Journal Articles Recommendation
01
A cluster randomised trial of digital messaging nudges to improve influenza vaccination uptake in China
This study, published in npj Digital Medicine, evaluated the effectiveness of behaviorally informed digital nudges in increasing influenza vaccination uptake among children aged 6–35 months in China. A pragmatic six-arm cluster randomized controlled trial was conducted during the 2024–2025 influenza season across 36 community health centers in Hangzhou.
Centers were stratified by local economic level and randomized to one of six groups: standard information, gain-framed messages with statistical evidence, gain-framed messages with narrative evidence, loss-framed messages with statistical evidence, loss-framed messages with narrative evidence, or no-message control. A total of 2,011 parents were included. Messages were delivered via WeChat by community physicians. The primary outcome was verified influenza vaccination of children and parents within five months, based on the official immunization information system.
Results showed that loss-framed messages combined with narrative evidence produced the strongest and most sustained effect on childhood vaccination uptake (24.0% vs. 9.4% in controls; adjusted RR = 2.50, 95% CI: 1.27–4.94), with effects persisting throughout the five-month follow-up. Loss-framed messages with statistical evidence increased uptake only transiently in the first month. Gain-framed or standard messages showed no significant effect. Subgroup analyses indicated particularly strong effects in higher-income areas. The intervention had minimal impact on parental vaccination behavior, except among previously unvaccinated parents.
The study demonstrates that loss-framed, narrative-based digital nudges delivered via social media are a feasible and scalable strategy to sustainably improve childhood influenza vaccination uptake, consistent with behavioral science theories on risk perception and narrative engagement.
https://doi.org/10.1038/s41746-025-02137-5
02
Optimizing immunization through concurrent vaccination: a safety and cost analysis of PCV13 and rotavirus vaccines co-administration in Shanghai
This study, published in Vaccine, assessed the safety and economic impact of coadministration of PCV13 and rotavirus vaccines among children under 2 years of age in Shanghai, China, to inform strategies for simplifying immunization schedules and improving delivery efficiency. The study was conducted in both urban and suburban clinics. Safety was evaluated by monitoring adverse events on the day of vaccination and during the subsequent 7 days. Economic evaluation was performed from a societal perspective, incorporating direct medical, direct non-medical, and indirect costs, and estimating costs per dose and for completion of the full vaccination schedule. Cost-minimization and budget impact analyses were conducted, with sensitivity analyses to test robustness.
Safety results showed no significant differences in systemic adverse event rates among PCV13 alone (4.82%), rotavirus vaccine alone (4.35%), and coadministration (4.11%). Economic analyses demonstrated that coadministration was cost-saving: compared with separate vaccination, simultaneous administration of 1, 2, and 3 doses reduced total costs by 2.29%, 2.20%, and 1.07%, respectively. Cost savings were driven mainly by reductions in direct non-medical and indirect costs, with potential savings exceeding 40%.
The study indicates that coadministration of PCV13 and rotavirus vaccines is safe and economically advantageous, reducing clinic visits and household burden while optimizing resource use. This strategy may enhance the efficiency and sustainability of immunization programs in densely populated urban settings.
https://doi.org/10.1016/j.vaccine.2025.127880
03
Optimising a 1 + 1 PCV schedule: Key considerations in the current global climate
This article, published in Vaccine, systematically examines how to optimize the pneumococcal conjugate vaccine (PCV) “1+1” schedule (one primary dose plus one booster) for children under 5 years of age in the context of constrained global public health resources. Drawing on existing evidence, it evaluates how adjusting vaccination timing can enhance individual protection while maintaining herd immunity in settings with suboptimal coverage or incomplete population-level protection.
The World Health Organization’s 2025 position paper recommends the “1+1” schedule in countries that have achieved strong herd immunity and high booster coverage. Since adopting this schedule in 2020, the UK has not observed an increase in breakthrough disease, and a randomized trial in Viet Nam showed that, following large-scale catch-up campaigns, the “1+1” schedule was non-inferior to the traditional three-dose schedule in reducing vaccine-type carriage.
Evidence indicates that infant immune responses to PCVs increase with age, particularly for PCV13. When co-administered early with the first dose of DTP-containing vaccines, PCV10-GSK elicits stronger immune responses than PCV13; however, delaying the first PCV13 dose to around 14 weeks substantially improves immunogenicity. This suggests that postponing the primary dose—especially for PCV13—may enhance individual protection, albeit at the cost of a longer period of susceptibility before vaccination.
