38576845 PMCID: PMC10993818 DOI: 10.26633/rpsp.2024.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 01/23/2024] [Indexed: 04/06/2024] Open
Abstract
Objective To provide an overview of the status of the childhood vaccination schedule in the Americas, outline program structures, and identify updated implementation strategies to improve vaccination coverage following the COVID-19 pandemic. Methods A group of experts in pediatrics, epidemiology, vaccines, and global and public health discussed the current status of the childhood vaccination schedule in the Americas, describing the program structure and identifying new implementation strategies that have the potential to improve vaccination coverage in the post-pandemic context, after the challenges COVID-19 presented for more than two years. Results The Americas currently face a high risk of resurgence of diseases that were previously controlled or eliminated. Therefore, it is important to find new strategies to educate citizens on the risks associated with lower vaccination rates, especially in children. Conclusions New strategies along with strong mobilization of the population and advocacy by citizens are necessary to prevent antivaccination groups from gaining a stronger presence in the region and jeopardizing the credibility of the Expanded Program on Immunization.
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Affiliation(s)
| | - Marco Aurelio P. Safadi
- Santa Casa de São Paulo School of Medical Sciences (FCMSCSP)São PauloBrazilSanta Casa de São Paulo School of Medical Sciences (FCMSCSP), São Paulo, Brazil
| | - Carlos Espinal
- Florida International UniversityMiamiUnited States of AmericaFlorida International University, Miami, United States of America
| | - Ruby Trejo Varon
- Florida International UniversityMiamiUnited States of AmericaFlorida International University, Miami, United States of America
| | - Francisco Becerra-Posada
- Florida International UniversityMiamiUnited States of AmericaFlorida International University, Miami, United States of America
| | - Sebastián Ospina-Henao
- Universidad de Ciencias Médicas (UCIMED)San JoséCosta RicaUniversidad de Ciencias Médicas (UCIMED), San José, Costa Rica
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Tan LLJ, Safadi MAP, Horn M, Regojo Balboa C, Moya E, Schanbaum J, Pimenta P, Lambert E, Soumahoro L, Sohn WY, Bruce T, Ruiz García Y. Pandemic's influence on parents' attitudes and behaviors toward meningococcal vaccination. Hum Vaccin Immunother 2023; 19:2179840. [PMID: 36883777 PMCID: PMC10026861 DOI: 10.1080/21645515.2023.2179840] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Invasive meningococcal disease is a life-threatening infection preventable through vaccination. Pediatric vaccination rates have declined during the coronavirus disease 2019 (COVID-19) pandemic. This survey aimed to understand how parents' attitudes and behaviors have changed during the pandemic with regard to immunization and, more specifically, meningococcal vaccination. An online survey was emailed to parents of eligible children 0-4 years, following the selection process from UK, France, Germany, Italy, Brazil, Argentina, and Australia; and of adolescents 11-18 years from US. Data collection took place 19 January-16 February 2021. Quotas were set to ensure a representative sample. Eleven questions relating to general perceptions around vaccination and attitudes and behaviors toward meningitis vaccination were displayed. On 4,962 parents (average 35 years) participating in the survey, most (83%) believed important for their child to continue receiving recommended vaccines during the COVID-19 pandemic. Nearly half of routine vaccine appointments were delayed or canceled due to the pandemic, and 61% of respondents were likely to have their children catch up once COVID-19 restrictions were lifted. 30% of meningitidis vaccination appointments were canceled or delayed during the pandemic, and 21% of parents did not intend to reschedule them because of lockdown/stay at home regulations, and fear of catching COVID-19 in public places. It is crucial to communicate clear instructions to health workers and the general population and to provide appropriate safety precautions in vaccination centers. This will help to maintain vaccination rates and limit infections to prevent future outbreaks.
