A targeted quality improvement program was associated with increased rates of healthcare providers recommending human papillomavirus (HPV) vaccination initiation to eligible children at a Utah-based family medicine health care system. The methodology may be applicable to other practices that which practice with nurse practitioners (NPs) serving a more involved role in HPV vaccine initiation.
A new poster presented at the National Association of Pediatric Nurse Practitioners (NAPNAP) 2024 National Conference on Pediatric Health Care showed a multifaceted education program targeted for each of healthcare providers and medical assistants resulted in increased rates of HPV vaccination upwards of 60% across 3 pediatric clinics over just 1 year.
A team of investigators from the BYU Family Nurse Practitioner Program, led by Michael S. Robinson, DNP, FNP-C, sought to evaluate the rate of HPV vaccination among pediatric patients aged 9 10 years old following the application of educational interventions across a trio of Salt Lake City-based pediatric clinics. The educational intervention included a pair of 15 20-minute educational presentations, targeted toward healthcare providers and medical assistants, respectively.
The healthcare provider education intervention entailed evidence for delivering the first HPV vaccination to children at age 9 10. It also provided evidence-based responses to common questions raised around HPV vaccination.
The medical assistant education intervention additionally addressed the same evidence, as well as guidance on identifying eligible pediatric patients for vaccination and how to communicate said eligibility to healthcare providers.
The HPV vaccine initiation recommendation was updated to age 9 years old by the American Cancer Society (ACS) in 2020. Whats more, the Healthy People 2030 national strategy has set a goal to increase HPV vaccination rates from 48% to 80%. Despite these initiatives, HPV vaccination has increased by only 10% in the last 3 years.
As Robinson and colleagues noted, an optimal approach to applying better practices may be multifactorial.
Although HPV vaccine is safe and effective, vaccine uptake can improve, they wrote. Nurse Practitioners must identify and implement strategies to improve HPV vaccination.
Investigators assessed the total count of HVP 1 and 2 vaccine doses initiated in children based on age groups of 9 10 years old, 11 12 years old, and 13 years old, in 2022 (pre-education intervention) and 2023 (post-education).
Among children aged 9 10 years old, they observed a 57.3% (n = 140) increase in total HPV 1 vaccine doses provided in 2023 versus 2022. Among children aged 11 12 years old, the increase in HPV 1 vaccine doses was 41.7% (n = 485) and the increase in HPV 2 doses was 54.6% (n = 131) following the educational intervention.
Though the rate of annual HPV 1 vaccine doses in children aged 13 years old actually decreased by 5% in 2023, the team did observe an increase of HPV vaccine regimen conclusion in this age group (n = 105 [18.2%]).
In total, the educational intervention strategy was associated with 811 more HPV vaccine doses administered in 2023 versus 2022 (24.5%). Investigators additionally observed reports of increased confidence among both healthcare providers and medical assistants in initiating the HPV vaccine dose in the ACS-recommended age group following the educational intervention.
Implementing clinic-wide educational interventions to improve HPV vaccination rates among 9-10-year-olds is successful, Robinson and colleagues wrote. To increase HPV vaccination rates among 9-10-year-olds, multiple strategies should be used.
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The following essay is reprinted with permission from The Conversation, an online publication covering the latest research.
Why would a mother reject safe, potentially lifesaving vaccines for her child?
Popular writing on vaccine skepticism often denigrates white and middle-class mothers who reject some or all recommended vaccines as hysterical, misinformed, zealous or ignorant. Mainstream media and medical providers increasingly dismiss vaccine refusal as a hallmark of American fringe ideology, far-right radicalization or anti-intellectualism.
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But vaccine skepticism, and the broader medical mistrust and far-reaching anxieties it reflects, is not just a fringe position.
Pediatric vaccination rates had already fallen sharply before the COVID-19 pandemic, ushering in the return of measles, mumps and chickenpox to the U.S. in 2019. Four years after the pandemics onset, a growing number of Americans doubt the safety, efficacy and necessity of routine vaccines. Childhood vaccination rates have declined substantially across the U.S., which public health officials attribute to a spillover effect from pandemic-related vaccine skepticism and blame for the recent measles outbreak. Almost half of American mothers rated the risk of side effects from the MMR vaccine as medium or high in a 2023 survey by Pew Research.
