Journal Content Recommandation
01
Informing HPV vaccine pricing for government-funded vaccination in mainland China: a modelling study
This article is published by Fanghui Zhao, Mark Jit et,.al on The Lancet Regional Health-Western Pacific, and aims to assess the cost-effective or cost-saving vaccine price thresholds in the Chinese government-funded HPV vaccination program, providing a reference for the government’s HPV vaccine price negotiations.
This study validated the transmission model to estimate the health and economic impact of HPV vaccination over a 100-year time horizon from a healthcare payer perspective. A threshold analysis was conducted to evaluate different vaccination scenarios (national, rural, and urban), cervical cancer screening programs, vaccine types (domestic HPV-2, imported HPV-2, HPV-4, and HPV-9), vaccination schedules (two-dose or one-dose), vaccination strategies (routine vaccination with or without later switching to high-valent vaccines), willingness-to-pay thresholds, and decision criteria (cost-effective or cost-saving).
Using the current market price, national routine HPV vaccination with any currently available vaccine is unlikely cost-effective. Under a two-dose schedule, the prices of the four available HPV vaccine types cannot exceed $26–$36 per dose (44.1%–80.2% reduction from current market prices) depending on the vaccine type to ensure the cost-effectiveness of the national program. Adopting the threshold prices would require an annual increase of 72.18%–96.95% of the total annual National Immunization Programme (NIP) budget in China. The cost-saving senario required the vaccine prices dropped to $5–$10 per dose (depending on vaccine type), resulting in a 21.38%–34.23% increase in the annual NIP budget, and taking 6.60%–10.17% of the total budget for cervical cancer control.
Adding the second dose is neither cost-effective nor cost-saving compared to a one-dose schedule. In a supplementary analysis, switching from domestically produced HPV-2 to HPV-9 in the NIP by 2030 required a maximum additional vaccine price of $10–13 (depending on different screening scenarios) per dose for HPV-9 to ensure the cost-effectiveness of the switch.
Our study could inform vaccine price negotiation and thus facilitate the nationwide scale-up of current HPV vaccination pilot programs in China. The evidence may potentially be valuable to other countries facing HPV introduction barriers due to high costs. This approach may also be adapted for other contexts that involve the introduction of a pricy vaccine.
https://doi.org/10.1016/j.lanwpc.2024.101209
02
A prospective cohort study comparing the efficacy of 1 dose of quadrivalent human papillomavirus vaccine to 2 and 3 doses at an average follow-up of 12 years postvaccination
The article is published in the Journal of the National Cancer Institute Monographs. Aiming to evaluate the long-term protective efficacy of single-dose, two-dose, and three-dose quadrivalent HPV vaccines. The study was originally designed as a randomized multicenter trial in India, with the initial goal of administering two or three doses of the quadrivalent HPV vaccine to unmarried girls aged 10–18. However, a ministerial decree to halt vaccination in trials resulted in the creation of cohorts receiving different doses, including just a single dose.
The study established a prospective cohort, and participants were contacted once a year by study staff to check their general health status and update their contact details and marital status. Participants were invited to a clinic to provide cervical samples for HPV genotyping 18 months after marriage or 6 months after first childbirth, whichever was earlier. Cervical samples were collected yearly for 4 consecutive years by care providers. Married participants underwent HPV testing starting at age 25. Those with positive screening results were invited for colposcopy, while others were advised to undergo screening again after five years. The study also recruited unvaccinated married women, matched by age and residence, as a control group. Vaccine efficacy was assessed using incidence rate ratios. The primary outcome variable was persistent HPV16/18 infection, while secondary outcomes included HPV16/18 infection events and HPV16/18-related CIN2+ severe lesions.
