目的分析世界卫生组织(World Health Organization,WHO)成员国疫苗纳入国家免疫规划(National Immunization Program,NIP)现状。方法通过WHO网站获取WHO-联合国儿童基金会联合报表数据,对成员国NIP疫苗种类和目标人群进行描述性分析。结...目的分析世界卫生组织(World Health Organization,WHO)成员国疫苗纳入国家免疫规划(National Immunization Program,NIP)现状。方法通过WHO网站获取WHO-联合国儿童基金会联合报表数据,对成员国NIP疫苗种类和目标人群进行描述性分析。结果WHO推荐所有成员国将10种疫苗纳入NIP。在194个成员国中,卡介苗、乙型肝炎疫苗、脊髓灰质炎灭活疫苗、含百日咳白喉破伤风成分疫苗、含麻疹成分疫苗、含风疹成分疫苗、b型流感嗜血杆菌疫苗(Haemophilus influenzae type b vaccine,Hib)、肺炎球菌多糖结合疫苗(Pneumococcal polysaccharide conjugate vaccine,PPCV)、轮状病毒疫苗(Rotavirus vaccine,RotV)和人乳头瘤病毒疫苗(Human papillomavirus vaccine,HPV)疫苗纳入NIP的成员国比例分别为87.63%、100%、100%、98.97%、99.48%、89.17%、98.97%、82.47%、59.79%和66.49%。在10种疫苗中,中国尚未将Hib、PPCV、HPV和RotV纳入NIP。中国NIP疫苗覆盖人群主要为儿童;青少年和成人用疫苗、结合疫苗、联合疫苗纳入NIP较发达国家少。结论多数成员国将WHO推荐疫苗纳入NIP;中国需考虑将更多优质疫苗纳入NIP,并扩大覆盖人群。展开更多
Introduction: As new vaccines become available, countries must assess the relevance to introduce them into their vaccination schedules. Malawi has recently introduced several new vaccines and plans to introduce more. ...Introduction: As new vaccines become available, countries must assess the relevance to introduce them into their vaccination schedules. Malawi has recently introduced several new vaccines and plans to introduce more. This study was conducted to identify key factors that need to be considered when deciding to introduce a new vaccine and current challenges faced by low and middle income countries using Malawi as an example. Methodology: The study employed a desk review approach, examining published literature from various sources such as PubMed, Medline, and Google Scholar. Policy documents from organizations like the World Health Organization, GAVI the Alliance, and the Ministry of Health for Malawi were also included. A total of 99 articles and documents on new vaccine introduction, challenges of immunization, policy documents in immunization and health systems strengthening were included. The review focused on addressing five key areas critical to new vaccine introduction namely: the need for a vaccine, availability of the vaccine, safety and effectiveness of the vaccine, demand for the vaccine, and the prudent use of public or private funds. Results: Malawi considered the burden of cervical cancer and the significance of malaria in the country when introducing the HPV and malaria vaccines. The country opted for vaccines that can be handled by the cold chain capacity and available human resources. Despite that malaria vaccine and Typhoid Conjugate Vaccine trials were done in country, there are limited vaccine safety and efficacy trials conducted in Malawi, leading to a reliance on WHO-prequalified vaccines. Demand for newly introduced vaccines varied, with high demand for Oral Cholera Vaccine during a cholera outbreak, while demand for COVID-19 vaccines decreased over time. Although cost-effectiveness studies were limited in the country, 2 studies indicated that Typhoid Conjugate Vaccine and malaria vaccine would be cost effective. All these have been implemented despite having challenges like lack of accurate s展开更多
Despite high pneumococcal disease and economic burden in Indonesia and interest to introduce pneumococcal conjugate vaccine (PCV), there were challenges in establishing a comprehensive strategy to accelerate and enabl...Despite high pneumococcal disease and economic burden in Indonesia and interest to introduce pneumococcal conjugate vaccine (PCV), there were challenges in establishing a comprehensive strategy to accelerate and enable the introduction in country in the early 2010s. Starting in 2017, Clinton Health Access Initiative and partners supported the government of Indonesia with evidence-based decision-making and implementation support for introducing PCV into the routine immunization program. Indonesia has since accelerated PCV roll out, with nationwide reach achieved in 2022. On the path to PCV introduction, several challenges were observed that impacted