Recommended vaccines go through rigorous testing and evaluation, and the most infamous charges of vaccine-induced injury have been thoroughly debunked. How do so many mothers primary caregivers and health care decision-makers for their families become wary of U.S. health care and one of its most proven preventive technologies?
Im a cultural anthropologist who studies the ways feelings and beliefs circulate in American society. To investigate whats behind mothers vaccine skepticism, I interviewed vaccine-skeptical mothers about their perceptions of existing and novel vaccines. What they told me complicates sweeping and overly simplified portrayals of their misgivings by pointing to the U.S. health care system itself. The medical systems failures and harms against women gave rise to their pervasive vaccine skepticism and generalized medical mistrust.
I conducted this ethnographic research in Oregon from 2020 to 2021 with predominantly white mothers between the ages of 25 and 60. My findings reveal new insights about the origins of vaccine skepticism among this demographic. These women traced their distrust of vaccines, and of U.S. health care more generally, to ongoing and repeated instances of medical harm they experienced from childhood through childbirth.
As young girls in medical offices, they were touched without consent, yelled at, disbelieved or threatened. One mother, Susan, recalled her pediatrician abruptly lying her down and performing a rectal exam without her consent at the age of 12. Another mother, Luna, shared how a pediatrician once threatened to have her institutionalized when she voiced anxiety at a routine physical.
As women giving birth, they often felt managed, pressured or discounted. One mother, Meryl, told me, I felt like I was coerced under distress into Pitocin and induction during labor. Another mother, Hallie, shared, I really battled with my provider throughout the childbirth experience.
Together with the convoluted bureaucracy of for-profit health care, experiences of medical harm contributed to one million little touch points of information, in one mothers phrase, that underscored the untrustworthiness and harmful effects of U.S. health care writ large.
Many mothers I interviewed rejected the premise that public health entities such as the Centers for Disease Control and Prevention and the Food and Drug Administration had their childrens best interests at heart. Instead, they tied childhood vaccination and the more recent development of COVID-19 vaccines to a bloated pharmaceutical industry and for-profit health care model. As one mother explained, The FDA is not looking out for our health. Theyre looking out for their wealth.
After ongoing negative medical encounters, the women I interviewed lost trust not only in providers but the medical system. Frustrating experiences prompted them to do their own research in the name of bodily autonomy. Such research often included books, articles and podcasts deeply critical of vaccines, public health care and drug companies.
These materials, which have proliferated since 2020, cast light on past vaccine trials gone awry, broader histories of medical harm and abuse, the rapid growth of the recommended vaccine schedule in the late 20th century and the massive profits reaped from drug development and for-profit health care. They confirmed and hardened womens suspicions about U.S. health care.
The stories these women told me add nuance to existing academic research into vaccine skepticism. Most studies have considered vaccine skepticism among primarily white and middle-class parents to be an outgrowth of todays neoliberal parenting and intensive mothering. Researchers have theorized vaccine skepticism among white and well-off mothers to be an outcome of consumer health care and its emphasis on individual choice and risk reduction. Other researchers highlight vaccine skepticism as a collective identity that can provide mothers with a sense of belonging.
The perceptions mothers shared are far from isolated or fringe, and they are not unreasonable. Rather, they represent a growing population of Americans who hold the pervasive belief that U.S. health care harms more than it helps.
Data suggests that the number of Americans harmed in the course of treatment remains high, with incidents of medical error in the U.S. outnumbering those in peer countries, despite more money being spent per capita on health care. One 2023 study found that diagnostic error, one kind of medical error, accounted for 371,000 deaths and 424,000 permanent disabilities among Americans every year.
Studies reveal particularly high rates of medical error in the treatment of vulnerable communities, including women, people of color, disabled, poor, LGBTQ+ and gender-nonconforming individuals and the elderly. The number of U.S. women who have died because of pregnancy-related causes has increased substantially in recent years, with maternal death rates doubling between 1999 and 2019.
