Cervical Cancer Prevention Challenges and Barriers to Cervical Cancer Screening and HPV Vaccinations in Ukraine and Eastern Europe

Objectives: To identify the obstacles and issues that hinder effective cancer prevention efforts in Ukraine. The study aims to provide a comprehensive assessment of the barriers to cancer prevention, including both infrastructure and behavioral factors, and identify potential solutions to address these challenges. Study Design: Comprehensive literature review. Methods: The following databases were searched: National Center for Biotechnology Information (NCBI) and PubMed (U.S. National Library of Medicine at the National Institutes of Health). The keywords used in the search included “Cervical Cancer”, “Human Papillomavirus Vaccination (HPV)”, “Ukraine”, “Eastern Europe”, “Healthcare Infrastructure in Disasters”, “Cervical Cancer Prevention”, “Pap Smear”, and “HPV Testing”. Results: A total of 3500 articles were screened. A total of 65 articles met the inclusion criteria. Limited public awareness and limited access to vaccination and screening, combined with inadequate treatment facilities lead to higher rates of cervical cancer. The COVID pandemic, war with Russia, and the Chernobyl disaster are significant factors for the low level of vaccination in Ukraine. Conclusion: The prevention and treatment of cervical cancer in Ukraine face significant challenges due to the inadequate HPV vaccination rates and screening by cytology. Efforts to improve funding and increase education of both the population and health care providers are necessary to increase interventions such as HPV vaccination, cervical cytology, and HPV testing to reduce cervical cancer rates in Ukraine.

Routine pediatric vaccinations during the COVID-19 pandemic:A review of the global impact

The coronavirus disease 2019(COVID-19)pandemic has put standard,routine childhood vaccinations at risk worldwide.The disruption in vaccine coverage has resulted in a negative impact on the health of children,with some races,ethnicities,age groups,areas of settlement,and parts of the world affected more than others.This literature review studied and examined the impact of COVID-19 on infant,child,and adolescent vaccinations.Retrospectively,the analysis showed a decline,delays,or interruptions in the coverage of vaccines during the pandemic and a decline in some countries'pre-pandemic and post-pandemic eras.Necessary attempts and efforts should be made for these delayed and missed vaccinations,as failure to do so could put children's health at risk.Thus,priority should be directed at instituting catch-up programs to support vaccine uptake and decrease the probability of acquiring vaccine-preventable diseases.

Vaccinations in immunosuppressive-dependent pediatric inflammatory bowel disease

AIM To determine the vaccination rates in pediatric immunosuppression-dependent inflammatory bowel disease(IBD) and review the safety and efficacy of vaccinations in this population.METHODS The electronic medical records from October 2009 to December 2015 of patients diagnosed with IBD at 10 years of age or younger and prescribed antitumor necrosis factor alpha(anti-TNF-α) therapy were reviewed for clinical history, medication history, vaccination history, and hepatitis B and varicella titers. Literature discussing vaccination response in IBD patients were identified through search of the MEDLINE database and reviewed using the key words "inflammatory bowel disease", "immunization", "vaccination", "pneumococcal", "varicella", and "hepatitis B". Non-human and non-English language studies were excluded. Search results were reviewed by authors toselect articles that addressed safety and efficacy of immunizations in inflammatory bowel disease.RESULTS A total of 51 patients diagnosed with IBD prior to the age of 10 and receiving anti-TNF-α therapy were identified. Thirty-three percent of patients(17/51) had incomplete or no documentation of vaccinations. Sixteen case reports, cohort studies, cross-sectional studies, and randomized trials were determined through review of the literature to describe the safety and efficacy of hepatitis B, pneumococcal, and varicella immunizations in adult and pediatric patients with IBD. These studies showed that patients safely tolerated the vaccines without significant adverse effects. Importantly, IBD patients receiving immunosuppressive medications, particularly anti-TNF-α treatment, have decreased vaccine response compared to controls. However, the majority of patients are still able to achieve protective levels of specific antibodies. CONCLUSION Immunizations have been shown to be well-tolerated and protective immunity can be achieved in patients with IBD requiring immunosuppressive therapy.