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Affiliation(s)
| | | | | | | | - Elena Moya
- Asociación Española contra la meningitis, Madrid, Spain
| | | | - Pedro Pimenta
- Meningitis Survivor, Santana de Parnaíba, São Paulo, Brazil
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Abitbol V, Sohn WY, Horn M, Safadi MAP. Safety and immunogenicity of co-administered meningococcal serogroup B (4CMenB) vaccine: A literature review. Hum Vaccin Immunother 2023; 19:2245705. [PMID: 37642229 PMCID: PMC10467517 DOI: 10.1080/21645515.2023.2245705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 07/17/2023] [Accepted: 07/28/2023] [Indexed: 08/31/2023] Open
Abstract
The four-component meningococcal serogroup B vaccine (4CMenB) is indicated for the prevention of invasive meningococcal disease (IMD) caused by Neisseria meningitidis serogroup B. Co-administering 4CMenB with other vaccines may improve vaccine uptake provided that the safety and immunogenicity of either are not affected. Published literature on the immunogenicity and reactogenicity of 4CMenB co-administered with other routine childhood and adulthood vaccines was reviewed. From 282 publications identified, data were collated from 10 clinical studies, 3 real-world studies, and 3 reviews. The evidence showed that 4CMenB co-administration is not associated with significant safety concerns or clinically relevant immunological interferences. The increased reactogenicity (e.g., fever) associated with 4CMenB co-administration can be adequately managed with prophylactic paracetamol in children. Thus, 4CMenB co-administration has the potential to maximize vaccine coverage and improve protection against IMD globally.
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Affiliation(s)
| | | | | | - Marco Aurelio P. Safadi
- Department of Pediatrics, Santa Casa de Sao Paulo School of Medical Sciences, Sao Paulo, Brazil
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Abstract
INTRODUCTION Vaccination is an effective strategy to combat invasive meningococcal disease (IMD). Vaccines against the major disease-causing meningococcal serogroups are available; however, development of vaccines against serogroup B faced particular challenges, including the inability to target traditional meningococcal antigens (i.e. polysaccharide capsule) and limited alternative antigens due to serogroup B strain diversity. Two different recombinant, protein-based, serogroup B (MenB) vaccines that may address these challenges are currently available. These vaccines have been extensively evaluated in pre-licensure safety and immunogenicity trials, and recently in real-world studies on effectiveness, safety, and impact on disease burden. AREAS COVERED This review provides healthcare professionals, particularly pediatricians, an overview of currently available MenB vaccines, including development strategies and evaluation of coverage. EXPERT OPINION Overall, recombinant MenB vaccines are valuable tools for healthcare professionals to protect patients against IMD. Their development required innovative design approaches that overcame challenging hurdles and identified novel protein antigen targets; however, important distinctions in the approaches used in their development, evaluation, and administration exist and many unanswered questions remain. Healthcare providers frequently prescribing MenB vaccines are challenged to keep abreast of these differences to ensure patient protection against this serious disease.
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Affiliation(s)
- Marco Aurelio P Safadi
- Department of Pediatrics, Santa Casa De São Paulo School of Medical Sciences, São Paulo, Brazil
| | - Federico Martinón-Torres
- Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario De Santiago De Compostela, Santiago De Compostela, Spain.,Genetics, Vaccines and Pediatrics Research Group, Universitario De Santiago De Compostela, Instituto De Investigación Sanitaria De Santiago De Compostela, Santiago De Compostela, Spain
| | - Lidia Serra
- Pfizer Vaccine Medical Development, Scientific and Clinical Affairs, Collegeville, PA, USA
| | - Cynthia Burman
- Pfizer Vaccine Medical Development, Scientific and Clinical Affairs, Collegeville, PA, USA
| | - Jessica Presa
- Pfizer Vaccines, Medical and Scientific Affairs, Collegeville, PA, USA
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Martinón-Torres F, Serra L, Safadi MAP. Protecting the most vulnerable age group: a review of MenACWY-TT immunogenicity and safety in infants. Expert Rev Vaccines 2020; 19:313-325. [PMID: 32250710 DOI: 10.1080/14760584.2020.1745070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Neisseria meningitidis causes invasive meningococcal disease (IMD), with the highest incidence observed in infants and young children. Meningococcal serogroups A, B, C, W, X, and Y account for almost all IMD cases worldwide. Available meningococcal vaccines targeting serogroups A, C, W, and Y (MenACWY) include those conjugated to diphtheria toxoid (MenACWY-D), diphtheria protein cross-reactive material 197 (MenACWY-CRM197), and tetanus toxoid (MenACWY-TT). MenACWY-TT is indicated for use starting at 6 weeks of age. AREAS COVERED This review discusses data from the four primary studies assessing MenACWY-TT safety and immunogenicity in infants, which evaluated a variety of dosing schedules, short-term and long-term outcomes, and impact of coadministration on the immunogenicity of routine childhood vaccines. Remaining gaps in the field are addressed. EXPERT OPINION Robust data support the use of MenACWY-TT in infants starting as early as 6 weeks of age. MenACWY-TT was safe and well tolerated in infants, was immunogenic after priming and booster, and demonstrated persistent immunogenicity. Lower persistence for serogroup A relative to other serogroups based on serum bactericidal assays (SBAs) using human complement appears to be a class effect of MenACWY conjugate vaccines. Correlates of protection other than SBA are being explored, including immunologic responses associated with different carrier proteins.
