Journal Content Recommendation
01
WHO Releases Report on Estimating the impact of vaccines in reducing antimicrobial resistance (AMR) and antibiotic use
The WHO report highlights the critical role of vaccines in addressing the threat of antimicrobial resistance (AMR). AMR is one of the most significant global public health and development challenges, responsible for approximately 5 million deaths in 2019. Vaccines can reduce infection rates, pathogen transmission, antibiotic use, and the evolution of resistance genes, preventing an estimated 515,000 deaths caused by AMR annually. However, the role of vaccines in controlling AMR has not received sufficient attention.
The report examined the potential role of 24 pathogens and 44 vaccines in reducing the burden of antimicrobial resistance (AMR), including approved vaccines, vaccines under clinical development, and hypothetical vaccines. Using data combined with insights from international experts, the study quantified the potential of these vaccines to reduce AMR, antibiotic use, and associated impacts. The report highlighted that existing vaccines are estimated to prevent 106,000 deaths, 9.1 million disability-adjusted life years (DALYs), $861 million in hospitalization costs, and $5.9 billion in productivity losses annually. Additionally, they could reduce 142 million defined daily doses (DDDs) of antibiotic use. For instance, achieving the World Health Organization’s (WHO) target of 90% pneumococcal vaccine coverage for children and older adults could prevent an additional 27,100 deaths, 1.5 million DALYs, and reduce $507 million in hospitalization costs and $879 million in productivity losses annually.
The report also analyzed the potential of vaccines at different stages of development in reducing the burden of AMR. For example, an adolescent tuberculosis vaccine (in late-stage clinical development) could significantly alleviate the AMR burden by preventing the progression of latent infections to active disease, potentially preventing 71,000 deaths, 2.6 million DALYs, and the use of 1.2 billion defined daily doses (DDDs) of antibiotics annually. Similarly, maternal vaccination with a Klebsiella pneumoniae vaccine (in early-stage clinical development) could protect newborns from bloodstream infections, potentially preventing approximately 27,000 deaths, 2.4 million DALYs, $280 million in hospitalization costs, and $2.5 billion in productivity losses annually.
The report makes a series of recommendations, emphasizing that the impact of vaccines on AMR should be integrated into decision-making processes and recognized as a vital intervention to reduce AMR. Vaccines should be incorporated into global, regional, and national AMR and immunization strategies. Preparations for the rollout of new vaccines should include integrating AMR impact assessment systems into existing regulatory and policy frameworks, cost-effectiveness analyses, and national immunization strategies. Additionally, the report calls for further advancements in vaccine development, delivery, and implementation. This includes incorporating AMR-related endpoints in clinical trials, identifying priority vaccine features for development, and expanding vaccine use among high-risk populations and non-human hosts through a “One Health” approach.
02
Characteristics of children with invasive pneumococcal disease eligible for the 1+1 compared with the 2+1 PCV13 infant immunisation schedule in England: a prospective national observational surveillance study
The article was published in The Lancet Child & Adolescent Health. This study aims to explore the impact of the United Kingdom’s adjustment of the national immunization schedule for PCV13 in infants from a “2+1” to a “1+1” schedule, implemented on January 1, 2020. The focus is on the incidence, disease characteristics, and outcomes of invasive pneumococcal disease (IPD) in children aged 0-3 years.
The study used The UK Health Security Agency’s data on IPD surveillance and serotyping of invasive pneumococcal isolates via whole-genome sequencing in England. The study compared IPD incidence, demographics, clinical presentation, comorbidity prevalence, serotype distribution, and case-fatality rates (CFRs) in children from a single birth cohort eligible for the 1+1 schedule (born between Jan 1, 2020, and Dec 31, 2022) who developed IPD in the 2022–23 fiscal year (April to March in next year) with children from three equivalent historical birth cohorts (born between Jan 1, 2015, and Dec 31, 2019) eligible for the 2+1 schedule who developed IPD during three respective pre-pandemic fiscal years: 2017–18, 2018–19, and 2019–20.
The research found that there were a total of 702 IPD episodes in 697 children, including 158 (incidence 8·99 per 100 000 person-years) in the single 1+1 birth cohort and 544 (incidence 9·39 per 100 000 person-years) in the 2+1 birth cohorts, with no significant difference in the incidence of overall IPD (incidence rate ratio 0·96, 95% CI: 0.80–1.14, p=0.63), PCV13-type IPD (1.21, 95% CI: 0.71–2.00, p=0.45), or pneumococcal meningitis (0.97, 0.66–1.40, p=0.88). Comorbidity prevalence, clinical presentation, and CFRs were also similar between the two cohorts, as was the percentage of cases in infants too young to be vaccinated (<2 months old) and infants aged 5–11 months who received one or two PCV13 priming doses, in the 1+1 and 2+1 cohorts respectively.