decision making on whether and on how to optimally roll out PCV, resulting in significant introduction delays;including (1) a complex country context with a devolved government structure, fragmented domestic funding streams, and an imminent transition out of major immunization donor (Gavi) support;(2) strong preference to use domestically sourced products, with limited experience accessing global pooled procurement mechanism including for vaccines;and (3) concerns around programmatic feasibility and sustainability. This case study documents key insights into the challenges experienced and how those were systematically addressed to accelerate new vaccine introduction in Indonesia, with support from local and global stakeholders over time. The learnings would be beneficial for other countries yet to introduce critical new vaccines, in particular those with similar archetype as Indonesia e.g., middle-income countries with domestic manufacturing capacity and/or countries recently transitioning out of Gavi support.展开更多
Development of an effective vaccine against the leading human bacterial pathogen group A Streptococcus(GAS)is a public health priority.The species defining group A cell wall carbohydrate(GAC,Lancefield antigen)can be ...Development of an effective vaccine against the leading human bacterial pathogen group A Streptococcus(GAS)is a public health priority.The species defining group A cell wall carbohydrate(GAC,Lancefield antigen)can be engineered to remove its immunodominant N-acetylglucosamine(GlcNAc)side chain,implicated in provoking autoimmune cross-reactivity in rheumatic heart disease,leaving its polyrhamnose core(GACPR).Here we generate a novel protein conjugate of the GACPR and test the utility of this conjugate antigen in active immunization.Instead of conjugation to a standard carrier protein,we selected SpyAD,a highly conserved GAS surface protein containing both B-cell and T-cell epitopes relevant to the bacterium that itself shows promise as a vaccine antigen.SpyAD was synthesized using the XpressTM cell-free protein expression system,incorporating a non-natural amino acid to which GACpr was conjugated by site-specific click chemistry to yield high molecular mass SpyAD-GACPR conjugates and avoid disruption of important T-cell and B-cell immunological epitopes.The conjugated SpyAD-GACPR elicited antibodies that bound the surface of multiple GAS strains of diverse M types and promoted opsonophagocytic killing by human neutrophils.Active immunization of mice with a multivalent vaccine consisting of SpyAD-GACPR,together with candidate vaccine antigens streptolysin O and C5a peptidase,protected against GAS challenge in a systemic infection model and localized skin infection model,without evidence of cross reactivity to human heart or brain tissue epitopes.This general approach may allow GAC to be safely and effectively included in future GAS subunit vaccine formulations with the goal of broad protection without autoreactivity.展开更多
Objective:To explore and understand the attitude towards dengue vaccination and its modifiable determinants among inhabitants of Aceh(northern Sumatra Island,Indonesia),the region that was most severely affected by th...Objective:To explore and understand the attitude towards dengue vaccination and its modifiable determinants among inhabitants of Aceh(northern Sumatra Island,Indonesia),the region that was most severely affected by the earthquake and tsunami of 26 December 2004.Methods:A communitybased,cross-sectional study was conducted among 535 healthy inhabitants in nine regencies(Kabupaten or Kotamadya) of Aceh that were selected randomly from November 2014 to March 2015.A set of validated,pre-tested,structured questionnaires was used to guide the interviews.The questionnaires covered a range of explanatory variables and one outcome variable(attitude to dengue vaccination).Multi-step logistic regression analysis