Vaccinations against respiratory infections in Arabian Gulf countries: Barriers and motivators

AIM To study the uptake, barriers and motivators of influen-za, pneumococcal, meningococcal and pertussis vaccines among members of public in Arabian Gulf countries.METHODS A cross-sectional survey among the Gulf Cooperation Council(GCC) countries' residents. Data collected electronically through a smartphone app. The survey variables aimed to investigate the respondents' awareness about vaccines against influenza, pneumococcal, meningococcal and pertussis infections. Collected data concerning the respondents' socio-demographic characteristics, their perception toward vaccine uptake and the factors that motivate or demotivate them from taking influenza vaccine. The data were analysed statistically using the SPSS v.23.0. Differences in the characteristics of users from different countries were quantified through bivariate analysis. Other important variables and controlling factors were studied using logistic regression. RESULTS A total of 1812 respondents participated in the study. Their mean age was 27 years, 82% were male and 24% had ≥ 1 chronic diseases. The overall uptake of influenza vaccine was 17%(21% among "at risk" people) and ranged from 15% in Saudi Arabia to 24% in Qatar. Doctor's advice(23%) and a perception of having low body immunity(21%) were the main cited reasons for being vaccinated, whereas unawareness about the vaccine(43%) was the main barrier. The overall uptake of pneumococcal vaccine in the preceding three years was 22%(25% among "at risk" individuals) and ranged from 0% in Bahrain to 79% in Kuwait. The overall uptake of pertussis vaccine was 16%(31% among "vulnerable" people), and ranged from 7% in Saudi Arabia to 75% in Oman. The overall uptake of meningococcal vaccine was 20%(29% among the "at risk" people) and ranged from 3% in Oman to 50% in Bahrain.CONCLUSION The vaccination uptake across GCC countries is suboptimal and varies widely across the countries. Further research is needed to unearth the reasons and formulate action plan.

Effects of Good Practices for Catch-Up Vaccinations: Assessment with a Quasi-Experimental Study in Democratic Republic of Congo

Introduction: Despite the enormous resources deployed and the success achieved in vaccination, reducing the number of children who remain unvaccinated remains a major operational challenge in certain countries. In 2014, the Kalemie Expanded Program of Immunization outpost in the Democratic Republic of the Congo was faced with a high number of unvaccinated children. They instituted a “token” catch-up system based on a collaborative approach with community health workers. This study aims to document the effects of this strategy on vaccination coverage. Methods: This study was a comparative quasi-experimental test/control study. The “test” health area was Undugu where the catch-up strategy was implemented and the “control” health area was Kanunka. A vaccination coverage survey was conducted according to the WHO method in both health areas, examining children aged 12 to 23 months. The proportions were compared using a Pearson chi-square test and the odds ratios were estimated. Results: Vaccine coverage was significantly higher in the “test” health area for all the antigens. Full vaccination coverage was 69.4% in the “test” health area versus 31% in the “control” health area, with a 4.7 times greater chance of being fully vaccinated in the “test” health area (OR: 4.7;CI 95% [3.1 - 7.2];p = 0.0001). Conclusion: This study demonstrates the value of a strategy that can increase access to vaccination and use of vaccination services, leading to a reduction in inequality in this area. However, this is linked to adapting the collaborative model on which it is based. This must be taken into consideration in plans to reproduce the findings.

Vaccinations in kidney transplant recipients: Clearing the muddy waters

Vaccine preventable diseases account for a significant proportion of morbidity and mortality in transplant recipients and cause adverse outcomes to the patient and allograft. Patients should be screened for vaccination history at the time of pre-transplant evaluation and vaccinated at least four weeks prior to transplantation. For non-immune patients, dead-vaccines can be administered starting at six months post-transplant. Live attenuated vaccines are contraindicated after transplant due to concern for infectious complications from the vaccine and every effort should be made to vaccinate prior to transplant.Since transplant recipients are on life-long immunosuppression, these patients may have lower rates of serological conversion, lower mean antibody titers and waning of protective immunity over shorter period as compared to general population. Recommendations regarding booster dose in kidney transplant recipients with sub-optimal serological response are lacking. Travel plans should be part of routine post-transplant assessment and pre-travel vaccines and counseling should be provided. More studies are needed on vaccination schedules, serological response, need for booster doses and safety of live attenuated vaccines in this special population.