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Affiliation(s)
- Federico Martinón-Torres
- Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago de Compostela , Santiago de Compostela, Spain.,Genetics, Vaccines and Pediatrics Research Group, University of Santiago de Compostela, Instituto de Investigación Sanitaria de Santiago de Compostela , Santiago de Compostela, Spain
| | - Lidia Serra
- Pfizer Vaccine Medical Development, Scientific & Clinical Affairs , Collegeville, PA, USA
| | - Marco Aurelio P Safadi
- Department of Pediatrics, Santa Casa de São Paulo School of Medical Sciences , São Paulo, Brazil
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Safadi MAP, Martinon-Torres F, Weckx LY, Moreira ED, da Fonseca Lima EJ, Willemsen A, Toneatto D, Habib MA, Borys D. Immunogenicity of the pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV) administered concomitantly with the meningococcal serogroup B (4CMenB) vaccine in infants: A post-hoc analysis in a phase 3b, randomised, controlled trial. Vaccine 2019; 37:4858-4863. [PMID: 31327652 DOI: 10.1016/j.vaccine.2019.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 06/24/2019] [Accepted: 07/07/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND No data are currently available on immunogenicity of higher-valent pneumococcal conjugate vaccines when co-administered with a 4-component meningococcal serogroup B vaccine (4CMenB). METHODS Post-hoc analysis of pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV) immunogenicity when co-administered with 4CMenB (2 + 1 schedule) and/or a CRM-conjugated meningococcal serogroup C vaccine (MenC-CRM) in a trial assessing 4CMenB reduced schedules and co-administration with MenC-CRM (NCT01339923). Infants were randomized to receive 4CMenB and MenC-CRM (Group 1) or MenC-CRM (Group 2) at 3, 5, and 12 months (M) of age. Both groups received PHiD-CV (3 + 1 schedule) as part of the Brazilian national immunisation programme at 3 M, 5 M, 7 M, and 12 M of age. Antibody responses were assessed pre-vaccination, 1 M post-dose 2, pre-booster, and 1 M post-booster. RESULTS Anti-pneumococcal antibody responses were in similar ranges in the two study groups. CONCLUSIONS 4CMenB co-administration did not seem to impact antibody responses to PHiD-CV in infants.
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Affiliation(s)
| | - Federico Martinon-Torres
- Hospital Clinico Universitario de Santiago de Compostela, Santiago de Compostela, Spain; Genetics, Vaccines and Pediatrics Research Group (GENVIP), Instituto de Investigación Sanitaria de Santiago, University of Santiago de Compostela, Spain.
| | | | - Edson Duarte Moreira
- CPEC - Associação Obras Sociais Irma Dulce and Oswaldo Cruz Foundation, Brazilian Ministry of Health, Salvador, Brazil.
| | | | - Arnold Willemsen
- Plus100 B.V. c/o Biostatistics, GSK, Amsterdam, the Netherlands.