The result showed that after 3 years, the 1+1 schedule continues to provide direct and indirect protection against PCV13-type IPD in children, with no significant change in overall IPD incidence, serotype distribution, clinical presentation, or CFRs in children eligible for the 1+1 compared with the 2+1 schedule. Ongoing surveillance will be important to assess longer-term direct and indirect population protection.
https://doi.org/10.1016/S2352-4642(24)00193-7
03
Does Tobacco Smoking Affect Vaccine-Induced Immune Response? A Systematic Review and Meta-Analysis
This article was published in Vaccine, and aims to provide a comprehensive overview of the literature regarding how smoking reduces the effectiveness of active immunization by affecting vaccine-induced immune response. The study was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement to investigate the effects of exposure to active and/or passive tobacco smoking, including the use of new tobacco products such as e-cigarettes and heat-not-burn products, on vaccine-induced immune response were included. The study included English and Italian observational, quasi-experimental, and experimental studies examining the impact of active and passive smoking on vaccine immune responses. A total of 34 studies were included, with 26 used for the meta-analysis.
The meta-analysis results showed that the vaccine-induced immune response in smokers was significantly lower than that in non-smokers. Smoking notably reduced the mean difference in antibody levels post-vaccination, particularly for vaccines against COVID-19, influenza, pneumococcal disease, hepatitis B, HPV, and tetanus. Overall, smokers experienced a decline in both antibody affinity and quantity following vaccination, along with suppressed immune cell production. Subgroup analysis further highlighted that the negative impact of smoking on immune cells was most pronounced for COVID-19 mRNA vaccines (e.g., BNT162b2) and hepatitis B vaccines, while the effect on some inactivated vaccines was relatively lower. Additionally, the study found that the impact of smoking on vaccine effectiveness varied depending on smoking method (e.g., cigarettes or e-cigarettes) and population characteristics (e.g., gender and age). For example, antibody waning was significantly faster in female smokers compared to male smokers.
The article suggests that smoking cessation interventions could be considered as a potential public health strategy to enhance vaccine efficacy. During pandemics, it is also recommended to adjust vaccine dosage regimens based on smoking status.
https://doi.org/10.3390/vaccines12111260
04
The impact of COVID-19 on routine child immunisation in South Africa
This article was published in BMC Public Health and explored the impact of COVID-19 on the uptake of routine child immunization services in South Africa. The research conducted qualitative research using in-depth interviews with 51 purposively selected parents/caregivers of children below the age of five who missed or delayed one or more scheduled immunisation doses in 2020–2022 and with 12 healthcare providers who provided public immunisation services during the pandemic.
The results showed that during the pandemic lockdowns, most caregivers perceived the risk of their child being infected with COVID-19 during a clinic visit as more salient than the risk of missing immunisation doses. Caregivers reported minimal exposure to routine immunisation communication, as well as shortages of routine vaccines for children at public health facilities, healthcare workers experienced anxiety and burnout. There was a post-pandemic shift to more active decision-making about immunisation, which had previously been an almost automatic behaviour, leading some caregivers to delay vaccinating their children. There was also evidence of a “bad vaccine” mental model among some caregivers regarding COVID-19 vaccinations, which could lead to doubts about the safety of routine childhood vaccinations.
The study emphasizes that to prevent similar situations from affecting vaccination rates in the future, government should build resilient health systems and focus on understanding and engaging procrastinating and doubtful caregivers. Additionally, efforts to support vaccination should consider educational initiatives and community engagement, particularly targeting vaccine-hesitant parents.
https://doi.org/10.1186/s12889-024-20591-w
05
Health impact of rotavirus vaccination in China
This article was published in Human Vaccines & Immunottherapeutics, and aims to to understand the differential impact of vaccination in reducing the RVGE burden in children under 7 years old in China. A Markov Model was used to investigate the health impact of introducing two different RV vaccines into the Chinese population. The analysis was conducted for RV5, a live pentavalent human-bovine reassortant vaccine, and Lanzhou Lamb RV (LLR), a live-attenuated monovalent RV vaccine, separately, by comparing the strategy of each vaccine to no vaccination within a Chinese birth cohort, including 100,000 children modeled until 7 years of age. The vaccination scenario assumed a vaccination coverage of 2.5%, 2.5%, 90% and 5% for doses one, two, three and no vaccine, respectively, for both vaccines.
Strategies with RV5, LLR, and no vaccination were associated with 9,895, 49,069, and 64,746 symptomatic RV infections, respectively. RV5 and LLR were associated with an 85% and 24% reduction in the total symptomatic RV infections, respectively, suggesting that the health benefits of RV5 are at least three-fold greater than those associated with the LLR. Further, strategies with RV5 and LLR resulted in an estimated 206 and 59-year increase in quality-adjusted life years, respectively. Sensitivity and scenario analyses supported the robustness of the base-case findings. The use of the RV vaccine is expected to improve RV-associated health outcomes and its adoption will help alleviate the burden of RVGE in China. RV5 use will result in significantly better health outcomes.
*This study is sponsored and written by Merck Sharp & Dohme LLC
https://doi.org/10.1080/21645515.2024.2386750
Content Editor: Xiaotong Yang
Page Editor: Ziqi Liu