The number of participants in the 1-, 2- (at 0 and 6 months), and 3-dose cohorts was 4949, 4980, and 4348, respectively. Of the recipients, 71%-82% in the different cohorts were eligible to provide samples for genotyping. Vaccine efficacy against persistent HPV 16 and 18 infection was 92.0% (95% confidence interval [CI]: 87.0% to 95.0%) in 3022 recipients of the single dose; and comparable with that observed in the 2-dose arm (94.8%, 95% CI: 90.0% to 97.3%) and the 3-dose arm (95.3%, 95% CI: 90.9% to 97.5%). No high-grade precancer associated with HPV 16 and 18 was detected among vaccinated participants compared with 8 precancers detected among the unvaccinated women.
Additionally, the study found that a single-dose vaccination also provided some cross-protective efficacy against HPV types 31, 33, and 45, though the efficacy was relatively low (29.5%). The HPV positivity rate in the single-dose group was 4.6%, which was lower than that of the two-dose group (6.3%) and the unvaccinated group (7.9%).
This observational cohort study has established that a single dose of HPV vaccine provides high protective efficacy against persistent HPV 16 and 18 infections and associated neoplasia 15 years postvaccination. This study provides evidence supporting cost-saving and program-simplifying solutions for vaccine rollouts in low-income countries.
https://doi.org/10.1093/jncimonographs/lgae042
03
Investigating parental perceptions of respiratory syncytial virus (RSV) and attitudes to RSV vaccine in Jiangsu, China: Insights from a cross-section study
This article, authored by Leesa Lin, Wang Weibing, et al., published in Vaccine, aimed to assess parents’ perceptions of respiratory syncytial virus (RSV) and their attitudes toward the RSV vaccine in China.
The cross-section study was performed between August 21 and November 15, 2023, in Jiangsu province, eastern China. We collected socio-demographics, awareness, knowledge, perceptions of susceptibility and severity of RSV, and attitudes towards RSV vaccine using online survey questionnaires from parents of children aged ≤14 years old.
A total of 2135 participants were included. About 26.0 % indicated that they had never heard of RSV (556/2135) and were unaware that infants and young children are at a high risk of contracting RSV (557/2135). The proportion of parents with a child under 1 year of age who were unaware of RSV was notably higher than that of parents with children in other age groups. 42.9 % of parents (916/2135) showed low level of perceived susceptibility of contacting RSV infection for their child. 70.6 % of parents (1508/2135) expressed their willingness to vaccinate their child against RSV. The most common reason for refusing the RSV vaccine was “Concern about vaccine’s safety or side effects.” 60.8 % of participants (1299/2135) considered a price of the RSV vaccine below 200 CNY (28 USD) as acceptable.
The parents, particularly those with younger children, exhibited limited awareness and knowledge regarding RSV infection. Our study also showed the potential role of vaccine price as a barrier to the future use of RSV vaccine in China.
https://doi.org/10.1016/j.vaccine.2024.126570
04
Impact of rotavirus vaccination in Malawi from 2012 to 2022 compared to model predictions
This article was published on npj vaccines. Rotarix® vaccine was introduced into the Malawi national immunization program in October 2012.The study analyzed data on children <5 years old hospitalized with acute gastroenteritis from January 2012 to June 2022, and compared to pre-vaccination data from 1997 to 2009. The study estimated vaccine coverage before, during, and after the COVID-19 pandemic using data from rotavirus-negative children. The study compared the observed weekly number of rotavirus-associated gastroenteritis (RVGE) cases by age to predictions from a previously developed mathematical model to estimate overall vaccine effectiveness. The number of RVGE and rotavirus-negative acute gastroenteritis cases declined substantially following vaccine introduction. Vaccine coverage among rotavirus-negative controls was >90% with two doses by July 2014, and declined to a low of ~80% in October 2020 before returning to pre-pandemic levels by July 2021. Our models captured the post-vaccination trends in RVGE incidence. Comparing observed RVGE cases to the model-predicted incidence without vaccination, overall effectiveness was estimated to be modest at 36.0% (95% prediction interval: 33.6%-39.9%), peaking in 2014, and was highest in infants (52.5%; 95% prediction interval: 50.1%-54.9%).