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Villena R, Safadi MAP, Valenzuela MT, Torres JP, Finn A, O'Ryan M. Global epidemiology of serogroup B meningococcal disease and opportunities for prevention with novel recombinant protein vaccines. Hum Vaccin Immunother 2018; 14:1042-1057. [PMID: 29667483 DOI: 10.1080/21645515.2018.1458175] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Meningococcal disease (MD) is a major cause of meningitis and sepsis worldwide, with a high case fatality rate and frequent sequelae. Neisseria meningitidis serogroups A, B, C, W, X and Y are responsible for most of these life-threatening infections, and its unpredictable epidemiology can cause outbreaks in communities, with significant health, social and economic impact. Currently, serogroup B is the main cause of MD in Europe and North America and one of the most prevalent serogroups in Latin America. Mass vaccination strategies using polysaccharide vaccines have been deployed since the 1970s and the use of conjugate vaccines has controlled endemic and epidemic disease caused by serogroups A, C, W and Y and more recently serogroup B using geographically-specific outer membrane vesicle based vaccines. Two novel protein-based vaccines are a significant addition to our armamentarium against N. meningitidis as they provide broad coverage against highly diverse strains in serogroup B and other groups. Early safety, effectiveness and impact data of these vaccines are encouraging. These novel serogroup B vaccines should be actively considered for individuals at increased risk of disease and to control serogroup B outbreaks occurring in institutions or specific regions, as they are likely to save lives and prevent severe sequelae. Incorporation into national programs will require thorough country-specific analysis.
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Affiliation(s)
- Rodolfo Villena
- a Department of Pediatrics , Hospital de Niños Exequiel González Cortés, Facultad de Medicina, Universidad de Chile , Santiago , Chile
| | - Marco Aurelio P Safadi
- b Department of Pediatrics , Santa Casa de São Paulo School of Medical Sciences , São Paulo , Brazil
| | - María Teresa Valenzuela
- c Department of Epidemiology and Public Health , Universidad de Los Andes , Santiago , Chile
| | - Juan P Torres
- d Department of Pediatrics , Hospital Luis Calvo Mackenna, Facultad de Medicina, Universidad de Chile , Santiago , Chile
| | - Adam Finn
- e Bristol Children's Vaccine Centre, Schools of Cellular and Molecular Medicine and Population Health Sciences, University of Bristol , United Kingdom
| | - Miguel O'Ryan
- f Programa de Microbiología y Micología, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile , Santiago , Chile.,g Instituto Milenio de Inmunología e Inmunoterapia, Facultad de Medicina, Universidad de Chile , Santiago , Chile
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Martinón-Torres F, Safadi MAP, Martinez AC, Marquez PI, Torres JCT, Weckx LY, Moreira ED, Mensi I, Calabresi M, Toneatto D. Reduced schedules of 4CMenB vaccine in infants and catch-up series in children: Immunogenicity and safety results from a randomised open-label phase 3b trial. Vaccine 2017; 35:3548-3557. [PMID: 28533054 DOI: 10.1016/j.vaccine.2017.05.023] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 04/19/2017] [Accepted: 05/08/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND This study evaluated the immunogenicity and safety of a licensed meningococcal serogroup B vaccine (4CMenB) administered alone according to reduced schedules in infants or catch-up series in children. METHODS In this open-label, multicentre, phase 3b study (NCT01339923), infants randomised 1:1:1 received 4CMenB: 2+1 doses at 3½-5-11months or 6-8-11months of age, 3+1 doses at ages 2½-3½-5-11months. Children aged 2-10years received 2 catch-up doses administered 2months apart. Immune responses were measured by hSBA assays against 4 strains specific for vaccine components fHbp, NadA, PorA and NHBA. Sufficiency of immune responses was defined in groups with 2+1 doses schedules as a lower limit ≥70% for the 97.5% confidence interval of the percentage of infants with hSBA titres ≥4, 1month post-dose 2 for fHbp, NadA, PorA. Adverse events were collected for 7days post-vaccination; serious adverse events (SAEs) throughout the study. RESULTS 754 infants and 404 children were enrolled. Post-primary vaccination, 98-100% of infants across all groups developed hSBA titres ≥4 for fHbp, NadA, PorA, and 48-77% for NHBA. Sufficiency of immune responses in infants receiving 2+1 schedules was demonstrated for fHbp, NadA, PorA after 2 doses of 4CMenB, as pre-specified criteria were met. Following receipt of 2 catch-up doses, 95-99% of children developed hSBA titres ≥4 for 4CMenB components. Similar safety profiles were observed across groups. A total of 45 SAEs were reported, 3 of which were related to vaccination. CONCLUSION Reduced infant schedules and catch-up series in children were immunogenic and safe, having the potential to widen 4CMenB vaccine coverage. FUNDING GlaxoSmithKline Biologicals SA.