The prevalence of medical harm points to the relevance of philosopher Ivan Illichs manifesto against the disease of medical progress. In his 1982 book Medical Nemesis, he insisted that rather than being incidental, harm flows inevitably from the structure of institutionalized and for-profit health care itself. Illich wrote, The medical establishment has become a major threat to health, and has created its own epidemic of iatrogenic illness that is, illness caused by a physician or the health care system itself.
Four decades later, medical mistrust among Americans remains alarmingly high. Only 23% of Americans express high confidence in the medical system. The United States ranks 24th out of 29 peer high-income countries for the level of public trust in medical providers.
For people like the mothers I interviewed, who have experienced real or perceived harm at the hands of medical providers; have felt belittled, dismissed or disbelieved in a doctors office; or spent countless hours fighting to pay for, understand or use health benefits, skepticism and distrust are rational responses to lived experience. These attitudes do not emerge solely from ignorance, conspiracy thinking, far-right extremism or hysteria, but rather the historical and ongoing harms endemic to the U.S. health care system itself.
This article was originally published on The Conversation. Read the original article.
(Precision Vaccinations News)
With an estimated 11 to 20 million typhoid fever casesevery year and about 120,000 related deaths, global health leaders are aggressively improving access to new vaccines.
The World Health Organization (WHO) recently confirmed its recommendation to use three vaccines to control endemic and epidemic typhoid fever.
In late February 2024, SK bioscience and the International Vaccine Institute (IVI) announced that the SKYTyphoid typhoid conjugate vaccine had received prequalification (PQ) from the World Health Organization.
WHO PQ certifies a vaccine's safety, efficacy, and GMP by evaluating its manufacturing process, quality, and clinical trial results according to stringent standards.
SKYTyphoidutilizes the 'purified Vi polysaccharide-diphtheria toxoid conjugate' method, which conjugates diphtheria toxin protein (diphtheria toxoid), which acts as a carrier, to polysaccharide of typhoid bacteria, which acts as an antigen.
Adopting conjugation technology, the vaccine is safe for infants and young children aged six months to 2 years. It is expected to provide sufficient immune response and long-term protection with a single dose compared to existing oral live or polysaccharide typhoid vaccines.
SKYTyphoid initiallyobtained a licensure in Korea in 2022.
Dr. Sushant Sahastrabuddhe,Director of IVI's Typhoid program, said in a February 23, 204 press release, "The WHO licensure ofSKYTyphoid... will diversify and expand the supply of TVCs and help improve vaccine access in the endemic countries. With SK's commitment to makingthe vaccine for global public health at a competitive price, SKYTyphoidwill play an important role in typhoid prevention globally."
SK bioscience plans to start supplying the vaccine as soon as possible and expand global supply through public procurement markets including typhoid endemic countries.
Typhoid fever is transmitted by consuming raw or undercooked food or water contaminated with the feces of an infected person.
In 2024, there are significanttyphoid fever outbreaks in sub-Saharan Africa.
In March 2024, local media reported that Taiwan confirmedits first locally acquired typhoid fever case this year. Since 2019, Taiwan has accumulated 49 typhoid cases, 18 of which were domestic cases.
In the United States, about5,700 people gettyphoid fevereach year,and 620 of those people are hospitalized.
There are currently two typhoid fever vaccines available in the United States.
(Precision Vaccinations News)
The United States government recentlyissued a strong warning regarding the ongoing measles outbreaks in 46 countries.
And the federal government is supporting Chicago's efforts to curb the spread of the highly infectious measles virus.
To clarify its vaccination recommendations, on March 13, 2024, the U.S. Centers for Disease Control and Prevention (CDC) updated its Level 1 Travel Health Advisory to ensure that all international travelers are fully protected against this vaccine-preventable disease.
Vaccination with a measles-containing vaccine is the best way to make sure that you are protected. Even young infantsshould receive one dose of the MMR vaccine, says the CDC.
If you are unsure if you or your travel companions are fully protected against measles, schedule an appointment to see your clinician or pharmacist at least six weeksbefore traveling so that you have enough time to get vaccinated.
However, some people should not get a measles-containing vaccine or should wait. If you don't think you can safely receive one, talk to your clinician and consider making alternative travel plans.