Research indicates that although the overall vaccine efficacy in low-income countries is relatively limited, mathematical models have validated the vaccine’s significant impact on reducing RVGE incidence. This platform provides important reference data for further optimizing rotavirus vaccine implementation strategies and maximizing vaccine benefits.
https://doi.org/10.1038/s41541-024-01008-6
05
Progress Toward Measles Elimination — Worldwide, 2000–2023
On November 15, 2024, the World Health Organization released a systematic review of global measles elimination progress from 2000 to 2023, covering measles vaccination coverage, outbreaks, and mortality, as well as the surveillance and control of measles epidemics.
In terms of measles vaccination coverage, MCV1 coverage increased worldwide from 71% to 86%, then declined to 81% in 2021 during the COVID-19 pandemic, increased to 83% in 2022, and remained unchanged in 2023. Coverage in all regions declined during 2019–2021 and only increased during 2022–2023 in the African Region, Region of the Americas, and European Region. No region regained its 2019 MCV1 coverage levels. In 2023, MCV1 coverage was 64% in low-income countries, 86% in middle-income countries, and 94% in high-income countries.
In terms of measles outbreaks and mortality, 663,795 measles cases were reported in 2023, representing a 224% increase compared to 2022 (205,173 cases). However, as outbreaks occurred in countries with lower mortality rates, global measles deaths decreased by 8% compared to 2022, dropping to 107,000. In 2023, 57 countries experienced large-scale or severe outbreaks, with 47% occurring in the African region. In low-income countries, the measles incidence rate reached 583 cases per million, while it was 37 and 26 cases per million in middle- and high-income countries, respectively. Additionally, the number of global measles virus genotypes decreased from nine in 2013 to two (D8 and B3) since 2021.
In terms of outbreak surveillance and control, 149 countries globally conducted case surveillance in 2023, with 86 countries (58%) meeting the sensitivity target of identifying at least 2 suspected cases per 100,000 population. The number of laboratory-tested samples increased by 59% compared to 2022. Through immunization campaigns and supplementary immunization activities (SIAs), approximately 112 million measles vaccine doses were administered globally in 2023, further reducing the immunization gap. From 2000 to 2023, measles vaccination cumulatively averted 60.3 million deaths. However, stagnation in vaccination coverage has sustained immunization gaps, with children in low-income countries remaining at particularly high risk.
Overall, global measles vaccination coverage stagnated between 2022 and 2023, with a clear resurgence of outbreaks. While certain regions, such as Africa, showed some improvement, overall progress remains slow, particularly in low-income, fragile, and conflict-affected countries (Fragility, Conflict, and Violence Countries). To address the global immunization gap, efforts must be strengthened in routine immunization, disease surveillance, and improving vaccine equity, to accelerate progress toward global measles elimination.
06
Acceptance of human papillomavirus vaccine among boys in Asia: A narrative review
This article, authored by Lu Yihan et al., was published in Human Vaccines & Immunotherapeutics. The burden of HPV-related diseases in males has been rising significantly in recent years. The article reviewed studies published until September 2024 from databases like PubMed, Embase®, and Web of Science, summarizing HPV vaccination acceptance among boys and parents in Asia and exploring influencing factors.
As of October 10, 2024, the following Asian countries have adopted gender-neutral HPV vaccination strategies (Gender Neutral Vaccination), where both males and females receive the HPV vaccine: Bahrain, Bhutan, Cyprus, Georgia, Israel, Kuwait, Qatar, Turkmenistan, and the United Arab Emirates. The study found that HPV vaccine acceptance rates among boys ranged from 48.4% to 69.9%, while parental acceptance ranged from 10.0% to 91.0%. In recent years, acceptance has shown an upward trend as awareness of HPV and its vaccine has increased. Factors influencing acceptance include perceived risks of HPV-related diseases and vaccine benefits, potential barriers, sociodemographic characteristics, levels of knowledge and awareness about HPV and the vaccine, and social support factors.
https://doi.org/10.1080/21645515.2024.2429894
Content Editor: Xiaotong Yang
Page Editor: Ziqi Liu