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Affiliation(s)
- Federico Martinón-Torres
- Translational Pediatrics and Infectious Diseases, Department of Pediatrics, Hospital Clinico Universitario de Santiago de Compostela, A Choupana, s/n, 15706 Santiago de Compostela, Spain.
| | - Marco Aurelio P Safadi
- Santa Casa de São Paulo School of Medical Sciences, Rua Doutor Cesário Motta Júnior, 61 - Vila Buarque, 01221-020 São Paulo, Brazil.
| | | | | | | | - Lily Yin Weckx
- CRIE UNIFESP, Universidade Federal de Sao Paulo, R. Sena Madureira, 1500 - Vila Clementino, 04021-001São Paulo, Brazil.
| | - Edson Duarte Moreira
- CPEC-Associação Obras Sociais Irma Dulce and Oswaldo Cruz Foundation, Brazilian Ministry of Health, Salvador, Brazil.
| | - Ilhem Mensi
- GSK, Huis Ter Heideweg 62, 3705 LZ Zeist, Amsterdam, The Netherlands.
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P Safadi MA, Martinon-Torres F, Weckx LY, Moreira ED, da Fonseca Lima EJ, Mensi I, Calabresi M, Toneatto D. Immunogenicity and safety of concomitant administration of meningococcal serogroup B (4CMenB) and serogroup C (MenC-CRM) vaccines in infants: A phase 3b, randomized controlled trial. Vaccine 2017; 35:2052-2059. [PMID: 28318767 DOI: 10.1016/j.vaccine.2017.03.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 02/28/2017] [Accepted: 03/01/2017] [Indexed: 01/24/2023]
Abstract
BACKGROUND After implementation of routine infant MenC vaccination, MenB remains a serious cause of meningococcal disease, yet to be targeted by vaccination programs in several countries. This study (NCT01339923) investigated the immunogenicity and safety of MenC CRM-conjugated vaccine (MenC-CRM) concomitantly administered with MenB vaccine (4CMenB). METHODS Infants (N=251) were randomised 1:1 to receive 4CMenB and MenC-CRM (Group 1) or MenC-CRM alone (Group 2) at 3 and 5months (M3, M5) and a booster at 12months of age (M12), and pneumococcal vaccine at M3, M5, M7, M12. Antibody responses to meningococcal vaccines were measured at M3, M6, M12, and M13. Non-inferiority of MenC-CRM response in Group 1 vs Group 2 was demonstrated at M6 and M13, if the lower limit of the 95% confidence interval (LL95%CI) of the difference in percentage of infants with hSBA titres ≥1:8 was >-10%. Sufficiency of MenB response was achieved if LL95%CI of the percentage of infants with hSBA titres ≥1:4 against fHbp, NadA and PorA strains was ≥70% at M6 or ≥75% at M13. Adverse events (AEs) were collected for 7days post-vaccination, and serious AEs (SAEs) and medically attended AEs throughout the study. RESULTS Non-inferiority of MenC response in Group 1 vs Group 2 (LL95%CI -6.4% [M6]; -5.2% [M13]) and sufficiency of MenB response in Group 1 (LL95%CI 92%, 90%, 89% [M6]; 97%, 92%, 93% [M13] against fHbp, NadA, PorA, respectively) were demonstrated. Higher rates of mild to moderate solicited AEs were reported in Group 1. Unsolicited AEs and SAEs incidences were similar across groups. CONCLUSIONS Concomitant administration of MenC-CRM and 4CMenB in infants was immunogenic, resulting in non-inferior responses against MenC compared to MenC-CRM alone and demonstration of sufficient immune response to MenB, after primary and booster vaccination. Reactogenicity was higher for concomitant vaccines administration, but no safety concerns were identified.