Individuals must take the necessary steps to safeguard their health and the health of others by following these guidelines, says the CDC.
As of March 16, 2024, measles vaccines are offered at community pharmacies in the U.S.
Vaccines are the most cost-effective strategy to prevent and suppress global infections, such as viral pathogens.
Conventional vaccines are classified under three categories: live, attenuated or non-live. Conventional vaccines have shown utility in irradicating smallpox and slowing the spread of other diseases, such as polio, measles, mumps and rubella over past decades.1 However, producing these attenuated vaccines is complex and time-consuming; creating new vaccines is estimated to take 5-10 years and costs over $500 million, with additional costs associated with manufacturing and equipment.2
Pandemic-era vaccine manufacturing and beyond
The established methods of conventional vaccine production are no longer adequate to identify and produce new vaccines to ensure global protection.
Technology utilizing mRNA promises to change the current paradigm for vaccine development, as the platform allows the production of vaccine candidates in as little as a few weeks by altering just the viral RNA sequence.3,4
While the mRNA vaccine technology allowed the production of a vaccine against SARS-CoV-2 in just one year, global vaccination efforts were severely strained by the capacity to manufacture.
These bottlenecks were caused by a lack of manufacturing facilities, tech-transfer personnel as well as shortages in raw materials.5 It is now apparent that there is a need for more resilience and robustness to allow for rapid, safe and large-scale production of vaccines, especially in developing countries. The COVID-19 mRNA vaccine has sparked a movement to advance mRNA technology into other therapeutic avenues and to develop better manufacturing technology and practices.
Model-based assessment of the mRNA vaccine manufacturing pipeline
As the COVID-19 vaccine was the first authorized vaccine to use mRNA technology and be mass-produced, little data was available regarding the economic production of mRNA-based therapeutics. The vaccine production started at risk, before the completion of clinical trials and before the optimization or scale-up of the product process, which had led to uncertainties in the substrate amount required for dose and the number of doses that would be required.6
Now, data from this experience can be used to model the manufacturing process.
Dr. Zoltn Kis, lecturer and assistant professor of chemical and biological engineering at the University of Sheffield is working to better understand and optimize the mRNA manufacturing landscape. Kis research focuses on experimental and modeling techniques to produce platform processes that enable the rapid development and mass manufacturing of RNA vaccines.
In a recent paper, Kis sought to build a model-based assessment to understand vaccine production better.7 We ran a global sensitivity analysis to evaluate key performance indicators on different vaccine production platforms, namely adenovirus vectors vaccines, mRNA vaccines and saRNA vaccines to assess baseline performance of the production process, Kis says. Certain inputs such as scale, titers, failure rates, dose size, labor rates and failure rates were used. The model sampled 10,000 simulations and plotted these inputs against key performance indicators to understand how each input affects production.
In terms of mRNA production, we found that the process was sensitive to a few process specifics, primarily the substrate dose, batch lead times and the production scale. The main driver is the amount of mRNA per dose as well as production scale and titer, explains Kis. The key takeaways of mRNA manufacturing that should be noted moving forward are:
We believe that producing an mRNA platform technology for vaccine production will help alleviate many issues. This would mean using the same production platform [equipment] and only changing the RNA that is encapsulated for different diseases. Facilitating the move from batch processing to an efficient continuous process would also speed up production, Kis says.
These insights are useful not only for the production of vaccines against emerging SARS-CoV-2 variants, but to also better understand the mRNA production process as technology becomes more efficient.8
Engineering better LNPs for mRNA vaccines
Using vaccines to induce a highly potent immune response, such as the production of neutralizing antibodies, is an urgent need. With mRNA technology, scientists are looking into building a mechanistic insight into the function of LNP-mRNA vaccines and engineering them to be more immunologically potent.
For future vaccine development and manufacturing, we need to look at lowering vaccination dose while maintaining or enhancing vaccination efficacy, says Dr. Yizhou Dong, professor in the Icahn Genomics Institute at the Icahn School of Medicine at Mount Sinai. The Dong lab focuses on designing and developing biotechnology platforms for treating cancers, infectious diseases and genetic disorders.