Migratory Phenomenons, Bioethics and Vaccinations

The evolution of the HIV following migratory phenomenons is reported in an interesting study carried on for 15 years. Polymerase Chain Reaction (PCR) is a technique in molecular biology that amplifies a specific region of deoxyribonucleic acid (DNA), and has been useful in the molecular characterization of viruses as poxviruses. In many countries, such as?Italy,the vaccinations are included in the so-called sanitary obliged not coercive treatments. This means that the obligation is anticipated for all the subjects belonging to one determined range of age to undergo some vaccinations, but these are not subministrated by force in case of refusal. The legitimacy of the obligatory vaccination against the smallpox, with all the risks connected,?stated that such “risks were too much reduced to be seriously taken in consideration for the benefits produced on the collectivity”.?To ratify this obligation brings, however, to the reimbursement of the?incidental?damages produced by the vaccination. Nevertheless, mass vaccination against smallpox continues to be a leading initiative in western countries to guard against bioterrorist attack.

Vaccinations Rates in the Elderly with Diabetes Mellitus

Infections are a major cause of morbidity and mortality in the elderly. Improvements in health care prevention including vaccinations and treatment have led to an increase in the birth life expectancy. The vaccines that are now recommended for people over 60 are influenza, herpes zoster and a vaccine combining tetanus toxoid, reduced diphtheria toxoid, and pneumococcal vaccine. Our aim was to estimate the prevelance of vaccination among diabetic patients attending in Tepecik Training Hospital and in Ege University Faculty of Medicine. Patients and Methods: Individuals at or over the age of 60 who were attending to Tepecik Training Hospital and at Ege University Faculty of Medicine. Department of Internal Medicine was targeted from February to May 2014. Our data are collected from the patients face to face by questionnaire. Results: A total of 274 elderly patients with a mean ± SD (range) age of 72 ± 6 (62 - 93) years were questioned. The vaccination ratios were determined as 34% (93) for influenza, 9.5% (26) for pneumococcal, 10.6% (27) for tetanus vaccine. The patients were divided in two groups as diabetics and non-diabetics. The influenza vaccination rate is 38.1% in diabetic patients, rate of 31.8% in non-diabetic patients, the pneumococcal vaccine rate is 13.4% in diabetic patients, rate of 7.39% in non-diabetic patients. The tetanus vaccination rate is 9.28% in diabetic patients, rate of 11.36% in non-diabetic patients. No statistically significant difference between two groups was determined.

Homologous and Heterologous Covid-19 Booster Vaccinations

Background:Although the three vaccines against coronavirus disease 2019(Covid-19)that have received emergency use authorization in the United States are highly effective,breakthrough infections are occurring.Data are needed on the serial use of homologous boosters(same as the primary vaccine)and heterologous boosters(different from the primary vaccine)in fully vaccinated recipients.

Controlling the Worldwide Chaotic Spreading of COVID-19 through Vaccinations

The striking differences and similarities between the “Spanish-flu” of 1918 and the Coronavirus disease of 2019 (COVID-19) are analyzed. Progress in medicine and technology and in particular the availability of vaccines has decreased the death probability from about 2% for the Spanish-flu, to about 10-4 in the UK and 10-3 in Italy, USA, Canada, San Marino and other countries for COVID-19. The logistic map reproduces most features of the disease and may be of guidance for predictions and future steps to be taken in order to contrast the virus. We estimate 6.4 × 107 deceases worldwide without the vaccines, this value decreases to 1.6 × 107 with the current vaccination rate. In November 2021, the number of deceased worldwide was 5.1 × 106. To reduce the fatalities further, it is imperative to increase the vaccination rate worldwide to at least 120 millions/day and the AstraZeneca vaccine due to its efficacity and cost is a possible route to accomplish this.