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Affiliation(s)
| | | | - Lily Yin Weckx
- CRIE UNIFESP, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Edson Duarte Moreira
- CPEC - Associação Obras Sociais Irma Dulce and Oswaldo Cruz Foundation, Brazilian Ministry of Health, Salvador, Brazil
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Taylor S, Lopez P, Weckx L, Borja-Tabora C, Ulloa-Gutierrez R, Lazcano-Ponce E, Kerdpanich A, Angel Rodriguez Weber M, Mascareñas de Los Santos A, Tinoco JC, Safadi MAP, Lim FS, Hernandez-de Mezerville M, Faingezicht I, Cruz-Valdez A, Feng Y, Li P, Durviaux S, Haars G, Roy-Ghanta S, Vaughn DW, Nolan T. Respiratory viruses and influenza-like illness: Epidemiology and outcomes in children aged 6 months to 10 years in a multi-country population sample. J Infect 2016; 74:29-41. [PMID: 27667752 PMCID: PMC7112512 DOI: 10.1016/j.jinf.2016.09.003] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 06/01/2016] [Accepted: 09/16/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Better population data on respiratory viruses in children in tropical and southern hemisphere countries is needed. METHODS The epidemiology of respiratory viruses among healthy children (6 months to <10 years) with influenza-like illness (ILI) was determined in a population sample derived from an influenza vaccine trial (NCT01051661) in 17 centers in eight countries (Australia, South East Asia and Latin America). Active surveillance for ILI was conducted for approximately 1 year (between February 2010 and August 2011), with PCR analysis of nasal and throat swabs. RESULTS 6266 children were included, of whom 2421 experienced 3717 ILI episodes. Rhinovirus/enterovirus had the highest prevalence (41.5%), followed by influenza (15.8%), adenovirus (9.8%), parainfluenza and respiratory syncytial virus (RSV) (both 9.7%), coronavirus (5.6%), human metapneumovirus (5.5%) and human bocavirus (HBov) (2.0%). Corresponding incidence per 100 person-years was 29.78, 11.34, 7.03, 6.96, 6.94, 4.00, 3.98 and 1.41. Except for influenza, respiratory virus prevalence declined with age. The incidence of medically-attended ILI associated with viral infection ranged from 1.03 (HBov) to 23.69 (rhinovirus/enterovirus). The percentage of children missing school or daycare ranged from 21.4% (HBov) to 52.1% (influenza). CONCLUSIONS Active surveillance of healthy children provided evidence of respiratory illness burden associated with several viruses, with a substantial burden in older children.
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Affiliation(s)
| | - Pio Lopez
- Centro de Estudios en Infectologia Pediatrica, Cali, Colombia
| | - Lily Weckx
- Pediatric Infectious Diseases, Department of Pediatrics, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Charissa Borja-Tabora
- Research Institute for Tropical Medicine, Department of Health, Alabang, Muntinlupa City, Philippines
| | | | | | - Angkool Kerdpanich
- Infectious Diseases Unit, Department of Pediatrics, Phramongkutklao Hospital, Thailand
| | | | | | | | - Marco Aurelio P Safadi
- Faculdade de Ciências Médicas da Santa Casa de São Paulo and Associação Fundo de Incentivo à Pesquisa, Department of Pediatrics, São Paulo, Brazil
| | - Fong Seng Lim
- National Healthcare Group Polyclinics, National University of Singapore, Singapore
| | | | - Idis Faingezicht
- Instituto Costarricense de Investigaciones Clínicas, San José, Costa Rica
| | | | | | - Ping Li
- GSK Vaccines, King of Prussia, PA, USA
| | | | | | | | | | - Terry Nolan
- Murdoch Children's Research Institute and Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
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Abstract
Despite the success of routine immunization programs against pertussis worldwide, control of the disease in young infants has never been achieved. The greatest risk of disease, hospitalization and death occur in infants, who are too young to have received the primary pertussis immunization course. Different interventions to provide indirect protection to infants were recommended, including vaccination programs with Tdap for adolescents, adults, postpartum women and household contacts of infants, but all of them failed to effectively control the disease in infants. Based on the successful experience of maternal tetanus vaccination, and more recently influenza vaccination, maternal Tdap vaccine has been universally recommended since 2011/2012 in several countries to prevent pertussis in infants. The recent publication of data on the uptake, safety and effectiveness of these programs, as well as impact on disease rates in infants is encouraging, anticipating the possibility to at last control pertussis in this vulnerable age group.