and Spearman's rank correlation were used to test the role of explanatory variables for the outcome variable.Results:More than 70%of the participants had a poor attitude towards dengue vaccination.Modifiablc determinants associated with poor attitude to dengue vaccination were low education level,working as farmers and traditional market traders,low socioeconomic status and poor knowledge,attitude and practice regarding dengue fever(P<0.05).The KAP domain scores were correlated strongly with attitude to dengue vaccination,r_s=0.25,r_S=0.67 and r_s=0.20,respectively(P<0.001).Multivariate analysis found that independent predictors associated with attitude towards dengue vaccination among study participants were only sex and attitude towards dengue fever(P<0.001).Conclusions:This study reveals that low KAP regarding dengue fever,low education level and low socioeconomic status are associated with a poor attitude towards dengue vaccination.Therefore,inhabitants of suburbs who are working as larmers or traditional market traders with low socioeconomic status are the most appropriate target group for a dengue vaccine introduction program.展开更多
文摘目的分析世界卫生组织(World Health Organization,WHO)成员国疫苗纳入国家免疫规划(National Immunization Program,NIP)现状。方法通过WHO网站获取WHO-联合国儿童基金会联合报表数据,对成员国NIP疫苗种类和目标人群进行描述性分析。结果WHO推荐所有成员国将10种疫苗纳入NIP。在194个成员国中,卡介苗、乙型肝炎疫苗、脊髓灰质炎灭活疫苗、含百日咳白喉破伤风成分疫苗、含麻疹成分疫苗、含风疹成分疫苗、b型流感嗜血杆菌疫苗(Haemophilus influenzae type b vaccine,Hib)、肺炎球菌多糖结合疫苗(Pneumococcal polysaccharide conjugate vaccine,PPCV)、轮状病毒疫苗(Rotavirus vaccine,RotV)和人乳头瘤病毒疫苗(Human papillomavirus vaccine,HPV)疫苗纳入NIP的成员国比例分别为87.63%、100%、100%、98.97%、99.48%、89.17%、98.97%、82.47%、59.79%和66.49%。在10种疫苗中,中国尚未将Hib、PPCV、HPV和RotV纳入NIP。中国NIP疫苗覆盖人群主要为儿童;青少年和成人用疫苗、结合疫苗、联合疫苗纳入NIP较发达国家少。结论多数成员国将WHO推荐疫苗纳入NIP;中国需考虑将更多优质疫苗纳入NIP,并扩大覆盖人群。
文摘Introduction: As new vaccines become available, countries must assess the relevance to introduce them into their vaccination schedules. Malawi has recently introduced several new vaccines and plans to introduce more. This study was conducted to identify key factors that need to be considered when deciding to introduce a new vaccine and current challenges faced by low and middle income countries using Malawi as an example. Methodology: The study employed a desk review approach, examining published literature from various sources such as PubMed, Medline, and Google Scholar. Policy documents from organizations like the World Health Organization, GAVI the Alliance, and the Ministry of Health for Malawi were also included. A total of 99 articles and documents on new vaccine introduction, challenges of immunization, policy documents in immunization and health systems strengthening were included. The review focused on addressing five key areas critical to new vaccine introduction namely: the need for a vaccine, availability of the vaccine, safety and effectiveness of the vaccine, demand for the vaccine, and the prudent use of public or private funds. Results: Malawi considered the burden of cervical cancer and the significance of malaria in the country when introducing the HPV and malaria vaccines. The country opted for vaccines that can be handled by the cold chain capacity and available human resources. Despite that malaria vaccine and Typhoid Conjugate Vaccine trials were done in country, there are limited vaccine safety and efficacy trials conducted in Malawi, leading to a reliance on WHO-prequalified vaccines. Demand for newly introduced vaccines varied, with high demand for Oral Cholera Vaccine during a cholera outbreak, while demand for COVID-19 vaccines decreased over time. Although cost-effectiveness studies were limited in the country, 2 studies indicated that Typhoid Conjugate Vaccine and malaria vaccine would be cost effective. All these have been implemented despite having challenges like lack of accurate s
基金This work was made possible through funding support from Bill and Melinda Gates Foundation.