One approach is to engineer the LNP delivery system to stimulate multiple immune system pathways and increase therapeutic efficacy. A pathway of interest is the STING pathway, known to active type 1 interferon(IFN) secretion. Type 1 IFN response is critical for expanding and activating CD8+ T-cells against viral infections.9
By integrating an agonist for the STING pathway into the LNP of the SARS-CoV-2 vaccine, the Dong lab produced a vaccine that was more immunologically potent than the LNPs used for the current mRNA vaccines. This was achieved by producing a potent STING agonist with unique physiochemical properties on the LNP, which, when endocytosed, activates the STING pathway, causing the production of INF-. When the engineered STING agonist LNP (SAL-12) was compared with the ALC-0315 (the lipid used in the COVID mRNA vaccine) in a mouse study, SAL-12 produced an over 15 times better neutralization titer (NT50), and enhanced protection against SARS-CoV-2.10
This work is a proof of concept for using agonists within LNPS to enhance immune response. Solutions like this one open the avenue for next-generation mRNA vaccines.
How can this technology be used in the future? Well, each disease has its own challenges, and the vaccine will need to be created and studied accordingly. We need to alter the delivery platform or tune the mRNA cargo and final formulation to match the needs of the disease, Dong says.
Although mRNA-based vaccines are being tested for many different indications, augmenting the immune response by targeting pathways that amplify the therapeutic response can lower the required doses and manufacturing costs.11
Emerging platform for viral-like particle vaccines
Virus-like particles (VLPs) are structures that mimic both the organization and conformation of viruses but lack a viral genome, which renders them non-infectious.
VLPs have structural characteristics that enable a stronger immune response than conventional vaccines.12 VLP-based vaccines are already available against Hepatitis B, zika and malaria. 13
The production of VLP vaccines using genetic engineering has been challenging because of low yields, high costs and complex and time-consuming expression and purification processes. Advancements are needed to produce a more simplified workflow for VLP-based vaccines.
In a recent study a team at Qingdao Municipal Hospital in Qingdao, China, developed a novel VLP platform that mimics infection and confers protection to influenza through fluorination-drive self-assembly.14
Fluorination is a chemical process that involves the introduction of fluorine atoms into a chemical structure. Fluorination promotes cytosolic delivery of both small molecules and macromolecules, and promotes self-assembly.15 Taking advantage of this phenomenon allows for the self-assembly of viral antigens for VLP vaccines.
In viral antigen self-assembly, the viral surface antigens are fluorinated by conjugating them with tridecafluoroheptanoic acid. These virus proteins then self-assemble into VLPs through fluorophilic interactions, which mimic a natural virus structure. Different influenza strains were used such as H1N1, H6N2 and H9N2. Besides the production of single VLPs from each influence strain, a mosaic VLP was also produced with surface antigens of all three influenza strains.
Both these mosaic VLPs and individual VLPs from single influence strains provided protection against lethal viral challenges in a mouse model, where mouse body weight change and survival rate were used to test efficacy. Mice were immunized using either the fluorinated VLP influenza vaccine, whole inactivated influenza virus, soluble influenza antigen or with saline. The VLP vaccine demonstrated the most robust protection and survival against other vaccine types and had also showed low viral loads and inflammation in the lungs.
The fluorination process could enhance the breadth of protection offered by vaccines as it enables the targeting of multiple virus strains simultaneously. This could open avenues to produce VLP vaccines against highly mutable viruses. Using this self-assembly approach may also offer a scalable alternative to conventional VLP vaccine production, making it a more attractive option for manufacturing.
Upcoming advancements in vaccine technology and manufacturing
The utility of mRNA and VLPs have shown technology advancements that will alter the vaccine production and manufacturing landscape.
The modularity and quick production of mRNA sequences allow for rapid adaptation to new targets currently being investigated for cancers, viral infections and genetic disorders.16 This technology is still relatively new and suffers from mRNA thermal stability, storage concerns and unwanted immunogenic responses. 17
VLP vaccines are known to produce a strong immune response that closely resemble viral infection. Since VLPs do not contain genetic information, they are neither infectious nor pathogenic. Current research is looking at redefining VLP-based vaccines by altering adjuvants, stabilizers, and delivery vehicles to reduce required dosages and enhance shelf life.