For the booster dose, longer intervals between doses are associated with stronger immune responses and improved herd effects, although early infancy before boosting remains a high-risk period for pneumococcal disease. Most studies have evaluated boosters at 9 or 12 months, demonstrating benefits in reducing carriage and supporting herd immunity. Limited exploratory evidence suggests that earlier boosters (e.g., at 6 months) may also be effective, warranting further investigation. The emergence of lower-cost vaccines such as PCV10-SII may increase the attractiveness of the “1+1” schedule in low- and middle-income countries, but additional data are needed to define optimal timing.
Overall, optimizing the PCV “1+1” schedule requires balancing local epidemiology, vaccine characteristics, and achievable coverage to maximize both individual and population-level protection. Generating robust evidence to support simplified schedules is critical to sustaining pneumococcal disease control under increasing financial constraints.
https://doi.org/10.1016/j.vaccine.2025.128021
04
Systematic Review of Active Safety Surveillance of Vaccines and Medicines in Low- and Middle-Income Countries
This article, published in Drug Safety, systematically reviews and evaluates the current status, key characteristics, and challenges of active vaccine and medicine safety surveillance systems in low- and middle-income countries (LMICs), aiming to identify strengths and limitations of existing models and provide evidence to support capacity strengthening in pharmacovigilance. The review followed the PRISMA-ScR guidelines, which included studies narratively synthesized and classified according to surveillance system characteristics.
A total of 423 eligible publications from 96 LMICs were included. Countries with the highest number of publications were India (96), China (57), Brazil (30), Iran (26), Ethiopia (21), Indonesia (20), Uganda (18), Kenya (17), and Ghana (16). Nearly half of the studies (211, 49.9%) focused on active vaccine safety surveillance.
Prospective cohort studies were the predominant surveillance approach, while retrospective cohorts and pregnancy exposure registries were less commonly used. At the implementation level, 127 studies employed mobile technologies or electronic platforms for follow-up, online data collection, and/or adverse event reporting. Analysis of system characteristics showed that only about 15% of vaccine surveillance systems could flexibly incorporate new vaccines or medicines; 34% reported multi-sectoral or public–private collaboration, and only 10% involved cross-national collaboration. Common challenges included small sample sizes, limited sustainability, low system flexibility, workforce constraints, and insufficient use of standardized case definitions and digital technologies.
Overall, although substantial progress has been made in active safety surveillance in LMICs, monitoring capacity remains uneven and fragile. Future efforts should prioritize harmonized digital tools for safety data collection and management, improved consistency in documentation and reporting, and strengthened international collaboration.
https://doi.org/10.1007/s40264-025-01625-7
05
Effectiveness of the 13-valent pneumococcal conjugate vaccine against medically attended pneumococcal lower respiratory tract infection among older adults: a case–control study
This study, published in Scientific Reports, evaluated the real-world effectiveness of the 13-valent pneumococcal conjugate vaccine (PCV13) against pneumococcal lower respiratory tract infections (LRTIs) among older adults and high-risk populations, providing evidence to inform immunization strategies in low- and middle-income countries.
A case–control design was used, based on clinical records from a university-affiliated tertiary hospital between January 2014 and December 2024. Adults aged ≥60 years who sought care for LRTIs were included. Cases were patients with microbiologically confirmed pneumococcal LRTIs, while controls were patients with non-pneumococcal LRTIs identified using ICD-10 codes. Vaccine effectiveness (VE) was estimated using logistic regression by comparing PCV13 vaccination status between groups.
Among 825 included patients, 39 (4.7%) had received PCV13. The crude VE against pneumococcal LRTIs was 71.9% (95% CI: 27.3–89.1), and the adjusted VE was 73.3% (95% CI: 9.0–92.1). Vaccinated patients had a lower proportion of mechanical ventilation at admission compared with unvaccinated pneumococcal cases. VE was similar between individuals aged ≥75 years and those aged <75 years. Sensitivity analyses restricting controls to non-pneumococcal bacterial LRTIs yielded a higher crude VE of 76.1% (95% CI: 34.3–91.3).
These findings demonstrate that PCV13 is effective in preventing pneumococcal LRTI-related healthcare visits and reducing disease severity among older adults in real-world settings, supporting its public health value in low- and middle-income countries.
https://doi.org/10.1038/s41598-025-24784-0
Content Editor: Tianyi Deng
Page Editor: Ruitong Li