文摘Despite high pneumococcal disease and economic burden in Indonesia and interest to introduce pneumococcal conjugate vaccine (PCV), there were challenges in establishing a comprehensive strategy to accelerate and enable the introduction in country in the early 2010s. Starting in 2017, Clinton Health Access Initiative and partners supported the government of Indonesia with evidence-based decision-making and implementation support for introducing PCV into the routine immunization program. Indonesia has since accelerated PCV roll out, with nationwide reach achieved in 2022. On the path to PCV introduction, several challenges were observed that impacted decision making on whether and on how to optimally roll out PCV, resulting in significant introduction delays;including (1) a complex country context with a devolved government structure, fragmented domestic funding streams, and an imminent transition out of major immunization donor (Gavi) support;(2) strong preference to use domestically sourced products, with limited experience accessing global pooled procurement mechanism including for vaccines;and (3) concerns around programmatic feasibility and sustainability. This case study documents key insights into the challenges experienced and how those were systematically addressed to accelerate new vaccine introduction in Indonesia, with support from local and global stakeholders over time. The learnings would be beneficial for other countries yet to introduce critical new vaccines, in particular those with similar archetype as Indonesia e.g., middle-income countries with domestic manufacturing capacity and/or countries recently transitioning out of Gavi support.
基金supported by the CARB-X,Vaxcyte,Inc.,and NIH Grant(AI077780)NJG was supported in part by a Ruth L.Kirschstein Institutional National Research Award from the National Institute for General Medical Sciences(T32 GM008666)。
文摘Development of an effective vaccine against the leading human bacterial pathogen group A Streptococcus(GAS)is a public health priority.The species defining group A cell wall carbohydrate(GAC,Lancefield antigen)can be engineered to remove its immunodominant N-acetylglucosamine(GlcNAc)side chain,implicated in provoking autoimmune cross-reactivity in rheumatic heart disease,leaving its polyrhamnose core(GACPR).Here we generate a novel protein conjugate of the GACPR and test the utility of this conjugate antigen in active immunization.Instead of conjugation to a standard carrier protein,we selected SpyAD,a highly conserved GAS surface protein containing both B-cell and T-cell epitopes relevant to the bacterium that itself shows promise as a vaccine antigen.SpyAD was synthesized using the XpressTM cell-free protein expression system,incorporating a non-natural amino acid to which GACpr was conjugated by site-specific click chemistry to yield high molecular mass SpyAD-GACPR conjugates and avoid disruption of important T-cell and B-cell immunological epitopes.The conjugated SpyAD-GACPR elicited antibodies that bound the surface of multiple GAS strains of diverse M types and promoted opsonophagocytic killing by human neutrophils.Active immunization of mice with a multivalent vaccine consisting of SpyAD-GACPR,together with candidate vaccine antigens streptolysin O and C5a peptidase,protected against GAS challenge in a systemic infection model and localized skin infection model,without evidence of cross reactivity to human heart or brain tissue epitopes.This general approach may allow GAC to be safely and effectively included in future GAS subunit vaccine formulations with the goal of broad protection without autoreactivity.
文摘Objective:To explore and understand the attitude towards dengue vaccination and its modifiable determinants among inhabitants of Aceh(northern Sumatra Island,Indonesia),the region that was most severely affected by the earthquake and tsunami of 26 December 2004.Methods:A communitybased,cross-sectional study was conducted among 535 healthy inhabitants in nine regencies(Kabupaten or Kotamadya) of Aceh that were selected randomly from November 2014 to March 2015.A set of validated,pre-tested,structured questionnaires was used to guide the interviews.The questionnaires covered a range of explanatory variables and one outcome variable(attitude to dengue vaccination).Multi-step logistic regression analysis and Spearman's rank correlation were used to test the role of explanatory variables for the outcome variable.Results:More than 70%of the participants had a poor attitude towards dengue vaccination.Modifiablc determinants associated with poor attitude to dengue vaccination were low education level,working as farmers and traditional market traders,low socioeconomic status and poor knowledge,attitude and practice regarding dengue fever(P<0.05).The KAP domain scores were correlated strongly with attitude to dengue vaccination,r_s=0.25,r_S=0.67 and r_s=0.20,respectively(P<0.001).Multivariate analysis found that independent predictors associated with attitude towards dengue vaccination among study participants were only sex and attitude towards dengue fever(P<0.001).Conclusions:This study reveals that low KAP regarding dengue fever,low education level and low socioeconomic status are associated with a poor attitude towards dengue vaccination.Therefore,inhabitants of suburbs who are working as larmers or traditional market traders with low socioeconomic status are the most appropriate target group for a dengue vaccine introduction program.