Assessing parameter sensitivity in a university campus COVID-19 model with vaccinations

From the beginning of the COVID-19 pandemic,universities have experienced unique challenges due to their dual nature as a place of education and residence.Current research has explored non-pharmaceutical approaches to combating COVID-19,including representing in models different categories such as age groups.One key area not currently well represented in models is the effect of pharmaceutical preventative measures,specifically vaccinations,on COVID-19 spread on college campuses.There remain key questions on the sensitivity of COVID-19 infection rates on college campuses to potentially time-varying vaccine immunity.Here we introduce a compartment model that decomposes a campus population into constituent subpopulations and implements vaccinations with timevarying efficacy.We use this model to represent a campus population with both vaccinated and unvaccinated individuals,and we analyze this model using two metrics of interest:maximum isolation population and symptomatic infection.We demonstrate a decrease in symptomatic infections occurs for vaccinated individuals when the frequency of testing for unvaccinated individuals is increased.We find that the number of symptomatic infections is insensitive to the frequency of testing of the unvaccinated subpopulation once about 80%or more of the population is vaccinated.Through a Sobol’global sensitivity analysis,we characterize the sensitivity of modeled infection rates to these uncertain parameters.We find that in order to manage symptomatic infections and the maximum isolation population campuses must minimize contact between infected and uninfected individuals,promote high vaccine protection at the beginning of the semester,and minimize the number of individuals developing symptoms.

Approaches and challenges in cancer immunotherapy pathways

Cancer immunotherapy is an effective with critical approaches in the treatment of oncological patients.Whilst numerous research and clinical trials are underway to develop endogenous immunotherapy approaches,it is necessary to focus on fundamental issues and identify barriers to basic clinical progress.Addressing these challenges and the new pathways will require researchers and clinicians to join forces to accelerate the understanding of the complex interactions between cancer and the immune system and focus resources on developing better treatments for patients.

A novel live attenuated vaccine candidate protects chickens against subtype B avian metapneumovirus

Avian metapneumovirus(aMPV) is a highly contagious pathogen that causes acute upper respiratory tract diseases in chickens and turkeys, resulting in serious economic losses. Subtype B aMPV has recently become the dominant epidemic strain in China. We developed an attenuated aMPV subtype B strain by serial passaging in Vero cells and evaluated its safety and efficacy as a vaccine candidate. The safety test showed that after the 30th passage, the LN16-A strain was fully attenuated, as clinical signs of infection and histological lesions were absent after inoculation.The LN16-A strain did not revert to a virulent strain after five serial passages in chickens. The genomic sequence of LN16-A differed from that of the parent wild-type LN16(wtLN16) strain and had nine amino acid mutations. In chickens, a single immunization with LN16-A induced robust humoral and cellular immune responses, including the abundant production of neutralizing antibodies, CD4^(+) T lymphocytes, and the Th1(IFN-γ) and Th2(IL-4 and IL-6)cytokines. We also confirmed that LN16-A provided 100% protection against subtype B aMPV and significantly reduced viral shedding and turbinate inflammation. Our findings suggest that the LN16-A strain is a promising live attenuated vaccine candidate that can prevent infection with subtype B aMPV.

COVID-19 vaccination produces exercise-responsive SARS-CoV-2 specific T-cells regardless of infection history

Background:The mobilization and redistribution of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)specific T-cells and neutralizing antibodies(nAbs)during exercise is purported to increase immune surveillance and protect against severe coronavirus disease 2019(COVID-19).We sought to determine if COVID-19 vaccination would elicit exercise-responsive SARS-CoV-2 T-cells and transiently alter nAb titers.Methods:Eighteen healthy participants completed a 20-min bout of graded cycling exercise before and/or after receiving a COVID-19 vaccine.All major leukocyte subtypes were enumerated before,during,and after exercise by flow cytometry,and immune responses to SARS-CoV-2 were determined using whole blood peptide stimulation assays,T-cell receptor(TCR)-βsequencing,and SARS-CoV-2 nAb serology.Results:COVID-19 vaccination had no effect on the mobilization or egress of major leukocyte subsets in response to intensity-controlled graded exercise.However,non-infected participants had a significantly reduced mobilization of CD4+and CD8+naive T-cells,as well as CD4+central memory T-cells,after vaccination(synthetic immunity group);this was not seen after vaccination in those with prior SARS-CoV-2 infection(hybrid immunity group).Acute exercise after vaccination robustly mobilized SARS-CoV-2 specific T-cells to blood in an intensity-dependent manner.Both groups mobilized T-cells that reacted to spike protein;however,only the hybrid immunity group mobilized T-cells that reacted to membrane and nucleocapsid antigens.nAbs increased significantly during exercise only in the hybrid immunity group.Conclusion:These data indicate that acute exercise mobilizes SARS-CoV-2 specific T-cells that recognize spike protein and increases the redistribution of nAbs in individuals with hybrid immunity.