Both mRNA and VLP vaccines represent a significant advancement in vaccine technology and will play a role in protection against infectious diseases. Given the unique advantages of these platforms and ongoing research and development to address drawbacks in their manufacturing, the future of mRNA and VLP-based vaccines holds great promise for production.
About the interviewees:
Zoltn Kis is a senior lecturer and assistant professor of chemical and biological engineering at the University of Sheffield. His research work looks to innovate RNA vaccine and therapeutic production processes. This includes using experimental development, techno-economic modeling and the use of quality by design principles.
Yizhou Dong is a professor at the Icahn Genomics Institute, the Marc and Jennifer Lipschultz Precision Immunology Institute,the Department of Immunology and Immunotherapyand the Department of Oncological Sciences at the Icahn School of Medicine at Mount Sinai. His research focuses on the design and development of nanoparticles delivery systems as well as RNA therapeutics primarily for treating cancers, genetic disorders and infectious diseases.
References (Click to expand)
References:
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Protected health information and personal details of over a million Irish citizens were accidently exposed by the Irelands Health Service Executive (HSE) during the COVID pandemic, according to an AppOmni security researcher.
This information included individuals vaccine status and type received, which could have been accessed by anyone who registered to the HSE COVID Vaccination Portal before the end of 2021.
The misconfiguration in the portal also made internal HSE documents publicly available, Aaron Costello, Principal SaaS Security Engineer at AppOmni, revealed in a blog dated March 14, 2024.
The exposed health and personal information included:
Costello discovered the issue in December 2021, and HSE confirmed to him it had been fixed on January 17, 2022.
There is no evidence that the information was accessed by any unauthorized individuals with malicious intent.
Costello explained that he has decided to make the issue public to help educate organizations on the risks of handling sensitive data in SaaS applications.
The HSE vaccination portal was created during the COVID-19 crisis to enable Irish citizens to quickly book vaccine appointments, with users signing up through a self-registration form.
The portal was built on top of the Salesforce platform, in what is known as a Digital Community. These communities are configured to grant all registered individuals a specific profile, which gives them permissions to perform actions on the portals user interface, such as register for a vaccination or view their appointment details.
However, the profile permissions were accidently configured by HSE to grant users access to the Health Cloud object that stored information about other registrants including their vaccination status.
Users were also granted excessive privileges that could enable them to access a folder containing internal HSE documents.
Most users would not have realized they had this level of access because the portal is specifically designed to only show the individuals data, Costello noted.
However, a malicious actor could have exploited the misconfiguration to access and exfiltrate the sensitive information about individuals and HSE.
Costello explained this could have been achieved by simply registering to the Vaccination Portal to be automatically assigned the over-privileged Salesforce profile, then viewing all objects that existed within the Salesforce platform through the API, including those in the Health Cloud application.
From there, a malicious actor could iterate over the list of available objects and attempt to access and download the data within them.
This would have allowed the malicious individual to access both internal HSE documentation, and all vaccine administration records for over a million individuals, Costello explained.
The Irish Times quoted a HSE spokesperson who confirmed the misconfiguration had occurred, and said it was remediated the day it was alerted to the issue.
It highlighted the time pressure of the COVID-19 vaccination program as the cause for the accidental exposure, but reiterated that there was no evidence that a malicious actor accessed the data.
Costello set out the best practices for organizations that have publicly facing content on the Salesforce platform to take to avoid the risk of data exposure:
Costello acknowledged that these actions would have been exceptionally difficult for HSE to manually implement amid the rush to manage the rapid vaccination rollout across the country during the pandemic.
Image credit: Lukassec / Shutterstock.com
Polio
After no reported cases of wild polio for 19 weeks, vaccination efforts boosted at last endemic spots in Pakistan and Afghanistan
Sat 16 Mar 2024 09.00 EDT
The world is tantalisingly close to eradicating polio with no confirmed cases of wild polio anywhere so far this year. But experts warn that vaccination efforts and funding must not falter if the world is to rid itself of a human infectious disease for the second time in history, after smallpox.