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Affiliation(s)
- Marco Aurelio P Safadi
- Department of Pediatrics, Division of Infectious Diseases, FCM da Santa Casa de Sao Paulo, Sao Paulo, Brazil
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Nolan T, Borja-Tabora C, Lopez P, Weckx L, Ulloa-Gutierrez R, Lazcano-Ponce E, Kerdpanich A, Weber MAR, Mascareñas de Los Santos A, Tinoco JC, Safadi MAP, Seng LF, Hernandez-de Mezerville M, Faingezicht I, Cruz-Valdez A, Feng Y, Li P, Durviaux S, Haars G, Roy-Ghanta S, Vaughn DW, Taylor S. Prevalence and Incidence of Respiratory Syncytial Virus and Other Respiratory Viral Infections in Children Aged 6 Months to 10 Years With Influenza-like Illness Enrolled in a Randomized Trial. Clin Infect Dis 2015; 60:e80-9. [PMID: 25673560 PMCID: PMC4429758 DOI: 10.1093/cid/civ065] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 01/24/2015] [Indexed: 02/06/2023] Open
Abstract
Background. The high burden of respiratory syncytial virus (RSV)-associated morbidity and
mortality makes vaccine development a priority. Methods. As part of an efficacy trial of pandemic influenza vaccines (NCT01051661), RSV
epidemiology in healthy children aged 6 months to <10 years at first vaccination with
influenza-like illness (ILI) was evaluated in Australia, Brazil, Colombia, Costa Rica,
Mexico, the Philippines, Singapore, and Thailand between February 2010 and August 2011.
Active surveillance for ILI was conducted for approximately 1 year, with nasal and throat
swabs analyzed by polymerase chain reaction. The prevalence and incidence of RSV among ILI
episodes were calculated. Results. A total of 6266 children were included, of whom 2421 experienced 3717 ILI episodes
with a respiratory sample available. RSV was detected for 359 ILI episodes, a prevalence
of 9.7% (95% confidence interval: 8.7–10.7). The highest prevalence was in children aged
12–23 or 24–35 months in all countries except the Philippines, where it was in children
aged 6–11 months. The incidence of RSV-associated ILI was 7.0 (6.3–7.7) per 100
person-years (PY). Eighty-eight ILI episodes resulted in hospitalization, of which 8 were
associated with RSV (prevalence 9.1% [4.0–17.1]; incidence 0.2 [0.1–0.3] per 100 PY). The
incidence of RSV-associated ILI resulting in medical attendance was 6.0 (5.4–6.7) per 100
PY. RSV B subtypes were observed more frequently than A subtypes. Conclusions. Active surveillance demonstrated the considerable burden of RSV-associated illness
that would not be identified through hospital-based surveillance, with a substantial part
of the burden occurring in older infants and children.
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Affiliation(s)
- Terry Nolan
- Murdoch Children's Research Institute and Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Charissa Borja-Tabora
- Department of Health, Research Institute for Tropical Medicine, Alabang, Muntinlupa City, Philippines
| | - Pio Lopez
- Centro de Estudios en Infectologia Pediatrica, Cali, Colombia
| | - Lily Weckx
- Pediatric Infectious Diseases, Department of Pediatrics, Universidade Federal de São Paulo, Brazil
| | | | | | - Angkool Kerdpanich
- Infectious Diseases Unit, Department of Pediatrics, Phramongkutklao Hospital, Thailand
| | | | | | | | - Marco Aurelio P Safadi
- Department of Pediatrics, Faculdade de Ciências Médicas da Santa Casa de São Paulo and Associação Fundo de Incentivo à Pesquisa, Brazil
| | | | | | - Idis Faingezicht
- Instituto Costarricense de Investigaciones Clínicas, San José, Costa Rica
| | | | | | - Ping Li
- GSK Vaccines, King of Prussia, Pennsylvania
| | | | | | | | | | | |
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