Recent advances on vaccines against malaria: A review

This review aims to summarize the currently viable vaccine strategies including the approved vaccines and the those in trials for next-generation malaria vaccines.Data on malaria vaccine development was collected through a comprehensive review.The literature search was performed using databases including Google Scholar,PubMed,NIH,and Web of Science.Various novel approaches of vaccination are being developed,including those based on radiation-attenuated strategies,monoclonal antibodies,targeted immunogenic peptides,RNA and DNA vaccines,nanoparticle-based vaccines,protein-based vaccination protocols,and whole organism-based vaccination strategies.Trials on RTS,S have entered phase Ⅲtesting,and those based on blood-stage vaccines and vaccines to interrupt malarial transmission have advanced to higher stages of trials.Mathematical modeling,combined drug and vaccine strategies,mass drug administration,polyvalent vaccine formulations,and targeted vaccination campaigns is playing an important role in malarial prevention.Furthermore,assessing coverage,accessibility,acceptability,deployment,compilation,and adherence to specific vaccination strategies in endemic regions is essential for vaccination drives against malaria.

Adherence to Advisory Committee on Immunization Practices in diabetes mellitus patients in Saudi Arabia:A multicenter retrospective study

BACKGROUND Patients with diabetes mellitus(DM)are predisposed to an increased risk of infection signifying the importance of vaccination to protect against its potentially severe complications.The Centers for Disease Control and Prevention/Advisory Committee on Immunization Practices(CDC/ACIP)issued immunization recommendations to protect this patient population.AIM To assess the adherence of patients with DM to the CDC/ACIP immunization recommendations in Saudi Arabia and to identify the factors associated with the vaccine adherence rate.METHODS An observational retrospective study conducted in 2023 was used to collect data on the vaccination records from 13 diabetes care centers in Saudi Arabia with 1000 eligible patients in phase I with data collected through chart review and 709 patients in phase II through online survey.RESULTS Among participants,10.01%(n=71)had never received any vaccine,while 85.89%(n=609)received at least one dose of the coronavirus disease 2019(COVID-19)vaccine,and 34.83%(n=247)had received the annual influenza vaccine.Only 2.96%(n=21),2.11%(n=15),and 1.12%(n=8)received herpes zoster,tetanus,diphtheria,and pertussis(Tdap),and human papillomavirus(HPV)vaccines,respectively.For patients with DM in Saudi Arabia,the rate of vaccination for annual influenza and COVID-19 vaccines was higher compared to other vaccinations such as herpes zoster,Tdap,pneumococcal,and HPV.Factors such as vaccine recommendations provided by family physicians or specialists,site of care,income level,DM-related hospitalization history,residency site,hemoglobin A1c(HbA1c)level,and health sector type can significantly influence the vaccination rate in patients with DM.Among non-vaccinated patients with DM,the most reported barriers were lack of knowledge and fear of side effects.This signifies the need for large-scale research in this area to identify additional factors that might facilitate adherence to CDC/ACIP vaccine recommendations in patients with DM.CONCLUSION In Saudi Arabia,patients with DM showed higher vaccination rates for annual influenza and COVID-19 vaccines compared to other vaccinations such as herpes zoster,Tdap,pneumococcal,and HPV.Factors such as vaccine recommendations provided by family physicians or specialists,the site of care,income level,DM-related hospitalization history,residency site,HbA1c level,and health sector type can significantly influence the vaccination rate in patients with DM.