There have been no reported cases of wild polio infection in people for the last 19 weeks. Figures from the World Health Organization reveal that the last confirmed cases were on the borders of Pakistan and Afghanistan in October and September 2023 respectively; these are the last nations on Earth where polio is endemic.
To have gone 19 straight weeks is a long period to go without a single case, thats why there is some hope [of eradication], Gordon McInally, president of Rotary International, a founding partner in the Global Polio Eradication Initiative (GPEI), told the Observer. All of us who are involved in this, every week we get an email giving us the updated figures and every week when I click open that email my heart rate goes up until I see the number in the hope that it will be zero and not one, or worse. But we take it week by week.
But those involved in eradication efforts are taking nothing for granted. The programme has come under fire before for its almost-there narrative, as described in a report last September by the Independent Monitoring Board, led by Liam Donaldson, a former chief medical officer for England.
Still, said McInally, if they can get through another 33 weeks (one full year after the last case), they will be celebrating cautiously, and if the world stays two years disease-free they can officially declare the global eradication of polio.
While the absence of confirmed cases is really encouraging, Aidan OLeary, director for polio eradication at the WHO, said: Its important we dont call the figures great. The campaign needs to be aggressive in closing any immunisation gaps, he added.
The latest WHO figures do reveal 34 samples of wild poliovirus detected from environmental and other sources in the first three months of this year, including from surveillance samples of sewage (where shed virus may circulate). We are identifying environmental isolates which does indicate theres some transmission, said OLeary, adding this needs to be zero too.
OLeary, McInally and other stakeholders met Andrew Mitchell, the minister for development, and his team on Wednesday to update them on polio, and ask the UK government to continue with its funding, which ends this year. They are asking the Foreign, Commonwealth and Development Office for 100m for the next two years. GPEIs goal is to eradicate polio by 2026.
The UK government has been the second biggest contributing government after the US towards eradicating polio, said McInally. He said funding is crucial because were at that challenging point in time where because of the geography, the nomadic nature of many of the people were trying to reach, its not easy to reach everybody to get it finished, and there is a realisation that unless we finish it completely we run the risk of it bubbling up again.
If they fail to eradicate polio in Afghanistan and Pakistan, WHO modelling suggests there could be a global resurgence resulting in some 200,000 new cases of polio each year within 10 years. Until this is done, McInally said, polio is only a plane-ride away. Imported polioviruses caused alarm in 2022 when an unvaccinated adult in New York was paralysed by the disease, and poliovirus was detected in sewage in London.
But McInally is hopeful, in part because of the programmes success in India 27 March will mark the countrys 10-year anniversary since it became officially polio-free. There are some parallelswith rural India which give him hope. Many people said you will never get rid of polio from Indiaand it was done.
Immunisations have been stepped up in Afghanistan and Pakistan; with the programme extending its target age for immunising children from under five to under 10, said OLeary, and synchronising on both sides of the border.
Another crucial challenge is vaccine-derived poliovirus transmission. This derives from the oral polio vaccine, still used in some regions, which harnesses live but weakened poliovirus.
This would not cause issues of itself, but if immunisation rates are low in a population, the vaccine strain can circulate and genetically change over time, and in rare cases cause paralysis like wild polio.
Any case is a worry, said McInally. But once we can eliminate wild virus then the vaccine-derived cases will clear up relatively quickly.
OLeary notes that there were 1,000 cases of polio a day in 125 countries in 1988 when the GPEI started. He likens the polio programme to running a marathon with a few hundred metres to go. Nonetheless he remained cautious: Eradication is a zero-sum game. We have to be very clear-eyed when we look back and everything is zero, then we can say its great.
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Volunteers are being sought to test a new mRNA vaccine for mpox, formerly known as monkeypox.
The vaccine trial from the National Institute for Health and Care Research (NIHR) and pharmaceutical firm Moderna will see whether the jab can offer good protection in people who have not been previously infected.
Mpox is passed on through close physical contact, including during sexual contact, kissing, cuddling or holding hands.
Symptoms include a high temperature, headache, muscle aches, backache, swollen glands, exhaustion, joint pain and a rash.