Control of highly pathogenic avian influenza through vaccination

The stamping-out strategy has been used to control highly pathogenic avian influenza viruses in many countries,driven by the belief that vaccination would not be successful against such viruses and fears that avian influenza virus in vaccinated birds would evolve more rapidly and pose a greater risk to humans.In this review,we summarize the successes in controlling highly pathogenic avian influenza in China and make suggestions regarding the requirements for vaccine selection and effectiveness.In addition,we present evidence that vaccination of poultry not only eliminates human infection with avian influenza virus,but also significantly reduces and abolishes some harmful characteristics of avian influenza virus.

Neoantigen cancer vaccines:a new star on the horizon

Immunotherapy represents a promising strategy for cancer treatment that utilizes immune cells or drugs to activate the patient's own immune system and eliminate cancer cells.One of the most exciting advances within this field is the targeting of neoantigens,which are peptides derived from non-synonymous somatic mutations that are found exclusively within cancer cells and absent in normal cells.Although neoantigen-based therapeutic vaccines have not received approval for standard cancer treatment,early clinical trials have yielded encouraging outcomes as standalone monotherapy or when combined with checkpoint inhibitors.Progress made in high-throughput sequencing and bioinformatics have greatly facilitated the precise and efficient identification of neoantigens.Consequently,personalized neoantigen-based vaccines tailored to each patient have been developed that are capable of eliciting a robust and long-lasting immune response which effectively eliminates tumors and prevents recurrences.This review provides a concise overview consolidating the latest clinical advances in neoantigen-based therapeutic vaccines,and also discusses challenges and future perspectives for this innovative approach,particularly emphasizing the potential of neoantigen-based therapeutic vaccines to enhance clinical efficacy against advanced solid tumors.

Epidemic management in a measles outbreak in 2023,the return of vaccine-preventable diseases:A single center,retrospective observational study

Objective:To investigate the importance of immunization in preventing measles infection and to determine the most useful laboratory tests for confirmation of measles.Methods:This study included pediatric cases evaluated with a presumed diagnosis of measles between December 2022 and June 2023,at Marmara University Pendik Training and Research Hospital.The effects of vaccination status and underlying disease on the clinical course,treatments,and complications were evaluated.Results:In total,117 patients were enrolled in the study with a median age of 80 months(IQR:32.5-125.0).Twelve patients with contact history were asymptomatic and had an underlying disorder,and intravenous immunoglobulin was given to them for post-exposure prophylaxis.Fifty-one patients had confirmed measles diagnosis.Ribavirin treatment was given to three patients(a newborn,a girl with rhabdomyosarcoma,and a healthy boy)with respiratory distress.Seventy-eight percent of confirmed measles cases were unvaccinated,and all hospitalized cases were unvaccinated or under-vaccinated.Four full-vaccinated children had confirmed measles infection.Measles PCR from nasopharyngeal swabs was negative in all of them,and their diagnosis was established with anti-measles IgM positivity.Conclusions:The measles vaccine is the most effective way to protect from measles and measles-related complications.Although measles can also occur in fully vaccinated patients,the disease is milder than in unvaccinated patients.Using ELISA and RT-PCR tests together may be beneficial in patients with high clinical suspicion for early diagnosis.

Covid-19 vaccination in pregnancy and placental pathology

Objective:To describe and determine the association between Covid-19 vaccination in pregnancy and placental pathology.Methods:Conducted in a tertiary hospital in Medan,Indonesia,from April 30th 2022 to June 30th 2022,this single-center cross-sectional study involved Covid-19 vaccinated and unvaccinated women with singleton full-term pregnancies delivering live fetuses via cesarean section.Maternal characteristics,placental pathologies,and the placental index were documented at enrollment.The association between Covid-19 vaccination status and placental pathology was assessed.Results:The study enrolled 200 pregnant women,including 110 vaccinated women and 90 unvaccinated women.No significant differences were observed in birthweight(P=0.48),placental index(P=0.48),and placental pathology findings[intervillous bleeding(P=0.20),increased syncytial knots(P=0.83),chorangiosis(P=0.13),villous stromal edema(P=0.13),vascular dilation and congestion(P=0.13),and vascular wall thrombus(P=0.71)]between the vaccinated and unvaccinated groups.Conclusions:This study revealed no statistically significant association between Covid-19 vaccination and placental pathology.The findings support the safety of Covid-19 vaccination during pregnancy,in regards to changes of the placental pathology.