In the UK, one vaccine is currently licensed for immunisation against mpox.
Scientists now hope to offer another choice in the form of an mRNA jab for mpox and smallpox.
Volunteers in the mPower Trial will be randomly selected to receive one of three dose levels of the vaccine, or a placebo.
The trial is recruiting people from sites across the UK and will be led by the University Hospitals Bristol and Weston NHS Foundation Trust.
Dr Rajeka Lazarus, national co-ordinating investigator for the new study, said: Mpox is a global public health threat and more vaccines are urgently needed to prevent future outbreaks.
Throughout the Covid-19 pandemic, we were overwhelmed with the generosity of volunteers who came forward to take part in a number of vaccine trials.
Without them, the advances weve seen would not have been possible. It would be fantastic to see the same support for mpox research.
A health professional shows doses of Monkeypox vaccines
(AFP or licensors)
Experts are hoping to recruit 175 volunteers to the study, who are aged 18 to 49 and who are in good health, with plans to complete enrolment in April.
Volunteers must not have been previously vaccinated for mpox or smallpox, or had a suspected or confirmed mpox infection.
In 2022, there was an outbreak of monkeypox, with the UK reporting some of the highest case numbers in Europe, mostly in men who are gay, bisexual or have sex with other men.
The numbers have now dropped, with only 16 cases of mpox reported in England this year so far.
Dr Matthew Hallsworth, NIHR director of strategic partnerships, said: Were really pleased that Moderna has chosen to run its mpox trial in the UK. This demonstrates our strength in clinical research.
Our partnership with Moderna ensures UK research is at the cutting edge of new vaccine technologies, with the potential to protect against global health threats such as mpox and future pandemics.
We hope that recruitment to this trial will be as successful as the Covid-19 vaccine trials that were run in the UK and we encourage the public to help out where they can whether thats by volunteering or encouraging others.
Harun Tulunay, a 36-year-old sexual health advocate from London, suffered from the mpox virus in June 2022.
He ended up unable to eat or drink due to lesions in his throat. He was admitted to hospital and treated with an antiviral drug, which was originally developed for smallpox.
He said: As a man living with HIV, I took part in Covid trials and other trials to help other people.
People who will participate in this trial will be part of advancing research that will maybe change lives.
Being a part of that is such a great feeling I know that from my own experience.
People can find out more at trials.modernatx.com
More than 3,700 cases of mpox have been identified in the UK since May 2022
The National Institute for Health and Care Research (NIHR) has announced a new phase 1/2 trial, delivered by the NIHR Clinical Research Network and sponsored by Moderna, to test the effectiveness of an investigational mRNA vaccine for mpox.
The mPower trial will evaluate the safety and immune response to mRNA-1769, which aims to protect against illness caused by the mpox virus.
Currently a global public health threat, mpox is an infectious disease caused by the monkeypox virus, which is spread through physical contact with someone who is infected, leading to symptoms including painful rashes, enlarged lymph nodes and fever.
Since May 2022, over 3,700 cases of mpox have been identified in the UK, the majority of which have been from the Clade II B.1 lineage, predominantly in gay, bisexual and other men who have sex with men.
In the UK and Europe, there is only one vaccine licensed for the immunisation against mpox, called Imvanex, manufactured by Bavarian Nordic, along with Jynneos in the US and Imvamune in Canada.
Undertaken as part of the Moderna-UK Strategic Partnership, the trial aims to recruit around 350 healthy participants between the ages of 18 and 49 years old who have not been previously vaccinated for mpox and who have not had a suspected or confirmed mpox infection to receive the investigational vaccine or a placebo.
Researchers from University Hospitals Bristol and Weston NHS Foundation Trust are hoping to recruit a further 175 volunteers for the study, aiming to complete enrolment by April this year.
Dr Matthew Hallsworth, NIHR Director of Strategic Partnerships, said: Our partnership with Moderna ensures UK research is at the cutting edge of new vaccine technologies with the potential to protect against global health threats such as mpox and future pandemics.
We hope that recruitment to this trial will be as successful as the COVID-19 vaccine trials that were run in the UK and we encourage the public to help out where they can.
